Table of Contents
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
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 10-30Ëš 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!