Patient Identification, Assessment and Site Preparation
Assessment begins before the needle: review the order, check for allergies (latex, adhesive, antiseptic), anticoagulant or antiplatelet therapy, and any history of fainting. Assess vein quality by palpation, not just inspection-feel for a resilient, bouncy vein. Choose a site, avoiding areas with IV lines, fistulas, grafts, edema, hematoma, infection, scarring, or mastectomy on the affected side. The antecubital fossa is preferred for larger draws; hand veins are alternatives.
Site preparation: clean the site with an approved antiseptic in concentric circles, allow it to dry completely (do not fan or blow), and do not re-palpate after cleaning unless wearing a clean glove and re-cleaning. For blood cultures, follow the manufacturer's and policy time and use appropriate antiseptic; a common trap is inadequate dry time causing hemolysis or contamination. Another trap is choosing a site distal to an IV or drawing above a running IV.
Worked rule of thumb: if you can't feel it, don't stick it. Palpate, release the tourniquet within one minute, and if the vein collapses or the draw is slow, adjust rather than probe blindly. For syncope-prone patients, draw supine or with support and monitor throughout.
Document site, number of attempts, and any complications. Know when to stop: after the allowed number of attempts per policy, escalate rather than persist.