Venepuncture

 

 

An Open learning pack for registered nurses and midwives

 

 

Start off your study of this pack by reading this article

 

Venepuncture

This procedure is perhaps the most common extended role activity carried out by nurses.  With some basic instruction most qualified nurses should quickly become competent.

 

BACKGROUND

"The Scope of Professional Practice ",(1) is the current UKCC document covering what used to be called "extended role activities", this term is no  longer considered suitable as it tends to limit the parameters of practice. The Code of Professional Conduct,(2) places emphasis on the principles of knowledge, skills, responsibility and personal accountability. This means that the individual is fully accountable for all aspects of their own practice. The best way to give evidence of professional competence in any area not covered in basic training is to be able to demonstrate attendance at a recognised course of training, and to retain recorded evidence of supervised practice in the clinical area. Once any skill or area of knowledge has been learned it is the responsibility of the individual to maintain and improve professional knowledge and competence,(2).

 

Nurses usually take blood as delegated by the doctor or when following local protocols. The type of tests used are usually  haematological, biochemical or immunological. In common with all nursing procedures the patient will be treated as a whole person and care individualised.

 

SAFE PRACTICE - RISK OF NEEDLE STICK INJURY

Needle stick injuries do pose a hazard to health care workers,(3).  The scale of this risk has been found to be as high as one needle stick injury for every 3 175 to 4 006 needle-handling procedures,(4). Another study found that there were 6.9 needle stick injuries per hundred full time nursing staff per year,(5).  It should be remembered that Hepatitis B is  much more transmissible that HIV,(6) so any nurse working with body fluids should be vaccinated for Hepatitis B and have their antibody levels checked.

 

If unfortunately an inoculation injury does occur the wound should be encouraged to bleed. An effective way to do this is to squeeze the area round the puncture site to "milk" out as much blood as possible, it should also be held under warm running water. After this it may be soaked in an iodine based solution. In addition to these first aid measures the patients details should be recorded on an accident form and a medical opinion taken, usually through the occupational health department.

 

The idea of a "high risk patient" is perhaps an unhelpful one, patients carrying Hepatitis B or HIV may look perfectly healthy and "respectable" so all body fluids must be treated with respect.

 

Seamless rubber gloves should be word unless the individual feels that these will interfere with manual dexterity. However many nurses feel they are more likely to stab themselves with the needle if they wear gloves. Gloves should be worn when the practitioner has any wounds on the hands or, arguably, if the patient is known to be infected with HIV, Hepatitis B or C virus,(7). However no blood at all should be spilled with good technique. Local infection control protocols and policies should of course be obeyed.

 

Perhaps the main risk to the nurse is posed by unpredictable patients who may move or otherwise thrash around during the procedure. If the procedure is explained and the psychological status of the patient assessed before the procedure this risk may be minimised. If there is any perceived risk of being splashed with blood goggles should be worn.

 

CORRECT USE OF TOURNIQUET

The tourniquet should be applied at a pressure which is greater than venous blood pressure and lower than arterial.  This will allow blood into the arm but restrict blood leaving thereby causing the veins to engorge with blood.  Care should be taken not to nip the patients skin during application. A good tourniquet will allow palpation of veins which feel "bouncy". The tourniquet is removed before the needle is withdrawn.

 

SELECTION OF A VEIN

The primary method of vein selection should be palpation, (fig.1) although it is more straightforward if the vein can be visualised as well. The usual site used is the antecubital fossa where there is a selection of superficial veins,(8), (Fig. A). The area should be palpated from side to side  to assess all the possible veins.  When one is selected it should be palpated in an up and down direction to allow the practitioner to learn the position of the vein.  If time is taken at this stage to be sure of the local anatomy there should be little question of missing the vein with the needle.

 

Usually the left arm would be used in a right handed person. However if a suitable vein is not found in one arm the other should be examined. The opposite arm should also be used if there is a haemodialysis arterio-venous fistula in place as venepuncture can damage the vessels concerned.

 

SKIN PREPARATION

For some time it was commonly believed that skin cleaning with alcohol was only ritual based practice. Research had shown that although skin cleaning did reduce the number of bacteria on the skin surface(9) it was not necessary to prevent infection prior to parental procedures,(10).  However current bacteriological opinion is firmly in favour of cleaning the site of insertion. The skin should be cleaned to remove blood, mucus and other organic debris with a preparation such as isopropyl alcohol or 1% iodine in ethanol 70%. In practice alcohol swabs are usually used. The area should be swabbed in one direction. This will help to move material and bacteria away from the entry site. If the area is swabbed back and forward the bacteria will also be moved back and forward. The site should then be allowed to dry, usually for about 30 seconds, before insertion of the needle, this is to prevent stinging(11). Once the site has been swabbed it should not be touched again.

 

TEMPORARY CANNULATION

In a right handed practitioner the vein should be "anchored" with the left thumb about two inches down the arm from the entry site, (see fig. 2).  This is especially important in older patients who often have more "mobile" veins.  The needle should be inserted  along the line of the vein, the position of which has previously been learned at the palpation stage. Table 1 give some guide-lines for "difficult patients".

 

The pointed tip of the needle should be inserted through the skin into the vein first.  The movement should be a continuous one.  If there is delay in cannulating the vein, blood will leak out round the bevelled tip of the needle,  However, once the round part of the needle is in contact with the vein the walls will form a seal around the shaft of the needle.  The vein should be cannulated for about one centimetre, (half an inch) before the specimen is withdrawn.  The angle of entry into the vein should be about thirty degrees,(12).  Once the vein is cannulated the left thumb can move to secure the needle position, (see fig 3).

 

As a general rule in adults a green needle, (21 G) should be used as smaller bore needle may cause increased haemolysis of the blood as it is drawn through the narrow lumen. Slower drawing up of blood would also give it more time for the blood to clot in the syringe.

 

ALTERNATIVE SYSTEMS

Several "vacutainer" type systems are now available. These leave the needle in situ while the different specimen containers are attached. The specimen containers are pre-evacuated to draw up the precise volume of blood required for the test. The advantage to these closed systems is that there is no "aerosol" effect when transferring the specimen from the syringe to the container, and the volume should be automatically correct. However the various systems are incompatible and it takes some practice to hold the needle in place while changing the bottles. However the main problem is that there is no `flashback` when the needle enters the vein. To get around this problem while learning, a conventional green needle may be used on the end of a blue cannular connector. As well as this there can be cost implications.

 

WITHDRAWAL OF THE NEEDLE AND FURTHER MANAGEMENT

Once the required amount of blood has been drawn into the syringe or specimen container the needle should be left in place and a folded gauze swab or cotton wool ball placed over the entry site, (see fig 4).  Next the tourniquet is released, (see

fig 5). If this is not done venous blood will still be at high pressure when the needle is withdrawn causing significant bleeding and bruising. No pressure is applied on the swab until the needle has been withdrawn as this may cause pain and damage to the lower wall of the vein.  The instant the needle is withdrawn "white finger nail pressure" should be applied for two to three minutes to arrest haemorrhage, (see

fig 6).  The arm should not be folded as this will cause sheering forces to be applied to the hole in the vein, thereby enlarging it and causing more bleeding and bruising.  In addition if the arm is folded no white finger nail pressure can be applied over the entry site. A small sticking plaster may be applied to the site once the wound is sealed.

 

MANAGEMENT OF THE SPECIMEN

Blood should be transferred to the specimen bottles without forcing it quickly from the syringe as this may cause haemolysis and give altered results. This would especially cause raised potassium readings. If citrate bottles are used these may be rolled in the hands to ensure mixing. When using the vacutainer system no further transfer of blood is required. If a needle and syringe has been used and blood needs to be transferred to a vacutainer the needle should be inserted into the vacutainer and the appropriate volume of blood gently transferred.

 

DISPOSAL OF MATERIALS

The needle should be removed from the syringe as soon as it is withdrawn from the vein, (fig. 7).  With vacutainers, as long as the sharps container is big enough the needle and hub may be thrown away without unscrewing the needle. Again acquisition of such safe habits reduces the risk of inoculation injuries.

 

In terms of practitioner safety this is perhaps the most important stage of the procedure.  One study reported that 58% of needle stick injuries occurred when needles were cut, broken or recapped,(6).  The needle should be removed from the syringe using the graduated slot in the top of the sharps box.  The habit many nurses have of recapping needles can be overcome by disposal of the cap as soon as it is removed from the needle the first time.

 

The use of puncture resistant containers should now be universal, (see fig 8).  However they are often over filled, with sharps sticking out from the top of the container, so this should be avoided.  The use of these specific containers has been demonstrated to reduce related injuries three fold,(13).

 

DEALING WITH BLOOD SPILLAGE SHOULD IT OCCUR

Seamless gloves and a protective apron should be worn. The blood should be removed by sprinkling on enough hypochlorite granules to soak it up(7). The granules should be left on the spillage for at least two minutes before removal into a clinical waste bag with a with a scoop and scraper. The area may then be cleaned using a general purpose detergent.

 

An obvious additional danger is broken glass, if present this should be picked up using forceps. All contaminated materials should be collected in a puncture resistant container. A "spillage kit" could be available locally, (see Table 2)

 

CONCLUSION

If these guide-lines are followed venepuncture should indeed be a straightforward procedure, safe for nurse and patient, yielding accurate diagnostic results.

 

   -   Disposable towels

   -   Spillage absorption hypochlorite granules

   -   Waste bucket and lid

   -   Safety glasses

   -   Seamless gloves

   -   Plastic aprons

   -   Disposable scoop and scraper

   -   Clinical waste bag

   -   Chlorine releasing tablets, (a useful disinfectant)

   -   Forceps

Table. 2   Suggested contents of a "Spillage Kit"

 

 

Venepuncture – potential problems

 

Anxiety

Explanation of the procedure in broad terms before starting

Importance of a professional, "competent" approach

Recognise the problem as real and treat as such

Needle Phobia

Use of desensitisation techniques

Allow selected patients to familiarise themselves with the equipment to remove fears based on misconceptions

Use of local analgesic cream, (especially for children)

History of fainting

Take the specimen with the patient lying down

Use diversionary techniques to distract the patients attention, eg. asking questions

Elderly people with collagen loss

"Anchor" the vein with the left thumb

Make sure the needle is precisely in line with the vein

Obesity and/or hidden veins                              

Take time to learn the position of the vein by palpation

Ask the patient to squeeze on something in their hand

Gently tap or rub the area - do not slap

Use a sphygmomanometer cuff instead of a tourniquet inflated to diastolic pressure,

Immerse the arm in warm water

Consider use of an alternative site, eg. back of the hand or ankle

 

Stages in the procedure using needle and syringe

Appropriate explanation to the patient

 

Assess degree of expected patient compliance

 

Application of tourniquet

 

Palpation of candidate veins

 

Learn the position of chosen vein

 

Clean the skin with unidirectional swabbing

 

Allow time for antiseptic to dry

 

"Anchor" the vein

 

Line the needle up with the vein, go in at about 25 - 30`

 

Insert the needle  about 1-2 cm into the vein

 

Observe the flashback for conformation of entry

 

Stabilise syringe and needle

 

Withdraw required volume of blood

 

Release tourniquet

 

Apply dry swab over the entry site

 

Withdraw needle

 

Immediately apply white finger nail pressure

 

Ensure haemostasis

 

Asepsis is maintained at all times

 

Use of vacutainers

This has the advantage of protecting the practitioner from the blood as it is transferred from the vein directly into the specimen container.

 

Stages in the procedure

A needle is screwed into the hub, the sheath is left in position at this stage. The required specimen containers are arranged in the correct order.

 

The tourniquet is applied and the vein selected by palpation. The `line` and position of the vein is accurately assessed.

 

The site is cleaned using an alcohol based swab using unidirectional swabbing

 

The vein is `anchored` using the left, (on non - dominant thumb)

 

The sheath is removed from the needle and discarded

 

The hub and needle are lined up with the vein.

 

The needle is advanced into the vein penetrating the skin at an angle of about 25 -30`degrees.

 

The vein is `cannulated` by about 1 cm. Once the needle is in the vein the needle may need to be levelled off slightly to prevent the needle penetrating the other wall of the vein.

 

Once the needle is in the vein the first specimen container is pushed forward onto the sealed needle inside the hub. It is essential that the specimen container is not penetrated before the needle is in the vein, if this is done air would be drawn into the specimen container. When this is done the position of the hub must be secured with reference to the vein to prevent the needle being pushed through the vein.

 

One difficulty in learning the vacutainer system is the lack of a flash back when the vein is first entered. When learning to use the system a cannular connector may be screwed into the hub and a green needle fitted to the cannular connector, this combination should provide a flashback.

 

When the specimen bottles are changed it is essential to have a technique for securing the position of the hub to keep the needle in the same position in the vein.

 

The specimens must be collected in the correct order, plain tube for clotted specimen first, then biochemistry, then haematology. (Additives in the haematology tube can contaminate the blood in the biochemistry tube, potentially altering some results.)

 

Once the last specimen is collected the tourniquet is released. A dry swab is placed over the entry site of the needle, no pressure is applied until the needle is out of the arm. The instant the needle is out of the arm `white finger nail pressure` is applied to the site for three minutes to ensure haemostasis.

 

Throughout the procedure the systemic condition of the patient is monitored.

Asepsis is maintained at all times

 

References

1.  The Scope of Professional Practice, (1992), London, UKCC.

2. Code of Professional Conduct, (1992), UKCC.

3. Krasinski K. LaCouture R.  Holzman RS (1987).  Effects of changing needle disposal systems on needle injuries.  Infection Control, 8 (2):59-62, 1987 Feb.

4. Goldwater PN. Law R. Nixon AD. Officer JA. Cleland JF (1989).  Impact of recapping device on venepuncture related needle stick injury.  Infection Control and Hospital Epidemiology, 10 (1): 21-5  Jan.

5. Whitby M. Stead P Najman JM. (1991)  Needle stick injury: Impact of a recapping device and an associated education programme.  Infection control and hospital epidemiology, 12 (4) : 220-5 Apr.

6. De Laune S. (1990).  Risk reduction through testing, screening and infection control precautions.  Infection control and hospital epidemiology, 11 (10): 563-5, Oct.

7.  HMSO, (1990), Guidance for Clinical Health Care Workers: Protection Against Infection with HIV and Hepatitis Virus. 

8.  Pollard C. (1990), How to take blood, Practice Nurse, September.

9. Veikko AK. Philip F. (1978).  Is skin preparation necessary before insulin injection?  The Lancet, 1072-1073, 20th May.

10. Dann TC.  (1969)  Routine skin preparation before injection, An Unnecessary Procedure.  The Lancet, 96-98. July 12th.

11. Elliott TS.  Faroqui MH. Infections and intravascular devices. British Journal of Hospital Medicine.  48(8):496-7, 500-3, 1992 Oct 21-Nov 3.

12. Lippincott Nursing Series, Manual of Clinical Nursing Procedures, (1986).  Page 466, Harper and Row Ltd.

13. Ribner BS, Landry MN. Gholson GL. Linden LA. (1987)  Impact of a puncture resistant container system upon needle stick injuries.  Infection Control, 8 (2): 63-6, Feb.

 

 

Answer all of the following questions, it is best if this is done after discussion with colleagues on your ward or unit.

 

List the blood tests commonly carried out from your ward or unit. For each test you list give one example of diagnostic information that the test may yield.

 

 

 

 

 

For each of the tests listed state the type of container used and the volume of blood required for the test.

 

 

 

 

List the order in which vacutainer specimens should be taken, (using colour codes and the names of the specimen containers).

 

 

 

What steps would you take if a patient was particularly anxious prior to the procedure?

 

 

 

How would you modify the way you carry out the procedure if an individual has a history of syncope?

 

 

 

How would you select the vein to be used for withdrawal of the specimen?

 

 

 

How will you prepare the skin prior to needle insertion?

 

 

 

Why is it important to allow the alcohol on the skin to dry before inserting the needle?

 

 

 

List the reasons for bruising and/or haematoma formation after the procedure

 

 

 

For each of the possible caused of bleeding listed state how you will prevent its occurrence

 

 

 

How far into the lumen of the vein will you insert the needle?

 

 

 

How may pain be minimised during the procedure?

 

 

 

How may tissue damage be minimised during the procedure?

 

 

 

What additional measures will be taken if blood is being taken for blood culturing?

 

 

How will you remove the risk of nosocomial or other infectious complications from  the patient?

 

 

How will you minimise the risk to yourself and colleagues during and after the procedure?

 

 

 

What measures would you take if you unfortunately sustained a needle stick injury

 

 

 

What measures would you take if some blood was splashed into your eye?

 

 

Other points and comments

 

 

Finally read through these objectives and satisfy yourself that you can meet them all. Space is left under each objective for your self-evaluation or evaluation by someone else

 

 

The student will be able to;

 

 

Discuss the types of hypodermic needles, their sizes and individual indications.

 

 

Give reasons for the strict maintenance of asepsis.

 

 

Discuss how asepsis will be maintained in practice.

 

 

Describe possible veins which may be used for venepuncture.

 

 

Demonstrate the selection of an appropriate vein.

 

 

Describe the use of the tourniquet

 

 

Discuss the appropriate skin preparation for the procedure

 

Demonstrate the correct method of insertion of the needle.

 

Discuss the removal of the needle.

 

Discuss the correct methods for transferring blood specimens from

the syringe to the specimen bottles.

 

Discuss the protection of the practitioner and others from the possibility of nosocomial infection.

 

State current policy from "Guidance on the management of infections" re. wearing of gloves.

 

Describe how any haemorrhage or haematoma will be managed.

 

Discuss first aid and administrative procedures in the event of needle stick injury.

 

Discuss possible complications of cannulation, eg. air embolism, haematoma, infection.

 

Demonstrate awareness of the role of the Nurse in relation to the scope of professional practice document and the code of ethics.

 

Give the indications for venepuncture as agreed with local nurse managers

 

 

Once you have completed this pack you should keen it safe as part of your PREP portfolio

 

Please give John Campbell a call at St. Martins, Carlisle if any of the following apply;

 

*           You have any suggestions for improving this pack

*           There are any omissions of information or concepts

*           You have found any mistakes or points of disagreement

 

 

 

 

 

 

 

Fig. 1 Some possible sites for venepuncture. Underlying arteries and nerves are protected by muscle facia.

 

1. The tourniquet is applied. Time is taken to palpate and learn the position of the vein to be cannulated.

 

2.  The needle is inserted into the lumen, in line with the vein. Note the left thumb anchoring the vein in position.

 

3.  Once the vein is cannulated the left thumb is moved to secure the position of the needle. The specimen is drawn up.

 

4. When the specimen has been drawn up a cotton wool ball is placed over the entry site.

 

5. Prior to withdrawal of the needle the tourniquet is loosened. No pressure is applied to the cotton wool ball until after the needle has been withdrawn.

 

6. Bleeding is prevented by application of "white finger nail pressure" for at least two minutes.

 

7. The needle is removed from the syringe, using the slot on the sharps container, prior to transferring the specimen to the containers.

 

8. All equipment is safely disposed of.

 

 

 

 

Venepuncture

Background

Venous blood samples are often required for diagnostic tests in areas such as biochemistry, haematology, endocrinology or virology, (Black and Hughes 1997). The blood sample is removed from the venous circulation, usually from a vein in the arm.

 

Practical aspects

The procedure must be explained to the patient to reduce their anxiety and secure co-operation. Gloves should be worn to protect the nurse against accidental spillage of blood, however with good technique there should be no haemorrhage at all.

 

The equipment is assembled and a tourniquet is applied above the elbow. This will cause the veins to fill up with blood as their drainage is restricted, allowing improved palpation and needle insertion.

 

Possible veins which may be used are palpated, a suitable vein will feel full and bouncy. It is essential time is taken to learn the position of the vein to be used so venepuncture may be achieved at the first attempt, (Anonymous 1999). The direction and `line` of the vein must be assessed so the needle can be aligned along the vein later in the procedure. The vein chosen will often be in the upper forearm in the antecubital fossa. 

 

The skin over the vein should be cleaned, in one direction, using an alcohol impregnated swab. Unidirectional swabbing will remove bacteria from the area of overlying skin. The alcohol must be allowed time to dry, if the needle is inserted when the alcohol is still wet this will cause stinging.

 

The sheath is removed from the needle and discarded to remove the temptation of later re-sheathing. Most needle stick injuries occur when needles are re-sheathed unnecessarily after use, (De Laune 1990).

 

With vacutainers the needle is screwed into the needle holder, with a needle and syringe the needle is fitted firmly onto the syringe hub to produce an airtight seal.

 

The vein will tend to move when the needle is inserted, to prevent this it should be `anchored` with the left thumb. The needle is lined up along the line of the vein and should be inserted into the lumen at an angle of about 15 - 20 degrees. 

 

It is ensured that the pointed tip of the needle penetrates the skin first. A green (21 G) needle is normally used for venepuncture.

 

Once the needle is in the vein the angle may need to be reduced to prevent the penetration of the other wall of the vein, (Stevenson 1997). When using a needle and syringe a `flash back` of blood is usually seen in the hub of the needle. One of the disadvantages of the vacutainer system is that there is no flashback when the vein is first penetrated. When learning to use these systems a cannula connector may be screwed into the hub and a green needle fitted to the cannula connector, this combination should provide a flashback.

 

The needle should cannulate the vein by about 1 - 2 cm to give stability and prevent blood leaking out around the needle. The left thumb may now be moved to hold the needle holder or syringe in position.

 

With a needle and syringe the desired volume of blood is drawn up into the syringe using gentle suction. At this stage care should be taken not to pull the needle out of the vein prematurely.

 

With a vacutainer system the needle holder is held firmly and the first specimen container pressed onto the internal needle. When this is done the position of the needle holder must be secured to prevent the needle being pushed through the vein. It is essential that the specimen container is not penetrated before the needle is in the vein, if this occurred air would be drawn into the specimen container filling the vacuum.

 

With vacutainers the correct volume of blood should be drawn into the container automatically. If subsequent specimens are required the needle holder is secured with the left finger and thumb, the full specimen bottle removed and the next one pushed onto the internal needle. It is important to follow the manufacturers recommendations on the order in which the specimen bottles are filled. If this is not done fluids from one container may adversely effect the quality of a later blood sample.

 

Once the last specimen is collected the tourniquet is released. A dry swab is placed over the entry site of the needle; no pressure is applied until the needle is out of the vein. The instant the needle is out of the arm `white finger nail pressure` is applied to the site for three minutes to ensure haemostasis. Throughout the procedure the systemic condition of the patient is monitored.

 

If a needle and syringe system has been used the blood specimen will be transferred into the appropriate containers up to the marked volume lines. Specimen containers should be gently inverted 8 to 10 times to mix additives with blood.

 

A small sterile elastoplast may be applied over the puncture site, finally all used equipment must be safely disposed of.

 

 

Safe practice

The principle risks to the nurse are needle stick injury or being splashed with blood in the eye. Hepatitis B is more transmissible than HIV, so any nurse working with body fluids should be vaccinated against Hepatitis B and have their antibody levels checked. Hepatitis C is also a growing threat with no vaccination currently available.

 

Perhaps the main risk to the nurse is posed by unpredictable patients who may move or otherwise thrash around during the procedure, (Campbell 1995). If the procedure is explained and the psychological status of the patient assessed before commencement this risk may be minimised.

 

If an inoculation injury does occur the wound should be encouraged to bleed. This can be helped by squeezing around the puncture site to "milk" out as much blood as possible, it should also be held under warm running water. Both of these measures are designed to wash out as many possible infective agents as possible. Patient details should be recorded on an accident form and a medical opinion taken, usually through the occupational health department.

 

References

Anonymous.  Venepuncture. Nursing Standard.  13(36):supplement 1-2, 1999 May 26

Black F.  Hughes J.  Venepuncture.  Nursing Standard.  11(41):49-53,  1997 Jul 2.

Campbell J.  Making Sense of Venepuncture.  Nursing Times. 91 (27) 34 – 35 1995 August 2.

De Laune S.  Risk reduction through testing, screening and infection control precautions.  Infection control and hospital epidemiology. 11 (10): 563-5, 1990 Oct.

Stevenson B.   Venepuncture. Community Nurse.  3(9):21-2, 1997 Oct.

Venepuncture.             (Notes)

 

Read through these notes after you have attended a classroom session or watched the video and read through the above article. Make additional comments on the right hand side of the page of any  points that come to mind as you read.

 

Tests

*  haematological

*  biochemical

*  immunological

Treat person as  an individual

 

SAFE PRACTICE

Needle stick injury

*              Hepatitis B and C

*              HIV

 

First aid

 

*  encourage bleeding

*  squeeze the area

*  hold under warm running water

*  soak in iodine

 

Universal precautions

Seamless latex gloves

Unpredictable patients

Goggles

 

USE OF TOURNIQUET

*  greater than venous pressure

*  lower than arterial 

*  veins should feel "bouncy"

 

SELECTION OF A VEIN

Palpation

Visualisation

Antecubital fossa

 

*  palpate from side to side

*  palpate up and down

*  learn the position of the vein

*  check both arms

 

Never puncture an arterio-venous fistula

Skin cleaning with alcohol - allow time to dry

 

TEMPORARY VENOUS ACCESS

Anchor the vein

Insert along the line of vein

Pointed tip of needle first

Angle of entry into the vein - about thirty degrees

Continuous movement

Cannulate for about one to two centimetres

Secure the needle position

 

Adults - green needle, (21 G)

 

ALTERNATIVE SYSTEMS

Vacutainer type systems

 

WITHDRAWAL OF THE NEEDLE AND FURTHER MANAGEMENT

Tourniquet is released

Folded gauze swab or cotton wool ball

No pressure until needle is out

"White finger nail pressure"  - two minutes

Do not bend arm

A small sticking plaster

 

MANAGEMENT OF THE SPECIMEN

Remove needle

Transferred to the specimen bottles - no forcing

Citrate bottles - roll

 

DISPOSAL OF MATERIALS

58% of needle stick injuries - needles were cut, broken or recapped

Dispose of the cap beforehand

Puncture resistant containers

Do not overfill

Puncture proof containers -  reduce related injuries three fold

 

DEALING WITH BLOOD SPILLAGE SHOULD IT OCCUR

Seamless gloves, apron

Sprinkle on enough hypochlorite granules to soak it up

Granules should be left on the spillage for at least two minutes

Remove into a clinical waste bag

Scoop and scraper

Clean area with a general purpose detergent

Broken glass - forceps

 

CONCLUSION

Safe for nurse and patient

Accurate diagnostic results

 

COMMENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Venepuncture

 

Anxiety

Explanation of the procedure in broad terms before starting

Importance of a professional, "competent" approach

Recognise the problem as real and treat as such

Needle Phobia

Use of desensitisation techniques

Allow selected patients to familiarise themselves with the equipment to remove fears based on misconceptions

Use of local analgesic cream, (especially for children)

History of fainting

Take the specimen with the patient lying down

Use diversionary techniques to distract the patients attention, eg. asking questions

Elderly people with collagen loss

"Anchor" the vein with the left thumb

Make sure the needle is precisely in line with the vein

Obesity and/or hidden veins                              

Take time to learn the position of the vein by palpation

Ask the patient to squeeze on something in their hand

Gently tap or rub the area - do not slap

Use a sphygmomanometer cuff instead of a tourniquet inflated to diastolic pressure,

Immerse the arm in warm water

Consider use of an alternative site, eg. back of the hand or ankle

 

Stages in the procedure using needle and syringe

Appropriate explanation to the patient

 

Assess degree of expected patient compliance

 

Application of tourniquet

 

Palpation of candidate veins

 

Learn the position of chosen vein

 

Clean the skin with unidirectional swabbing

 

Allow time for antiseptic to dry

 

"Anchor" the vein

 

Line the needle up with the vein, go in at about 25 - 30`

 

Insert the needle  about 1-2 cm into the vein

 

Observe the flashback for conformation of entry

 

Stabilise syringe and needle

 

Withdraw required volume of blood

 

Release tourniquet

 

Apply dry swab over the entry site

 

Withdraw needle

 

Immediately apply white finger nail pressure

 

Ensure haemostasis

 

Asepsis is maintained at all times

 

Use of vacutainers

This has the advantage of protecting the practitioner from the blood as it is transferred from the vein directly into the specimen container.

 

Stages in the procedure

A needle is screwed into the hub, the sheath is left in position at this stage. The required specimen containers are arranged in the correct order.

 

The tourniquet is applied and the vein selected by palpation. The `line` and position of the vein is accurately assessed.

 

The site is cleaned using an alcohol based swab using unidirectional swabbing

 

The vein is `anchored` using the left, (on non - dominant thumb)

 

The sheath is removed from the needle and discarded

 

The hub and needle are lined up with the vein.

 

The needle is advanced into the vein penetrating the skin at an angle of about 25 -30`degrees.

 

The vein is `cannulated` by about 1 cm. Once the needle is in the vein the needle may need to be levelled off slightly to prevent the needle penetrating the other wall of the vein.

 

Once the needle is in the vein the first specimen container is pushed forward onto the sealed needle inside the hub. It is essential that the specimen container is not penetrated before the needle is in the vein, if this is done air would be drawn into the specimen container. When this is done the position of the hub must be secured with reference to the vein to prevent the needle being pushed through the vein.

 

One difficulty in learning the vacutainer system is the lack of a flash back when the vein is first entered. When learning to use the system a cannular connector may be screwed into the hub and a green needle fitted to the cannular connector, this combination should provide a flashback.

 

When the specimen bottles are changed it is essential to have a technique for securing the position of the hub to keep the needle in the same position in the vein.

 

The specimens must be collected in the correct order, plain tube for clotted specimen first, then biochemistry, then haematology. (Additives in the haematology tube can contaminate the blood in the biochemistry tube, potentially altering some results.)

 

Once the last specimen is collected the tourniquet is released. A dry swab is placed over the entry site of the needle, no pressure is applied until the needle is out of the arm. The instant the needle is out of the arm `white finger nail pressure` is applied to the site for three minutes to ensure haemostasis.

 

Throughout the procedure the systemic condition of the patient is monitored.

Asepsis is maintained at all times

 

The student will be able to;

 

 

Discuss the types of hypodermic needles, their sizes and individual indications.

 

 

Give reasons for the strict maintenance of asepsis.

 

 

Discuss how asepsis will be maintained in practice.

 

 

Describe possible veins which may be used for venepuncture.

 

 

Demonstrate the selection of an appropriate vein.

 

 

Describe the use of the tourniquet

 

 

Discuss the appropriate skin preparation for the procedure

 

Demonstrate the correct method of insertion of the needle.

 

Discuss the removal of the needle.

 

Discuss the correct methods for transferring blood specimens from

the syringe to the specimen bottles.

 

Discuss the protection of the practitioner and others from the possibility of nosocomial infection.

 

State current policy from "Guidance on the management of infections" re. wearing of gloves.

 

Describe how any haemorrhage or haematoma will be managed.

 

Discuss first aid and administrative procedures in the event of needle stick injury.

 

Discuss possible complications of cannulation, eg. air embolism, haematoma, infection.

 

Demonstrate awareness of the role of the Nurse in relation to the scope of professional practice document and the code of ethics.

 

Give the indications for venepuncture as agreed with local nurse managers