The Process: Protocol Flashcards
How do you carry out venepuncture? (Preparation)
1) ID (name, address, DOB)
2) Informed verbal consent
3) Check history e.g. previous problems with procedure or surgery to one side where use of other arm advised (e.g. lymph node clearance). Fasted if needed?
4) Position
5) Decontaminate hands. Gloves
6) Prepare equipment: blood collection bottles according to tests to be collected + spare set (in date), 2 needles (1 spare): 20, 21 and 22 gauge, cotton wool balls, alcohol wipe. tourniquet, plaster/hypoallergenic tape, sharps box, bottle holder (if vacuette system)
7) ID arm, expose antecubital fossa, support and advise to keep straight, look for most visible/palpable vein. Median cubital vein usually easiest. Basilic vein may be used but runs above artery and nerve = grater risk of damage. If no vein visible = tourniquet. Avoid site where veins diverging as higher bruising risk
8) Clean area (alcohol wipe, 30s), prepare equipment while dries
9) Retighten tourniquet if necessary
Where are the cephalic and basilic veins in the antecubital fossa?
Describe venipuncture - VACUETTE SYSTEM (used most)
1) Attach needle to holder (vacuette)
2) Drop sheath off needle at 90 degrees
3) Warn patient, insert needle bevel upwards into vein (30 deg) to about half needle length
4) Push on first bottle while anchoring holder 5) When blood flows loosen tourniquet if tightened, allow blood to finish filling tube completely before removing and inverting tube x2
6) Apply next bottle and repeat
Describe venepuncture - MONOVETTE SYSTEM
1) Attach needle to first bottle, twist to lock, drop sheath off needle at 90deg
2) Warn patient, insert needle bevel upwards into vein at 30 deg to half needle length
3) Pull out plunger of bottle until clicks, taking care not to move needle into vein
4) When blood flows loosen tourniquet if tightened, allow blood to finish filling tube completely before removing and inverting tube x2
5) Attach next bottle and repeat
How do you carry out venepuncture? (Finishing off)
1) Remove tourniquet, then needle
2) Apply cotton wool, patient press firmly for few mins 3) Pick up all bottles and invert again x4
4) Label bottles checking details and put in pathology bag
5) Apply appropriate dressing to site (allergy check)
6) Dispose of sharps and equipment
7) Remove gloves and decontaminate hands
8) Advise after-care and follow-up
9) Document: consent, which blood tests, practitioner request, problems
What if the patient faints during the procedure?
If safe and lying down, continue procedure. If not safe, take off tourniquet and remove needle. Advise: lean forwards with head down/lie down, apply dressing, support patient to floor and elevate legs. Recovery quite quick - may need water and obs. If blood not taken, refer to practitioner for further tests. Always have them check over by practitioner before leaving.
What if an artery is punctured instead of a vein?
Artery blood pumps into bottle in spurts & be brighter red. Take tourniquet off and remove needle, apply pressure for 5 mins minimum and pressure dressing once bleeding stopped. Ask registered practitioner to assess patient before attempting venepuncture again/before patient leaves
What if the vein collapses?
Usually means vacuum has sucked vein wall onto needle and stopped blood flow. Sometimes overcome by taking bottle off and reapplying, or gently tilting needle into vein
What if there is no blood flow?
Needle may have gone through vein/missed it, gently and slowly withdraw or manoeuvre needle until blood flows. If still nothing, slowly remove needle and repeat with fresh needle and bottle. Do not make >2 attempts on each arm
