Clinical Skills - Venepuncture

Question 1

Steps in venepuncture

Answer 1

Introduction
Equipment retrieval and assembly
Identify a vein and prepare site 
Draw blood
Dispose of needle 
Conclusion

Question 2

Introduction steps

Answer 2

Wash hands
Introduce self
Obtain name, DoB, check hospital number (likely on wristband)
Explain procedure and common risks (bleeding, bruising)
Gain consent
Check for allergies (e.g. latex, Elastoplast), needle phobia (ever fainted before during previous procedure), preferred arm (or which arm has been previously successful)

Question 3

Equipment required

Answer 3

Non-sterile gloves
Clean tourniquet
Appropriate needle or vacutainer needle
Appropriate syringe or vacutainer 
Alcohol wipe
Cotton wool
Blood bottles (specimen tubes)
Elastoplast/dressing
Blood test request forms (if required)

Question 4

Equipment assembly

Answer 4

Select correct needle and attach needle to vacutainer or syringe. Do not unsheathe the needle and employ aseptic non-touch technique.

Ensure the bevel is up.

If assembled in patient area, then don’t need to wash hands again. If assembled outside of patient area, then need to wash hands when re-entering the patient area.

Question 5

Identify vein and prepare site

Answer 5

The largest and most accessible veins are usually found in the antecubital fossa (inside of elbow).

1. Rest patient’s arm on pillow
2. Apply tourniquet to find a suitable vein. It should not be painful to the patient, an arterial pulse should still be present.
3. Choose a vein which fells ‘bouncy’ - go for this rather than how visible the vein is. Make sure it is not an artery (will have a pulse if artery)
4. Ask patient to make a fist and relax if having trouble (increases blood flow to arm).

Question 6

Drawing blood preparation

Answer 6

1. Wash hands and put on non-sterile gloves
2. Clean area with alcohol wipe in a circular motion, moving outwards for 30 seconds. Let dry for 30 seconds.
3. Do not re palpate the vein, if you do, re-clean area for 30 seconds with fresh wipe.
4. With apparatus in dominant hand, unsheathe needle.
5. Tether (make taut) skin in downward direction with non-dominant hand - do below site of insertion and do not re-palpitate.
6. With bevel facing upwards and needle always in view, insert the needle steadily at an angle of 15-30 degrees. Say when needle is going in maybe with ‘sharp scratch’.

Question 7

Actually drawing blood (needle and syringe)

Answer 7

7. Once needle is in vein, there will be some give and you will see ‘flashback’ of blood at base of needle.
8. Withdraw required amount of blood by pulling plunger.
9. Once drawn, hold needle and syringe steady while releasing the tourniquet with other hand.
10. Gently remove needle along line of insertion and apply firm pressure with cotton wool ball once the needle is fully out.
11. Ask the patient to apply firm pressure for 2 mins (if able).
12. Immediately after the needle is removed and patient is applying pressure, the needle should be removed from the syringe and disposed of into sharps bin.
13. Decant the blood from the syringe into the blood bottles.
14. Discard the syringe into clinical waste bin.

Question 8

Actually drawing blood (vacutainer)

Answer 8

7. No ‘flashback’ will be seen with vacutainer needles.
8. Insert needle into vein and hold steady (do not move needle or vacutainer)
9. Insert blood bottle into vacutainer and draw blood.
10. Remove blood bottle and repeat with other blood bottles (if required) in the correct order.
11. Continue to hold needle steady and release tourniquet with free hand.
12. Withdraw needle along line of insertion and apply firm pressure with cotton wool ball.
13. Dispose of needle and vacutainer immediately in the sharps bin (don’t disassemble).

Question 9

Conclusion

Answer 9

Ask patient to apply firm pressure with cotton wool ball for 2 mins.

Once bleeding has stopped, offer plaster (ensure patient doesn’t have allergy)

Remove gloves and wash hands.

Label blood bottles at patient’s bedside with name, DoB and hospital number and fill out blood test request form (if required).

Thank patients and any questions?

Question 10

Risk to patinets

Answer 10

Bruising/ecchymosis can be as small as a pinprick or can spread down the entire arm.

Extensive bruising can occur if the patient is on anticoagulants, if the needle is removed before the tourniquet is released, sufficient pressure is not applied or not applied for long enough after withdrawing the needle.