Venepuncture

Venepuncture is the process of obtaining intravenous access – most commonly for the purpose of blood sampling. A hollow needle is inserted through the skin and into a superficial vein (typically in the cubital fossa of the forearm). Blood is then collected into evacuated tubes.

The process of venepuncture can be divided into four steps; explanation and consent, preparation, procedure and aftercare. We shall now look at these stages in more detail.


Explanation and Consent

Confirm the patients identification:

  • Check full name, DOB, and hospital number
  • Confirm against patients wristband

Explain rationale for the procedure

  • Describe the procedure
  • State the importance of the procedure

Explain the risks of the procedure to the patient

  • Infection (can be minimised by sterile equipment and aseptic non-touch technique)
  • Structure missed or another structure hit (nerve, artery, or bone)
  • Haematoma or phlebitis may develop

Ask about relevant past medical history

  • Blood clotting disorders or medication that affects blood clotting (e.g. warfarin)
  • Arterio-venous fistula present
  • Previous breast surgery or lymph node removal

Ask about needle phobia.

Ask about preferred location for venepuncture.

Check that the patient is happy to go ahead with the procedure. Ask the patient if they would like a chaperone present


Preparation

When in the treatment room, prepare your equipment on an appropriate equipment trolley

  • Decontaminate your hands
  • Clean your trolley and plastic tray with appropriate aseptic agent (e.g. Chlor-clean), allowing to dry fully.

Decontaminate your hands

Gather the rest of the equipment into the plastic tray on the trolley and move to the patients bedside

  • Equipment required includes needle, tourniquet, appropriate blood bottles, chlorhexidine wipes, cotton ball with tape, inco pad, and sharps bin

Once at the patient’s bedside

  • Re-confirm the patients identification
  • Decontaminate your hands and position the patient’s arm underneath a pillow with the inco pad
  • Apply the tourniquet, select a suitable vein, remove the tourniquet and carry on with the procedure

Procedure

Don your gloves and apron

Clean the puncture site with the chloraprep wipe (in a cross-hatch formation) and allow to air dry

Apply the tourniquet and do not repalpate the cleaned skin

Placing traction on the skin below the intended puncture site, insert the needle with the bevel up at an angle of 30o into the puncture site

Advance the needle and release traction on the skin

Attach the sample bottles in turn, filling up to the necessary level and inverting each bottle once removed

  • Most trusts will have a specific order by which the blood sample bottles should be filled

Once the last bottle is removed, release the tourniquet

Place the cotton wool over the puncture site and slowly withdraw the needle

  • Place the needle straight into the sharps bin

Apply direct pressure over the puncture site for 1min and secure with tape

Discard all waste into the correction disposal bins and ensure the patient is comfortable

Remove your gloves and decontaminate your hands

Place the sample bottles into the sample bag alongside the blood request form

If you are unsuccessful in obtaining blood, remove needle and restart the whole procedure. Never reinsert the same needle into a patient. It is good practice to have maximum of two attempts before finding a colleague to attempt instead.


Aftercare

Instruct the patient to inform the nursing staff if:

  • Puncture site becomes red, hot, or swollen
  • They develop pain at the puncture site

Thank the patient and leave the patient’s bedside.

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