CLINICAL LAB SCIENEC

CHAPTER 11: PHLEBOTOMY 279
the barrel (tube holder). The bevel or flattened
open side of the needle should be visible from
above as one looks down toward the patient’s
arm (Figure 11-15). Anchor and pull the skin
tight at approximately 1 inch below the intended
puncture site. Hold the barrel (tube holder,
syringe, etc.) with the thumb and forefingers
of the dominant hand. Enter the skin at a 30-
to 45-degree angle. The angle can be adjusted
to better accommodate the patient’s anatomy
as the phlebotomist gains experience. In those
patients who are normal in weight with little
fatty tissue beneath the skin, an insertion of the
needle for only a few millimeters will be sufficient
to be properly positioned in the vein.
Make sure the barrel does not move by anchoring
the barrel with the fingers of the nondominant
hand, then push the first tube onto the inner needle
of the barrel. When the tube stops filling and if the
draw is without problem, there will be sufficient
blood in the tube, including the amount designed
for the level of an anticoagulant, if required, for
the test. If more than one tube is needed, remove
the first and insert the second prepositioned tube,
allowing it to also fill completely. When all needed
tubes are filled, remove the last tube and lay it
aside with the previous one(s).
Loosen the tourniquet appropriately depending
on the type of tourniquet used and leave it
FIGURE 11-14 Palpating a vein before venipuncture.
Source: Delmar/Cengage Learning.
lying flat on the support surface beneath the arm. Continue to maintain support
of the barrel while loosening the tourniquet. NEVER remove the needle while the
tourniquet is still in place! Place moderate pressure with a gauze sponge or cotton
ball over the puncture site and over the needle before smoothly withdrawing the
needle. Carefully lay the needle and barrel in a safe place while maintaining pressure
on the site. Maintain pressure for a minute or so but if the patient is alert and
Needle
Epidermis
Vessel Wall
A
B
Lumen of Vein
FIGURE 11-15 (A) View of the needle’s bevel, and (B) Illustration of proper position in lumen (open area) of the vein.
Source: Delmar/Cengage Learning.
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