Venepuncture Training

Aim of The Session

To ensure staff will have the knowledge and skills to perform venepuncture safely and effectively

Learning Objectives

• Outline current legislation, local policies and procedures relevant to venepuncture practice

• Distinguish between when to perform venepuncture and when it should not be performed

• Describe the relevant anatomy and physiology of the arm and name the common veins used for venepuncture.

Demonstrate the correct procedure for obtaining venous blood samples

Venepuncture Competency Requires You to

Understand your Role & Responsibilities

Knowledge of Procedure and all related Policies

Trained to Undertake Venepuncture

Assessed prior to undertaking Venepuncture

Record your competency and keep Updated

Legal Framework

Duty of Care

responsibility to deliver high quality safe care to required standard

Accountability

being responsible for acts or omissions

Incident Reporting

Risk Assessment

RecordKeeping

Consent

InfectionPrevention

Control

Health And Safety

Venepuncture

Policies And Guidelines

Underpinning Policies and Guidelines

Venepuncture

Introduction of a needle into a vein in order to obtain a blood sample

Reasons For Undertaking Venepuncture

>Investigative purposes

>To detect a disease or illness

>Monitoring clinical conditions or medications

ANATOMY & PHYSIOLOGY OF BLOOD AND BLOOD VESSELS

DIFFERENT APPROACHES

BLOOD COLLECTION SYSTEMS

UNIVERSAL PRECAUTIONS

RIGHT EQUIPMENT

CONTRAINDICATIONS

POTENTIAL PROBLEMS

WHEN TO SEEK ASSISTANCE

REPORT INCIDENTS

PROCEDURE

Venepuncture Knowledge

Blood - Three Main Functions

1.Transports oxygen, waste products and nutrients

2. Regulates body temperature

3. Protects against blood loss through clotting mechanisms

ARTERIES

To The Heart

Oxygenated Blood

Thicker Wall

Muscular

VEINS

From The Heart

Deoxygenated Blood

Thinner Wall

Less Muscular

Blood Vessels

Veins commonly used

Median Cubital Accessory Cephalic Basilic

Easily Accessible Less Painful.

Number of Attempts

Median Nerve

Shooting Pain in arm

> Abnormal sensation (Dysethesia)

Special Precautions

Alternative Sites used in LCH but only after training !

Systems in Use in LCH

VACUTAINER

MONOVETTE

Infection Control

Attend Mandatory Training 2 yearly

Follow LCH Trust Policy

Decontamination Clinical AreaDecontamination of HandsUse of PPEDisposal of Waste

Waste Disposal

Attend Health and Safety Training 3 yearly

Follow LCH Trust Policy.Safe Use and Disposal of Sharps

GOOD

SoftBouncyRefills when depressedVisible

Characteristics of Veins

POOR

FirmRoll easilyFeel Cord Like

CAUTION HERE

if it PULSATES, feels ELASTIC (ARTERY)

X XSites to Avoid

Scars from burns and surgery

Arm on side of a Mastectomy

Haematoma/ Bruising

IV / Transfusion arm

Oedema

Site of previous venepuncture attempts

( RCN 2003)

Blood Form not Completed in full

Patient is Unwell

Child under ??

Patient cannot consent to procedure

3 attempts have been made

X XWhen Not Perform if ……………

Gloves Tourniquet – (disposable or decontaminate between use)Needles butterflies /adaptersBlood Collection system Alcohol hand gel/rubReceiversSharps boxAdhesive Spot PlastersLow Linting gauze

Equipment

RLBUHT – Handout 1AINTREE – Handout 2

Order of Draw

Specific Test

Testosterone take sample before noon.

Carbamazepine, Phenobarbitone and Phenytoin ranges are for pre dose samples

Lithium range is for 12 hours post dose

Digoxin at least 6 hours post dose.

Hematoma formed

Vein collapsed

Bevel near or in vein wall

Needle passed through vein

Trouble Shooting - No blood flow

Trouble shooting - Small veins

• Costly• Safety device• Used when vacuum in

evacuated system may be too much for fragile veins

Bright Red Blood. Arterial Puncture Remove needle Tube fills fast

quickly, apply pressure IR1

Uncontrolled Bleeding Anticoagulant therapy Apply Pressure at puncture site

Haematoma Trauma to vein or late Apply pressure release of tourniquet

Pain Needle hits nerve STOP PROCEDURE seek advice form senior colleague IR1

Adverse Events Possible Causes First Aid

Adverse Events Possible Causes First Aid

Nausea, Giddiness Needle phobia Don’t Panic, StopSweating, Pallor Anxiety, Stress procedure. Sit or lie Rapid Pulse, sudden Heat, Pain, Hunger down if possible, raise loss of consciousness Medical Conditions legs, loosen clothing,

call for assistance, monitor airway until patient recovers, givewater, reassure, contactrelative to accompany home. IR1

FAINTING

Specific Individual Needs

Alternative or Additional Communication Needs

Adjustment to Appointments

Alternative types of appointments

Different Practitioners

Disabled access

Best Interest Assessment

Other

Contact Equality and Diversity Team either via the internet or

Tel: 0151 295 3041

YOU Request Form is completedCollect equipmentInfection Control Procedures

ENVIRONMENT Clean, Well lit

Appropriate

PATIENT Consent and Agree to procedurePositive Patient IdentificationNo Contraindications

Before You Begin - Prepare and Protect

Step by Step Guide to Venepuncture

Over To You

Venepuncture is a common Procedure

Undertaken by a Range of Healthcare Staff

Duty of Care to provide High Quality Safe Care

Practical skill requires updating and assessing regularly

Work within Policy and Guidelines

Summary Learning

Laboratory Test Results are only as good as the specimen and the specimen is only as good as the method by which it is collected, handled and processed.

Competency Assessment

Practice, Practice, Practice