Patient Preparation
Patient Preparation tests whether you can verify the right patient and test, confirm fasting and consent, position the patient safely, and choose a suitable venipuncture site. Many items are scenario questions about preventing misidentification, inaccurate results, and syncope.
Before the draw
- Compare the requisition with two identifiers, such as full name and date of birth or medical record number. For inpatients, use the armband; never identify by room number, diagnosis, or appearance alone.
- Explain the procedure, answer questions, and obtain consent. Ask about latex, iodine, and adhesive allergies.
- Confirm fasting specifically. A lipid panel usually requires 9-12 hours without food, and glucose is commonly 8 hours; water is allowed. Ask what and when the patient last ate or drank rather than accepting a simple yes.
- Screen for syncope history, bleeding disorders, anticoagulants, mastectomy or lymphedema, and dialysis access.
Positioning and site selection
- Seat the patient with the arm supported and palm up; use a reclining chair if there is a syncope history.
- Apply the tourniquet 3-4 inches above the site for no more than 1 minute, and release it as soon as blood flow is established.
- Palpate the median cubital vein first, then the cephalic and basilic. Avoid an arm with an IV, dialysis fistula or graft, mastectomy-related lymph node removal, edema, scarring, hematoma, or infection.
- A gentle clench is acceptable; repeated fist pumping can raise potassium and distort results.
Worked example
A patient scheduled for a lipid panel says, I have not eaten, only coffee with cream and sugar. The fast is broken. Notify the provider or reschedule and document the conversation; drawing anyway produces results that may be misinterpreted.
Traps that cost marks
- Identifying a patient by name alone.
- Drawing above a running IV.
- Leaving the tourniquet on too long or ignoring a syncope history.