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Peripheral venepuncture

Introduction

  • Wash hands
  • Introduce self
  • Patient’s name, DOB and wrist band
  • Explain procedure and obtain consent
  • Check for allergies (including chlorhexidine)
  • Ask preferred (or non-dominant) arm 
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Venepuncture equipment

Preparation 

  • Wash hands 
  • Clean tray
  • Gather equipment around tray (think through what you need in order)

Equipment list

  • Gloves
  • Tourniquet 
  • Alcohol 70%/chlorhexidine 2% skin-cleansing wipe
  • Green 21G Vacutainer needle (standard or butterfly)
  • Vacutainer holder
  • Required blood tubes (in order of draw order)
    • Light blue – clotting 
    • Yellow – U&Es and everything else 
    • Purple – FBC  
    • Pink – group and save
    • Grey – glucose 
    • NB: yellow tube must be taken before purple tube which contains K+ EDTA that will produce a pseudo-hyperkalaemia)
  • Sterile gauze
  • Tape

  • Wash hands
  • Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
  • Attach Vacutainer holder to end of needle/butterfly
  • Return to patient (with tray and a sharps bin)

Procedure

Vein identification

  • Wash hands 
  • Expose arm and place a pillow beneath it
  • Place tourniquet around patient’s arm 4-5 finger widths above intended venepuncture site (antecubital fossa is usually the easiest)
    • NB: if you are using the back of the hand, you must use a butterfly needle.
  • Identify a suitable vein (i.e. one you can feel, not necessarily one you can see)
    • NB: take sufficient time to find the best vein – this is the main determinant of whether you will be successful or not.
  • Remove tourniquet

Venepuncture 

  • Wash hands
  • Put on gloves
  • Sterilise area using skin-cleansing wipe (clean for 30 seconds, then allow to air-dry for 30 seconds)
  • Re-apply tourniquet
  • Anchor the skin distally with your non-dominant hand and insert the needle (bevel up) at 10-30˚ with your dominant hand

Use your dominant hand to hold the butterfly wings/Vacutainer steady on the patient’s arm. Then use your non-dominant hand to:

  • Fill blood bottles in correct order of draw, inverting them after filling
  • Remove tourniquet after removing the last bottle 
  • Place gauze loosely over the puncture site while you remove the needle. Then apply pressure to the gauze once the needle is fully removed.
  • Put the needle immediately in the sharps bin
  • Maintain pressure over the gauze until bleeding has stopped, then tape the gauze down over puncture site

To complete

  • Thank patient and restore clothing
  • Discard waste and clean tray; then discard gloves; wash hands
  • Fill in blood bottle labels, put in bags with printed request forms, send to lab
  • Document procedure and tests requested in patient’s notes

Learn how to interpret the results too…

We have notes on interpreting the full blood count, urea & electrolytes, liver function tests, and the coagulation screen!

Try it out with a simulated station

  1. Venepuncture
  2. Find more stations here!
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