Clinical 9: Venepuncture

Question 1

Why might venepuncture be needed?

Answer 1

To perform blood tests for diagnostic purposes
To check baseline levels of blood components
To monitor a disease pathway
To monitor drug levels including medications, chemotherapy and illicit drugs
To remove excess blood due to excess levels of iron (hemochromatosis) or rbcs (polychtaemia)
To collect blood for lateral use, e,g for transfusion to another person or back to the donor.

Question 2

What equipment is needed for venepuncture?

Answer 2

Alcohol hand gel
Apron
Non-sterile gloves
Face mask
Sharps bins
Blue plastic trays
Skin cleanserts
Tourniquet
Cotton wool balls
Stainless steel trolley (if required e.g for multiple patients)

Question 3

What are the different methods of equipment used to collect the blood in venipuncture?

Answer 3

1) 21G safety vacutainer needle
Vacuum tube sampling system/holder
Blood bottles (BD vacutainer)

2) 21G safety needle (green)
10ml syrgine
Blood bottles

3)21 G safety vacutainer butterfly needle
Vacuum tube sampling system/holder
Blood bottles

Question 4

What documents are needed to take blood from a patient?

Answer 4

Lab request form
Microbiology request form

Question 5

How should you prepare to take blood from a patient?

Answer 5

Wash hands
Inspect for vein
Apply tourniquet
Palpate vein
Clean and dry patient skin
Apply non-sterile govles
Move to needle

Question 6

How should I take blood from a patients arm?

Answer 6

Connect needle dan vacutainer holder together, remove sheath from needle
Ensure bevel edge of needle is in an upward position
Anchor vein by applying manual traction a few centimeters below needle insertion site
Informa patient - ‘little scrrath’
Insert needle at approximately 15-30 degrees
Ensure vacutainer set is stabilised and held securely
Draw in correct order
Remove final blood bottle from vacutainer holder before needle extraction from vein
Place cotton wool over arm and ask patient to apply pressure
Dispose of sharps into sharps bin
Dispose of cotton wool into clinical waste bin.
Remove arpon and gloves - into clinical waste bin
Wash hands.

Question 7

What order are blood samples taken from a patient?

Answer 7

1. Blood culture -areobic then anaerobic
2. Sodium citrate (light blue)
3. serum (red)
4. SST 2 (gold)
5. Lithium heparin (green) U&Es where K+ clinically important
   6.EDTA (lavender)
6. Cross match (pink)
7. Flouride oxalate (grey)
8. Trace Element (royal blue)

Question 8

What safety measures should be taken when handling needles?

Answer 8

Use safer sharps where reasonably practical
Use needlestick protection devices e.g retractable needles
Always follow manufacturers instructions
keep handling of sharps to a minimum and dispose of any sharps used immediately
Do not pass sharps directly from hand to hand
Do not try to bend/break sharps before disposal
Never re-sheath used needles
Always carry sharp containers to point of use by handle
Never try to recover something from a sharps bin.

Question 9

What should happen is a needlestick injury occurs?

Answer 9

Record details and ensure first aid is received
Encourage wound to bleed - do not suck
Wash wound with soap and running water
Dry wound and apply waterproof dressing

In uni: report to clinical manager and School of Medicine Occupation Health Department to provide with copy of clinical managers risk assessment
Complete and adverse incident form

Question 10

What are the risks of infection associated with needle use?

Answer 10

Low risk - unused or clean sharps (no disease transmission), do not need to attend A&E from an infection risk perspective

High risk - hepatitis or HIV, dirty or uncertainty seek advice from trust or SoM on the same day. If patient is known to be HIV positive seek immediate advice from the consultant microbiologist via the switchboard.