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Venepuncture

TI CMPP:CANNU&VENE 0019/09Brought to you by Trust Interventions

Venepuncture is the procedure of inserting a needle into a vein, usually to obtain blood

In order to do this safely the student must:

1. Know the relevant anatomy and physiology

2. Understand the criteria for selection of an appropriate vein and device

3. Appreciate potential problems that may occur

4. Have an awareness of associated Health and Safety/ risks involved in undertaking the procedure and correct disposal of equipment

TI CMPP:CANNU&VENE 0019/09

Indications• To obtain blood for diagnostic purposes

• To establish/ monitor levels of blood components

• To establish/ monitor levels of drugs

• To monitor response to medical treatments (e.g. fluids)

• To provide a sample to cross match prior to transfusion

• To screen for infection


Vein construction: 3 Layers

Tunica adventitia

Connective tissue

Surrounds, supports

Tunica media

Muscular tissue

Contracts and relaxes

Tunica intima

Smooth endothelial cells

Valves


Selecting a site

Usually those found in the antecubital fossa

1. Median cubital vein2. Cephalic vein3. Basilic vein

Metacarpal veins should only be utilised for venepuncture when the other veins are not accessible


Choosing a vein• Accessible• Unused• Easily detected• Appears healthy and patent

The most prominent vein is not necessarily the most suitable vein

-Visual inspection

-Palpation


Visually scrutinise the veins in both arms, avoiding:• Evidence of infection, bruising and phlebitis• An oedematous limb where there is status of lymph• Areas of previous venepuncture. Repeated trauma

causes pain

Palpate veins too:• Distinguish vein from arteries and tendons• Identify deeper veins and presence of valves• Use index finger, or fore finger, not thumb• Healthy veins are soft, bouncy and refill when depressed


Other factors influencing vein selection

? Injury, disease or treatment

? Position of patient

? Age of patient

? Weight of the patient

? Dehydration or Shock

? Medication/ condition that causes excessive bleeding or delayed clotting (anticoagulants, steroids, thrombocytopenia)

? Fear


Hazards/ Risks• Infection- adherence to an aseptic technique (thorough hand

washing and use of alcohol gel) required. Performed with single use equipment, non- sterile gloves may be worn.

• Accidental damage- inadvertently punctured nerve, tendon or artery. Spend time undertaking visual inspection and palpation.

• Haematoma- Caused by poor technique, failure to remove the tourniquet before removing the needle and inadequate pressure on the site. Patient/ Client must not flex arm on completion of the procedure. Identify those with relevant medical history/ drug therapy.


Associated hazards

• Incorrect or lack of details on request form and/or sample- Increases likelihood of errors occurring. Sample will be rejected by lab, necessitating repetition of the procedure. Always check details with patient, request form and sample correspond.

• Insufficient sample/ wrong specimen bottle- necessitating repetition.

• Needlestick injury- correct use of Vacutainer system and Sharps policy help reduce this.

• Infected/ ‘High risk’ samples- correctly identified as such through labelling so all those involved with handling are aware.


Equipment list…..Sharps binProcedure trayNon-sterile glovesApronVacutainer device/ needleTourniquetAlcohol hand gelPatient identification labelsSpecimen requestSpecimen bottleGauze/ swab


Procedure

• Correctly identifies patient/ gains consent• Hand washing/ use of alcohol gel• Supports chosen limb• Applies Tourniquet• Selects appropriate vein


Technique

• Anchor vein• Verbally warn patient• Insert needle smoothly at angle of 15-30 degrees with bevel

upwards• Level off needle and advance approx 1mm• Push specimen bottle into heamguard• Allow vacutainer to fill specimen bottle• Gently but firmly remove bottle• Remove tourniquet• Cover puncture site with gauze, remove needle, dispose of needle

into sharps bin• Apply pressure to straight arm, apply plaster• Correctly label sample


References and further reading

Nottingham City Hospital/ queens Medical Centre/ Rushcliffe PCT Nursing Practice Guidelines (2004) Venepuncture using the Vacutainer System (*Accessible on Hospital intranet- contains extensive further reading list)

Nottingham City Hospital/ Queens Medical Centre Nottingham ‘Working in New Ways’ (2004) Venepuncture and Cannulation: An educational Self-directed Package for Registered Nurses, Midwives and Non- registered staff.

Johnson and Johnson (1997) Practical Guide to Peripheral Cannulation

R.Seeley, T Stephens, P.Tate (1988) Anatomy and Physiology


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Documents

establish monitor levels

ti cmpp

obtain blood

request form

cannu

vacutainer system

veins

patient