Venepuncture

Question 1

How would you explain to a patient what venepuncture is?

Answer 1

Procedure to obtain a blood sample from the vein

Used to either confirm a diagnosis of a suspected condition or to monitor levels of a blood component

Question 2

What are the 2 main reasons why a venepuncture is performed?

Answer 2

Aid diagnosis of a condition

Monitor blood component levels

Question 3

Before performing venepuncture, what 2 patient details should you confirm?

Answer 3

Patient name, DOB, first line of address: Should match referral letter

Consent

Question 4

Before performing venepuncture, what 4 questions should you ask the patient in terms of their medical history?

Answer 4

Are they taking any anticoagulants eg. aspirin, warfarin

Do they have any clotting or bleeding disorders

Do they have a latex allergy

Have they had any reactions to blood draws in the past

Question 5

Before performing venepuncture, how should you position the patient?

Answer 5

Sitting up in a chair with back supported/supine if anxious or at risk of collapse

Put pillow under straight arm, make sure that arm is lower than heart level

Question 6

Before performing venepuncture, what PPE should you wear?

Answer 6

Gloves

Plastic apron

Question 7

How do you decide which arm to take a venepuncture sample from?

Answer 7

Ask patient if they have a preferred arm for blood draws

Question 8

Where on the arm is the insertion site for venepuncture?

Answer 8

Antecubital fossa (upside down triangle) of elbow

Question 9

What are the 3 main veins in the antecubital fossa which are used for venepuncture?

Answer 9

Median cephalic vein: Medial aspect

Median basilic vein: Lateral aspect

Median cubital vein: Medial aspect of arm, going diagonally upwards

Question 10

Out of the 3 veins in the antecubital fossa, which is most preferred for venepuncture and why?

Answer 10

1. Median cubital vein: Most superficial, large lumen and doesn’t roll

Question 11

When performing venepuncture, how should you decide if the vein is suitable?

Answer 11

Apply torniquet to patient’s arm

Put on sterile gloves

Palpate veins with fingertips

Question 12

At what point in the venepuncture procedure should you apply the torniquet, and what does this do?

Answer 12

Tightly apply torniquet after confirming patient details and donning sterile gloves

Increases venous filling so makes them more prominent to palpate and enter

Question 13

In venepuncture, where should you apply the torniquet and for how long?

Answer 13

4-5 fingertip widths or 7-8 cm above insertion site

60-90 seconds

Question 14

When palpating suitable veins for venepuncture, what are the 4 qualities of a good vein?

Answer 14

Soft

Bouncy

Straight

Refills when depressed

Question 15

When palpating suitable veins for venepuncture, what are 4 features of a bad vein?

Answer 15

Sclerosed or fibrosed veins (feel hard to touch)

Surrounding skin looks infected, erythematous, bruised

Limb has edema

Narrow

Question 16

After palpating a suitable vein, how should you clean the insertion site for venepuncture?

Answer 16

Clean with alcohol wipe, leave to dry before blood draw

Cannot palpate vein again after cleaning area

Question 17

Before inserting the needle for venepuncture, how do you stabilise the vein without rolling it?

Answer 17

Pull skin below insertion site taut with thumb in opposite direction to needle insertion

Hold taut until procedure is completed and needle has been removed

Question 18

Which 3 needles can be used for venepuncture?

Answer 18

Butterfly needle

Vacutainer needle

Straight needle

Question 19

What are the 3 indications for using butterfly needles in venepuncture?

Answer 19

Thin, fragile veins

Young or elderly patients

Using veins in hand dorsum

Question 20

What are the indications for using a vacutainer needle in venepuncture?

Answer 20

Contain additives to lower risk of haemolysis

Allow multiple tube draws

Reduces risk of needle-stick injury

Question 21

How do you correctly hold and insert a butterfly needle for venepuncture?

Answer 21

Bevel facing upwards so that point enters skin first, hold with thumb on top and pointer, middle fingers below needle

Insert at 10-30 degrees into vein whilst stabilising vein

Question 22

How do you know when the butterfly needle has entered the vein, and what do you do after this?

Answer 22

Flashback of blood in the collection device

Can now connect tubes for blood draw to the collection device

Question 23

If there is no flashback in the needle, how do you fix this?

Answer 23

Withdraw needle slightly whilst still stabilising vein and move around

Question 24

How do you hold and insert a vacutainer needle for venepuncture?

Answer 24

Hold with bevel facing upwards and safety cap above needle, then place thumb below safety cap and hold from below with pointer and middle fingers

Stabilise vein and insert needle at 10-30 degrees

Question 25

After filling a tube with a blood sample in venepuncture, what should you do to prevent haemolysis of the sample?

Answer 25

Gently invert tube 4-6 times

Fill up tubes to correct amount by filling to the line on the tube

Question 26

When should you remove the torniquet?

Answer 26

When the last tube is almost filled to the correct amount

Question 27

How do you remove the needle from the vein after venepuncture?

Answer 27

Press gauze over insertion site then remove needle

Apply pressure with gauze for a minute or until bleeding stops

Question 28

How should you safely dispose of the needle after venepuncture?

Answer 28

Put on safety cap with needle facing away from you, discard in sharps bin

Don’t need to disconnect needle from blood collection device

Question 29

After you have disposed of the needle, what should you do with the patient?

Answer 29

Check if the venepuncture site is still bleeding, if so tape gauze on

Question 30

How do you label the blood samples after venepuncture?

Answer 30

Complete details on specimen request form: Date, time, who took sample

Remove labels from request form and stick on tubes, write details in all caps