Venepuncture Flashcards
Define venepuncture
A term used to describe the procedure of entering a vein with a needle to obtain blood
What are the indications for venepuncture?
- Diagnostic purposes (haematological, biochemical, bacterial or viral)
- To monitor levels of blood components via laboratory testing
What is venepuncture used for in midwifery?
- 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
Give some examples of pre-existing conditions tested for in midwifery
- Thyroid function test
- Blood glucose monitoring
- Sickle cell
- Thalassaemia
Give some examples of conditions arising in pregnancy that are tested for
- Pre-eclampsia
- Anaemia
- Infections
- Gestational diabetes
What are the legal responsibilities to be considered in venepuncture?
- Negligence
- Vicarious liability (someone is held responsible for actions or omissions of another person)
- Expected standard of care
What are the ethical responsibilities to be considered in venepuncture?
- Do not harm/ do good (non-maleficence, beneficence)
- Promote autonomy
Give 3 other things that should be considered when performing venepuncture
- Informed consent
- Local policies and guidelines
- Personal accountability and professional responsibility
How should a vein be selected?
- Take time to assess
- Most common site = antecubital fossa (elbow pit)
- Do not infiltrate brachial artery
Why is the antecubital fossa usually chosen for venepuncture?
Contains 3 major veins:
- Cephalic
- Basilic
- Median cubital
- All are easily accessible and well supported
- Median cubital best because its the most stable, least sensitive area and close to surface
How should the vein be assessed?
- Visual inspection and palpation
- Palpation determines position and condition of vein and distinguishes between veins and arteries/tendons
What should veins be chosen based on?
- Easily detected on inspection and palpation
- From unused area
- Soft and bouncy
- Refills easily when depressed
Give some areas that should be avoided
- Veins adjacent to bruising, phlebitis or infected areas
- Thrombosed/ fibrosed veins
- Thin, fragile veins
- Veins over bony prominences
- Arms affected by medical conditions
What is phlebitis?
Inflammation of a vein
What equipment is required?
- 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
Name the different types of collection devices
- Vacutainer
- Monovettes and wing devices
How should the client be prepared?
- 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
How should the environment be prepared?
- Woman should be comfortable
- Adequate lighting
- Warm environment
- Privacy
- Limbs supported
- Equipment at hand
How can venous access be improved?
- 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
Give steps 1-9 of the venepuncture procedure
- After client is prepared and identified, wash hands
- Prepare environment
- Assemble equipment
- Assess veins
- Apply tourniquet to assess veins
- When vein is identified, release tourniquet
- Wash hands and use aseptic technique
- Put on gloves
- Reapply tourniquet
Give steps 10-14 of the venepuncture procedure
- Clean skin with alcohol swab for 30 secs
- Allow skin to dry
- Stretch skin over chosen site to anchor vein
- Ensure bevel of needle is uppermost and smoothly insert needle into vein at 30 degree angle
- Observe for flashback, reduce angle and advance needle slightly
Why should the needle not be inserted too fast/slow?
Too fast = may go through vein
Too slow = increases discomfort
Give steps 15-20 of the venepuncture procedure
- Stabilise needle and syringe and either withdraw plunger or attach pre-vacuumed bottle
- Collect blood sample
- If unsuccessful after 2 attempts, seek midwife assistance
- If successful, release tourniquet before removing needle
- Cover needle with cotton wool/ gauze and remove from vein
- Invert tube at least 6 times
In what order should blood samples be taken?
- Blood culture
- Coagulation
- Serum tube
- Additive tubes
- All other tubes
Give steps 21-28 of the venepuncture procedure
- Ensure patient is comfortable
- Do not apply pressure when removing needle
- After needle is removed, apply pressure with arm straight for 30-60secs
- Apply plaster
- Discard needle appropriately and safely
- Complete relevant forms and blood bottles and sign at bed side
- Documentation
- Send specimens to lab
What are the potential problems caused?
- 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)
How might pain be caused during venepuncture?
- Puncturing an artery
- Touching a nerve or valve
- Anxiety
- Use of vein in a sensitive area
Why might limited venous access be an issue?
- Repeated use of vein
- Peripheral shut down
- Dehydration
- Sclerosed veins
How might a bruising haematoma be caused?
- Needle punctured both sides of the vein
- Inadequate pressure on needle removal
- Forgetting to remove tourniquet before needle removal
What might cause fainting?
- Anxiety/ fear
- Pain
- Hot environment
Why might the patient have anxiety surrounding venepuncture?
- Previous experiences
- Fear of needles
Why might the blood stop flowing?
- Overshooting of vein
- Contact with valve
- Venous spasm
- Vein collapse
- Small vein
- Poor blood flow
How might a needlestick injury occur?
- Lack of safe practice
- Incorrect disposal of sharps
How might blood spillage occur?
- Poor technique
- Damaged equipment
Why might the vein be missed?
- Inadequate anchoring
- Poor vein selection
- Wrong positioning
- Lack of concentration
- Poor lighting
- Difficult venous access
