Most people dread getting their blood drawn, and it can be the same for nursing staff. It is true that there are special phlebotomy teams and staff that specialize in drawing blood, but taking blood cultures is a critical skill that nurses need to be able to do.
Since everyone is so different, there are a number of different ways to draw blood for labs. While one may study and practice drawing blood, it is still a tricky process to take blood specimens. Depending on the setting, the person, experience level, or volume of blood, there may be a better technique to use. To help you and your patients feel more comfortable with blood specimen collection, we break down everything you need to know about blood draws. We also take a quick glance at the different ways that nurses draw blood for labs.
History of Phlebotomy
Phlebotomy is the practice of drawing blood to run clinical tests. The term comes from the word “phlebotomia”, meaning “bloodletting” in Greek. It is often used interchangeably with the term venipuncture but is actually distinctively different from one another.
Venipuncture is a more general term defined by puncturing the vein either to draw blood for blood donation, testing, or to insert an IV to deliver fluid. Some larger medical facilities may have their own phlebotomy teams but nurses still may need to learn this important skill. In some nursing programs, nursing students may not learn to draw blood making it a nerve-racking experience.
Phlebotomy is practiced used thousand of years ago in ancient civilizations. In parts of Egypt and other ancient civilizations, people used phlebotomy to remove blood for their religious ceremonies. Later, the practice of phlebotomy or bloodletting was used for medical processes by the Greeks. As explained by Hippocrates, the human body is made up of the four humors that work together to balance the body. The body would be sick if there was an imbalance or excess of one. They used bloodletting to remove this excess.
From these ancient uses, the practice of phlebotomy developed and took shape as we know it today. When the pilgrims came to the United States in the 1700s they brought their bloodletting practice which used leeches to remove blood. Since there were consequences of using this method, modern blood draws were invented. This method of using a thin needle is much less invasive and safer.
Fortunately for you, you will be puncturing the patient with a needle instead of handling leeches. Even though the modern technique of drawing blood is much more refined, it is still not enjoyable for most. To help your patients feel more comfortable, it is important to feel comfortable with the process yourself first.
Why Nurses Draw Blood
Even though most people would prefer not to get their blood draw, blood samples can be especially useful in many medical situations. A person’s blood can reveal a lot about their health including things such as complete blood count, blood enzymes, blood chemistry, the risk for heart disease, and more. Through clinical tests that measure the components of our blood such as red blood cells, white blood cells, hemoglobin, blood glucose, hemoglobin, electrolytes, cholesterol, and calcium, medical practitioners are better able to treat patients. It not only confirms a diagnose for disease, but it can also alert medical professionals about certain risk factors. Even though the skill of blood specimen collection is not always taught in nursing skills, most nurses are required to learn it. Some smaller medical facilities do not have a dedicated phlebotomy team, so this task is often delegated to the nurses.
How to Learn to Draw Blood
Liability issues limit nursing schools from teaching this important skill, but there are a number of ways to learn and practice the process of blood sampling. There are a number of different organizations and even workplaces that offer separate courses for phlebotomy. Since it is such an important process that yields important results, special care needs to be taken. Often these courses have a separate fee but are necessary to work in some settings. While you can learn to do it from classes, books, online, or even on a dummy, it is difficult to get the true feeling of it without practicing on a live patient in a real setting. We recommend getting a good feel for feeling veins, since finding the right vein is an important step in the process. You can practice on yourself and others, since it is non-invasive. Along with the courses and books that teach phlebotomy, we recommend watching live or video tutorials, so you can see the whole process. After learning how to draw blood, the best way to improve and feel more comfortable is practicing.
Phlebotomy Equipment That You Will Need
While most hospital settings will have everything you need to perform the procedure, it is helpful to know what tools you will need. This way you are able to practice and familiarize yourself with all the necessary equipment. Especially since there are different methods that require different syringes, needles, blood collection tubes, and more, we go through the different equipment you will need. You may also want your own backups, just in case, the blood draw does not work the first time. An important aspect of phlebotomy is to always use sterile equipment, meaning you are not able to use the same needle on a second or third attempt.
The necessary blood drawing equipment includes:
- alcohol prep pads
- appropriate blood-drawing needles in different needle sizes
- sterile gloves
- butterfly needle
- collection tubes
- blood transfer device
- biohazard transportation bags
- puncture-resistant disposal containers
- Laboratory forms and specimen labels
- hand sanitizer
- bandages or medical tape
These tools for blood sampling may differ slightly depending on many factors. These factors include the types of labs ordered, the number of collection tubes, and patient factors such as age.
Steps to Draw Blood
To help you get a better idea of which technique to use to draw blood, we go over the general process of drawing blood. It is important to be familiar with the overall technique before determining which is the best way to draw blood for your patient.
The first step to drawing blood is to identify and find a vein that will work well for the procedure. It can be quite tricky even though there are areas that are better suited for this. A person’s veins can differ dramatically from others, making it a complicated process. Some have larger veins than others, and some have veins that are closer to the surface of their skin. To able to stick the needle successfully on the first attempt, you need to first be able to find an adequate vein. The areas that are best suited to draw blood include the inside of the elbow, on the hand, or on the wrist or forearm. These include the median cubital vein, cephalic vein, or basilic vein. The inside of the elbow is a popular spot to draw blood since the veins are closer to the surface, and are larger than other areas. It does depend on the person, so for some, the elbow may not be the best place. To find a vein, you can not only use your eyes but also your sense of touch. Using your index or middle finger you can feel around the area. The technique is known as palpation and can help you more accurately find a good vein to puncture. A good vein will usually feel bouncy against the pressure from your fingers. We recommend practicing feeling around for healthy veins on yourself or others. Another way to find a suitable vein is to help make the veins more visible. You can do this by wrapping a tourniquet or applying a warm pack to the puncture area. You should place the tourniquet about 3-4 inches above the intended drawing location. This helps to dilate the blood vessels making them easier to see.
Now for the actual puncture of the vein. You want to make sure you have all your tools gathered beforehand. These are general guidelines, and you should always double-check with your supervisor for specific instructions and processes first. While there are two main techniques: venous and central line blood draws, the needle insertion is relatively the same. Always be sure to use a sterile needle and make sure never to reuse needles.
Before actually completing the process it is important to let your patient know what the process will be like. This can help them feel more comfortable and make them less nervous. If they are extremely nervous you can take the time to make conversation with them to help them feel less anxious. We also recommend having the count to three then taking a deep breath to help them focus on something other than the puncture. This can help to calm their nerves, as well as keep their mind on breathing than the actual needle puncture.
Then, you should double-check the blood tests the patient needs to make sure you have the proper equipment. You are now ready to position the patient. Depending on the type and vein you will be using, you may need a slightly different position. Ideally, you want the patient to sit comfortably and extend their arm. Make sure to wash your hands and use gloves, then tie the tourniquet if needed. Make sure not to tie the tourniquet too tight as the bein could collapse due to the pressure.
After, sterilize the puncture site with an alcohol swab and allow to air dry for at least 30 seconds. Some recommend pumping the fist for better blood flow, but this is actually a myth. When you are ready for the puncture, make sure to firmly hold the area so the skin is taut. This helps with rolling veins and ensures a smooth blood draw. When inserting the needle, puncture the blood vessel at a 15 to 30-degree angle.
If the needle was inserted correctly, the blood should flow into the catheter. Make sure to attach the collection tubes quickly and only remove the necessary amount of blood. If you are using a tourniquet, make sure to remove this as you are completing the last collection tube.
Finally, remove the needle and put pressure on the patient’s puncture site for pain relief as well as to soak up any additional blood. You can put a bandage or medical tape over to protect the site. Make sure to properly dispose of the contaminated needles into the appropriate disposal containers. Then label the collection tubes and place them into biohazard transport bags. The blood samples should be delivered as soon as possible to ensure the most accurate lab results. Sometimes if the samples are left out too long, it can cause the rupturing of the red blood cells, which leads to inaccurate or skewed results.
Different Ways to Draw Blood
1. Capillary Collection– This method is great for those that require a smaller volume of blood. This includes fingerstick sampling, puncturing the heel, or puncturing the earlobe. It is quick and easy and is less invasive than typical venous blood sampling. Keep in mind, this method is not preferred and certain labs cannot be run off of a capillary collection.
2. Through an IV start– This is a great method for those that require an IV already. For this method, you would start an IV as you normally do (no butterfly needle). After you insert the needle, get the vein, and insert the catheter and withdraw your needle… you can connect a syringe draw the appropriate volume of blood, aspirate what you need into the syringe, and then you can hook up your normal IV set up.
3. Straight Needle with a Hub– In this method, the needle is already pre-attached to the tube holder or syringe. The hub is the end of the needle that is attached to the collection device. This is often the most popular method if multiple samples are needed.
4. Straight Needle with a Syringe– This method is similar to using a hub, but the syringe helps to reduce additional stress. This technique is often used when the blood draw is more difficult. The syringe helps to prevent vesicular collapse as well as reduce some of the pressure on the vein.
5. Butterfly Needle with a Hub– A butterfly needle is used when puncturing a superficial vein. The needles are much smaller, making them less painful for the patient. This is also a popular option for drawing blood in kids as it is smaller and less painful. This technique is not as suitable for those with multiple collection samples.
6. Butterfly Needle with a Syringe– Like the Butterfly Needle with Hub Draw, the needle is much shallower and more suited to place precisely on fragile or smaller veins.
7. Central Line Draw– This method is nurses draw blood from a large vein in the chest, neck, or groin. This is used mainly for larger blood draws, or used in conjunction to give fluids, or medications quickly.
Looking to learn more?
If you want specific guidance and instruction on how to complete these different processes, we recommend you check out the Phlebotomy for Nurses Online Video from Brain the IV Guy.
He gives a detailed account of each process and helps you become more familiar with each. Blood drawing is an important medical process that you can improve on by learning more about the process and practicing on patients.