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11/13/24, 7\:28 PM Guide | Venepuncture

Venepuncture

Table of contents
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Gather equipment

Collect all equipment needed for the procedure and place it within reach on a tray or trolley, ensuring that all the items are
clearly visible\:
Clean procedure tray
Non-sterile gloves
Tourniquet
requirements.
Blood sampling device (e.g. butter
Blood specimen bottles
Sharps container
Alcohol swab (2% chlorhexidine gluconate in 70% isopropyl)
Gauze or cotton wool
Sterile plaster
Laboratory forms, labels and transportation bag
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Gather equipment

Introduction

Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Brie
i n v o l v e s i n s e r t i n g a s m a l l n e e d l e i n t o y o u r v e i n . Y o u m a y b r i e
"
Gain consent to proceed with venepuncture.
Check if the patient has any allergies (e.g. latex).
Adequately expose the patient's arms for the procedure.
Position the patient so that they are sitting comfortably. If a bed is available, the patient can lay down for the procedure (this is
sometimes preferable, particularly if the patient is prone to vasovagal syncope).
Ask the patient if they have any pain before continuing with the clinical procedure.

Choosing an arm

1. Choose an arm to perform venepuncture on\:
You should ask the patient if they have a preference.
Pre-existing medical conditions may prevent particular limbs from being used (e.g. arterio-venous
stroke a
Do not perform venepuncture on an arm that has an intravenous infusion in progress as this may alter blood test results.
2. Place a pillow under the relevant arm.

Choosing a vein

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1. Inspect the patient's arm for an appropriate venepuncture site\:
The median cubital vein in the antecubital fossa is commonly used for venepuncture.
Areas of broken, bruised or erythematous skin should be avoided.
Areas in which two veins join should be avoided where possible, as valves are often present.
2. Position the patient's arm in a comfortable extended position that provides adequate access to the planned venepuncture
site.
3. Apply the tourniquet approximately 4-5
4. Palpate the vein you have identi
Gently stroking or tapping the vein can make it easier to visualise and palpate.
An ideal vein feels 'springy'
. A vein that feels hard is likely sclerosed, thrombosed or phlebitic (in
avoided.
5. Once you have identi
more than 1-2 minutes at a time.
6. Wash your hands again.
7. Don gloves (gloves don't need to be worn for cleaning the site, but they should always be donned prior to performing
venepuncture itself).
8. Clean the site with an alcohol swab for 30 seconds and then allow to dry completely for 30 seconds\:
You should start cleaning from the centre of the venepuncture site and work outwards to cover an area of 5cm or more.
DO NOT touch the cleaned site afterwards at any point, otherwise, the cleaning procedure will need to be repeated prior to
venepuncture.
Inspect the patient's arm for an appropriate vein

Insertion of the needle

1. Re-apply the tourniquet if removed previously.
2. Attach the needle to the barrel (some blood collection systems come pre-assembled, such as the butter
barrel shown in the video).
3. Unsheathe the needle.
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4. Anchor the vein from below with your non-dominant hand by gently pulling on the skin distal to the insertion site.
5. Warn the patient that they will experience a sharp scratch.
6. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. You should see
the needle's chamber and feel a sudden decrease in resistance as the needle enters the vein.
7. Advance the needle a further 1-2 mm into the vein after
8. Lower and anchor the needle to the patient's skin using the wings of the butter
9. Attach each blood bottle, in the correct order of draw, to the barrel and allow them to
to continue to anchor the needle to the skin as you remove each bottle from the barrel by gently pulling and twisting. If no
blood begins to
10. Release the tourniquet.
11. Withdraw the needle and then apply gentle pressure to the site with some gauze or cotton wool.
12. Ask the patient to hold the gauze or cotton wool in place whilst you dispose of the needle into a sharps container.
13. Apply a dressing to the patient's arm (e.g. cotton wool, gauze, plaster).
14. Invert each of the blood bottles the suggested number of times based on its colour.
15. Discard the used equipment into the appropriate clinical waste bin.
Unsheathe the needle and ensure the bevel is facing upwards
Number of times to invert blood bottles
Inversion aids the mixing of a blood sample with the blood bottle's additives. The recommended number of times a
blood bottle should be inverted di
Light blue\: 3-4 inversions
Gold/yellow\: 5-6 inversions
Purple\: 8-10 inversions
Pink\: 8-10 inversions
Grey\: 8-10 inversions
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Blood tests and order of draw
Di
speci
Below is a list of the common blood bottle types and the associated blood tests, organised by the recommended order
of draw\:
1. Blood culture\: these bottles should always be attached
2. Light blue\: coagulation screen, INR and D-dimer.
*
3. Gold/yellow\: U&Es, CRP, LFTs, amylase, calcium, phosphate, magnesium, TFTs, lipid pro
4. Purple\: FBC, blood
5. Pink\: group and save allowing for crossmatching.
6. Grey\: glucose and lactate.
*If your
to obtain a full sample. This is because when you attach the
sample that is unable to
blood bottle to remove the air (i.e.
level.
If you want to learn more, check out our blood bottles guide.

To complete the procedure...

Explain to the patient that the procedure is now complete and that they should seek review if the venepuncture site becomes
painful or in
Thank the patient for their time.
Document the patient's details on the blood sample bottles at the bedside (using either pre-printed or handwritten labels).
Dispose of PPE appropriately and wash your hands.
Send the blood samples to the lab for analysis in an appropriate plastic leak-proof bag with the completed laboratory request
form.

Reviewer

Graham Bone
Senior Clinical Lecturer in Medical Education

References

1. WHO guidelines on drawing blood\: best practices in phlebotomy. Published in 2010. Available from\: [LINK].
2. WHO Guidelines on Hand Hygiene in Healthcare\: a Summary. Published in 2009. Available from\: [LINK].
Source\: geekymedics.com
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