title: Vacuum-venipuncture skills: time required and importance of tube order.
abstract: BACKGROUND
  The purpose of this study was to assess specific vacuum-venipuncture skills and the influence of the time involved in skin puncture and blood collection.
  
  
  METHODS
  Thirty subjects undergoing venipuncture in which video analysis was possible were included. These procedures were carried out by four nurses and recorded with a digital camera. Venipuncture skills classified by our observations were delineated on the basis of frame-by-frame video images, and a graph of x and y coordinates was created.
  
  
  RESULTS
  With the first blood-collection tube, strong blood flow required the practitioner to push the tube back in to compensate for the strong repulsive force in approximately 46% of cases. By the third blood-collection tube, the blood flow had weakened; therefore, the tube was moved up and down. In cases that required a second venipuncture, the tube was already pierced, so the time required to fill it to 5 mL was significantly longer.
  
  
  CONCLUSIONS
  Hand movement of the practitioner is adjusted according to blood flow. Reflex movement in response to strong blood flow may increase the risk of pushing the needle through the vein with excessive force. The time required to fill the tube varies among nurses, tube order, and level of venipuncture skills.
authors: Faculty of Nursing and Medical Care, Keio University, Fujisawa, Kanagawa, Japan. chieko@sfc.keio.ac.jp
authors: Chieko
authors: C
authors: Fujii
mesh_terms: D000328:Adult; D002983:Clinical Competence; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009339:Needles; D018962:Phlebotomy / Q000295:instrumentation / Q000379:methods / Q000451:nursing; D012018:Reflex; D013647:Task Performance and Analysis; D013997:Time Factors; D014618:Vacuum; D014741:Video Recording
keywords: blood collection; blood-collection tube; clinical practice; venipuncture skill
references: Clin Lab Sci. 1999 May-Jun;12(3):137-9
references: 10539100
references: N Engl J Med. 1990 May 3;322(18):1290-2
references: 2325722
references: Semin Thromb Hemost. 2012 Sep;38(6):565-75
references: 22669757
references: N Engl J Med. 1951 Nov 15;245(20):760-5
references: 14882422
references: Acad Emerg Med. 1998 Jan;5(1):40-4
references: 9444341
references: Am J Clin Pathol. 2010 Feb;133(2):331-5
references: 20093244
references: Clin Chem. 2000 Feb;46(2):306-7
references: 10657399
references: Ann Clin Biochem. 2009 May;46(Pt 3):244-6
references: 19389888
references: Postgrad Med J. 1990 Jul;66(777):547-8
references: 2217012