Skin Puncture for Adults

Peripheral blood is obtained from the tip of the 3 rd and 4th finger or earlobe in adults.
Procedure
1. Wipe the area with a cotton ball soaked in 70% isopropyl alcohol.
2. Allow the site to air-dry or pat-dry with sterile cotton.
3. Puncture the preferred site with a sterile disposable lancet. The puncture is
ideally 2-3 mm in depth.
4. Wipe off the first drop of blood and collect the subsequent drops. Avoid
squeezing the puncture site, as this will alter the composition of the blood.
Note: Difficulty in obtaining blood can be relieved by putting warm compress on the
site.

Venipuncture
Procedure for Syringe Method
1. Apply the tourniquet 3-4 inches above the puncture site in a half-knot manner
to congest the vein. Ask the patient to open and close hand the several
times.
2. Cleanse the puncture site with 70% isopropyl alcohol. Allow the site to dry.
Puncture the vein with a sterile 20-21 gauge needle attached to a syringe at
a 15 angle and a depth of about 0.5-1 cm.
3. Loosen the tourniquet and gently aspirate the blood.
4. After obtaining the required quantity of blood, place sterile gauze or cotton
over the puncture site then withdraw the needle. Apply pressure to stop
bleeding. Never flex the arm.
Note: If bleeding is not arrested, elevate the arm and apply more pressure. Stay
with the patient until the bleeding stops.
Detach the needle from the syringe and transfer the blood along the side of
an appropriate test tube. If the tube is anticoagulated, mix the tube with blood by
gentle inversion.

Procedure for Evacuated Tube Method

1. Attach the two-way needle to the adaptor. Prepare the evacuated tubes.
2. Apply the tourniquet 3-4 inches above the site of puncture.
3. Cleanse the site with 70% isopropyl alcohol. Allow the site to dry. Puncture
the vein with the two-way needle attached to the adaptor. Push the tube into

the adaptor until the other side of the needle penetrates the evacuated tube,
making sure that the needle remains in position in the vein.
4. Loosen the tourniquet and withdraw the needle when blood has filled the
tube tot its proper volume.
5. Gently invert the tube several times for proper mixing if the tube is
anticoagulated.
Note: For multiple blood draws, remove the tube from the adaptor without
withdrawing the needle and push the succeeding tubes into the adaptor.

Skin Puncture for Infants

Peripheral blood from infants is obtained from the heel or big toe.
Procedure
1. Hold the babys foot firmly between the thumb and the index finger of your
(the phlebotomists) non-working hand.
2. Puncture the anterior rim of the posterior aspect of the heel or big toe only
after a suitable preparation.
3. Follow steps 1-4 for skin puncture of adults.
Note: The recommended site for skin puncture on newborns is the heel only.

Procedure for Two-Way Syringe Method

1. Perform steps 1-3 of the procedure for the syringe method.
2. Place sterile gauze or cotton below the hub of the needle to prevent spillage
of blood.
3. Remove the syringe after aspirating 3 mL of blood, taking care not to dislodge
the needle from the vein.
4. Attach a second syringe and aspirate the required amount of blood.
5. Perform steps 4-5 of the procedure for the syringe method.
Note: The two-syringe method is recommended for whole blood clotting time
technique.