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Scientific Basis of Midwifery > Venepuncture > Flashcards

Venepuncture Flashcards

1
Q

Define venepuncture

A

A term used to describe the procedure of entering a vein with a needle to obtain blood

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2
Q

What are the indications for venepuncture?

A
  1. Diagnostic purposes (haematological, biochemical, bacterial or viral)
  2. To monitor levels of blood components via laboratory testing
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3
Q

What is venepuncture used for in midwifery?

A
  • Antenatal booking bloods
  • Assessment of FBC and presence of rhesus antibodies
  • Tests for pre-existing conditions or conditions arising in pregnancy
  • Antenatal screening for abnormalities
  • Blood grouping or cross-matching
  • Emergency access for drug administration
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4
Q

Give some examples of pre-existing conditions tested for in midwifery

A
  • Thyroid function test
  • Blood glucose monitoring
  • Sickle cell
  • Thalassaemia
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5
Q

Give some examples of conditions arising in pregnancy that are tested for

A
  • Pre-eclampsia
  • Anaemia
  • Infections
  • Gestational diabetes
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6
Q

What are the legal responsibilities to be considered in venepuncture?

A
  • Negligence
  • Vicarious liability (someone is held responsible for actions or omissions of another person)
  • Expected standard of care
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7
Q

What are the ethical responsibilities to be considered in venepuncture?

A
  • Do not harm/ do good (non-maleficence, beneficence)

- Promote autonomy

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8
Q

Give 3 other things that should be considered when performing venepuncture

A
  1. Informed consent
  2. Local policies and guidelines
  3. Personal accountability and professional responsibility
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9
Q

How should a vein be selected?

A
  • Take time to assess
  • Most common site = antecubital fossa (elbow pit)
  • Do not infiltrate brachial artery
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10
Q

Why is the antecubital fossa usually chosen for venepuncture?

A

Contains 3 major veins:

  1. Cephalic
  2. Basilic
  3. Median cubital
    - All are easily accessible and well supported
    - Median cubital best because its the most stable, least sensitive area and close to surface
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11
Q

How should the vein be assessed?

A
  • Visual inspection and palpation

- Palpation determines position and condition of vein and distinguishes between veins and arteries/tendons

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12
Q

What should veins be chosen based on?

A
  • Easily detected on inspection and palpation
  • From unused area
  • Soft and bouncy
  • Refills easily when depressed
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13
Q

Give some areas that should be avoided

A
  • Veins adjacent to bruising, phlebitis or infected areas
  • Thrombosed/ fibrosed veins
  • Thin, fragile veins
  • Veins over bony prominences
  • Arms affected by medical conditions
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14
Q

What is phlebitis?

A

Inflammation of a vein

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15
Q

What equipment is required?

A
  • Non-sterile gloves
  • Tourniquet
  • Alcohol swabs
  • Needle for blood collection system
  • Appropriate blood bottles/ collection devices
  • Cotton wool/ gauze swab
  • Plasters
  • Sharps bin
  • Appropriate blood forms and transport bag
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16
Q

Name the different types of collection devices

A
  • Vacutainer

- Monovettes and wing devices

17
Q

How should the client be prepared?

A
  • Identify women with name and hospital number
  • Put woman at ease
  • Informed consent
  • Ask if bloods have been taken before
  • Woman should lie down if particularly anxious
  • Inform women of procedure
18
Q

How should the environment be prepared?

A
  • Woman should be comfortable
  • Adequate lighting
  • Warm environment
  • Privacy
  • Limbs supported
  • Equipment at hand
19
Q

How can venous access be improved?

A
  • Application of tourniquet
  • Opening/closing fist
  • Lowering arm below heart level
  • Use of warm pack/ warm water
  • Do NOT tap veins as this may cause bruising and pain
20
Q

Give steps 1-9 of the venepuncture procedure

A
  1. After client is prepared and identified, wash hands
  2. Prepare environment
  3. Assemble equipment
  4. Assess veins
  5. Apply tourniquet to assess veins
  6. When vein is identified, release tourniquet
  7. Wash hands and use aseptic technique
  8. Put on gloves
  9. Reapply tourniquet
21
Q

Give steps 10-14 of the venepuncture procedure

A
  1. Clean skin with alcohol swab for 30 secs
  2. Allow skin to dry
  3. Stretch skin over chosen site to anchor vein
  4. Ensure bevel of needle is uppermost and smoothly insert needle into vein at 30 degree angle
  5. Observe for flashback, reduce angle and advance needle slightly
22
Q

Why should the needle not be inserted too fast/slow?

A

Too fast = may go through vein

Too slow = increases discomfort

23
Q

Give steps 15-20 of the venepuncture procedure

A
  1. Stabilise needle and syringe and either withdraw plunger or attach pre-vacuumed bottle
  2. Collect blood sample
  3. If unsuccessful after 2 attempts, seek midwife assistance
  4. If successful, release tourniquet before removing needle
  5. Cover needle with cotton wool/ gauze and remove from vein
  6. Invert tube at least 6 times
24
Q

In what order should blood samples be taken?

A
  1. Blood culture
  2. Coagulation
  3. Serum tube
  4. Additive tubes
  5. All other tubes
25
Q

Give steps 21-28 of the venepuncture procedure

A
  1. Ensure patient is comfortable
  2. Do not apply pressure when removing needle
  3. After needle is removed, apply pressure with arm straight for 30-60secs
  4. Apply plaster
  5. Discard needle appropriately and safely
  6. Complete relevant forms and blood bottles and sign at bed side
  7. Documentation
  8. Send specimens to lab
26
Q

What are the potential problems caused?

A
  • Pain
  • Infection (poor aseptic technique)
  • Limited venous access
  • Bruising haematoma
  • Vasovagal reaction/ fainting
  • Anxiety
  • Blood stops flowing
  • Needlestick injury
  • Accidental blood spillage
  • Missed vein
  • Spurt of blood on entry (superficial vein used)
27
Q

How might pain be caused during venepuncture?

A
  • Puncturing an artery
  • Touching a nerve or valve
  • Anxiety
  • Use of vein in a sensitive area
28
Q

Why might limited venous access be an issue?

A
  • Repeated use of vein
  • Peripheral shut down
  • Dehydration
  • Sclerosed veins
29
Q

How might a bruising haematoma be caused?

A
  • Needle punctured both sides of the vein
  • Inadequate pressure on needle removal
  • Forgetting to remove tourniquet before needle removal
30
Q

What might cause fainting?

A
  • Anxiety/ fear
  • Pain
  • Hot environment
31
Q

Why might the patient have anxiety surrounding venepuncture?

A
  • Previous experiences

- Fear of needles

32
Q

Why might the blood stop flowing?

A
  • Overshooting of vein
  • Contact with valve
  • Venous spasm
  • Vein collapse
  • Small vein
  • Poor blood flow
33
Q

How might a needlestick injury occur?

A
  • Lack of safe practice

- Incorrect disposal of sharps

34
Q

How might blood spillage occur?

A
  • Poor technique

- Damaged equipment

35
Q

Why might the vein be missed?

A
  • Inadequate anchoring
  • Poor vein selection
  • Wrong positioning
  • Lack of concentration
  • Poor lighting
  • Difficult venous access

Scientific Basis of Midwifery (22 decks)

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