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class="vector-toc-numb">2</span> <span>Equipment</span> </div> </a> <button aria-controls="toc-Equipment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Equipment subsection</span> </button> <ul id="toc-Equipment-sublist" class="vector-toc-list"> <li id="toc-With_evacuated_or_vacuum_tubes" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#With_evacuated_or_vacuum_tubes"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>With evacuated or vacuum tubes</span> </div> </a> <ul id="toc-With_evacuated_or_vacuum_tubes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Additives_and_order_of_draw" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Additives_and_order_of_draw"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>Additives and order of draw</span> </div> </a> <ul id="toc-Additives_and_order_of_draw-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-In_children" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#In_children"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>In children</span> </div> </a> <ul id="toc-In_children-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-With_needle_and_syringe" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#With_needle_and_syringe"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>With needle and syringe</span> </div> </a> <ul id="toc-With_needle_and_syringe-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Blood_cultures" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Blood_cultures"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Blood cultures</span> </div> </a> <ul id="toc-Blood_cultures-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Taking_blood_samples_from_animals" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Taking_blood_samples_from_animals"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Taking blood samples from animals</span> </div> </a> <ul id="toc-Taking_blood_samples_from_animals-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Blood_alcohol_tests" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Blood_alcohol_tests"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Blood alcohol tests</span> </div> </a> <ul id="toc-Blood_alcohol_tests-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" 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href="https://bg.wikipedia.org/wiki/%D0%9F%D1%83%D0%BD%D0%BA%D1%86%D0%B8%D1%8F" title="Пункция – Bulgarian" lang="bg" hreflang="bg" data-title="Пункция" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Venipunci%C3%B3" title="Venipunció – Catalan" lang="ca" hreflang="ca" data-title="Venipunció" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Venepunkce" title="Venepunkce – Czech" lang="cs" hreflang="cs" data-title="Venepunkce" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Blutentnahme" title="Blutentnahme – German" lang="de" hreflang="de" data-title="Blutentnahme" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Venopunci%C3%B3n" title="Venopunción – Spanish" lang="es" hreflang="es" data-title="Venopunción" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%AE%D9%88%D9%86%DA%AF%DB%8C%D8%B1%DB%8C_%D8%B3%DB%8C%D8%A7%D9%87%D8%B1%DA%AF%DB%8C" title="خونگیری سیاهرگی – Persian" lang="fa" hreflang="fa" data-title="خونگیری سیاهرگی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Pr%C3%A9l%C3%A8vement_sanguin" title="Prélèvement sanguin – French" lang="fr" hreflang="fr" data-title="Prélèvement sanguin" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Puntura_venosa" title="Puntura venosa – Italian" lang="it" hreflang="it" data-title="Puntura venosa" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A0%D7%98%D7%99%D7%9C%D7%AA_%D7%93%D7%9D_%D7%95%D7%A8%D7%99%D7%93%D7%99" title="נטילת דם ורידי – Hebrew" lang="he" hreflang="he" data-title="נטילת דם ורידי" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Tusukan_vena" title="Tusukan vena – Malay" lang="ms" hreflang="ms" data-title="Tusukan vena" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Venapunctie" title="Venapunctie – Dutch" lang="nl" hreflang="nl" data-title="Venapunctie" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%8E%A1%E8%A1%80%E6%B3%95" title="採血法 – Japanese" lang="ja" hreflang="ja" data-title="採血法" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Wenopunkcja" title="Wenopunkcja – Polish" lang="pl" hreflang="pl" data-title="Wenopunkcja" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Flebotomia" title="Flebotomia – Portuguese" lang="pt" hreflang="pt" data-title="Flebotomia" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%92%D0%B5%D0%BD%D0%B5%D0%BF%D1%83%D0%BD%D0%BA%D1%86%D0%B8%D1%8F" title="Венепункция – Russian" lang="ru" hreflang="ru" data-title="Венепункция" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Blood_draw" title="Blood draw – Simple English" lang="en-simple" hreflang="en-simple" data-title="Blood draw" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Venepunkcia" title="Venepunkcia – Slovak" lang="sk" hreflang="sk" data-title="Venepunkcia" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%92%D0%B5%D0%BD%D0%B5%D0%BF%D1%83%D0%BD%D0%BA%D1%86%D0%B8%D1%98%D0%B0" title="Венепункција – Serbian" lang="sr" hreflang="sr" data-title="Венепункција" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-tl mw-list-item"><a href="https://tl.wikipedia.org/wiki/Beneseksyon" title="Beneseksyon – Tagalog" lang="tl" hreflang="tl" data-title="Beneseksyon" data-language-autonym="Tagalog" data-language-local-name="Tagalog" class="interlanguage-link-target"><span>Tagalog</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%81%E0%B8%B2%E0%B8%A3%E0%B9%80%E0%B8%88%E0%B8%B2%E0%B8%B0%E0%B8%AB%E0%B8%A5%E0%B8%AD%E0%B8%94%E0%B9%80%E0%B8%A5%E0%B8%B7%E0%B8%AD%E0%B8%94%E0%B8%94%E0%B8%B3" title="การเจาะหลอดเลือดดำ – Thai" lang="th" hreflang="th" data-title="การเจาะหลอดเลือดดำ" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tg mw-list-item"><a href="https://tg.wikipedia.org/wiki/%D0%92%D0%B5%D0%BD%D0%B5%D0%BF%D1%83%D0%BD%D0%BA%D1%81%D0%B8%D1%8F" title="Венепунксия – Tajik" lang="tg" hreflang="tg" data-title="Венепунксия" data-language-autonym="Тоҷикӣ" data-language-local-name="Tajik" class="interlanguage-link-target"><span>Тоҷикӣ</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/L%E1%BA%A5y_m%C3%A1u_t%E1%BB%AB_t%C4%A9nh_m%E1%BA%A1ch" title="Lấy máu từ tĩnh mạch – Vietnamese" lang="vi" hreflang="vi" data-title="Lấy máu từ tĩnh mạch" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E9%9D%99%E8%84%89%E7%A9%BF%E5%88%BA" title="静脉穿刺 – Chinese" lang="zh" hreflang="zh" data-title="静脉穿刺" data-language-autonym="中文" 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id="siteSub" class="noprint">From Wikipedia, the free encyclopedia</div> </div> <div id="contentSub"><div id="mw-content-subtitle"></div></div> <div id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Process of obtaining intravenous access</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"Drawing blood" redirects here. For the book, see <a href="/wiki/Drawing_Blood" title="Drawing Blood">Drawing Blood</a>.</div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Venipuncture_using_a_BD_Vacutainer.JPG" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9b/Venipuncture_using_a_BD_Vacutainer.JPG/170px-Venipuncture_using_a_BD_Vacutainer.JPG" decoding="async" width="170" height="227" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9b/Venipuncture_using_a_BD_Vacutainer.JPG/255px-Venipuncture_using_a_BD_Vacutainer.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9b/Venipuncture_using_a_BD_Vacutainer.JPG/340px-Venipuncture_using_a_BD_Vacutainer.JPG 2x" data-file-width="2448" data-file-height="3264" /></a><figcaption>Still photo of a venipuncture procedure</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><span><video id="mwe_player_0" poster="//upload.wikimedia.org/wikipedia/commons/thumb/1/13/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm/220px--Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.jpg" controls="" preload="none" data-mw-tmh="" class="mw-file-element" width="220" height="220" data-durationhint="16" data-mwtitle="Video_of_venipuncture_(blood_draw_or_collection)_using_the_BD_Vacutainer_product..webm" data-mwprovider="wikimediacommons" resource="/wiki/File:Video_of_venipuncture_(blood_draw_or_collection)_using_the_BD_Vacutainer_product..webm"><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/1/13/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.480p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="480p.vp9.webm" data-width="480" data-height="480" /><source src="//upload.wikimedia.org/wikipedia/commons/1/13/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm" type="video/webm; codecs="vp8, vorbis"" data-width="640" data-height="640" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/1/13/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.240p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="240p.vp9.webm" data-width="240" data-height="240" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/1/13/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.360p.vp9.webm" type="video/webm; codecs="vp9, opus"" data-transcodekey="360p.vp9.webm" data-width="360" data-height="360" /><source src="//upload.wikimedia.org/wikipedia/commons/transcoded/1/13/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm/Video_of_venipuncture_%28blood_draw_or_collection%29_using_the_BD_Vacutainer_product..webm.360p.webm" type="video/webm; codecs="vp8, vorbis"" data-transcodekey="360p.webm" data-width="360" data-height="360" /></video></span><figcaption>Video of a venipuncture procedure</figcaption></figure> <p>In medicine, <b>venipuncture</b> or <b>venepuncture</b> is the process of obtaining intravenous access for the purpose of venous <a href="/wiki/Sampling_(medicine)#blood" title="Sampling (medicine)">blood sampling</a> (also called <i><a href="/wiki/Phlebotomy" title="Phlebotomy">phlebotomy</a></i>) or <a href="/wiki/Intravenous_therapy" title="Intravenous therapy">intravenous therapy</a>. In healthcare, this procedure is performed by <a href="/wiki/Medical_Laboratory_Scientist" class="mw-redirect" title="Medical Laboratory Scientist">medical laboratory scientists</a>, <a href="/wiki/Physician" title="Physician">medical practitioners</a>, some <a href="/wiki/EMTs" class="mw-redirect" title="EMTs">EMTs</a>, <a href="/wiki/Paramedics" class="mw-redirect" title="Paramedics">paramedics</a>, <a href="/wiki/Phlebotomist" class="mw-redirect" title="Phlebotomist">phlebotomists</a>, <a href="/wiki/Kidney_dialysis" title="Kidney dialysis">dialysis</a> technicians, and other nursing staff.<sup id="cite_ref-NT_2004_1-0" class="reference"><a href="#cite_note-NT_2004-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In <a href="/wiki/Veterinary_medicine" title="Veterinary medicine">veterinary medicine</a>, the procedure is performed by <a href="/wiki/Veterinarians" class="mw-redirect" title="Veterinarians">veterinarians</a> and <a href="/wiki/Paraveterinary_worker" title="Paraveterinary worker">veterinary technicians</a>. </p><p>It is essential to follow a standard procedure for the collection of blood specimens to get accurate laboratory results. Any error in collecting the blood or filling the test tubes may lead to erroneous laboratory results.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Venipuncture is one of the most routinely performed invasive procedures and is carried out for any of five reasons: </p> <ol><li>to obtain blood for diagnostic purposes;</li> <li>to monitor levels of blood components;<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></li> <li>to administer therapeutic treatments including medications, nutrition, or chemotherapy;</li> <li>to remove blood due to excess levels of iron or erythrocytes (<a href="/wiki/Red_blood_cell" title="Red blood cell">red blood cells</a>); or</li> <li>to collect blood for later uses, mainly <a href="/wiki/Blood_transfusion" title="Blood transfusion">transfusion</a> either <a href="/wiki/Autologous_blood_transfusion" class="mw-redirect" title="Autologous blood transfusion">in the donor</a> or <a href="/wiki/Blood_donation" title="Blood donation">in another person</a>.</li></ol> <p><a href="/wiki/Blood_analysis" class="mw-redirect" title="Blood analysis">Blood analysis</a> is an important diagnostic tool available to clinicians within healthcare. </p><p>Blood is most commonly obtained from the superficial veins of the upper limb.<sup id="cite_ref-NT_2004_1-1" class="reference"><a href="#cite_note-NT_2004-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Median_cubital_vein" title="Median cubital vein">median cubital vein</a>, which lies within the <a href="/wiki/Cubital_fossa" title="Cubital fossa">cubital fossa</a> anterior to the elbow, is close to the surface of the skin without many large nerves positioned nearby. Other veins that can be used in the cubital fossa for venipuncture include the <a href="/wiki/Cephalic_vein" title="Cephalic vein">cephalic</a>, <a href="/wiki/Basilic_vein" title="Basilic vein">basilic</a>, and <a href="/wiki/Median_antebrachial_vein" title="Median antebrachial vein">median antebrachial veins</a>.<sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> </p><p>Minute quantities of blood may be taken by <a href="/wiki/Fingerstick" title="Fingerstick">fingerstick sampling</a> and collected from infants by means of a <a href="/wiki/Heelprick" class="mw-redirect" title="Heelprick">heelprick</a> or from scalp veins with a <a href="/wiki/Winged_infusion_needle" class="mw-redirect" title="Winged infusion needle">winged infusion needle</a>. </p><p>Phlebotomy (incision into a vein) is also the treatment of certain diseases such as <a href="/wiki/Hemochromatosis" class="mw-redirect" title="Hemochromatosis">hemochromatosis</a> and primary and secondary <a href="/wiki/Polycythemia" title="Polycythemia">polycythemia</a>. </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Complications">Complications</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=1" title="Edit section: Complications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A 1996 study of blood donors (a larger needle is used in blood donation than in routine venipuncture) found that 1 in 6,300 donors sustained a nerve injury.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>Risk and side affects can include a variety of things. Dizziness, sweating, and a drop in your heart rate and blood pressure. <a rel="nofollow" class="external autonumber" href="https://www.webmd.com/a-to-z-guides/what-is-phlebotomy">[1]</a><sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Equipment">Equipment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=2" title="Edit section: Equipment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Pr%C3%A4meta_tourniquet-4981.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c0/Pr%C3%A4meta_tourniquet-4981.jpg/220px-Pr%C3%A4meta_tourniquet-4981.jpg" decoding="async" width="220" height="124" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c0/Pr%C3%A4meta_tourniquet-4981.jpg/330px-Pr%C3%A4meta_tourniquet-4981.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c0/Pr%C3%A4meta_tourniquet-4981.jpg/440px-Pr%C3%A4meta_tourniquet-4981.jpg 2x" data-file-width="5717" data-file-height="3216" /></a><figcaption>An elastic <a href="/wiki/Tourniquet" title="Tourniquet">tourniquet</a> used to temporarily restrict blood flow. The tourniquet distends the veins, making them more <a href="/wiki/Palpation" title="Palpation">palpable</a> and visible.</figcaption></figure> <p>There are many ways in which blood can be drawn from a vein, and the method used depends on the person's age, the equipment available, and the type of tests required. </p><p>Most <a href="/wiki/Blood_collection" class="mw-redirect" title="Blood collection">blood collection</a> in the US, UK, Canada and Hong Kong is done with an evacuated tube system. Two common systems are <a href="/wiki/Vacutainer" title="Vacutainer">Vacutainer</a> (Becton, Dickinson and company) and Vacuette (Greiner Bio-One). The equipment consists of a plastic adapter, also known as a tube or needle holder/hub, a hypodermic needle and a vacuum tube. Under certain circumstances, a syringe may be used, often with a <a href="/wiki/Winged_infusion_set" title="Winged infusion set">butterfly needle</a>, which is a plastic catheter attached to a short needle. In the developing world, the evacuated tube system is the preferred method of drawing blood.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="With_evacuated_or_vacuum_tubes">With evacuated or vacuum tubes</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=3" title="Edit section: With evacuated or vacuum tubes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Vacutainer_blood_bottles.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/ee/Vacutainer_blood_bottles.jpg/220px-Vacutainer_blood_bottles.jpg" decoding="async" width="220" height="220" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/ee/Vacutainer_blood_bottles.jpg/330px-Vacutainer_blood_bottles.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/ee/Vacutainer_blood_bottles.jpg/440px-Vacutainer_blood_bottles.jpg 2x" data-file-width="960" data-file-height="960" /></a><figcaption>Vacutainer blood vials</figcaption></figure> <p>Greiner Bio-One manufactured the first ever plastic evacuated blood collection tube in 1985 under the VACUETTE brand name. Today, many companies sell vacuum tubes as the patent for this device is now in the public domain. These tubes are manufactured with a specific volume of gas removed from the sealed tube. When a needle from a hub or transfer device is inserted into the stopper, the tube's vacuum automatically pulls in the required volume of blood.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p><p>The basic Evacuated Tube System (ETS) consists of a needle, a tube holder, and the evacuated tubes. The needle is attached to the tube holder by the phlebotomist prior to collection, or may come from the manufacturer as one unit. The needle protrudes through the end of the tube holder, and has a needle on each end. After first cleaning the venipuncture site and applying a tourniquet, the phlebotomist uncaps the needle attached to the tube holder, inserts the needle into the vein, then slides evacuated tubes into the tube holder, where the tube's stopper is pierced by the back end of the needle. The vacuum in the tube then automatically draws the needed blood directly from the vein. Multiple vacuum tubes can be attached to and removed in turn from a single needle, allowing multiple samples to be obtained from a single procedure. This is possible due to the multiple sample sleeve, which is a flexible rubber fitting over the posterior end of the needle <a href="/wiki/Cannula" title="Cannula">cannula</a> which seals the needle until it is pushed out of the way. This keeps blood from freely draining out of the back of the needle inserted in the vein, as each test tube is removed and the next impaled. <a href="/wiki/Occupational_Safety_and_Health_Administration" title="Occupational Safety and Health Administration">OSHA</a> safety regulations require that needles or tube holders come equipped with a safety device to cover the needle after the procedure to prevent accidental needle stick injury.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Fittings and adapters used to fill evacuated tubes from butterfly needle kits and syringes are also available.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p><p>There are several needle gauges for a phlebotomist to choose from. The most commonly used are as follows: a 21g (green top) needle, a 22g (black top) needle, a 21g (green label) butterfly needle, a 23g (light blue label) butterfly needle, and a 25g (orange or dark blue label) butterfly needle (however this needle is only used in pediatrics or extreme cases as it is so small that it can often result in hemolyzing the blood sample). There are also a variety of tube and bottle sizes and volumes for different test requirements.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Additives_and_order_of_draw">Additives and order of draw</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=4" title="Edit section: Additives and order of draw"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The test tubes in which blood is collected may contain one or more of several additives. In general, tests requiring whole blood call for blood samples collected in test tubes containing some form of the anticoagulant <a href="/wiki/EDTA" class="mw-redirect" title="EDTA">EDTA</a>. EDTA <a href="/wiki/Chelation" title="Chelation">chelates</a> calcium to prevent clotting. EDTA is preferred for hematology tests because it does minimum damage to cell morphology. Sodium citrate is the anticoagulant used in specimens collected for coagulation tests. The majority of chemistry and immunology tests are performed on serum, which is produced by clotting and then separating the blood specimen via centrifuge. These specimens are collected in either a non-additive tube or one containing a <a href="/wiki/Coagulation" title="Coagulation">clotting</a> activator. This clotting activator can interfere with some <a href="/wiki/Assay" title="Assay">assays</a>, and so a plain tube is recommended in these cases, but will delay testing. Tubes containing lithium heparin or sodium heparin are also commonly used for a variety of chemistry tests, as they do not require clotting and can be centrifuged immediately after collection. A combination of <a href="/wiki/Sodium_fluoride" title="Sodium fluoride">sodium fluoride</a> and potassium oxalate is used for glucose tests, as these additives both prevent clotting and stop glycolosis, so that blood glucose levels are preserved after collection.<sup id="cite_ref-pmid1644639_9-0" class="reference"><a href="#cite_note-pmid1644639-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Another specialty tube is an opaque amber colored tube used to collect blood for light sensitive analytes, such as <a href="/wiki/Bilirubin" title="Bilirubin">bilirubin</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p><p>Test tubes are labeled with the additive they contain, but the stopper on each tube is color coded according to additive as well. While colors vary between manufacturers, stopper colors generally are associated with each additive as listed below. Because the additives from each tube can be left on the needle used to fill the tubes, they must be drawn in a specific order to ensure that cross contamination will not negatively affect testing of the samples if multiple tubes are to be drawn at once. The "order of draw" varies by collection method. Below in the order of draw generally required for the Evacuated Tube System (ETS) collection method are the most common tubes, listing additive and color:<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-unc_11-0" class="reference"><a href="#cite_note-unc-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable"> <caption><a href="/wiki/Vacutainer" title="Vacutainer">Vacutainer</a>/<a href="/wiki/Test_tube" title="Test tube">sample tube</a> types for <a class="mw-selflink selflink">venipuncture</a>/<a href="/wiki/Phlebotomy" title="Phlebotomy">phlebotomy</a>   <span class="noprint plainlinks" title="Edit Template:Table of blood sampling tubes"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Template:Table_of_blood_sampling_tubes&action=edit">edit</a></span> </caption> <tbody><tr> <th>Tube cap color or type in order of draw</th> <th>Additive</th> <th>Usage and comments </th></tr> <tr> <td><b><a href="/wiki/Blood_culture" title="Blood culture">Blood culture</a></b> bottle</td> <td><b>Sodium polyanethol sulfonate</b> (<a href="/wiki/Anticoagulant" title="Anticoagulant">anticoagulant</a>) and <b><a href="/wiki/Growth_media" class="mw-redirect" title="Growth media">growth media</a></b> for <a href="/wiki/Microorganisms" class="mw-redirect" title="Microorganisms">microorganisms</a></td> <td>Usually drawn first for minimal risk of contamination.<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Two bottles are typically collected in one blood draw; one for <a href="/wiki/Aerobic_organism" title="Aerobic organism">aerobic organisms</a> and one for <a href="/wiki/Anaerobic_organism" title="Anaerobic organism">anaerobic organisms</a>.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <th style="background: skyblue">Blue <p>("light blue") </p> </th> <td><a href="/wiki/Sodium_citrate" title="Sodium citrate">Sodium <b>citrate</b></a> <p>(weak calcium chelator/<a href="/wiki/Anticoagulant" title="Anticoagulant">anticoagulant</a>) </p> </td> <td><b>Coagulation tests</b> such as <a href="/wiki/Prothrombin_time" title="Prothrombin time">prothrombin time</a> (PT) and <a href="/wiki/Partial_thromboplastin_time" title="Partial thromboplastin time">partial thromboplastin time</a> (PTT) and <a href="/wiki/Thrombin_time" title="Thrombin time">thrombin time</a> (TT). Tube must be filled to the proper line. </td></tr> <tr> <th style="background: red; color: white">Plain red </th> <td><b>No additive</b></td> <td><b>Serum</b>: <a href="/wiki/Total_complement_activity" title="Total complement activity">Total complement activity</a>, <a href="/wiki/Cryoglobulin" class="mw-redirect" title="Cryoglobulin">cryoglobulins</a> </td></tr> <tr> <th style="background: goldenrod">Gold (sometimes red and grey "tiger top"<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup>) </th> <td><b>Clot activator</b> and <b>serum separating</b> gel<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup></td> <td><b><a href="/wiki/Serum-separating_tube" title="Serum-separating tube">Serum-separating tube</a></b> (SST): Tube inversions promote clotting. Most chemistry, endocrine and serology tests, including <a href="/wiki/Hepatitis" title="Hepatitis">hepatitis</a> and <a href="/wiki/HIV" title="HIV">HIV</a>. </td></tr> <tr> <th style="background: orange">Orange </th> <td><b>Clot activator</b> and <b>serum separating</b> gel<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup></td> <td>Rapid <b><a href="/wiki/Serum-separating_tube" title="Serum-separating tube">serum-separating tube</a></b> (RST). </td></tr> <tr> <th style="background: mediumseagreen; color: white">Dark green </th> <td>Sodium <b><a href="/wiki/Heparin" title="Heparin">heparin</a></b> (anticoagulant)</td> <td>Chromosome testing, <a href="/wiki/Human_leukocyte_antigen" title="Human leukocyte antigen">HLA</a> typing, <a href="/wiki/Ammonia" title="Ammonia">ammonia</a>, <a href="/wiki/Lactic_acid" title="Lactic acid">lactate</a> </td></tr> <tr> <th style="background: lightgreen">Light green </th> <td>Lithium <b><a href="/wiki/Heparin" title="Heparin">heparin</a></b> (anticoagulant) <p>Plasma separator gel </p> </td> <td><b><a href="/wiki/Blood_plasma" title="Blood plasma">Plasma</a></b>. Tube inversions prevent clotting </td></tr> <tr> <th style="background: MediumOrchid">Lavender ("purple") </th> <td><b><a href="/wiki/Ethylenediaminetetraacetic_acid" title="Ethylenediaminetetraacetic acid">EDTA</a></b> (<a href="/wiki/Chelation" title="Chelation">chelator</a> / <a href="/wiki/Anticoagulant" title="Anticoagulant">anticoagulant</a>)</td> <td><b><a href="/wiki/Whole_blood" title="Whole blood">Whole blood</a></b>: <a href="/wiki/Complete_blood_count" title="Complete blood count">CBC</a>, <a href="/wiki/Erythrocyte_sedimentation_rate" title="Erythrocyte sedimentation rate">ESR</a>, <a href="/wiki/Coombs_test" title="Coombs test">Coombs test</a>, platelet antibodies, <a href="/wiki/Flow_cytometry" title="Flow cytometry">flow cytometry</a>, blood levels of <a href="/wiki/Tacrolimus" title="Tacrolimus">tacrolimus</a> and <a href="/wiki/Cyclosporin" class="mw-redirect" title="Cyclosporin">cyclosporin</a> </td></tr> <tr> <th style="background: pink">Pink </th> <td><b>K<sub>2</sub> EDTA</b> (<a href="/wiki/Chelator" class="mw-redirect" title="Chelator">chelator</a> / <a href="/wiki/Anticoagulant" title="Anticoagulant">anticoagulant</a>)</td> <td><b><a href="/wiki/Blood_typing" class="mw-redirect" title="Blood typing">Blood typing</a></b> and <a href="/wiki/Cross-matching" title="Cross-matching">cross-matching</a>, direct <a href="/wiki/Coombs_test" title="Coombs test">Coombs test</a>, <a href="/wiki/HIV" title="HIV">HIV</a> viral load </td></tr> <tr> <th style="background: royalblue; color: white">Royal blue <p>("navy") </p> </th> <td><b>EDTA</b> (<a href="/wiki/Chelator" class="mw-redirect" title="Chelator">chelator</a> / <a href="/wiki/Anticoagulant" title="Anticoagulant">anticoagulant</a>)</td> <td>Trace elements, heavy metals, most drug levels, <a href="/wiki/Toxicology" title="Toxicology">toxicology</a> </td></tr> <tr> <th style="background: tan">Tan </th> <td><b>Sodium EDTA</b> (<a href="/wiki/Chelator" class="mw-redirect" title="Chelator">chelator</a> / <a href="/wiki/Anticoagulant" title="Anticoagulant">anticoagulant</a>)</td> <td><b><a href="/wiki/Lead" title="Lead">Lead</a></b> </td></tr> <tr> <th style="background: gray; color: white">Gray </th> <td> <p><b>Fluoride Oxalate</b> </p> <ul><li><a href="/wiki/Sodium_fluoride" title="Sodium fluoride"> Sodium <b>fluoride</b></a> (<a href="/wiki/Glycolysis" title="Glycolysis">glycolysis</a> inhibitor)</li> <li><a href="/wiki/Potassium_oxalate" class="mw-redirect" title="Potassium oxalate">Potassium oxalate</a> (anticoagulant)<sup id="cite_ref-pmid1644639_9-1" class="reference"><a href="#cite_note-pmid1644639-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup></li></ul> </td> <td><b><a href="/wiki/Glucose_test" title="Glucose test">Glucose</a></b>, lactate,<sup id="cite_ref-DasguptaSepulveda2019_17-0" class="reference"><a href="#cite_note-DasguptaSepulveda2019-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Toxicology" title="Toxicology">toxicology</a><sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <th style="background: yellow">Yellow </th> <td><b><a href="/wiki/Acid-citrate-dextrose" title="Acid-citrate-dextrose">Acid-citrate-dextrose</a> A</b> (anticoagulant)</td> <td><a href="/wiki/Tissue_typing" title="Tissue typing">Tissue typing</a>, DNA studies, <a href="/wiki/HIV" title="HIV">HIV</a> cultures </td></tr> <tr> <th style="background: pearl">Pearlescent ("white") </th> <td><b>Separating gel</b> and (K<sub>2</sub>)<b>EDTA</b></td> <td><b><a href="/wiki/Polymerase_chain_reaction" title="Polymerase chain reaction">PCR</a></b> for <a href="/wiki/Adenovirus" class="mw-redirect" title="Adenovirus">adenovirus</a>, <a href="/wiki/Toxoplasma" class="mw-redirect" title="Toxoplasma">toxoplasma</a> and <a href="/wiki/Human_herpesvirus_6" title="Human herpesvirus 6">HHV-6</a> </td></tr> <tr> <th style="background: black; color: white">Black </th> <td><b><a href="/wiki/Trisodium_citrate" title="Trisodium citrate">Sodium Citrate</a></b></td> <td><a href="/wiki/Paediatric" class="mw-redirect" title="Paediatric">Paediatric</a> <a href="/wiki/Erythrocyte_sedimentation_rate" title="Erythrocyte sedimentation rate">ESR</a> </td></tr> <tr> <th style="background: White">QuantiFERON <p>Grey, Green, Yellow, Purple </p> </th> <td><b><a href="/wiki/QuantiFERON" class="mw-redirect" title="QuantiFERON">QuantiFERON</a></b> <p>1. Grey (nil) tube 2. Green (TB1 antigen) tube 3. Yellow (TB2 antigen) tube 4. Purple (mitogen) tube </p> </td> <td><b><a href="/wiki/Tuberculosis" title="Tuberculosis">Tuberculosis</a></b> </td></tr> </tbody></table> <div class="mw-heading mw-heading2"><h2 id="In_children">In children</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=5" title="Edit section: In children"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Pain_management_in_children" title="Pain management in children">Pain management in children</a></div> <p>Use of lidocaine <a href="/wiki/Iontophoresis" title="Iontophoresis">iontophoresis</a> is effective for reducing pain and alleviating distress during venipuncture in children.<sup id="cite_ref-rose_19-0" class="reference"><a href="#cite_note-rose-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> A needle-free powder <a href="/wiki/Lidocaine" title="Lidocaine">lignocaine</a> delivery system has been shown to decrease the pain of venipuncture in children.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Rapid dermal anesthesia can be achieved by local anesthetic infiltration, but it may evoke anxiety in children frightened by needles or distort the skin, making vascular access more difficult and increasing the risk of needle exposure to health care workers. Dermal anesthesia can also be achieved without needles by the topical application of local anesthetics or by lidocaine iontophoresis. By contrast, noninvasive dermal anesthesia can be established in 5–15 min without distorting underlying tissues by lidocaine iontophoresis, where a direct electric current facilitates dermal penetration of positively charged lidocaine molecules when placed under the positive electrode.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p><p>One study concluded that the iontophoretic administration of <a href="/wiki/Lidocaine" title="Lidocaine">lidocaine</a> was safe and effective in providing dermal anesthesia for venipuncture in children 6–17 years old. This technique may not be applicable to all children. Future studies may provide information on the minimum effective iontophoretic dose for dermal anesthesia in children and the comparison of the anesthetic efficacy and satisfaction of lidocaine iontophoresis with topical anesthetic creams and subcutaneous infiltration.<sup id="cite_ref-rose_19-1" class="reference"><a href="#cite_note-rose-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>Non-pharmacological treatments for pain associated with venipuncture in children includes <a href="/wiki/Hypnosis" title="Hypnosis">hypnosis</a> and distraction. These treatments reduced self reported pain and when combined with <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive-behavioural therapy</a> (CBT) the reduction of pain was even greater. Other interventions have not been found to be effective and these are suggestion, blowing out air, and distraction with parent coaching did not differ from control for pain and distress.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="With_needle_and_syringe">With needle and syringe</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=6" title="Edit section: With needle and syringe"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Some health care workers prefer to use a <a href="/wiki/Syringe" title="Syringe">syringe</a>-needle technique for venipuncture. <i>Sarstedt</i> manufactures a blood-drawing system (S-Monovette) that uses this principle.<sup id="cite_ref-Sarstedt_23-0" class="reference"><a href="#cite_note-Sarstedt-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> This method can be preferred on the elderly, those with cancer, severe burns, obesity, or where the veins are unreliable or fragile. Because syringes are manually operated, the amount of suction applied may be easily controlled. This is particularly helpful when veins are small which may collapse under the suction of an evacuated tube. In children or other circumstances where the quantity of blood gained may be limited it can be helpful to know how much blood can be obtained before distributing it amongst the various additives that the laboratory will require. Another alternative is drawing blood from indwelling cannulae.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Blood_cultures">Blood cultures</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=7" title="Edit section: Blood cultures"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are times when a blood culture collection is required. The culture will determine if there are pathogens in the blood. Normally blood is sterile. When drawing blood from cultures use a sterile solution such as <a href="/wiki/Betadine" class="mw-redirect" title="Betadine">Betadine</a> rather than <a href="/wiki/Ethanol" title="Ethanol">alcohol</a>. This is done using sterile gloves, while not wiping away the surgical solution, touching the puncture site, or in any way compromising the sterile process. It is vital that the procedure is performed in as sterile a manner as possible as the persistent presence of skin <a href="/wiki/Commensal" class="mw-redirect" title="Commensal">commensals</a> in blood cultures could indicate <a href="/wiki/Endocarditis" title="Endocarditis">endocarditis</a> but they are most often found as contaminants. It is encouraged to use an abrasive method of skin preparation. This removes the upper layers of dead skin cells along with their contaminating bacteria.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Povidone-iodine has traditionally been used but in the UK a 2% <a href="/wiki/Chlorhexidine" title="Chlorhexidine">chlorhexidine</a> in 70% ethanol or isopropyl alcohol solution is preferred and time must be allowed for it to dry. The tops of any containers used when drawing a blood culture should also be disinfected using a similar solution. Some labs will actively discourage iodine use where iodine is thought to degrade the rubber stopper through which blood enters the bottle, thus allowing contaminates to enter the container.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p><p>The blood is collected into special transport bottles, which are like vacuum tubes but shaped differently. The blood culture bottle contains transport media to preserve any microorganisms present while they are being transported to the laboratory for cultures. Because it is unknown whether the pathogens are <a href="/wiki/Anaerobic_organism" title="Anaerobic organism">anaerobic</a> (living without oxygen) or <a href="/wiki/Aerobic_organism" title="Aerobic organism">aerobic</a> (living with oxygen), blood is collected to test for both. The aerobic bottle is filled first, and then the anaerobic bottle is filled. However, if the collection is performed using a syringe, the anaerobic bottle is filled first. If a butterfly collection kit is used, the aerobic bottle is filled first, so that any air in the tubing is released into the oxygen-containing bottle.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p><p>Specially designed blood culture collection bottles eliminate the need for either the syringe or butterfly collection method. These specially designed bottles have long necks that fit into the evacuated tubes holders that are use for regular venipuncture collection. These bottles also allow for collection of other blood specimens via evacuated tubes, to be collected without additional venipuncture.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p><p>The amount of blood that is collected is critical for the optimal recovery of microorganisms. Up to 10mL of blood is typical, but can vary according to the recommends of the manufacturer of the collection bottle. Collection from infants and children are 1 to 5 mL. If too little blood is collected, the ratio of blood-to-nutrient broth will inhibit the growth of microorganisms. If too much blood is collected, there is the risk of a hospital-induced anemia and the ratio of blood-to-nutrient broth will tilt in the opposite direction, which also is not conductive to optimal growth.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p><p>The bottles are then incubated in specialized units for 24 hours before a lab technician studies and/or tests it. This step allows the very small numbers of bacteria (potentially 1 or 2 organisms) to multiply to a level which is sufficient for identification +/-antibiotic resistance testing. Modern blood culture bottles have an indicator in the base which changes color in the presence of bacterial growth and can be read automatically by machine. (For this reason the barcoded stickers found on these bottles should not be removed as they are used by the laboratory's automated systems.)<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Taking_blood_samples_from_animals">Taking blood samples from animals</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=8" title="Edit section: Taking blood samples from animals"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Blood samples from living laboratory animals may be collected using following methods:<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Parasuraman2010_27-0" class="reference"><a href="#cite_note-Parasuraman2010-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Blood collection not requiring anesthesia: <ul><li>Saphenous vein (rat, mice, guinea pig)</li> <li>Dorsal pedal vein (rat, mice)</li></ul></li> <li>Blood collection requiring anesthesia (local/general anesthesia): <ul><li>Tail vein (rat, mice)</li> <li>Tail snip (mice)</li> <li>Orbital sinus (rat, mice)</li> <li>Jugular vein (rat, mice)</li> <li>Temporary cannula (rat, mice)</li> <li>Blood vessel cannulation (guinea pig, ferret)</li> <li>Tarsal vein (guinea pig)</li> <li>Marginal ear vein or artery (rabbit)</li></ul></li> <li>Terminal procedure: <ul><li>Cardiac puncture (rat, mice, guinea pig, rabbit, ferret)</li> <li>Orbital sinus (rat, mice)</li> <li>Posterior vena cava (rat, mice)</li></ul></li></ul> <p>The volume of the blood sample collection is very important in experimental animals. All nonterminal blood collection without replacement of fluids is limited up to 10% of total circulating blood volume in healthy, normal, adult animals on a single occasion and collection may be repeated after three to four weeks. In case repeated blood samples are required at short intervals, a maximum of 0.6 ml/kg/day or 1.0% of an animal's total blood volume can be removed every 24 hours. The estimated blood volume in adult animals is 55 to 70 ml/kg body weight. Care should be taken for older and obese animals. If blood collection volume exceeds more than 10% of total blood volume, fluid replacement may be required. Lactated Ringer's solution (LRS) is recommended as the best fluid replacement by National Institutes of Health (NIH). If the volume of blood collection exceeds more than 30% of the total circulatory blood volume, adequate care should be taken so that the animal does not develop hypovolemia.<sup id="cite_ref-Parasuraman2010_27-1" class="reference"><a href="#cite_note-Parasuraman2010-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Blood_alcohol_tests">Blood alcohol tests</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=9" title="Edit section: Blood alcohol tests"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>It is generally not advisable to use <a href="/wiki/Isopropyl_alcohol" title="Isopropyl alcohol">isopropyl alcohol</a> to cleanse the venipuncture site when obtaining a specimen for a <a href="/wiki/Blood_alcohol" class="mw-redirect" title="Blood alcohol">blood alcohol</a> test. This has been related largely to the potential legal implications associated with the use of alcohol-based cleaners that could theoretically impact analysis. Numerous police alcohol collection kits have been marketed that incorporate a sodium fluoride/potassium oxalate preservative and non-alcohol-based cleansing agents to ensure proper collection. Using soap and hot water or a <a href="/wiki/Povidone-iodine" title="Povidone-iodine">povidone-iodine</a> swab are advisable alternatives to isopropyl alcohol in this case.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2021)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=10" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Arterial_blood" title="Arterial blood">Arterial blood</a> is taken from an artery instead of a vein</li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Venipuncture&action=edit&section=11" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-NT_2004-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-NT_2004_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-NT_2004_1-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFHiggins2004" class="citation journal cs1">Higgins, Dan (28 September 2004). <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200102152836/https://www.nursingtimes.net/clinical-archive/infection-control/venepuncture-28-09-2004/">"Venepuncture"</a>. <i><a href="/wiki/Nursing_Times" title="Nursing Times">Nursing Times</a></i>. <b>100</b> (39): 30–1. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/15500234">15500234</a>. 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"Venepuncture: Best Practice". <i>Nurs Stand</i>. <b>19</b> (49): 55–65. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.7748%2Fns2005.08.19.49.55.c3936">10.7748/ns2005.08.19.49.55.c3936</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/16134421">16134421</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Nurs+Stand&rft.atitle=Venepuncture%3A+Best+Practice.&rft.volume=19&rft.issue=49&rft.pages=55-65&rft.date=2005-08&rft_id=info%3Adoi%2F10.7748%2Fns2005.08.19.49.55.c3936&rft_id=info%3Apmid%2F16134421&rft.aulast=Lavery&rft.aufirst=I&rft.au=Ingram%2C+P&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture" class="Z3988"></span></span> </li> <li id="cite_note-4"><span class="mw-cite-backlink"><b><a href="#cite_ref-4">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFIalongoBernardini2016" class="citation journal cs1">Ialongo, Cristiano; Bernardini, Sergio (2016-02-15). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783087">"Phlebotomy, a bridge between laboratory and patient"</a>. <i>Biochemia Medica</i>. <b>26</b> (1): 17–33. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.11613%2FBM.2016.002">10.11613/BM.2016.002</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1330-0962">1330-0962</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783087">4783087</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26981016">26981016</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Biochemia+Medica&rft.atitle=Phlebotomy%2C+a+bridge+between+laboratory+and+patient&rft.volume=26&rft.issue=1&rft.pages=17-33&rft.date=2016-02-15&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4783087%23id-name%3DPMC&rft.issn=1330-0962&rft_id=info%3Apmid%2F26981016&rft_id=info%3Adoi%2F10.11613%2FBM.2016.002&rft.aulast=Ialongo&rft.aufirst=Cristiano&rft.au=Bernardini%2C+Sergio&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4783087&rfr_id=info%3Asid%2Fen.wikipedia.org%3AVenipuncture" class="Z3988"></span></span> </li> <li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFJapenga2006" class="citation news cs1">Japenga, Ann (30 May 2006). <a rel="nofollow" class="external text" href="https://www.nytimes.com/2006/05/30/health/30case.html">"<span class="cs1-kern-left"></span>'A Little Sting' Can Become a Debilitating Injury"</a>. <i>The New York Times</i><span class="reference-accessdate">. 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title="Venous cutdown">Venous cutdown</a></li> <li><a href="/wiki/Arteriotomy" title="Arteriotomy">Arteriotomy</a></li> <li><a href="/wiki/Phlebotomy" title="Phlebotomy">Phlebotomy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Aortic_aneurysm" title="Aortic aneurysm">Aortic aneurysm</a> / <a href="/wiki/Aortic_dissection" title="Aortic dissection">dissection</a>:</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Endovascular_aneurysm_repair" title="Endovascular aneurysm repair">Endovascular aneurysm repair</a></li> <li><a href="/wiki/Open_aortic_surgery" title="Open aortic surgery">Open aortic surgery</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a 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class="navbox-group" style="width:1%"><a href="/wiki/Medical_imaging" title="Medical imaging">Medical imaging</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Angiography" title="Angiography">Angiography</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Digital_subtraction_angiography" title="Digital subtraction angiography">Digital subtraction angiography</a> <ul><li><a href="/wiki/Cerebral_angiography" title="Cerebral angiography">Cerebral angiography</a></li> <li><a href="/wiki/Aortography" title="Aortography">Aortography</a></li> <li><a href="/wiki/Fluorescein_angiography" title="Fluorescein angiography">Fluorescein angiography</a></li> <li><a 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ultrasound">Intravascular ultrasound</a></li> <li><a href="/wiki/Carotid_ultrasonography" title="Carotid ultrasonography">Carotid ultrasonography</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other diagnostic</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Angioscopy" title="Angioscopy">Angioscopy</a></li> <li><a href="/wiki/Ankle%E2%80%93brachial_pressure_index" title="Ankle–brachial pressure index">Ankle–brachial pressure index</a></li> <li><a href="/wiki/Toe_pressure" title="Toe pressure">Toe pressure</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><style 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