NVQ workbooks

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.
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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.
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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.
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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