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 

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

Try it out with a simulated station

1. Venepuncture
2. Find more stations here!