Venepuncture

Question 1

What equipment will you need?

Answer 1

Equipment
- Disposable non-sterile gloves
- Disposable plastic apron
- Disposable tourniquet
- Alcohol swab (70% isopropyl alcohol)
- Gauze swab + tape
- Vacutainer blood collection system - vacutainer needle, holder and relevant vacutainer blood collection tube(s)
- Sealable sharps disposal box

Question 2

What things must you remember when using the needle?

Answer 2

• Never attempt to re-sheath (recap) a needle.
• A used Vacutainer system should be immediately discarded into a suitable hard plastic, securable Sharps Box which can then be locked and disposed of through incineration.
• Keep the sharps box on a hard surface e.g. a trolley or a table, and close to where you are
  working. This means that you don’t have to walk around with a sharp in your hand, thereby reducing the risk of injury to others.
• After removal of the needle, apply the safety shield immediately.
• Never point a needle towards another person after removal from the vein.

Question 3

What method should you follow?

Answer 3

1). Hand hygiene and select appropriate equipment and place in a tray. Check the expiry dates of equipment and ensure that the packaging of any sterile equipment is intact.

2. Take the sharps box and equipment tray with you to the bedside, placing them within easy reach at your dominant hand side, preferably on a trolley or other hard surface. Do not lay the tray or the sharps box on the patient or patient’s bed.
3. Introduce yourself to the patient. Confirm patient identity. Explain procedure and gain consent. Check for allergies. Put on plastic apron.
4. Perform hand hygiene then apply a disposable tourniquet 7.5 - 10cm above the antecubital fossa to occlude venous return but still allow an arterial pulse. Support the arm on a pillow or table as necessary with the limb below heart level to aid venous distension. Soon the superficial veins will fill to allow you to examine the fossa with your index finger. A vein will have a slight ‘bounce’ to it. If it is necessary to apply the tourniquet for a long time to find a suitable vein, then the tourniquet must be released at intervals to ensure normal blood flow is restored.
5. Feel for and select a vein in the antecubital fossa of suitable
   calibre, location and length rather than the small superficial veins which you can see but not feel. Visualise the direction of the vein. If you cannot find a suitable vein, look at the opposite arm - venous anatomy varies from person to person and a more suitable vein may be more easily found on the other arm.
6. Using an alcohol swab, clean the area with firm downwards strokes over the proposed venepuncture site for 30 seconds. This has the added benefit of causing a small degree of superficial vasodilatation, making the veins slightly easier to see. (After cleaning do not re- touch your selected vein. If you do, clean the area again).
7. While you are waiting for the alcohol from the swab to evaporate (approximately 30 seconds), put on non-sterile gloves.
8. Pull back the pink safety shield on the Vacutainer needle and remove the cover from the needle. Place the cover in the cardboard tray so that you can dispose of it into the domestic waste bin later.
9. Use your non-dominant hand to draw the skin over the vein taut and to stabilise the patient’s arm, but never place your fingers or hand into the path the needle will take. Do not retouch your selected vein. Hold the Vacutainer needle holder in your dominant hand with your thumb on top and three fingers underneath the barrel.
10. Tell the patient they will feel a sharp scratch and with one smooth and decisive (but not sudden) motion, insert the needle into the vein at an angle of 5-15°, bevel uppermost using your dominant hand. You will feel a “giving” sensation as you enter the vein.
11. Still supporting the Vacutainer holder, attach the Vacutainer tube with your non-dominant hand and blood will flow into the tube. Allow the blood to fill the tube until it stops flowing (approximately 2/3 full) or to the level marked on the tube. Remove the tube.
12. Once finished, release the tourniquet and apply gentle pressure over the venepuncture site with a gauze swab as you withdraw the needle. Note that you must never withdraw the needle with the Vacutainer attached because the blood is under pressure in the tube and may cause pain to the patient.
13. Place your thumb on the thumb pad to close the pink safety shield over needle. Dispose of the complete system into the sharps box immediately.
14. Ask the patient to apply pressure with 3 fingers placed over the wound with arm straight and elevated.
15. Label the full blood bottles at the patient’s bedside during this time.
16. Now place the blood sample containers into a sealable polythene bag.
17. After 2-3 minutes pressure, re-examine the venepuncture site under the swab and check that the bleeding has stopped before leaving the patient. Apply adressing/adhesive plaster if necessary.
18. Dispose of your gloves and apron into a healthcare waste bin and dispose of all other non- clinical waste e.g. packaging into domestic (black) waste bin.
19. Perform hand hygiene.
20. Thank the patient.
21. Finish off by recording the tests undertaken in the patient’s notes.

Question 4

How long can you keep a tourniquet on for and why?

Answer 4

Tourniquet must be released at intervals to ensure normal blood flow is restored. Tourniquets should be applied for no longer than 1 minute prior to sampling. Longer tourniquet times have been shown to affect blood results. Only recognised tourniquets must be used for this purpose e.g. do not use a glove tied around the patient’s arm.

Question 5

What are the most suitable veins to use in venipuncture?

Answer 5

The veins most suitable for venepuncture in the antecubital fossa are the median cubital vein, cephalic vein and basilic vein.

Question 6

What should you do if the tube contains an additive?

Answer 6

If the tube contains an additive, invert it gently from end to end to mix contents a minimum of 3-4 times, but do not shake. Most tubes require to be inverted 8-10 times. Insert, fill, remove and invert all other tubes as required for different tests in the recommended ‘order of draw’ (Please refer to document on the Galen element page). The order of draw is to be followed to ensure that different additives within the tubes do not ‘contaminate’ other tubes drawn during the same venepuncture sampling.