Step-by-Step Guide to Venipuncture

Learn the procedures, steps, risks, and requirements for venipuncture.

Taking a blood sample or placing a patient on an IV are common procedures performed by nurses. The clinical term for the process of obtaining intravenous access is known as venipuncture. While a seemingly straightforward and relatively simple procedure, there is an art to learning how to effectively enter the vein to take blood or start an IV. Patients appreciate nurses who can rapidly and accurately perform venipuncture without requiring additional needle sticks.

In this blog, let’s get into everything you’ll need to know about venipuncture. It is a common procedure performed by nurses. Click here to learn more about the common duties of a nurse.

What’s the Definition of Venipuncture?

Venipuncture is the process of obtaining intravenous access for a blood sample or for intravenous (IV) therapy. Venipuncture is performed by a nurse and other providers using a needle. When taking blood, the needle is attached to vacuum tubes to hold the collected blood.

Venipuncture is one of the most performed invasive procedures; in most cases, nurses do it.

You may have seen the terms “venipuncture” and “phlebotomy” used interchangeably. But there is a subtle difference. Phlebotomy strictly applies to blood collection. Venipuncture is the procedure title, and it can also include the introduction of the needle for use with IV therapy.

What is the Purpose of Venipuncture?

There are five primary reasons a nurse would perform venipuncture:

1. To obtain a blood sample for diagnostic purposes
2. For monitoring levels of components in the blood
3. To administer treatments (medications, chemotherapy, nutrition)
4. To remove blood due to excessive levels of iron or erythrocytes (red blood cells)
5. To collect blood for later use (as a blood donor)

How Long Does it Take to Perform Venipuncture?

These are fast procedures, usually taking just two or three minutes. The needle insertion takes just a few seconds, but there is some initial preparation to find the best vein and apply a tourniquet. Once the needle has been inserted into the vein, taking the typical three tubes of blood usually takes 30 seconds or so.

Who Performs Venipuncture?

Various members of the healthcare team can perform venipuncture. But it is most often performed by nurses (registered nurses, RNs; licensed vocational nurses, LVNs; or licensed practical nurses, LPNs). In some states, medical assistants are allowed to perform venipuncture if they have the requisite training in the procedure.

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What Are the Training Requirements for Venipuncture?

In the United States, special state certification in phlebotomy is required in just four states: California, Washington, Nevada, and Louisiana. Most healthcare providers that perform venipuncture require their employees performing the procedure to have specific certification in these areas or broader training, such as a nursing degree. Becoming proficient with venipuncture is a part of all nurse training. It is also part of medical assistant training. (Here’s a link if you’re interested in becoming a medical assistant.)

What Materials Are Needed for Venipuncture?

This straightforward procedure does not require many items beyond the needles, collection tubes, and tourniquets. Here’s a complete list of what’s needed:

• Lab forms
• Vacuum tubes specific to the lab requests
• Blood-drawing needle
• Tourniquet
• Completed laboratory specimen labels (patient name, etc.)
• Container for used needle
• Biohazard leak-proof transportation bags
• Alcohol swabs for disinfection before venipuncture
• Gauze and bandage to cover site after needle is removed
• Sterile gloves

How is Venipuncture Performed?

After you’ve gathered the materials listed above, you’re ready to perform venipuncture. These are the steps:

1. Explain the procedure and verify why you are drawing blood
2. Identify the patient using two patient identifiers as approved by The Joint Commission
3. Confirm the tests required and that you have the necessary vacuum tubes for collection
4. Ensure the vacuum tubes are labeled with the patient’s information
5. Wash your hands and put on your sterile gloves
6. Place the patient’s arm on the arm board (if available) and extend the arm fully
7. Apply the tourniquet 3 to 4 inches above the access site
8. Have the patient form a fist and look for a good vein
9. Select a vein, release the tourniquet, and ask the patient to relax their fist
10. Cleanse the site thoroughly with the alcohol swab
11. Reapply the tourniquet and have the patient again make a fist
12. Uncap the needle
13. Grasp the patient’s lower arm to draw the skin taut and anchor the vein from rolling.
14. Insert the needle
15. If correctly inserted, blood should flow into the vacuum tube. If this is not happening, the needle either missed or passed through the vein.
16. As the blood flows into the tube, have the patient release their fist.
17. After you collect the requisite number of tubes, you can release the tourniquet
18. Place the gauze pad over the needle and remove it. Apply slight pressure to the sight and cover it with a bandage.
19. Place the labels on the collected blood
20. Discard the collection unit, placing the needle in the container
21. Send the blood specimens to the lab for testing

Is There Recovery after Venipuncture?

There isn’t any recovery. Gauze covers the puncture, and a bandage holds it in place. There can be some slight soreness on the site, but this is a fleeting sensation. If the patient has donated blood, tell them they must drink water and eat something after leaving the facility.

What Are the Possible Complications with Venipuncture?

These are common, low-risk procedures whose benefits in attaining blood samples far outweigh any potential risks. These are the risks involved:

• Bruising and soreness
• Infection
• Hematoma formation
• Nerve injury
• Arterial puncture
• Fainting or near fainting

Pro Tips for Mastering the Art of Venipuncture

Everyone has blood drawn at some point, and they appreciate the expertise of the person performing the venipuncture. Accessing a vein that doesn’t efficiently deliver the blood means you’ll have to remove the needle and try again, likely with a different vein.

Here are some tips to help become an expert in venipuncture:

• Choose wisely. Identify a vein that is close to the surface, is large enough, and doesn’t roll when punctured. For example, the median cubital vein in the crook of the elbow is a good option for most patients.
• Avoid certain areas such as burned areas, swollen sites, fistulas, or hematomas.
• Keep the patient engaged. The goal here is distraction. Many patients get nervous about this procedure, so it is helpful to keep them from fixating on what you’re doing.
• Hold the arm below the site of the puncture. This draws the skin taut, which ensures a better chance of hitting the target on the first attempt. It also makes it less painful for the patient.
• Tie the tourniquet 3-4 inches above the venipuncture site. Don’t make it too tight. The tourniquet should not be in place for more than two minutes. Release the tourniquet before withdrawing the needle.
• You can apply a warm pad to the targeted vein for patients whose veins are not cooperating and showing themselves. This helps dilate the vein, making it more visible and accessible.
• The National Library of Medicine suggests inserting the needle with the bevel side up at an angle between 15 and 30 degrees with the surface of the arm. To avoid perforating the vein completely, the angle shouldn’t be too shallow or too deep.
• Label all your vacuum tube samples immediately to avoid any possible confusion.

Are You Ready to Move Into a Career in Nursing?

If so, you need to know about venipuncture, a common procedure nurses perform in medical settings.

Are you interested in working with people and making a difference in their lives? A career in nursing not only satisfies that goal, but the projections for employment are excellent: there aren’t enough nurses to fill the available jobs.

Brookline College has different options to help you make a move into nursing. Click this link to learn about our Nursing programs.