BLOOD
COLLECTIONTECHNIQUES
Guidelines andinstructions forvenous bloodcollection.

To this day, venipuncture is barely dealt with during study
courses; however, it is precisely in this area where medical
staff are subject to particularly critical evaluation by
patients. Therefore, it is important to adopt the best andmost stable technique possible for taking blood samples inall situations.
Before taking a blood sample, the top priority is to be fully
familiar with the respective collection system and products
used. Handling equipment that you are not familiar with not
only comes across as unprofessional, but also increases thepatient's anxiety, which in turn has a negative effect on thecondition of the patient's veins. For training purposes, demo
arms are provided so that venipuncture can be practiced asoften as necessary.
This product information is addressed exclusively to healthcare professionals.
Devices of Greiner Bio-One are to be used by properly trained healthcare professionals
only in accordance with the relevant Instructions for Use (IFU). For a listing ofindications, contraindications, precautions and warnings, please refer to theInstructions for Use which accompanies each product or is available for downloadfrom our website at www.gbo.com (Download Center). For more information contact
your local Greiner Bio-One sales representative or visit our website.
All information is provided without guarantee despite careful processing. Any liability, warranty
or guarantee of Greiner Bio-One GmbH is excluded. All rights, errors and changes are reserved.
If not stated otherwise, Greiner Bio-One GmbH has all copyrights and/or other (user-)rights inthis documents, in particular to signs such as the mentioned (word-picture-)brands and logos.
Any use, duplication or any other use of the rights of Greiner Bio-One GmbH is expressly prohibited.
Media owner: Greiner Bio-One GmbH / Manufacturer: [Samson Druck GmbH / 5581 St. Margarethen]2/

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This guide is intended to help you to correctly perform bloodcollection and make proper use of the various collection
systems. With thorough training, you will soon develop therequired skills.
These guidelines are recommended by Greiner Bio-One.
The content of the guidelines is based on international
standards and current specialist literature. Please comply
with the regulations in your facility and in your country.
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CONTENT

SAFETY ASPECTS WHEN
COLLECTING A BLOOD SAMPLE

6

PREPARATION FOR BLOOD COLLECTION

10

Requirements for blood collection..............................................12
Puncture sites............................................................................16
Optimal view of the veins ...........................................................20
Tourniquet..................................................................................21
Palpation ................................................................................... 26
Vein selection ............................................................................ 30
Disinfection of the puncture site................................................31

VENIPUNCTURE

32

Needle insertion........................................................................ 34
Recommended hand position.................................................... 35
Inserting the tube ...................................................................... 37
Corrective action in the event of weak or no blood flow............. 38
Pulling out the tube....................................................................40
Order of draw..............................................................................41
Inversions.................................................................................. 42
Removing the cannula................................................................ 43
Activating the safety mechanism.............................................. 45
Disposal..................................................................................... 47
Caring for the insertion site....................................................... 48
Blood collection from venous catheters.................................... 49
Tube labelling and sample transport...........................................51

SPECIAL INSTRUCTIONSFOR COLLECTING BLOOD

52

Complicating factors for venipuncture...................................... 55

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BLOOD COLLECTION IN SMALL CHILDREN

56

BLOOD COLLECTION IN NEWBORNSAND INFANTS

62

REFERENCES

67

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SAFETY ASPECTS
WHEN COLLECTINGA BLOOD SAMPLE
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THE TOPIC OF HEALTHAND SAFETY IN THE
WORKPLACE SHOULD BE
IMPORTANT TO ALL PEOPLE
WORKING IN THE HOSPITALAND HEALTH SECTOR.
Blood collection is also a potential
source of injury to staff and patients.
For this reason, a detailed descriptionof each step follows.
The main objective of social policies inthe European Union is an improvement
in working conditions. For this purpose,
COUNCIL DIRECTIVE 2010/32/EU was
drawn up for the prevention of injuries
from sharp/pointed instruments in thehospital and healthcare sector.
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AROUND
ONE MILLIONNEEDLESTICK
INJURIES
happen alone inEurope each year

WORKPLACE SAFETY
THE HEALTH AND SAFETY OF EMPLOYEES ISOF UTMOST IMPORTANCE AND IS CLOSELYASSOCIATED WITH THE HEALTH OF THE PATIENT.
The purpose of the COUNCIL DIRECTIVE 2010/32/EU for theprevention of injuries from sharp/pointed instruments is:/ to create the safest possible working environment/ to avoid injuries to employees by sharp/pointed medical
instruments (including needlestick injuries)/ to protect exposed employees
The use of sharp/pointed medical instruments withintegrated protection mechanisms is therefore an
important point.
The training and instruction of medical staff regarding thecorrect use of sharp/pointed medical instruments withintegrated protection mechanisms is the focus of the EU
Directive.

USE OF PLASTIC TUBES
By using plastic (PET) tubes instead of glass, tube breakage– and therefore the risk of injury due to broken glass – isvirtually eliminated.
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PREPARATION FOR
BLOOD COLLECTION
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BEFORE BEGINNING
WITH THE BLOOD
COLLECTION,
A NUMBER OFSTEPS ARE TO BE
CARRIED OUT, SUCH
AS PREPARING
THE WORKPLACE,POSITIONING THE
PATIENT CORRECTLY
AND SELECTING THE
PUNCTURE SITE.
There are a number of things tokeep in mind in order to makethis as safe and stress-free as
possible for both the healthcare
staff and the patient.
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REQUIREMENTS
FOR BLOOD COLLECTION
PATIENT'S RESPONSIBILITIES/ Many tests require the patient to fast.
/ The patient should not smoke prior to bloodcollection.
/ No sport or major physical exertion.
/ Consult the doctor before taking any
medication.
/ For better comparability with previous
laboratory results, blood collections should
always be carried out at the same time of day.
Patient preparation may varydepending on requirements.

PREPARED WORKPLACE
Each patient is different and has individual
requirements for blood collection.
Therefore it is important, that a range of blood collection
products are available at the workplace to enable the mostappropriate combinations to suit the patient’s characteristics as well as to meet the laboratory and test requirements.

REQUIRED MATERIALS
/
/
/
/
/
/
/

Blood collection system: VACUETTE®
Tourniquet
Gloves
Swabs
Disinfectant
Dressing material/sticking plasters
Sharps-proof disposal container

MEDICAL STAFF RESPONSIBILITIES
/
/
/
/
/

Making contact
Patient identification
Documentation of special diets and allergies
Explanation and consent
Hand disinfection

The next steps are describedon the next pages.

Various products should be available at the workplacein order to be able to select them individually.

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For venous blood collection,a venipuncture chair witharmrests is recommended.

POSITIONING THE PATIENTWith a venipuncure chair with armrests, it is possible toposition the patient in both a sitting and reclining position
and thereby ensure the patient's safety.

If a venipuncture chair is not available, the patient canalso be placed in a sitting or lying position. In any case, it isimportant that there is enough space to be able to move thepatient in an emergency situation.
It is also important to note that the patient should not makeany rapid movements during the few minutes leading up tp
blood collection.

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PUNCTURE SITES

ROUTINE PUNCTURE SITESINSIDE OF THE ELBOWPRIORITY LIST
Prior to the venipuncture, the puncture site must be selected. The veins on the inside of the elbow are almost always
suitable for blood collection; the veins in the back of thehand should be considered as a second choice. Puncture inthese regions is successful in about 95% of patients.
The course of the veins can bemade visible by using special
vein visualization equipment.

Prior to the puncture, both arms must be examined and one
vein selected, if possible on the non-dominant arm. If thepatient prefers to have the puncture on a certain arm, thisrequest should be granted.
The inside of the elbow
is positioned on a stablesupport. The elbow joint
should not be fully extended.
When the elbow is fully
extended the veins aresuppressed by the meetingof the joint and the skintension.

1. I nside of the elbow

BACK OF THE HAND
2. B ack of the hand

As a right-handed person,
use your left hand to takethe patient's hand to bepunctured, which is in aneutral position.
The skin is gently stretchedin a distal direction.

3. Alternative
puncture sites
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Tools such as the VeinViewer®
can be used for the inspectionof the puncture site.

INSPECTION OF
THE PUNCTURE SITE

Before you decide on a puncture site,
the limb must be inspected for injuries.

A suitable puncture site is selected on the basisof these criteria.
In this region, an initial palpation (feel) is carriedout, as a vein should not be selected solely basedon its appearance. The condition of the vein to bepunctured is vital when selecting which productto use, the position of the person taking the blood
sample and the angle of needle insertion.

EXCLUSION
CRITERIA*
include severe scartissue, haematoma, andlymphatic congestion
after mastectomies.
*CLSI GP 41 A7, S. 17

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OPTIMAL VIEW
OF THE VEINSUSING THE EXAMPLE
OF THE INSIDE OF THE ELBOWThere are various ways of making the veins easier to find:Tourniquet

Slightly bent arm(see next page)

Arm hanging down
and positioned
on stable support

Stretching the skin

TOURNIQUETThe use of a tourniquet is recommended to prioritise a veinand select a puncture site for the needle. A tourniquet is
not necessary if the vessel is large and easy to feel and,
therefore, also easy to puncture.
APPLICATION

Ball the hand into a fist
(do not pump)
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Warmth(arm bath or heat cushion)

The tourniquet is applied with a little pressure 7.5–10 cm
above the puncture site. With optimal application of thetourniquet, the pulse should be easy to feel.
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IDEALLY,
THE VEINBLOCKAGE

DURATION

lasts for the shortest
possible amount oftime and is 40 mmHg.

The tourniquet should not be applied for longer
than one minute in total.

If the steps for the vein selection, disinfection andpuncture last longer than one minute while a tourniquet is applied, the tourniquet must be released
for two minutes to avoid haemoconcentration.
Ideally, the vein blockage should last for the shortest possible amount of time and can be appliedwith a tourniquet or blood pressure cuff.
Once blood enters the tube following a successful
puncture, the tourniquet should be released.

TOURNIQUET PRESSURE

The tourniquet pressure should be 40 mmHg.
A higher pressure would impair the arterial
blood flow to the limb.

A tourniquet pressure of 40 mmHg is higher
than the venous vascular pressure, but analmost undisturbed arterial blood flow is still
possible.

A VEIN BLOCKAGE TIME
THAT IS TOO LONG
particularly affects the protein values,
cell counts, lipids and other substances
associated with proteins. In addition, longvein blockage times can lead to haemolysis
and thereby alter the red blood cell indices.

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A low tourniquet pressure is also essential forthe differentiation and prioritisation of thevessels. The higher the tourniquet pressure, theshallower the pulsation wave becomes, until it is
not palpable at all once it reaches or exceeds thesystolic blood pressure.
With an optimal tourniquet pressure, the vein
to be punctured will be completely filled by
the arterial blood flow. Following a successful
puncture, the blood collection tube fills up
easily.
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CAUTION - TOO TIGHT A BACKPRESSURE
In the case of poor vein conditions, the tourniquet is often
applied too tightly, so that the tourniquet pressure getsclose to or exceeds the arterial blood pressure. This leads
to problems when collecting venous blood.
If the systolic blood pressure is exceeded, the vein to bepunctured can no longer be filled with blood, as a stricture
occurs.
If a blood collection tube is used in such a situation, it sucks
the vein empty, the vessel collapses and the tip of theneedle adheres to the vein wall.

130 mm
HG

Tourniquetpressure
too high:
Vein can nolonger fill, tube
is underfilled.

RR 120/80 mmHg

4 0 m mHG

Optimum backpressure:
Vein fills, tube
is easily filled
up to the filling
mark.

RR 120/80 mmHg
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TIP TO DEVELOPA GOOD FEEL
FOR THECORRECT
PRESSURE:
We recommend applying a
tourniquet to one arm and ablood pressure cuff on the
opposite side at 40 mmHg.

The blocked veins can now
be compared on both arms.
The pressure in the arteries
is 120/80 mmHg; in the veins
it fluctuates between -5
to 20 mmHg.
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A fully filled veinfeels elastic and has
a springy resistanceupon palpation.

VEIN OR ARTERY?

PALPATION
The vein should be felt with the forefinger and/or
middle finger. The thumb is not suitable, as it has
its own pulse.

Using a low tourniquet pressure, the vein will bewell filled, easily palpable and easy to puncture.
A fully filled vein feels elastic and has a springy
resistance upon palpation. The vein is normallypunctured in the centre of the angular point.
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Arteries can be distinguished because
they pulsate when the tourniquetpressure is correct. When thetourniquet pressure exceeds thesystolic pressure, the arterial flow
is cut off and pulsation stops.

VEIN OR TENDON?
It is often difficult to differentiate thevein from a nearby tendon as tendon
tissue feels hard upon palpation. For
more accurate differentiation, thepatient should move the lower arm andhand. If the right muscles are tensed,
the tendon clearly moves with them.
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WHY PALPATE?
The information obtained from palpation
results in the optimal product combinations
and recommendations for action:

Position of the vein (course)/ Optimal position of the person doing the puncture/ Puncture site (below the elevation of the vein)

Depth of vein
/ Needle length/ Puncture angle/ Insertion depth

Size of the vein
/ Needle length/ Needle size
/ Insertion depth

DID YOU
KNOW?
The needle size is also
indicated in gauge (G), whichmeans "measuring rod".
The higher the G number, the thinner
the outer diameter of the bloodcollection needle. This, along with thestandardized colour coding, helps toquickly identify the correct needle
depending on the vein conditions.

yellow
20G

green
21G

black
22G

ANGLE VS NEEDLE LENGTH
The optimal angle can often be achieved
with a short needle with a length of 25 mm (1″).
For deeper tissue or a wider tube holder, alonger cannula of 38 mm (1.5″) can also be used.

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VEIN SELECTION
Based on the information obtained
through palpation, the most suitable vein
for puncture can be identified and theappropriate products and combinations
can be selected for blood collection.

VEIN SELECTION– PRIORITY LIST

(2) lateral(1) central(3) medial

DISINFECTION
OF THE PUNCTURE SITE
The puncture site must be thoroughly and carefully
disinfected immediately prior to the puncture. The skin is
wiped with disinfectant in a spiralling motion from the inside
towards the outside.
Please note the (minimum)
application time in the
product description of theskin antiseptic.
Always observe the
manufacturer's instructions and the regulations
in your facility.

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DON'T
FORGET!
The wearing ofgloves is mandatoryfor each procedure
carried out (caution:
hepatitis, HIV).

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VENIPUNCTURE

BASED ON
PALPATION, THE
MOST APPROPRIATE
VEIN AND PRODUCTS
WERE SELECTED.
THE VEIN IS NOW
PUNCTURED.
The use of safety products
is recommended in order tominimize the risk of needlestick injuries.

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The skin and the vein are heldin place by being stretchedwith the thumb. This enables
accurate penetration of theskin and prevents the vein
from "rolling".

NEEDLE INSERTION
The needle is inserted at anangle of ≤ 30 degrees with thepreferred hand of the person
taking the blood. When
doing this, the needle tip isfacing upwards. The patient
should be made aware of theimminent needle insertion.

In a successful puncture, a decrease in resistanceis felt when penetrating the vein wall. The insertion
depth can vary depending on the patient and theselected vein.

FOR A VISUAL
PUNCTURE CHECK
use our VACUETTE®
VISIO PLUS cannulawith transparent
viewing window.

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RECOMMENDED HAND POSITION
Hold the tube holder using your preferredtechnique. However, always ensure that the rear
opening and the grips of the tube holder are freely
accessible, so that the blood collection tube canbe easily inserted and pulled out later.

Hold the tube holder with the thumband forefinger in the preferredpuncturing hand. Using yourfree fingers, you can support thepatient's arm and hold it in place.
This way, the tube holder and thecannula can be easily inserted andaccurately adjusted.
This avoids making any further
movements of the cannula in thevein, which can cause pain andinjury.
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Once the blood is in the
blood collection tube,
the tourniquet can beremoved or loosened.

INSERTING THE TUBE
Using your free hand, push the blood collection tube
into the holder. Any unnecessary hand changes
should be avoided.

The forefinger and middle
finger are positioned on
the gripping strip of the
tube holder, while thetube is inserted with the
thumb.

The rear end of the cannula pierces the stopper in thecap and the blood flows into the tube. This hand position
prevents any cannula movement while inserting and pullingout the blood collection tube.

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INCORRECT CANNULA POSITIONING
AND SOLUTION POSSIBILITIESCORRECTIVE ACTION
IN THE EVENT OF
WEAK OR NO
BLOOD FLOW
If blood is only flowing into the tube
hesitantly or not at all, there may bevarious reasons for this. There is no
general solution for this problem, it must
be responded to individually. Once thishas become routine, you will develop afeeling for the varying situations andbe able to react intuitively.

Minimal re-positioning of the cannula under suction(with the tube inserted) can often be sufficientto activate the blood flow.
However, in the event ofbigger manipulations,
it is necessary to
remove the tube fromthe holder. In this way,
the suction from thevacuum is interrupted
and no longer acts on thecannula opening in thetissue.
The utmost caution is required
for any kind of manipulation.
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Cannula outside
the vein
Insert thecannula further

Needle tip not
fully inside vein
> haematom
Insert the cannula
further; possibly
stop procedure

Needle tip completely penetrated
through vein
Slowly withdraw
cannula (possibly
under vacuum)

Needle tip is on the veinwall and is incorrectly
facing downwards
Gently alter cannula
position; possibly
remove tube

Needle tip is ona vein valve
Gently alter thecannula position;
possibly remove
the tube

Cannula next to vein
Pull the skin taut,hold the vein inplace; alter cannula
position accordingly

Needle tip not
fully inside vein >haematoma; possible
nerve damage
Gently withdraw thecannula; possibly
stop the procedure

Needle tip partly
outside tissue >loss of vacuum
Insert cannula
further; use a
new tube

Needle tip is on thevein wall
Gently alter thecannula position;
possibly remove
tube

Collapsed vein
Loosen tourniquet;remove tube; waita short time

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PULLING OUT THE TUBE
When pulling the tube out of the holder, it must be ensured
that the cannula is kept in the same position.

This is achieved by placing the thumb on the grips of theholder and grasping the filled tube with the remaining
fingers. The tube is then pushed out of the holder
with the thumb.

A steady hand position is also important, as several bloodcollection tubes are usually used. These should be taken in
the following sequence.

ORDER OF DRAW

1

Blood Culture

2

Sodium Citrate/CTAD*

3

Serum

4

Heparin

5

EDTA

6

Glycolytic Inhibitor

7

Other Additives

with and without Separator

with and without Separator

with and without Separator

If a winged blood collection set is used, the first tube in the series will be
under-filled. Therefore, if a Sodium Citrate specimen is drawn first, a tube
without additive is recommended to be drawn prior to this tube to ensure theproper additive-to-blood ratio.
In addition, even though studies have shown that PT and aPTT tests are notaffected if drawn first in a tube series, it is advisable to draw a second tube
for other coagulation assays, since it is not known whether or not these tests
will be affected. (CLSI GP41-A7 Order of Draw S. 26)
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INVERSIONSREMOVING THE CANNULA

Each tube must be inverted immediately on removal.
Coagulation tubes should be inverted around 180 degrees
4–5 times and all other tubes 5–10 times.

Before the cannula
is removed from thevein, the tube must be
removed. A clean swab isplaced over the puncturesite and held in placewith a finger. Without
applying pressure atthe puncture site, thecannula is withdrawn in
one smooth movement.

There are a few exceptions, such as FC Mix tubes,
which contain a powder and must be inverted 10 times.
For anticoagulants or coagulants to be effective, good
mixing by "overhead" inverting is necessary - do not shake.
The air bubble should be clearly visible going from top tobottom and vice versa when inverting the tube.

Pressure is only applied
once the cannula
has been completely
removed.
5x

PRACTICAL TIP
Inverting each tube
5 times is correct
for most tubes.

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WHILE THE CANNULA IS BEINGREMOVED FROM THE VEIN,
PRESSURE MUST NOT BEAPPLIED ON THE SWAB.
The cannula tip would cut open the rear vein walland cause pain as well as a large haematoma.

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Needlestick injuries

PLEASEOBSERVE THE
INSTRUCTIONSFOR USEcan be avoided
with safety products.

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Protect yourself!
ACTIVATING THE
SAFETY MECHANISM
Safety Products can be assigned to two categories:

ACTIVE DEVICES,WHICH REQUIRE ONE OR
TWO-HANDED ACTIVATION
OF THE SAFETY MECHANISM.
/ Safety products whereby the safetymechanism is activated manually.
(slide/tilt protection)/ Safety products that have asemiautomatic safety mechanism.
VACUETTE®
QUICKSHIELDPASSIVE DEVICES,WHICH WORK AUTOMATICALLY
THROUGHOUT USAGE.

Learn more about oursafety products here:
power4safety.com/ Safety products whereby the safetymechanism is activated after theneedle is removed from the vein.
/ Safety products whereby the safetymechanism is activated while thecannula is still inside the vein.
VACUETTE®
EVOPROTECT

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Disposal containers
are of penetrationproof
plastic and feature a temporary
and permanent closure.

DISPOSAL
Needlestick injuries are a particularrisk during the disposal of sharp orpointed objects. To reduce the risk for
the user to a minimum, only containers
specifically for this purpose should be
used.
Furthermore, the safety mechanism of
the safety product should be activatedprior to disposal.

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CARING FOR THE
INSERTION SITE
The patient can normallytake over the compression
themselves. The pressure
should be maintained for 3–5
minutes – or until the bleeding
has stopped. If the patient
is too weak, the person
carrying out the punctureor an assistant must ensure
appropriate compression is
maintained.
When doing this, the arm is extended and may bepositioned facing upwards. Bending the arm may leadto blockage of the vessel again and cause a haematoma
to form. The formation of a haematoma after bloodcollection is unpleasant for both the patient as well as the
person taking the blood and is a complication that cangenerally be avoided. The wound dressing is only applied
once bleeding has stopped.
For patients receiving anticoagulation treatment, good
manual compression is vital. One minute too many isbetter than one minute too few!

ATTENTION!
Physical exertion or strain on the affected limb
too soon can cause bleeding or bruising.

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BLOOD
COLLECTIONFROM VENOUS
CATHETERS
Blood collection directly froman IV catheter is an option aslong as the intended use of
the catheter allows this.
Accessories with Luer lockor Luer slip connectors arerecommended for this.

Luer-Lock on the example of
the VACUETTE® SAFELINK

Luer-Slip on the example of the
HOLDEX® Single-Use Holder

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After blood collection,
the tubes should be sent
to the laboratory
without delay forfurther processing.

TUBE LABELLING AND
SAMPLE TRANSPORT
Clear labelling with thepatient's reference data
and the information
required for the laboratory is essential.
In order to avoid
mix-ups, you should try
to label the tube in thepresence of the patient.
If a tube is labelled withan adhesive label, it
must be applied in sucha way that the bloodflow remains visible andthe filling level can bechecked.

AS AN ALTERNATIVE TOSTICKING A LABEL ON
THE TUBE, PRE-BARCODEDBLOOD COLLECTION TUBESCAN BE USED.
In conjunction with the corresponding
software, all the necessary information forthe laboratory is automatically documented.
Errors are reduced, working steps are reduced
and complete traceability is ensured.

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SPECIAL
INSTRUCTIONSFOR COLLECTING
BLOOD

SEVERAL FACTORSINFLUENCE BLOOD
COLLECTION. FOR
EXAMPLE, POOR
VEIN CONDITIONS,COLD, OR SHOCKCAN MAKE THINGS
MORE DIFFICULT.
It is therefore important tocreate a pleasant atmosphere
for the patient and to havea wide range of different
products to choose fromin order to be able to reactindividually to different
circumstances.

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It is important toreact individuallyto different

COMPLICATINGFACTORS FOR
VENIPUNCTURE

circumstances
during bloodcollection.

There are many unfavourable
factors which negatively impact
on blood collection.
Stress can lead to vasoconstriction
in anxious patients. It is therefore
important to create a pleasantatmosphere.
Even if just the room temperature
is too low, there could be a negative
effect on venipuncture.

ADDITIONAL FACTORS:
/
/
/
/
/
/
/
/
/
/

thin veinsdelicate veins in children
veins punctured multiple times
rolling veinsanxietycold temperature
vasoconstriction
volume deficiency
pre-shock/shock
long-term treatment
with steroids/ cachexia
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BLOOD COLLECTION
IN SMALL CHILDREN

THERE IS BARELYANY TECHNICALDIFFERENCE IN
BLOOD COLLECTION
IN SMALL CHILDREN
AGED FROM ABOUTTWO YEARS OF AGE
IN COMPARISON TO
THE PROCEDURE
FOR ADULTS.
However, it is especiallychallenging in small children
and requires experience andsensitivity.

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For safety reasons andto keep the limb steady,it is recommended

Principally, a quiet and friendly atmosphereis important for very young patients. Children
cooperate much better when they are given an
explanation of what is going to happen to them.

that the child sitson the lap of the person
accompanying them.

POSITIONING OF THE PATIENTFor safety reasons and to keep the limb steady, it isrecommended that the child sits on the lap of theperson accompanying them. Reflex movements canbe counterbalanced in this way.

TOOLS AND PRODUCT SELECTION
The use of local anaesthetics and agents to stimulate
the blood flow can make the procedure easier.
The collection system must be adapted to the small
size of the vessels. The puncture is made using a finesafety blood collection set or safety tube holder.
The use of thin cannulas from 22G with viewing
window and blood collection tubes with a reduced
volume is recommended. In order to avoid iatrogenic
anaemia, the blood volume taken should be kept low
and documented.
If required,a children’s
tourniquet ora child-sizedblood pressure
cuff can beused.
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PRACTICAL TIP

Inform the young patient about
the forthcoming "stick".

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ROUTINE PUNCTURE SITESIN SMALL CHILDREN

PUNCTURE ON THE
INSIDE OF THE ELBOW
When puncturing the inside of theelbow, the accompanying person holds
down the child's arm. The cannula isinserted into the vein at a maximum
angle of 30 degrees. VACUETTE® bloodcollection tubes are then used in therecommended order of draw. The
accompanying person closely observes
the child during the blood collection andreacts to spontaneous movements.

PUNCTURE ON THE BACK OF THE HAND
The puncture hardly differs at all from the procedure
with adults, except that the accompanying person keeps
the child's lower arm steady during the whole procedure.
As a right-handed person, the person taking the blooduses their left hand to take the hand to be punctured,
which is in a neutral position. The skin is gently
stretched in a distal direction.

The needle is inserted
at a shallow angle

PUNCTURE ON THE BACK OF THE FOOTThe accompanying person keeps the child's leg steadyduring the whole procedure. As a right-handed person,
the person taking the blood uses their left hand to holdthe foot to be punctured. The toes are gently pulled
downwards. This provides the required skin tension for
optimal needle insertion.

The puncture is madeat a shallow angle.

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BLOOD COLLECTION
IN NEWBORNSAND INFANTS
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IN ADDITION TO
CAPILLARY BLOOD
COLLECTION IN
NEWBORNS OR
INFANTS, VENOUS
PUNCTURE MAY ALSO
BE NECESSARY.
This can prove difficult due to thecondition of the veins. The usualpuncture sites are scalp veins
which are easily visible.
Just like with small children, theblood collection system must be
adapted to the small size of thevessels. The puncture is madeusing a fine safety blood collection
set or safety tube holder.
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Needle insertion on the headmay be perceived as dangerous

ROUTINE PUNCTURE SITESIN NEWBORNS AND INFANTS

by the parents, which is why
it is helpful to explain
the procedure to themin a sensitive manner.

HEAD VEIN PUNCTURE
The baby's head can be positioned andrestrained by an accompanying person invarious ways and depends on the venipuncturesite. When doing this, it is important that thehead is well restrained, but spontaneous body
movements are also prevented.
By "combing", the head hairs can be parted andthe best vein for puncture can be selected. Finehairs can be fixed in place during disinfection. In
the case of a thick head of hair, it is recommended that the puncture site is shaved.
The skin under the puncture site is stretchedwith one finger on the free hand.

The puncture ismade at a very
shallow angle.

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REFERENCES
1. CLSI. Collection of Diagnostic Venous Blood Specimens.
7th ed. CLSI standard GP41.
Wayne, PA: Clinical and Laboratory Standards Institute; 2017.
2. Dennis J. Ernst MT (ASCP), Catherine Ernst RN:
Phlebotomy for Nurses and Nursing Personnel, 2005
3. Dörner K.: Klinische Chemie und Hämatologie, Thieme Verlag, 8. Auflage, 2013
4. Guder, W.G., Narayanan, S.l., Wisser, H., Zawta, B.: Proben zwischen Patient undLabor, Darmstadt 2000
5. McCall R.; Tankersley C. M.: Phlebotomy Essentials. Baltimore, Wolters Kluwer |Lippincott Williams & Wilkins, 2012
6. Robert Koch Institut: Anforderungen an die Hygiene bei Punktionen und Injektionen.
Springer-Verlag, 2011
7. The National Association of Phlebotomists: Phlebotomy Manual & Assessment Book,
3. Auflage, London 2010
8. World Health Organization: WHO guidelines on drawing blood: best practices inphlebotomy, WHO Document Production Services, Geneva 2010
9. Pöll JS. The story of the gauge. Anaesthesia. 1999;54(6):575-581. doi:10.1046/j.13652044.1999.00895.x

FURTHERINFORMATIONON OURPRODUCTS
can be found on our
corporate website
www.gbo.com.
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www.gbo.com
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PHONE
FAX
E-MAIL+43 7583 6791-0+43 7583 6318
office@at.gbo.com

980063 en[rev.08 01.2022]

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