EVACUATED TUBES SYSTEM or ETS

Venipuncture is often a frightening experience for the patient. For many patient the anticipation of the procedure is
worse than the actual drawing of the blood. The medical assistant should take time to explain the procedure to the
patient in unhurried and confident manner. This helps relive the patient’s fear which relaxes the patient veins,
relaxed veins makes the venipuncture easier to perform and result less pain for the patient.
Here are the supplies needed for venipuncture with the evacuated tube system or more known as ETS
Proper Protective Equipment
Gloves, tourniquet, adhesive bandages, cotton balls, anti-septic wipe, evacuated tubes with labels, plastic holder,
double pointed needle, bio-hazard sharp container and laboratory requisition form.
1. REVIEW AND ACCESSION TEST REQUEST
2. APPROACH, IDENTFY, AND PREPARE PATIENT
3. VERIFY DIET RESTRICTION AND LATEX SENSITIVITY
Greet the patient and introduce yourself. Identify the patient by asking the patient to state his or her full name, and
date of birth. It is important to confirm that you have the correct patient to avoid collecting specimen on a wrong
patient. Compare this information to the information of the patient chart. If the patient is require to prepare for the
test with fasting or medication restriction determine whether he or she has prepare properly. The patient should also
be asked if he or she is allergic to latex, exposure to latex can trigger life-threatening reactions in those allergic to it.
4. SANITIZE YOUR HANDS
5. POSITION PATIENT, APPLY TOURNIQUET, AND ASK PATIENT TO MAKE A FIST
POSITIONING OF THE PATIENT
The patient position for the venipuncture is especially important to the successful collection of a blood specimen.
Proper positioning allows easy access to the vein and is more comfortable for the patient. The patient position
depends on the vein to be used. The most common site for venipuncture is the anti-cubital space. The patient should
be seated comfortable in a chair. The arms should be extended downward to form a straight line from the shoulder to
the wrist with the palm facing up. The arm should be supported by the armrest or a roll towel for support. A
venipuncture should never be performed with the patient’s sitting on a stool or standing the patient may faint and
injure him or herself. If the patient appears nervous or has painted in the past venipuncture it is best to draw the
patient when they are in a supine or semi-reclined position.
APPLYING THE TOURNIQUET AND VEIN PALPATION.
An important step in the venipuncture procedure is the application of the tourniquet. The tourniquet makes the
patient veins stand out so they are easier to palpate. The tourniquet acts as dam which cause the venous blood to
slow down and pull in the veins in the front of the tourniquet. This pooling of blood makes the veins more
prominent so they are more visible and can be palpated. The tourniquet should be applied with enough tension to
slow the venous flow without affecting the arterial flow. A tourniquet that is too tight obstruct both the venous blood
flow and the arterial which may result in a specimen that produces an inaccurate test results. Never leave tourniquet
on an arm for more than one minute at a time.
6. SELECT VEIN, RELEASE TOURNIQUET, AND ASK PATIENT TO OPEN FIST
Thoroughly palpate the selected vein. Gently palpate the vein with the fingertips to determine the direction of the
vein and to estimate its size and depth.
7. CLEAN AND AIR-DRY THE SITE
Cleanse the site with an antiseptic wipe. Cleansing should be done in a circular motion starting from the inside and
moving away from the puncture site allow the site to air dry after cleansing do not touch the area.
8. PREAPARE EQUIPMENT AND PUT ON GLOVES
Assemble the equipment.
Select the proper tubes for the test to be performed.
Prepare the evacuated tube system
9. REAPPLY TOURNIQUET, UNCAP AND INSPECT NEEDLE
Remove the cap from the poster needle using a twisting and pulling motion
Insert the poster needle in the small opening of the plastic holder. Screw the plastic holder on to the lunar adapter
and tighten it securely.
Evacuated tube needles are package in a seal twist apart plastic needle. The needle use with the evacuated tube
method consist with a double pointed stainless steel needle with a threaded hub near at center. The needle is coated
with silicon enabling it to penetrate the skin smoothly. The anterior needle is longer and has a bevel point designed
to facilitate entry into the skin and the vein. The posterior needle is shorter and its purpose is to pierce the rubber
stopper of the evacuated tube. The posterior needle has rubber sleeve that facilitate as a valve pushing the tube
stopper of an evacuated tube unto the posterior needle compresses this rubber sleeve and exposes the opening of the
needle allowing the blood to enter the tube when a tube is removed the sleeve slides back over the needle opening
and stops the flow of blood.
10. ASK PATIENT TO REMAKE A FIST, ANCHOR THE VEIN, AND INSERT NEEDLE
ANCHORING THE VEIN
Position the needle at a 15 degree angle to the arm. Rest the backs of the fingers on the patient’s forearm. Ensure
that the needle points in the same direction as the vein to be entered. The bevel of the needle needs to be pointed up
tell the patient that he or she will feel a small stick and with one continuous steady motion enter the skin and then
the vein you may feel a sensation of resistance followed by a released as the vein is entered when the release is felt
you have entered the vein and should not advance needle any further.
11. ESTABLISHED BLOOD FLOW, RELEASE TOURNIQUET, AND ASK PATIENT TO OPEN
FIST
Stabilize the vacuum tube setup by firmly grasping the holder between the thumb and the underlying fingers to
prevent the needle from moving.
12. FILL, REMOVE, AND MIX TUBES IN ORDER OF DRAW
In this demonstration we will be drawing lavender purple top tube. This is the most common tube use for collecting
a specimen for a complete blood count. We will also be using a gold serum separator tube.
To ensure a proper ratio of blood to additive, allow ETS tubes to fill until the normal vacuum is exhausted and blood
ceases to flow. Place the other tube to be drawn in the holder, use a clockwise twist to engage them with the needle,
and push them the rest of the way onto the needle until blood flow established.
When the last ETS tube has been filled, remove it from the holder and mix it before removing the needle from the
arm.
13. PLACE GAUZE, REMOVE NEEDLE, ACTIVATE SAFETY FEATURE. AND APPLY
PRESSURE
Carefully withdraw at the same angle as that for penetration. Immediately placed a cotton ball over the puncture site
and apply firm pressure to activate the safety push the shield forward with your thumb until you hear an audible
which indicates the shield has been locked in the place.
14. DISCARD COLLECTION UNIT, SYRINGE NEEDLE, OR TRANSFER DEVICES
Immediately discard the plastic holder and attach needle in a biohazard sharps container. Cooperative patients can be
asked to apply pressure with a cotton ball on their arm for one to two minutes.
15. LABEL TUBES
Label the tubes with the patients first and last name, patients date of birth, time the blood was drawn, and your
initials.
16. OBSERVE SPECIAL HANDLING INSTRUCTIONS
17. CHECK PATIENTS ARM AND APPY BANDAGES
Remove the cotton ball and inspect the puncture site to ensure that the opening is sealed with the clot. Apply an
adhesive bandage to the puncture site.
18. DISPOSE OF CONTAMINATED MATERIALS
19. THANK PATIENT, REMOVE GLOVES, AND SANITIZE HANDS
Make sure the patient is feeling fine not dizzy or light headed before they stand.
20. TRANSPORT SPECIMEN TO THE LAB
BUTTERFLY METHOD

A winged blood collection allowed lower angle of insertion greater control and easier maneuverability. However using them in
every patient may not be appropriate because they are often associated with a higher accident on needle discrete when improperly
discard and a higher cause for use compare to other devices. Therefore choose winged collection set only when circumstances
require them examples include when blood cultures ordered in addition to other laboratory test or coupled with syringe on small
or fragile veins where needle placement and control are critical to the success of the puncture.

Select and cleanse the site.

If using a tube holder assemble the device and perform the puncture as usual. If possible the tourniquet upon venous access to
minimize the effect of hemoconcentration.

If drawing blood cultures apply the tube holder assembly to the aerobic vial first followed by the anaerobic vial if included in the
set. After filling the blood culture or vials, fill the other tubes in a prescribe order of draw.

If using a syringe in the winged collection set select and cleanse the site as usual. Assemble the device. Break the seal of the
plunger and expel the air from the syringe by advancing it fully forward.

Perform the puncture and withdraw the plunger until the appropriate volume of blood has obtained. Released the tourniquet and
placed a clean gauze pad over the insertion site.

Remove the needle and apply pressure, immediately activating the needle safety feature according to manufacturer’s
instructions.

Remove the set from the syringe and attach a safety transfer device. Discard the set according to OSHA guidelines and your
facilities policy. Fill the tubes in the correct order of draw inverting each tube after filling.

CAPILLARY PUNCTURE

1. REVIEW AND ACCESSION TEST REQUEST

2. APPROACH, IDENTFY, AND PREPARE PATIENT
3. VERIFY DIET RESTRICTION AND LATEX SENSITIVITY
4. SANITIZE YOUR HANDS AND PUTON SOME GLOVES
5. POSITION THE PATIENT
6. SELECT THE PUNCTURE INCISION SITE
7. WARM THE SITE IF APPLICABLE
8. CLEAN AND AIR-DRY THE SITE
9. PREPARE THE EQUIPMENT ANCHORING THE VEIN
10. PUNCTURE THE SITE AND DISCARD THE LANCET/INCISION DEVICE
11. WIPE AWAY THE FIRST BLOOD DROP.
12. FILL AND MIX TUBES IN ORDER OF DRAW
13. PLACE GAUZE AND APPLY PRESSURE
14. LABEL THE SPECIMEN AND OBSERVE SPECIAL HANDLING INSTRUCTIONS
15. CHECK THE SITE AND APPLY BANDAGES
16. DISPOSED OF USED AND CONTAMINATED MATERIALS
17. THANK PATIENT, REMOVE GLOVES, AND SANITIZE HANDS
18. TRANSPORT SPECIMEN TO THE LAB