Sunday, July 24, 2005
b3 vewnepuncture
Skills Training Pack
VENEPUNCTURE
Practice Development
June 2004
DEVELOPING PRACTICE
EDUCATION
Name:
Designation:
Area of Work:
Venepuncture
PDD/Reviewed June04
Review: June06
1
SKILLS TRAINING PACK
CONTENTS
Page No.
• Aim 2
• Definition 2
• Standard 2
• Self-Directed Learning Method 3
• Training Summary Sheet 4
• Responsibilities of an Assessor 5
• Child Health Directorate Criteria 6
• Learning Outcomes 7
• Theory Assessment 8
• Supervised Practice 15
• Reading List 16
• Evaluation 17
The concept of the Self Directed Learning Packs has resulted from funding from the
Cornwall and South Devon Education Purchasing Consortium and the subsequent joint
project work of the Consortium Project Team, consisting of a representative from Royal
Cornwall Hospitals NHS Trust, Plymouth Hospital NHS Trust and South Devon Healthcare
NHS Trust.
The Core Competency Skills Modules were developed as part of the Critical Care Project at
RCHT (2000 – 2001) in response to the Department of Health’s modernisation programme to
develop consistent and comprehensive critical care services throughout the NHS
(Comprehensive Critical Care, A Review of Adult Critical Care Services, DoH 2000).
All rights reserved. Should you need to copy, record, store in a retrieval system or transmit
electronically or otherwise, permission must be sought from the Practice Development
Department, Royal Cornwall Hospitals Trust, Royal Cornwall Hospital.
Venepuncture
PDD/Reviewed June04
Review: June06
2
AIM
To educate and train Health Care Professionals/Designated Support Workers to perform the
skill / competency safely and competently, in accordance with Trust procedures, with
underpinning theoretical knowledge to ensure evidence based practice.
DEFINITION
The insertion of a needle into a vein in order to obtain a blood specimen/s
STANDARD
• The skill is performed in accordance with RCHT policies, procedures, guidelines and
protocols.
• Staff have access to RCHT policies, procedures, guidelines and protocols available in all
clinical areas and the document library.
• Relevant policies, procedures guidelines and protocols are listed for each skill in the
specific skills training pack.
• There is validated education and training in place to enable staff to attain competency in
the skill.
• There is written evidence of attained competence.
Venepuncture
PDD/Reviewed June04
Review: June06
3
SELF DIRECTED LEARNING METHOD
This training pack is for use by Health Care Professionals/Designated Support Workers for
initial training, continual updating and self assessment.
• It is designed for you to direct your own learning to achieve the competence level
and Trust standard required for this skill.
• The flexibility of self directed learning will allow you to utilise your time for
study to obtain both theoretical knowledge and practical skills.
• You will be able to work at your own pace and decide for yourself when you are
ready for assessment. You will then be able to initiate your own updating to
maintain your competence of this skill.
• You must successfully complete the theory preparations and assessments before
your practical training, where indicated, followed by supervised practice.
• You must successfully complete the theory assessment and undertake a period of
supervised practice, where indicated, before undertaking this skill unsupervised.
It is expected that you direct yourself to gain competence in the theoretical assessment using
your Trust's resources. These may include:
Practice Development Resource Room.
Practice Development Website
Library
Pharmacy
Document Library
Clinical Practice Educators
Clinical Experts
Risk and Safety Department
Pathology Department
It is essential that you make full use of your Supervisor/Assessor to help with both the
learning and assessment stages of this skill.
Venepuncture
PDD/Reviewed June04
Review: June06
4
TRAINING SUMMARY SHEET
Training Entry Criteria
• Health Care Professionals/Designated Support Workers, with line manager’s approval.
• Health Care Professionals who show a clear understanding of their Governing Body's
directives regarding the procedure.
Criteria for Supervisors and Assessors
• Practice Educator.
• Competent Health Care Professional who has been assessed as having reached the
Trust's Standard for venepuncture.
• A competent Health Care Professional who performs venepuncture a minimum of twice
a week.
• The supervisor will supervise practice on a one to one basis.
• A supervisor is not necessarily required to be an assessor.
Policies, Procedures and Standards Associated with Venepuncture
• Trust Procedure for Venepuncture.
• Trust Risk and Safety Policy.
• Trust Infection Control Policy.
• Trust Standard for Venepuncture.
• Trust Standard for Records and Record Keeping.
• Health Care Professionals' Governing Body's directives on best practice.
• Trust Disposal of Waste Policy.
Teaching resources
• Equipment required for venepuncture as per Trust procedure.
• Model arms available.
Training Content/Presentation/Timetable
• Theoretical knowledge will be obtained and demonstrated using a self directed study
method.
• Practical training will take place in the clinical and/or study areas. Models will be used
followed by supervised practice
• Training sessions should be completed in one hour.
Venepuncture
PDD/Reviewed June04
Review: June06
5
Assessments
• It is advised that training should be completed within a period of one month.
• Each Health Care Professional will take responsibility for their own level of competence and
exercise their professional clinical judgement before undertaking this procedure unsupervised.
• Each Health Care Professional will be responsible for maintaining their knowledge base on
venepuncture by analysing the latest research and recommended changes in practice.
• Designated Support Workers will seek guidance from appropriate clinical supervisor regarding
their own competence and current research.
• Self directed theoretical study.
• Self assessment must be continuous once the individual is competent.
• The period of supervised practice to be negotiated on an individual basis, until the learner is
confident to undertake a practical assessment, where indicated, and ultimately perform the
procedure unsupervised.
Responsibilities of an Assessor
• Act always in such a manner as to promote and safeguard the interests and well-being of
patients and clients.
• Assist professional colleagues in the context of your own knowledge, expertise and sphere of
responsibility, to develop their professional competence.
• Must honestly acknowledge any limit of personal knowledge and skill and take steps to remedy
any relevant deficits.
• Recognise and honour the personal accountability borne for all aspects of professional practice.
• Enhance trust and confidence within a health care team and promote collaborative work
between other health care professionals.
• To assist health care professionals in their role as clinical assessors it is expected that all
experienced clinically competent health care professionals complete the theoretical self directed
learning section of the skills training packages.
• By completing the theoretical training the clinically competent health care professional will
maintain their knowledge base and ensure that they are equipped to assess other health care
workers.
• The Practice Educators will evaluate the assessors completed theoretical section. By monitoring
the assessor in this fashion the Practice Educators will be able to promote a high standard of
subsequent assessments.
• Health care professionals who decline to complete the theoretical section of the training
package may not have sufficient expertise or knowledge required to complete the theoretical
section and thus would not make suitable assessors.
• Health care professionals who do not follow this process may compromise trainees.
Venepuncture
PDD/Reviewed June04
Review: June06
6
CHILD HEALTH DIRECTORATE CRITERIA
To comply with the recommendations in the "Clothier Report"(1994), the following advice
should be adhered to when caring for children under the age of sixteen.
Children are cared for in areas other than the Child Health Directorate. When this occurs
the skills contained in these packs should only be performed by Registered Sick Children
nurses, experienced doctors or experienced paediatric therapists.
Personnel wishing to train in these skills who are Registered Sick Children nurse trained,
experienced doctors or experienced paediatric therapists, must seek the approval of the
Senior Nurse for the Child Health Directorate, Consultant Paediatrician or Therapies
Manager.
For personnel working in Accident and Emergency, Intensive Therapy Unit and in
theatres, approval must be sought from the appropriate Line Manager and Consultant.
Venepuncture
PDD/Reviewed June04
Review: June06
7
LEARNING OUTCOMES
At the conclusion of the theory assessment and supervised practice for venepuncture training
you will be able to:
• Demonstrate knowledge of national, local and professional policies, procedures and
standards in relation to venepuncture.
• Demonstrate knowledge of your governing body's directives if applicable, pertaining to
responsibilities and accountability regarding clinical skills.
• Demonstrate the correct procedure for patient identification and obtaining informed
consent.
• Demonstrate knowledge of the normal anatomy of the arm, having a clear
understanding of the location of nerves, arteries and veins.
• Explain the rationale behind correct vein choice and the concept of vein preservation.
• Prepare and use the equipment required.
• Demonstrate the principles of the correct venepuncture technique following the Trust's
procedure and standard.
• Demonstrate the ability to assess and identify practical problems associated with
venepuncture and state how to deal with these.
• Demonstrate knowledge of psychological problems patients may have in preparation
for and when venepuncture is performed.
• Demonstrate knowledge of how to identify the resources available for up-to-date
information and practical advice.
• Demonstrate knowledge of the rationale behind self assessment and a clear
understanding of how to use the Trust's assessment tool.
(Refer to descriptors for this skill in the Practice Development Prospectus / Website –
these can be downloaded for use).
Venepuncture
PDD/Reviewed June04
Review: June06
8
THEORY ASSESSMENT 1
Policies, procedures and standards
a) In accordance with the Health and Safety Policy what is your duty when caring for
patients?
b) How does the 'Control of Substances Hazardous to Health' legislation impact upon
venepuncture?
c) What is the Trust's Standard for venepuncture?
d) Where is the Trust's venepuncture procedure located?
e) Why is it important to have a Trust ratified procedure for clinical skills?
f) What is the Trust's Standard on record keeping by Health Care Professionals and how
are the principles applied in relation to the sample request forms and labelling the
specimens?
Venepuncture
PDD/Reviewed June04
Review: June06
9
THEORY ASSESSMENT 2
a) How will you assess your continual competence to perform this skill and maintain best
practice?
b) What resources are available to you in your Trust to facilitate theoretical knowledge and
practical skills?
Venepuncture
PDD/Reviewed June04
Review: June06
10
THEORY ASSESSMENT 3
Infection Control
a) Explain the importance of maintaining asepsis during the venepuncture procedure.
b) Explain why it is important to adhere to the 'Universal Precautions' policy during
venepuncture procedure and the patient's after care.
c) What is the single most important process in preventing nosocomial infections?
d) What should you do if you sustain a needlestick injury?
Venepuncture
PDD/Reviewed June04
Review: June06
11
THEORY ASSESSMENT 4
Knowledge required for venepuncture
a) How can you ensure the patient gives valid consent?
b) What should you do to ensure that the patient is correctly identified?
c) How do you clinically differentiate between a vein and an artery:
d) How would you describe veins which are:
i) Tortuous
ii) Thin walled
iii) Thrombosed
iv) Inflamed
Venepuncture
PDD/Reviewed June04
Review: June06
12
e) Explain which vein should ideally be used for venepuncture and the accompanying
rationale.
f) Where should you apply the tourniquet in relation to the proposed venepuncture site?
g) What is the rationale for palpating the radial pulse after applying the tourniquet?
h) Where would you find the information about which sample tubes to use and the order in
which to draw them?
i) List at least 3 situations / conditions when it may be inappropriate to take a blood sample:
(i)
(ii)
(iii)
Venepuncture
PDD/Reviewed June04
Review: June06
13
THEORY ASSESSMENT 5
The Risks
a) What are the three possible problems associated with venepuncture?
i)
ii)
iii)
b) What are the three possible causes?
i)
ii)
iii)
c) What are the three possible solutions?
i)
ii)
iii)
Venepuncture
PDD/Reviewed June04
Review: June06
14
d) Give three examples of blood borne viruses to which you may be at risk if you are
exposed to infected blood.
i)
ii)
iii)
e) Define 'needle phobia'
f) Explain how needle phobia may complicate the therapy/investigations which need to be
carried out on the patient.
Completed satisfactorily: Yes No
Signed: (Assessor)
Date:
Comments:
Venepuncture
PDD/Reviewed June04
Review: June06
15
SUPERVISED PRACTICE
SELF DIRECTED LEARNING PACK
You must successfully complete the theory assessments before attempting any practical
learning of this skill.
You must successfully complete the theory and supervised practice before undertaking this
skill unsupervised.
Supervisor:
Date Supervised Practice Completed:
Signature:
Comments:
Learners Signature:
Comments:
Venepuncture
PDD/Reviewed June04
Review: June06
16
READING LIST
Clothier Report (1994) Independent Enquiry Relative to Deaths and Injuries on the Childrens
Ward at Grantham & Kesteven General Hospital. London HMSO
Royal Cornwall Hospitals NHS Trust's Health and Safety Policy
Royal Cornwall Hospitals NHS Trust's Control of Substances Hazardous to Health
Royal Cornwall Hospitals NHS Trust's Infection Control Policy
Royal Cornwall Hospitals NHS Trust's Disposal of Waste Policy
The Royal Marsden Manual of Clinical Nursing Procedures (6th Edition)
Black. F. (1997) Venepuncture. Nursing Standard, Vol 11, No 41, pp 49-55
McConnell. A A. Mackay. G M. (1996) Venepuncture – the medicolegal hazards.
Postgraduate Medical Journal, No 72, pp 23-24
Stevenson. B. (1997) Venepuncture. Community Nurse, October, pp 21-22
Nursing Times Practice (2000) Tourniquets pose infection risk. Nursing Times, Vol 96, No 2.
Venepuncture
PDD/Reviewed June04
Review: June06
17
EVALUATION OF TRAINING PACK
Title of training package: …………………………………………………………………..
Duration of training: …………………………………………………………………………..
Final assessment date: …………………………………………………………………..
Successful assessment: Yes No
Please complete the following evaluations:
Very user friendly
5
4
3
2
1
Very difficult to use
Instructions were clear
5
4
3
2
1
Instructions were
unclear
Information was easily
resourced
5
4
3
2
1
Information was
difficult to resource
Knowledge about skill has
increased
5
4
3
2
1
Knowledge has not
increased
Able to reflect on your
training and its benefits
5
4
3
2
1
Difficult to reflect on
your training and its
benefits.
Please detach this page and return to:
Practice Development Department, Royal Cornwall Hospital.
VENEPUNCTURE
Practice Development
June 2004
DEVELOPING PRACTICE
EDUCATION
Name:
Designation:
Area of Work:
Venepuncture
PDD/Reviewed June04
Review: June06
1
SKILLS TRAINING PACK
CONTENTS
Page No.
• Aim 2
• Definition 2
• Standard 2
• Self-Directed Learning Method 3
• Training Summary Sheet 4
• Responsibilities of an Assessor 5
• Child Health Directorate Criteria 6
• Learning Outcomes 7
• Theory Assessment 8
• Supervised Practice 15
• Reading List 16
• Evaluation 17
The concept of the Self Directed Learning Packs has resulted from funding from the
Cornwall and South Devon Education Purchasing Consortium and the subsequent joint
project work of the Consortium Project Team, consisting of a representative from Royal
Cornwall Hospitals NHS Trust, Plymouth Hospital NHS Trust and South Devon Healthcare
NHS Trust.
The Core Competency Skills Modules were developed as part of the Critical Care Project at
RCHT (2000 – 2001) in response to the Department of Health’s modernisation programme to
develop consistent and comprehensive critical care services throughout the NHS
(Comprehensive Critical Care, A Review of Adult Critical Care Services, DoH 2000).
All rights reserved. Should you need to copy, record, store in a retrieval system or transmit
electronically or otherwise, permission must be sought from the Practice Development
Department, Royal Cornwall Hospitals Trust, Royal Cornwall Hospital.
Venepuncture
PDD/Reviewed June04
Review: June06
2
AIM
To educate and train Health Care Professionals/Designated Support Workers to perform the
skill / competency safely and competently, in accordance with Trust procedures, with
underpinning theoretical knowledge to ensure evidence based practice.
DEFINITION
The insertion of a needle into a vein in order to obtain a blood specimen/s
STANDARD
• The skill is performed in accordance with RCHT policies, procedures, guidelines and
protocols.
• Staff have access to RCHT policies, procedures, guidelines and protocols available in all
clinical areas and the document library.
• Relevant policies, procedures guidelines and protocols are listed for each skill in the
specific skills training pack.
• There is validated education and training in place to enable staff to attain competency in
the skill.
• There is written evidence of attained competence.
Venepuncture
PDD/Reviewed June04
Review: June06
3
SELF DIRECTED LEARNING METHOD
This training pack is for use by Health Care Professionals/Designated Support Workers for
initial training, continual updating and self assessment.
• It is designed for you to direct your own learning to achieve the competence level
and Trust standard required for this skill.
• The flexibility of self directed learning will allow you to utilise your time for
study to obtain both theoretical knowledge and practical skills.
• You will be able to work at your own pace and decide for yourself when you are
ready for assessment. You will then be able to initiate your own updating to
maintain your competence of this skill.
• You must successfully complete the theory preparations and assessments before
your practical training, where indicated, followed by supervised practice.
• You must successfully complete the theory assessment and undertake a period of
supervised practice, where indicated, before undertaking this skill unsupervised.
It is expected that you direct yourself to gain competence in the theoretical assessment using
your Trust's resources. These may include:
Practice Development Resource Room.
Practice Development Website
Library
Pharmacy
Document Library
Clinical Practice Educators
Clinical Experts
Risk and Safety Department
Pathology Department
It is essential that you make full use of your Supervisor/Assessor to help with both the
learning and assessment stages of this skill.
Venepuncture
PDD/Reviewed June04
Review: June06
4
TRAINING SUMMARY SHEET
Training Entry Criteria
• Health Care Professionals/Designated Support Workers, with line manager’s approval.
• Health Care Professionals who show a clear understanding of their Governing Body's
directives regarding the procedure.
Criteria for Supervisors and Assessors
• Practice Educator.
• Competent Health Care Professional who has been assessed as having reached the
Trust's Standard for venepuncture.
• A competent Health Care Professional who performs venepuncture a minimum of twice
a week.
• The supervisor will supervise practice on a one to one basis.
• A supervisor is not necessarily required to be an assessor.
Policies, Procedures and Standards Associated with Venepuncture
• Trust Procedure for Venepuncture.
• Trust Risk and Safety Policy.
• Trust Infection Control Policy.
• Trust Standard for Venepuncture.
• Trust Standard for Records and Record Keeping.
• Health Care Professionals' Governing Body's directives on best practice.
• Trust Disposal of Waste Policy.
Teaching resources
• Equipment required for venepuncture as per Trust procedure.
• Model arms available.
Training Content/Presentation/Timetable
• Theoretical knowledge will be obtained and demonstrated using a self directed study
method.
• Practical training will take place in the clinical and/or study areas. Models will be used
followed by supervised practice
• Training sessions should be completed in one hour.
Venepuncture
PDD/Reviewed June04
Review: June06
5
Assessments
• It is advised that training should be completed within a period of one month.
• Each Health Care Professional will take responsibility for their own level of competence and
exercise their professional clinical judgement before undertaking this procedure unsupervised.
• Each Health Care Professional will be responsible for maintaining their knowledge base on
venepuncture by analysing the latest research and recommended changes in practice.
• Designated Support Workers will seek guidance from appropriate clinical supervisor regarding
their own competence and current research.
• Self directed theoretical study.
• Self assessment must be continuous once the individual is competent.
• The period of supervised practice to be negotiated on an individual basis, until the learner is
confident to undertake a practical assessment, where indicated, and ultimately perform the
procedure unsupervised.
Responsibilities of an Assessor
• Act always in such a manner as to promote and safeguard the interests and well-being of
patients and clients.
• Assist professional colleagues in the context of your own knowledge, expertise and sphere of
responsibility, to develop their professional competence.
• Must honestly acknowledge any limit of personal knowledge and skill and take steps to remedy
any relevant deficits.
• Recognise and honour the personal accountability borne for all aspects of professional practice.
• Enhance trust and confidence within a health care team and promote collaborative work
between other health care professionals.
• To assist health care professionals in their role as clinical assessors it is expected that all
experienced clinically competent health care professionals complete the theoretical self directed
learning section of the skills training packages.
• By completing the theoretical training the clinically competent health care professional will
maintain their knowledge base and ensure that they are equipped to assess other health care
workers.
• The Practice Educators will evaluate the assessors completed theoretical section. By monitoring
the assessor in this fashion the Practice Educators will be able to promote a high standard of
subsequent assessments.
• Health care professionals who decline to complete the theoretical section of the training
package may not have sufficient expertise or knowledge required to complete the theoretical
section and thus would not make suitable assessors.
• Health care professionals who do not follow this process may compromise trainees.
Venepuncture
PDD/Reviewed June04
Review: June06
6
CHILD HEALTH DIRECTORATE CRITERIA
To comply with the recommendations in the "Clothier Report"(1994), the following advice
should be adhered to when caring for children under the age of sixteen.
Children are cared for in areas other than the Child Health Directorate. When this occurs
the skills contained in these packs should only be performed by Registered Sick Children
nurses, experienced doctors or experienced paediatric therapists.
Personnel wishing to train in these skills who are Registered Sick Children nurse trained,
experienced doctors or experienced paediatric therapists, must seek the approval of the
Senior Nurse for the Child Health Directorate, Consultant Paediatrician or Therapies
Manager.
For personnel working in Accident and Emergency, Intensive Therapy Unit and in
theatres, approval must be sought from the appropriate Line Manager and Consultant.
Venepuncture
PDD/Reviewed June04
Review: June06
7
LEARNING OUTCOMES
At the conclusion of the theory assessment and supervised practice for venepuncture training
you will be able to:
• Demonstrate knowledge of national, local and professional policies, procedures and
standards in relation to venepuncture.
• Demonstrate knowledge of your governing body's directives if applicable, pertaining to
responsibilities and accountability regarding clinical skills.
• Demonstrate the correct procedure for patient identification and obtaining informed
consent.
• Demonstrate knowledge of the normal anatomy of the arm, having a clear
understanding of the location of nerves, arteries and veins.
• Explain the rationale behind correct vein choice and the concept of vein preservation.
• Prepare and use the equipment required.
• Demonstrate the principles of the correct venepuncture technique following the Trust's
procedure and standard.
• Demonstrate the ability to assess and identify practical problems associated with
venepuncture and state how to deal with these.
• Demonstrate knowledge of psychological problems patients may have in preparation
for and when venepuncture is performed.
• Demonstrate knowledge of how to identify the resources available for up-to-date
information and practical advice.
• Demonstrate knowledge of the rationale behind self assessment and a clear
understanding of how to use the Trust's assessment tool.
(Refer to descriptors for this skill in the Practice Development Prospectus / Website –
these can be downloaded for use).
Venepuncture
PDD/Reviewed June04
Review: June06
8
THEORY ASSESSMENT 1
Policies, procedures and standards
a) In accordance with the Health and Safety Policy what is your duty when caring for
patients?
b) How does the 'Control of Substances Hazardous to Health' legislation impact upon
venepuncture?
c) What is the Trust's Standard for venepuncture?
d) Where is the Trust's venepuncture procedure located?
e) Why is it important to have a Trust ratified procedure for clinical skills?
f) What is the Trust's Standard on record keeping by Health Care Professionals and how
are the principles applied in relation to the sample request forms and labelling the
specimens?
Venepuncture
PDD/Reviewed June04
Review: June06
9
THEORY ASSESSMENT 2
a) How will you assess your continual competence to perform this skill and maintain best
practice?
b) What resources are available to you in your Trust to facilitate theoretical knowledge and
practical skills?
Venepuncture
PDD/Reviewed June04
Review: June06
10
THEORY ASSESSMENT 3
Infection Control
a) Explain the importance of maintaining asepsis during the venepuncture procedure.
b) Explain why it is important to adhere to the 'Universal Precautions' policy during
venepuncture procedure and the patient's after care.
c) What is the single most important process in preventing nosocomial infections?
d) What should you do if you sustain a needlestick injury?
Venepuncture
PDD/Reviewed June04
Review: June06
11
THEORY ASSESSMENT 4
Knowledge required for venepuncture
a) How can you ensure the patient gives valid consent?
b) What should you do to ensure that the patient is correctly identified?
c) How do you clinically differentiate between a vein and an artery:
d) How would you describe veins which are:
i) Tortuous
ii) Thin walled
iii) Thrombosed
iv) Inflamed
Venepuncture
PDD/Reviewed June04
Review: June06
12
e) Explain which vein should ideally be used for venepuncture and the accompanying
rationale.
f) Where should you apply the tourniquet in relation to the proposed venepuncture site?
g) What is the rationale for palpating the radial pulse after applying the tourniquet?
h) Where would you find the information about which sample tubes to use and the order in
which to draw them?
i) List at least 3 situations / conditions when it may be inappropriate to take a blood sample:
(i)
(ii)
(iii)
Venepuncture
PDD/Reviewed June04
Review: June06
13
THEORY ASSESSMENT 5
The Risks
a) What are the three possible problems associated with venepuncture?
i)
ii)
iii)
b) What are the three possible causes?
i)
ii)
iii)
c) What are the three possible solutions?
i)
ii)
iii)
Venepuncture
PDD/Reviewed June04
Review: June06
14
d) Give three examples of blood borne viruses to which you may be at risk if you are
exposed to infected blood.
i)
ii)
iii)
e) Define 'needle phobia'
f) Explain how needle phobia may complicate the therapy/investigations which need to be
carried out on the patient.
Completed satisfactorily: Yes No
Signed: (Assessor)
Date:
Comments:
Venepuncture
PDD/Reviewed June04
Review: June06
15
SUPERVISED PRACTICE
SELF DIRECTED LEARNING PACK
You must successfully complete the theory assessments before attempting any practical
learning of this skill.
You must successfully complete the theory and supervised practice before undertaking this
skill unsupervised.
Supervisor:
Date Supervised Practice Completed:
Signature:
Comments:
Learners Signature:
Comments:
Venepuncture
PDD/Reviewed June04
Review: June06
16
READING LIST
Clothier Report (1994) Independent Enquiry Relative to Deaths and Injuries on the Childrens
Ward at Grantham & Kesteven General Hospital. London HMSO
Royal Cornwall Hospitals NHS Trust's Health and Safety Policy
Royal Cornwall Hospitals NHS Trust's Control of Substances Hazardous to Health
Royal Cornwall Hospitals NHS Trust's Infection Control Policy
Royal Cornwall Hospitals NHS Trust's Disposal of Waste Policy
The Royal Marsden Manual of Clinical Nursing Procedures (6th Edition)
Black. F. (1997) Venepuncture. Nursing Standard, Vol 11, No 41, pp 49-55
McConnell. A A. Mackay. G M. (1996) Venepuncture – the medicolegal hazards.
Postgraduate Medical Journal, No 72, pp 23-24
Stevenson. B. (1997) Venepuncture. Community Nurse, October, pp 21-22
Nursing Times Practice (2000) Tourniquets pose infection risk. Nursing Times, Vol 96, No 2.
Venepuncture
PDD/Reviewed June04
Review: June06
17
EVALUATION OF TRAINING PACK
Title of training package: …………………………………………………………………..
Duration of training: …………………………………………………………………………..
Final assessment date: …………………………………………………………………..
Successful assessment: Yes No
Please complete the following evaluations:
Very user friendly
5
4
3
2
1
Very difficult to use
Instructions were clear
5
4
3
2
1
Instructions were
unclear
Information was easily
resourced
5
4
3
2
1
Information was
difficult to resource
Knowledge about skill has
increased
5
4
3
2
1
Knowledge has not
increased
Able to reflect on your
training and its benefits
5
4
3
2
1
Difficult to reflect on
your training and its
benefits.
Please detach this page and return to:
Practice Development Department, Royal Cornwall Hospital.
b3 venepuncture procedure
G28
PROCEDURE FOR VENEPUNCTURE
Equipment:
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Procedure:
Action Rationale
1 Wash hands using a bactericidal soap and
water and dry hands, or use bactericidal
alcohol hand rub.
To minimise the risk of infection.
2 Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
Explain the procedure.
To ensure patient safety and valid
consent
Ensures high risk specimens are
identified and processed correctly.
Page 1 of 4
M Pearce / PDD / August 2004
Review: August 2006
3 Ensure the patient is comfortable and
support the chosen limb on a pillow or
cushion. Raise the bed to a comfortable
working height.
To ensure the patient's comfort. To aid
venepuncture.
4 Place tourniquet around upper arm, making
sure it does not obstruct arterial flow, by
palpating radial pulse.
To dilate the veins by obstructing
venous return.
5 In good light, inspect the veins of the ante
cubital fossa. Observe for large
superficial, full veins in a site that is not
inflamed. Palpate the vein and ensure it is
soft and unscarred.
To ensure the most appropriate,
accessible vein is chosen.
If veins not prominent ask the patient to
hang their arm down and open and close
the fist. The area may be rubbed lightly.
Never hit the vein, it is extremely painful.
To increase the prominence of the veins.
If a vein cannot be located, remove the
tourniquet and apply moist heat, eg, a hot
compress or soak the arm in hot water.
To promote blood flow and therefore
distend the veins.
6. Apply gloves. To comply with universal precautions.
7. Holding the coloured section of the needle
with one hand, twist and remove the white
section. Screw needle into holder.
Carefully remove sheath.
To ensure correct assembly of
equipment.
8. Holding skin taut with one hand, insert
needle a short distance into vein, with
bevel uppermost, at an angle of
approximately 15 degrees from the skin.
If the first attempt fails and the needle is
completely withdrawn, the procedure must
be restarted using a new needle.
If you are unable to obtain the correct
amount of blood after a maximum of two
attempts, you should refer the request back
to the nurse or doctor responsible.
To immobilise the vein. To provide
countertension which will facilitate a
smoother needle entry.
Page 2 of 4
M Pearce / PDD / August 2004
Review: August 2006
Keeping needle holder steady in this
position with one hand, push specimen
tube onto needle inside the holder with the
other. Adjust position of needle gently as
necessary. Do not withdraw needle from
underneath the skin or vacuum in the tube
is lost. (Refer to Vacutainer Guide for tube
draw order)
To ensure blood sample is obtained
safely.
When specimen tube has filled to required
amount, remove and fill other tubes as
necessary. The vacuum in the tube will
ensure that the correct volume is taken.
Take last tube out of holder.
9. Release tourniquet. Apply dry cotton ball
to puncture site, as needle is removed from
vein. Apply pressure for a minimum of
two minutes, using tape as required. Do
not bend elbow.
To prevent bruising after needle is
removed.
10 While still with the patient, label all tubes
of blood with patient's full name, hospital
number, date of birth, ward and signature.
Also the date and time of collection.
Blood Transfusion specimens must be hand
written to include gender and must be
signed. Blood Transfusion request forms
are to be signed by the person taking blood
and the requesting doctor. (Refer to
Pathology Request Form and Sample
Labelling Policy RCHT 2004)
DO NOT LABEL THE BOTTLES
BEFORE TAKING BLOOD.
To prevent mis-labelling of specimen
tubes.
11 Dispose of needle safely. DO NOT RESHEATH
NEEDLES BY HAND.
To ensure safe disposal and to avoid
laceration or other injury to
staff/public.
12 Follow local procedure for transportation
of specimens to laboratory.
When veins are small or fragile, use of a 23g blood collection set (butterfly with adaptor and
needle holder) must be used.
Page 3 of 4
M Pearce / PDD / August 2004
Review: August 2006
References:
Infection Control Department, Royal Cornwall Hospitals NHS Trust
B-D Vacutainer Systems, Venous Access Guide.
Becton Disckinson. A Guide to the withdrawl of blood for laboratory testing.
Page 4 of 4
M Pearce / PDD / August 2004
Review: August 2006
PROCEDURE FOR VENEPUNCTURE
Equipment:
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Procedure:
Action Rationale
1 Wash hands using a bactericidal soap and
water and dry hands, or use bactericidal
alcohol hand rub.
To minimise the risk of infection.
2 Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
Explain the procedure.
To ensure patient safety and valid
consent
Ensures high risk specimens are
identified and processed correctly.
Page 1 of 4
M Pearce / PDD / August 2004
Review: August 2006
3 Ensure the patient is comfortable and
support the chosen limb on a pillow or
cushion. Raise the bed to a comfortable
working height.
To ensure the patient's comfort. To aid
venepuncture.
4 Place tourniquet around upper arm, making
sure it does not obstruct arterial flow, by
palpating radial pulse.
To dilate the veins by obstructing
venous return.
5 In good light, inspect the veins of the ante
cubital fossa. Observe for large
superficial, full veins in a site that is not
inflamed. Palpate the vein and ensure it is
soft and unscarred.
To ensure the most appropriate,
accessible vein is chosen.
If veins not prominent ask the patient to
hang their arm down and open and close
the fist. The area may be rubbed lightly.
Never hit the vein, it is extremely painful.
To increase the prominence of the veins.
If a vein cannot be located, remove the
tourniquet and apply moist heat, eg, a hot
compress or soak the arm in hot water.
To promote blood flow and therefore
distend the veins.
6. Apply gloves. To comply with universal precautions.
7. Holding the coloured section of the needle
with one hand, twist and remove the white
section. Screw needle into holder.
Carefully remove sheath.
To ensure correct assembly of
equipment.
8. Holding skin taut with one hand, insert
needle a short distance into vein, with
bevel uppermost, at an angle of
approximately 15 degrees from the skin.
If the first attempt fails and the needle is
completely withdrawn, the procedure must
be restarted using a new needle.
If you are unable to obtain the correct
amount of blood after a maximum of two
attempts, you should refer the request back
to the nurse or doctor responsible.
To immobilise the vein. To provide
countertension which will facilitate a
smoother needle entry.
Page 2 of 4
M Pearce / PDD / August 2004
Review: August 2006
Keeping needle holder steady in this
position with one hand, push specimen
tube onto needle inside the holder with the
other. Adjust position of needle gently as
necessary. Do not withdraw needle from
underneath the skin or vacuum in the tube
is lost. (Refer to Vacutainer Guide for tube
draw order)
To ensure blood sample is obtained
safely.
When specimen tube has filled to required
amount, remove and fill other tubes as
necessary. The vacuum in the tube will
ensure that the correct volume is taken.
Take last tube out of holder.
9. Release tourniquet. Apply dry cotton ball
to puncture site, as needle is removed from
vein. Apply pressure for a minimum of
two minutes, using tape as required. Do
not bend elbow.
To prevent bruising after needle is
removed.
10 While still with the patient, label all tubes
of blood with patient's full name, hospital
number, date of birth, ward and signature.
Also the date and time of collection.
Blood Transfusion specimens must be hand
written to include gender and must be
signed. Blood Transfusion request forms
are to be signed by the person taking blood
and the requesting doctor. (Refer to
Pathology Request Form and Sample
Labelling Policy RCHT 2004)
DO NOT LABEL THE BOTTLES
BEFORE TAKING BLOOD.
To prevent mis-labelling of specimen
tubes.
11 Dispose of needle safely. DO NOT RESHEATH
NEEDLES BY HAND.
To ensure safe disposal and to avoid
laceration or other injury to
staff/public.
12 Follow local procedure for transportation
of specimens to laboratory.
When veins are small or fragile, use of a 23g blood collection set (butterfly with adaptor and
needle holder) must be used.
Page 3 of 4
M Pearce / PDD / August 2004
Review: August 2006
References:
Infection Control Department, Royal Cornwall Hospitals NHS Trust
B-D Vacutainer Systems, Venous Access Guide.
Becton Disckinson. A Guide to the withdrawl of blood for laboratory testing.
Page 4 of 4
M Pearce / PDD / August 2004
Review: August 2006
Wednesday, July 06, 2005
b3
KNOWLEDGE EVIDENCE QUESTIONS
UNIT B3 – OBTAIN VENOUS BLOOD SAMPLES USING INVASIVE TECHNIQUES
1
KE3
Discuss why a doctor may refer a patient for Venepuncture
Levels of certain chemical in blood can be used not only to diagnose clients but also, changes in chemial levels in blood can also show if conditions are either worsening or getting better. Phylbotomy can provide vital information about clients.
2
Describe how infection is spread
For infection to spread, there needs to be a source of that infection, a vector (some way of transfering it), a portal (a way into a new living ground) and nutritions when it gets there, be that air, water or a food source. If one of these is ilimated, then the chain of infection will be broken.
3
KE1
How may its spread be limited?
Not washing hands before and after procedure.
Dirty equipment
Not using gloves
Tourniquet used should not be used between patients
Using the same
Gloves should not be worn between two patients
each individual patient should have completely new equipment each time. deviously
4
KE4
Why is it important to clean Venepuncture sites effectively, how and when should this be carried out?
Vein are being puntured. Infection on the skin can be transferred from here to the blood stream that can be very dangerous. Inadequate use of alcohol wipes can meerly disturb the skin flora. They are only effective if they are vigourously used for 30 seconds.
5
KE5
In relation to Venepuncture, what is hazardous and non-hazardous waste? How would you dispose of each?
Hazardous
Blood stained items such as cotton wool, etcetera, should be disposed of in yellow clinical waste bins.
Non-hazardous
Packaging, etcetera, should be placed in a non-clinical waste bag - black.
6
KE6
Why is correct labelling important and what are the possible consequences of muddling samples?
It is important that correct labelling occurs because then the right sample relates to the right client and then the right treatment happens to the correct client. If encorerect labelling occurs the so can death!!!
7
KE2
Describe the legal and organisational requirements regarding health and safety and infection control when working with blood (e.g. COSHH, DoH guidelines and local policies
Protective equipment such as gloves and aprons should be worn as they have been provided by the employer for the safety of the worker.
All sharps should be disposed of in a sharps bin
All clinical waste should be disposed of in a yellow clinical waste bag
No needle should be resheathed for fear of needle stick injury.
All blood bottles should be labled by hand. Even were a sticker has been stuck on to a bottle and removed the sample will be rejected. Where hand labelling and a sticker are present, the sample will be rejected
All relevent material should be indate and in intact packaging
8
KE7
Which types of sample have particular storage and transfer requirements (e.g. temperature dependant tests) and what are the requirements?
Cold agglutinins
Must be kept at body temperature
Haematoloty: INR, APTT
Coagualtion screen
Factor Assays and Thrombophilia
Screen by arrangement (3x tubes required)
fill to the line and mix well
Attp and coag Screen must be tesed the same day.
Pediatric 1ml size from lab
Haematoloty ERS
Mix well
Chemistry Profiles: Enzymes, TFT. Lipids, CRP, rheumatolid factors, Immunoglobulins, B12, feritin, Tumour markers, Tyroid function, other hormones, PSA , Theraputic Drugs, TPI,
1 tube
Haematology: fbc, flim, Reticulocytes, Viscoscitym, Hb electrophoresis, Sickle Test IM Screen Malaria parasites
folate HbA1C, Lead porphytrin, PCR Assays
Mix well. separet tube for viscosity kept at room temperature. Paediactric tobes from lab.
Blood transfution: Crosmatch, Group and Save< Ante-nateal Group and Screen, DAG, Kleihauer
Mix well.
Chemistry: Sample requieing rapid preservation, eg, insulin
Obtain from laboratorty after consulation. Mix well
lactate
keep in the dark and and be processed within ten minutes. Prewarn the lab.
9
Why is it important to get positive confirmation of individuals identity and consent before starting the procedure?
To insure correct client is being tested
To ensure that the client is not having the consent of a client constitutes assault.
10
KE8
Describe effective ways of getting positive identification.
Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
11
KE10
Describe the contra-indications and changes in behaviour and condition, which indicate that the procedure should be stopped, and advice sought. (e.g. allergies, skin problems, incorrect presentation such as non – fasting.)
The client may consent verbally and then, by behavieour imply they they do not want the proecure done. this could invodlve moving an amr just before the needle is incernted. if this persists, then the client should be asked if they want the test in the first place.
Allergies,
Any allergies should be discovered prior to commencement of the procedure. An which directly effect the procedure should be identified and any remedial action taken. For example, if a client is alergic to latex, then non-latex glove should be worn for the procedure. Client is alergic to micropore tape then another type of tape should be used.
Skin problems,
If the client has skin problems at a prospective venepuncture site, then an alternative stie should be investigated and adivice sort.
Incorrect presentation such as non – fasting
The procedure should be postonted until the correct condtions are implace.
12
KE12
What sites may you choose for Venepuncture and why.
the veian cubital veins
the cephalic vein
basilic vein
the metacarpal veins )only used when other sites are not accessible
13
KE13
What factors would you consider when choosing the best site to use (including the individuals own preference)
Previous experience of client
Accessiblity
Degree of tortuousness of veins
client contsent and ability to co-operate
lack of infection
14
KE14
What factors can affect the quality of the sample (e.g. prolonged use of a tourniquet)
Type of needle used. If the lumen is too small, then this can affect the sample. Also, the cells can be affected if a "butterfly" needle is used
15
KE15
Describe how you would prepare individuals for Venepuncture; include how their personal preferences may effect their preparation.
Check client identity and confirm by checking name band and asking for verbal verificaion if possible
Explain procdure and gain an informed conscent.
ensue the cleitn is comfotable.
Assess veins and determ which to use
Supprot lim comfortable invovling clinet to maximise comfoft here.
16
KE16
Describe the steps you would take to detect suitable veins
Appy a bouniquet above the site for inspection and visually inpsect the vein
palpate the vein
17
KE17
Describe the possible concerns individuals may have in relation to Venepuncture and blood sampling.
Is is going to hurt?
yes it is. Clients have the right to be told that this is the case. It is important that they are tol that the pain should be transitarty. If a particular needl phobia is in place, then skin-numbing cream can be prescribed.
How do they know if is my sample?
All samples are labed and placed in a labled form. this reduced the risk of mixing up samples.
18
KE18
What is likely to cause discomfort to individuals during and after the collection of blood samples? Describe how such discomforts can minimised. E.g. applying correct pressure to tourniquet and puncture site to avoid bruising)
Applying the tourniquet too hard can restrict arterial blood flow. To test if this has not occured, palpation of the radial pulse should be carried out.
Insertion of the needle will cause pain. In needle phobia or minors, skin numbing cream can be applied prior to procedure.
19
KE19
What remedial action can be taken if there are problems in obtaining blood?
If a client's veins collapse or are not very prominent, soaking the site in warm water can cause vasodilation thus fascilitating the procedure.
Aterial puncture
If this occurs:-
remove needle
apply pressure to site unit bleeding ceases.
explain what has happened
if there is contieneued pain, increase swelling or bruising, seek medical advice.
20
KE20
Why are anticoagulants added to blood samples and why is it important to collect the right volume of blood when it is to be mixed with anti-coagulant?
When blood leaves the body, the clotting proecess is initisated. Anticoagulent in the bottom of sample bottles help to stop this from happening. There is a specific vacumm in each tube which, in theory, attracts a specific volume of blood. Thus, there needs to be a speicif ammount of anticoagulanant in the bottom of the tube as to not excessively anticoagulate or allow haemolysation to occur.
21
Describe the dressings needed for the different types of puncture sites.
For younger clients, an ordinary sticking plaster may suffice. However, where skin is more friable such as in elderly clients, the lint free dressing secured with tape may be the dressing of choice.
22
Describe how you would apply dressings.
A lint free dressing should be held in place for two minutes then secured with tape once bleeding has ceased. The elbow should be kept straight as this helps to reduce bruising.
23
KE21
What advice would you give individuals on caring for the site? (Ke21)
keep the dressing on for 24 hours at least. keep dry and clean.
24
KE23
How would you recognise the common adverse reactions which individuals may have (e.g. fainting, bruising) What action would you take if they occurred.
Bruising and /or haematoma
This can occur when the needle has venetrated the posterier wall of the vein possibly due to the insertion angle being lower than 30 degrees. the needlw shoud be reomved and pressure applied and until the cessation of bleeding. The limb should be elevated, an ice pack should be applied then a pressure dressing should be applied.
Fainting
Place client's head between legs if feeling faint. encouage client to lie down. The use of a butterfly may be helpful. this should be secured if the client should need medication. Assistance should be summoned.
25
Describe how you would recognise an arterial puncture
Excessive pain on needle insertion. The punctured vessel has a pulse.
26
KE24
What action would you take if the above occurs.
The needle shoud be at once removed. Bleeding, which can be perfuse, should be stemmed by the application of pressure until it's cessation
27
KE25
What equipment and materials are needed for venous sampling, and how would you check and prepare them (including protective clothing for the worker and/or the individual.
Please note that all equipment must be checked that it has not been used before, is clean, within intact packaging, where appropriate and is within date, where appropriate.
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container (
This needs to be assembled at correctly, the relevant information (date assembled, location, the name of the person who assembled the bin) needs to be displayed on the bin. The bin must not be excessively full. If the bin is more than three-quarters full, it should be sealed, signed that it has been sealed and placed in the designated area where it will be collected for incineration.)
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Pillow to support limb
Plastic apron (for the Worker and optional for the client)
a bowl of warm water to aid the vasodilation of limb is necessary
28
How would you maintain confidentiality whilst transporting blood samples (i.e. from patients home to the surgery)
Confidentiality is very important at all times. Blood samples I used for testing for certain diseases such as HIV and hepatitis as well as many sexually transmitted diseases. The client may not wish all and sundry to know that they are being tested for such conditions. It is therefore important that all blood samples have their names and any tests that pertain to covered. The forms used within the trust fall back on themselves, hiding the identity and reason for the tests required. When taking Blood, it is important that the accompanying form is stuck down as to not allow the name of the patient to be read nor what tests have been taken.
29
How would you deal with any spillages of blood?
the excess is soaked up using disposable paper towles. neat milton solution is then poured on the top of these.
30
Describe the procedure you would follow if you sustain a needlestick injury
Immediately a needle stick injury is incurred, the site should be encouraged to bleed over a sink so that the workers own bloodstream helps to flush away the blood of the individual who had the needle used upon them. Once the needle stick site has been bled like this, it should then be covered by waterproofed plaster. If required, the individual who has been stuck can request to have blood taken and stored for future reference should the client who hadn't even used upon them have any blood borne diseases.
An incident report form should be completed. Occupational health should be informed also.
UNIT B3 – OBTAIN VENOUS BLOOD SAMPLES USING INVASIVE TECHNIQUES
1
KE3
Discuss why a doctor may refer a patient for Venepuncture
Levels of certain chemical in blood can be used not only to diagnose clients but also, changes in chemial levels in blood can also show if conditions are either worsening or getting better. Phylbotomy can provide vital information about clients.
2
Describe how infection is spread
For infection to spread, there needs to be a source of that infection, a vector (some way of transfering it), a portal (a way into a new living ground) and nutritions when it gets there, be that air, water or a food source. If one of these is ilimated, then the chain of infection will be broken.
3
KE1
How may its spread be limited?
Not washing hands before and after procedure.
Dirty equipment
Not using gloves
Tourniquet used should not be used between patients
Using the same
Gloves should not be worn between two patients
each individual patient should have completely new equipment each time. deviously
4
KE4
Why is it important to clean Venepuncture sites effectively, how and when should this be carried out?
Vein are being puntured. Infection on the skin can be transferred from here to the blood stream that can be very dangerous. Inadequate use of alcohol wipes can meerly disturb the skin flora. They are only effective if they are vigourously used for 30 seconds.
5
KE5
In relation to Venepuncture, what is hazardous and non-hazardous waste? How would you dispose of each?
Hazardous
Blood stained items such as cotton wool, etcetera, should be disposed of in yellow clinical waste bins.
Non-hazardous
Packaging, etcetera, should be placed in a non-clinical waste bag - black.
6
KE6
Why is correct labelling important and what are the possible consequences of muddling samples?
It is important that correct labelling occurs because then the right sample relates to the right client and then the right treatment happens to the correct client. If encorerect labelling occurs the so can death!!!
7
KE2
Describe the legal and organisational requirements regarding health and safety and infection control when working with blood (e.g. COSHH, DoH guidelines and local policies
Protective equipment such as gloves and aprons should be worn as they have been provided by the employer for the safety of the worker.
All sharps should be disposed of in a sharps bin
All clinical waste should be disposed of in a yellow clinical waste bag
No needle should be resheathed for fear of needle stick injury.
All blood bottles should be labled by hand. Even were a sticker has been stuck on to a bottle and removed the sample will be rejected. Where hand labelling and a sticker are present, the sample will be rejected
All relevent material should be indate and in intact packaging
8
KE7
Which types of sample have particular storage and transfer requirements (e.g. temperature dependant tests) and what are the requirements?
Cold agglutinins
Must be kept at body temperature
Haematoloty: INR, APTT
Coagualtion screen
Factor Assays and Thrombophilia
Screen by arrangement (3x tubes required)
fill to the line and mix well
Attp and coag Screen must be tesed the same day.
Pediatric 1ml size from lab
Haematoloty ERS
Mix well
Chemistry Profiles: Enzymes, TFT. Lipids, CRP, rheumatolid factors, Immunoglobulins, B12, feritin, Tumour markers, Tyroid function, other hormones, PSA , Theraputic Drugs, TPI,
1 tube
Haematology: fbc, flim, Reticulocytes, Viscoscitym, Hb electrophoresis, Sickle Test IM Screen Malaria parasites
folate HbA1C, Lead porphytrin, PCR Assays
Mix well. separet tube for viscosity kept at room temperature. Paediactric tobes from lab.
Blood transfution: Crosmatch, Group and Save< Ante-nateal Group and Screen, DAG, Kleihauer
Mix well.
Chemistry: Sample requieing rapid preservation, eg, insulin
Obtain from laboratorty after consulation. Mix well
lactate
keep in the dark and and be processed within ten minutes. Prewarn the lab.
9
Why is it important to get positive confirmation of individuals identity and consent before starting the procedure?
To insure correct client is being tested
To ensure that the client is not having the consent of a client constitutes assault.
10
KE8
Describe effective ways of getting positive identification.
Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
11
KE10
Describe the contra-indications and changes in behaviour and condition, which indicate that the procedure should be stopped, and advice sought. (e.g. allergies, skin problems, incorrect presentation such as non – fasting.)
The client may consent verbally and then, by behavieour imply they they do not want the proecure done. this could invodlve moving an amr just before the needle is incernted. if this persists, then the client should be asked if they want the test in the first place.
Allergies,
Any allergies should be discovered prior to commencement of the procedure. An which directly effect the procedure should be identified and any remedial action taken. For example, if a client is alergic to latex, then non-latex glove should be worn for the procedure. Client is alergic to micropore tape then another type of tape should be used.
Skin problems,
If the client has skin problems at a prospective venepuncture site, then an alternative stie should be investigated and adivice sort.
Incorrect presentation such as non – fasting
The procedure should be postonted until the correct condtions are implace.
12
KE12
What sites may you choose for Venepuncture and why.
the veian cubital veins
the cephalic vein
basilic vein
the metacarpal veins )only used when other sites are not accessible
13
KE13
What factors would you consider when choosing the best site to use (including the individuals own preference)
Previous experience of client
Accessiblity
Degree of tortuousness of veins
client contsent and ability to co-operate
lack of infection
14
KE14
What factors can affect the quality of the sample (e.g. prolonged use of a tourniquet)
Type of needle used. If the lumen is too small, then this can affect the sample. Also, the cells can be affected if a "butterfly" needle is used
15
KE15
Describe how you would prepare individuals for Venepuncture; include how their personal preferences may effect their preparation.
Check client identity and confirm by checking name band and asking for verbal verificaion if possible
Explain procdure and gain an informed conscent.
ensue the cleitn is comfotable.
Assess veins and determ which to use
Supprot lim comfortable invovling clinet to maximise comfoft here.
16
KE16
Describe the steps you would take to detect suitable veins
Appy a bouniquet above the site for inspection and visually inpsect the vein
palpate the vein
17
KE17
Describe the possible concerns individuals may have in relation to Venepuncture and blood sampling.
Is is going to hurt?
yes it is. Clients have the right to be told that this is the case. It is important that they are tol that the pain should be transitarty. If a particular needl phobia is in place, then skin-numbing cream can be prescribed.
How do they know if is my sample?
All samples are labed and placed in a labled form. this reduced the risk of mixing up samples.
18
KE18
What is likely to cause discomfort to individuals during and after the collection of blood samples? Describe how such discomforts can minimised. E.g. applying correct pressure to tourniquet and puncture site to avoid bruising)
Applying the tourniquet too hard can restrict arterial blood flow. To test if this has not occured, palpation of the radial pulse should be carried out.
Insertion of the needle will cause pain. In needle phobia or minors, skin numbing cream can be applied prior to procedure.
19
KE19
What remedial action can be taken if there are problems in obtaining blood?
If a client's veins collapse or are not very prominent, soaking the site in warm water can cause vasodilation thus fascilitating the procedure.
Aterial puncture
If this occurs:-
remove needle
apply pressure to site unit bleeding ceases.
explain what has happened
if there is contieneued pain, increase swelling or bruising, seek medical advice.
20
KE20
Why are anticoagulants added to blood samples and why is it important to collect the right volume of blood when it is to be mixed with anti-coagulant?
When blood leaves the body, the clotting proecess is initisated. Anticoagulent in the bottom of sample bottles help to stop this from happening. There is a specific vacumm in each tube which, in theory, attracts a specific volume of blood. Thus, there needs to be a speicif ammount of anticoagulanant in the bottom of the tube as to not excessively anticoagulate or allow haemolysation to occur.
21
Describe the dressings needed for the different types of puncture sites.
For younger clients, an ordinary sticking plaster may suffice. However, where skin is more friable such as in elderly clients, the lint free dressing secured with tape may be the dressing of choice.
22
Describe how you would apply dressings.
A lint free dressing should be held in place for two minutes then secured with tape once bleeding has ceased. The elbow should be kept straight as this helps to reduce bruising.
23
KE21
What advice would you give individuals on caring for the site? (Ke21)
keep the dressing on for 24 hours at least. keep dry and clean.
24
KE23
How would you recognise the common adverse reactions which individuals may have (e.g. fainting, bruising) What action would you take if they occurred.
Bruising and /or haematoma
This can occur when the needle has venetrated the posterier wall of the vein possibly due to the insertion angle being lower than 30 degrees. the needlw shoud be reomved and pressure applied and until the cessation of bleeding. The limb should be elevated, an ice pack should be applied then a pressure dressing should be applied.
Fainting
Place client's head between legs if feeling faint. encouage client to lie down. The use of a butterfly may be helpful. this should be secured if the client should need medication. Assistance should be summoned.
25
Describe how you would recognise an arterial puncture
Excessive pain on needle insertion. The punctured vessel has a pulse.
26
KE24
What action would you take if the above occurs.
The needle shoud be at once removed. Bleeding, which can be perfuse, should be stemmed by the application of pressure until it's cessation
27
KE25
What equipment and materials are needed for venous sampling, and how would you check and prepare them (including protective clothing for the worker and/or the individual.
Please note that all equipment must be checked that it has not been used before, is clean, within intact packaging, where appropriate and is within date, where appropriate.
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container (
This needs to be assembled at correctly, the relevant information (date assembled, location, the name of the person who assembled the bin) needs to be displayed on the bin. The bin must not be excessively full. If the bin is more than three-quarters full, it should be sealed, signed that it has been sealed and placed in the designated area where it will be collected for incineration.)
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Pillow to support limb
Plastic apron (for the Worker and optional for the client)
a bowl of warm water to aid the vasodilation of limb is necessary
28
How would you maintain confidentiality whilst transporting blood samples (i.e. from patients home to the surgery)
Confidentiality is very important at all times. Blood samples I used for testing for certain diseases such as HIV and hepatitis as well as many sexually transmitted diseases. The client may not wish all and sundry to know that they are being tested for such conditions. It is therefore important that all blood samples have their names and any tests that pertain to covered. The forms used within the trust fall back on themselves, hiding the identity and reason for the tests required. When taking Blood, it is important that the accompanying form is stuck down as to not allow the name of the patient to be read nor what tests have been taken.
29
How would you deal with any spillages of blood?
the excess is soaked up using disposable paper towles. neat milton solution is then poured on the top of these.
30
Describe the procedure you would follow if you sustain a needlestick injury
Immediately a needle stick injury is incurred, the site should be encouraged to bleed over a sink so that the workers own bloodstream helps to flush away the blood of the individual who had the needle used upon them. Once the needle stick site has been bled like this, it should then be covered by waterproofed plaster. If required, the individual who has been stuck can request to have blood taken and stored for future reference should the client who hadn't even used upon them have any blood borne diseases.
An incident report form should be completed. Occupational health should be informed also.
Tuesday, July 05, 2005
CU5
KNOWLEDGE EVIDENCE QUESTIONS
UNIT CU5 - RECEIVE, TRANSMIT, STORE AND RETRIEVE INFORMATION
1List the regulations/hospital policies that affect the gaining of information?
the Data Protection Act
The Freedom Information Act
2Briefly describe your responsibility in relation to the above regulations/hospital policies.
Individuals have the right to confidentiality of their care and medical history so my role is to reduce their risk of information being transferred to the wrong person and facilitating the relevant information being passed to the correct person.
3Through what sources can you obtain information about patient care?
The client themselves
The clients' friends
the clients' relatives (it must be noted that these are three sources may be subject to bias and may not be totally valid sources. Also, individuals can make mistakes, so care must be made when using these sources)
The client care plan
The client's medical notes
4How do you ensure that the information gained is relevant and correct?
objective information he's the most desired as it is without bias. However, 100 per cent objective information is really impossible to obtain because, at some level, subjective feelings come into play. It is therefore important to eliminate subjective feelings as much as possible when trying to gain information. If, for example, a client is confused, a relative or friend maybe a more suitable source of information than the client themselves.
it would be hoped that if a source is a another professional, that them this information would be more valid than a more subjective one. However, professionals, themselves been human, are subject to bias themselves.
5Briefly describe the different purposes for which information may be required in your work area and the degree of detail necessary for each purpose.
Handover
Handover information needs to be succinct and relevant to the client. It needs to be free from bias and, because it is verbalised, a suitable venue needs to be found for its delivery. Care needs to be taken when giving goal handover in front of the patient because do so she/he the main not want to here that they have cancer or they may not wish everyone in the bay to here when they last had their bowels open.
Clare plans
Again, information is to be six into relevant. Been succinct still need to be maintained, however, there is more room for morning depth information to berecorded . as clients have access to their care plans, care must be taken when recording in them and his reach its to be taken into consideration when recording anything in a care plan. Care plans need to be kept in the appropriate place, in an hour case, in the trolley pertaining to the baby in which the client is situated, when the care plan is not being used. Clients have access to their own care plan. Because an individual is a relative of a client, this does not guarantee that they have access by right to the information recorded in the care plan.
Medical notes
These are far more in depth tomes that clients do not have direct access to. A client does have access to their medical notes under certain circumstances. These arc, when the client requests in writing to see only a certain portion of the notes over which are the relevant consultant has veto. Once these have been accessed, they must be returned to the relevant notes trolley.
6How are patients’ records obtained on admission and transfer?
On admission
Clients are usually accompanied by a letter from their general practitioner or, if they have been admitted via ambulance, documentation from that service. From this information, a temporary medical notes are raised. If a relevant doctor sees fit, clients' medical modes I'll are located.
When a climb need to be transferred, then notes, if they are in the same location as the client, do with the client to the new location. It is essential that any confidential notes, such as medical notes, remain confidential. Also, as the client has not requested to see the medical notes at that point, the client themselves must not read the medical merits or any other confidential information. The database of the location of all medical notes is then updated so, at any point, though it can be traced if necessary.
7Where are the client’s medical and nursing notes stored in your work area?
In the relevant rate trolley pertaining to the Bay in which they are located.
8Who has the right to access these notes?
see Question 5
Also further to this, only relevant members of the multi-disciplinary team should have access to clients of nodes are who they are directly looking after. If as a professional is not looking after her a a patient, then they should not be accessing their notes.
9How should the notes be transferred between wards, departments and hospitals?
they should be transferred in specifically designed nodes bags ideally. The client to whom they pertain should not have access to them.
10Where are they stored when the patient has been discharged home?
Usually, notes her are stored at the Medical Records store.
11What is your responsibility with regards to patients’ notes?
Information the in them should be correct and accurate
Information should be legible and be a bias free
They should be stored in a manner appropriate to the type of notes
Actions to should be taken as to reduce risks of breaches in confidentiality
12A patient asks you if they can see their notes or a parent asks to see their childs notes. What should be your reply?
I would say that this shy and not in a position to allow any individual to look at the Medical notes belonging to others and would refer them to the registered practitioner.
13To whom do the notes belong?
medical notes belong to the health authority
Care plans belong to the client they pertain to
14What is the procedure for the notes in the event of a fire?
the although medical notes are very important, human life is far more important so it is far more important stat human life is preserved over that of medical notes.
15A relative on the ‘phone asks you what is wrong with their mother/daughter. How would you deal with this call?
as a health care support worker, a I am responsible for my actions. I am not accountable for them in the way in which a qualified what nurse is. Therefore, it is not my responsibility to discuss client diagnosis with a are either the client or their significant others. In this instance it, therefore, I would I get suggest that I'd take a telephone to the client in question, if they were unable and capable of talking on the telephone, or I would pass them over to be qualified nurse in question.
16What do you need to consider when speaking to people on the telephone?
Who are you talking to?
Who is listening where you areand where the individual this was on the phone?
What are they asking?
Are they who they say they are?
Do I need to pass a the call onto a more relevant person or am I able to answer this call within my role?
17When writing down a message, how do you ensure relevancy, accuracy and currency of information?
Be brief
Only record that which is necessary
Check for accuracy with others such as client themselves, significant others, or other healthcare professionals
18Why is it important to take messages accurately?
to facilitate beneficence
to reduce maleficence
19What actions need to be taken after obtaining this information?
Only the person for whom the information is intended accesses it
Others who do not need to access the information should be denied from doing so
The information should be placed/ recorded in the relevant place
20What do you need to consider when passing information to colleagues/relatives?
do these individuals specifically need to know?
Is it in their best interest?
Is it in the best interest of the client ?
As the client given consent?
Is it within the role of the information to giver to impart this information ?
21List the different types of charts used in your work area.
Observation charts
Fluid charts
Bowel charts
Weight charts
Food charts
Peak flow charts
Insulin sliding scale charts
Standard blood glucose level charts
22Who is responsible for maintaining these charts?
The registered practitioner that is accountable for the filling in of these charts. However, if a health care support worker has been designated to fill in any specific chart that is within their role then it is the responsibility of that said worker
23Why are these charts necessary?
It they show what has happened to a client
They provide a benchmark on admission against which any change maybe measured
The show if any changes in climate condition have occurred or are likely to occur
24Briefly describe the kind of problems that can arise during the maintenance and storage of these charts and the action you should take.
There is not enough room to fit in at a certain piece of information within the chart . Get a new chart
There is a chart without a name on in a patient's nodes. All paperwork should have Client name and number on it before it is written on.
UNIT CU5 - RECEIVE, TRANSMIT, STORE AND RETRIEVE INFORMATION
1List the regulations/hospital policies that affect the gaining of information?
the Data Protection Act
The Freedom Information Act
2Briefly describe your responsibility in relation to the above regulations/hospital policies.
Individuals have the right to confidentiality of their care and medical history so my role is to reduce their risk of information being transferred to the wrong person and facilitating the relevant information being passed to the correct person.
3Through what sources can you obtain information about patient care?
The client themselves
The clients' friends
the clients' relatives (it must be noted that these are three sources may be subject to bias and may not be totally valid sources. Also, individuals can make mistakes, so care must be made when using these sources)
The client care plan
The client's medical notes
4How do you ensure that the information gained is relevant and correct?
objective information he's the most desired as it is without bias. However, 100 per cent objective information is really impossible to obtain because, at some level, subjective feelings come into play. It is therefore important to eliminate subjective feelings as much as possible when trying to gain information. If, for example, a client is confused, a relative or friend maybe a more suitable source of information than the client themselves.
it would be hoped that if a source is a another professional, that them this information would be more valid than a more subjective one. However, professionals, themselves been human, are subject to bias themselves.
5Briefly describe the different purposes for which information may be required in your work area and the degree of detail necessary for each purpose.
Handover
Handover information needs to be succinct and relevant to the client. It needs to be free from bias and, because it is verbalised, a suitable venue needs to be found for its delivery. Care needs to be taken when giving goal handover in front of the patient because do so she/he the main not want to here that they have cancer or they may not wish everyone in the bay to here when they last had their bowels open.
Clare plans
Again, information is to be six into relevant. Been succinct still need to be maintained, however, there is more room for morning depth information to berecorded . as clients have access to their care plans, care must be taken when recording in them and his reach its to be taken into consideration when recording anything in a care plan. Care plans need to be kept in the appropriate place, in an hour case, in the trolley pertaining to the baby in which the client is situated, when the care plan is not being used. Clients have access to their own care plan. Because an individual is a relative of a client, this does not guarantee that they have access by right to the information recorded in the care plan.
Medical notes
These are far more in depth tomes that clients do not have direct access to. A client does have access to their medical notes under certain circumstances. These arc, when the client requests in writing to see only a certain portion of the notes over which are the relevant consultant has veto. Once these have been accessed, they must be returned to the relevant notes trolley.
6How are patients’ records obtained on admission and transfer?
On admission
Clients are usually accompanied by a letter from their general practitioner or, if they have been admitted via ambulance, documentation from that service. From this information, a temporary medical notes are raised. If a relevant doctor sees fit, clients' medical modes I'll are located.
When a climb need to be transferred, then notes, if they are in the same location as the client, do with the client to the new location. It is essential that any confidential notes, such as medical notes, remain confidential. Also, as the client has not requested to see the medical notes at that point, the client themselves must not read the medical merits or any other confidential information. The database of the location of all medical notes is then updated so, at any point, though it can be traced if necessary.
7Where are the client’s medical and nursing notes stored in your work area?
In the relevant rate trolley pertaining to the Bay in which they are located.
8Who has the right to access these notes?
see Question 5
Also further to this, only relevant members of the multi-disciplinary team should have access to clients of nodes are who they are directly looking after. If as a professional is not looking after her a a patient, then they should not be accessing their notes.
9How should the notes be transferred between wards, departments and hospitals?
they should be transferred in specifically designed nodes bags ideally. The client to whom they pertain should not have access to them.
10Where are they stored when the patient has been discharged home?
Usually, notes her are stored at the Medical Records store.
11What is your responsibility with regards to patients’ notes?
Information the in them should be correct and accurate
Information should be legible and be a bias free
They should be stored in a manner appropriate to the type of notes
Actions to should be taken as to reduce risks of breaches in confidentiality
12A patient asks you if they can see their notes or a parent asks to see their childs notes. What should be your reply?
I would say that this shy and not in a position to allow any individual to look at the Medical notes belonging to others and would refer them to the registered practitioner.
13To whom do the notes belong?
medical notes belong to the health authority
Care plans belong to the client they pertain to
14What is the procedure for the notes in the event of a fire?
the although medical notes are very important, human life is far more important so it is far more important stat human life is preserved over that of medical notes.
15A relative on the ‘phone asks you what is wrong with their mother/daughter. How would you deal with this call?
as a health care support worker, a I am responsible for my actions. I am not accountable for them in the way in which a qualified what nurse is. Therefore, it is not my responsibility to discuss client diagnosis with a are either the client or their significant others. In this instance it, therefore, I would I get suggest that I'd take a telephone to the client in question, if they were unable and capable of talking on the telephone, or I would pass them over to be qualified nurse in question.
16What do you need to consider when speaking to people on the telephone?
Who are you talking to?
Who is listening where you areand where the individual this was on the phone?
What are they asking?
Are they who they say they are?
Do I need to pass a the call onto a more relevant person or am I able to answer this call within my role?
17When writing down a message, how do you ensure relevancy, accuracy and currency of information?
Be brief
Only record that which is necessary
Check for accuracy with others such as client themselves, significant others, or other healthcare professionals
18Why is it important to take messages accurately?
to facilitate beneficence
to reduce maleficence
19What actions need to be taken after obtaining this information?
Only the person for whom the information is intended accesses it
Others who do not need to access the information should be denied from doing so
The information should be placed/ recorded in the relevant place
20What do you need to consider when passing information to colleagues/relatives?
do these individuals specifically need to know?
Is it in their best interest?
Is it in the best interest of the client ?
As the client given consent?
Is it within the role of the information to giver to impart this information ?
21List the different types of charts used in your work area.
Observation charts
Fluid charts
Bowel charts
Weight charts
Food charts
Peak flow charts
Insulin sliding scale charts
Standard blood glucose level charts
22Who is responsible for maintaining these charts?
The registered practitioner that is accountable for the filling in of these charts. However, if a health care support worker has been designated to fill in any specific chart that is within their role then it is the responsibility of that said worker
23Why are these charts necessary?
It they show what has happened to a client
They provide a benchmark on admission against which any change maybe measured
The show if any changes in climate condition have occurred or are likely to occur
24Briefly describe the kind of problems that can arise during the maintenance and storage of these charts and the action you should take.
There is not enough room to fit in at a certain piece of information within the chart . Get a new chart
There is a chart without a name on in a patient's nodes. All paperwork should have Client name and number on it before it is written on.
