Table of Contents
Introduction
Venepuncture is the process of taking a sample of blood from a vein. This is done using a needle and barrel, which uses a vacuum, and a blood bottle is connected to collect samples.
Blood samples are essential for many primary and secondary care investigations and are frequently seen in practice. Necessary blood samples are used to match blood transfusions and diagnose many conditions.
Equipment needed
- Hand Gel/Alcohol Gel
- Non-sterile gloves
- Alcohol swab
- Gauze
- Tourniquet
- Barrel
- Needle of choice (see guide below)
- Correct blood bottle for patient
- Clinical waste bin
- Labels for bottles/ forms with correct patient details
- Clean procedure tray
- Sterile plaster
- Pen to write details if needed.
- Laboratory form/bag
Precautionary checks
It’s crucial to ensure the information is correct and matches the patient’s information when taking blood.
Blood bottles:
– Type of bottle with colour matches needed for the patient
– Check against laboratory forms of what is needed
– Check the expiry of bottles and equipment
Key sites:
– Site of venupuncture
– Suitable vein
Patient information:
– Patient ID (Date of birth, Patients’ full name, NHS number)
– Allergies!
– Patient chart (Note any blood thinning medications may lead to increased bleeding afterwards)
– Consent for procedure
Before venupuncture:
- Wash your hands.
- Ensuring you have the correct PPE and equipment.
- Introduce yourself to the patient ensuring you are checking patient ID and allergies (latex allergy due to glove use) and check the prescription chart.
- Check the type of blood bottles taken note order of the draw.
- Explain the procedure to the patient and explore any concerns they have. Ensure the patient gives consent.
- Check if the patient is in any pain.
Order of draw:
The order of draw is vital as bottles need to be filled in a particular order to reduce the chance of sample contamination and improve the accuracy of results.
1) Blood cultures – aerobic sample before anaerobic sample to reduce air into the anaerobic sample.
2) Light Blue – Coagulation screen, INR, and D-dimer.
3) Red – Serology.
4) Gold – U&Es, LFTs, bone profile, CRP, thyroid function tests, troponin, lipid profile.
5) Green – Ammonia, insulin, renin, and aldosterone.
6) Purple – FBC, blood film, ESR and HbA1c.
7) Pink – Group and save, allowing for crossmatching and direct anti-globulin test.
8) Dark Blue – Trace elements.
9) Grey – Serum glucose and lactate.
Choosing the arm
1) Choose an arm to perform venepuncture and ask the patient if they have a preference.
– Ask if they have any medical conditions that prevent limb use, such as arterio-venous fistula, lymphoedema or a stroke affecting the movement of a limb and avoid causing damage.
– If they have an IV infusion in one arm, do not perform on this arm as it could alter blood test results of medications given IV.
2) Place a pillow under the chosen arm.
Choosing the vein
The median cubital vein in the antecubital fossa is commonly used for venupuncture. It is also possible to take blood from the hands, feet, and wrists.
– Avoid areas of broken skin or redness
– Avoid areas where two veins join as they may contain valves in that area. 
- Position the patient’s arm in a comfortable, extended position to get access to the site.
- Apply the tourniquet approximately 4-5 finger-widths above the planned venepuncture site. Ensure this is not too tight or too loose. Tie using the quick-release mechanism.
3. Palpate the vein and ensure it is ‘soft and bouncy’ avoiding veins that feel hard, which could be due to phlebitis.
4. Release the tourniquet; this should not be left on longer than one minute as it could lead to blood pooling.
5. Wash hands and put on gloves.
6. Clean the site of venupuncture using the alcohol swab working from the centre to around 5cm away. Clean for 30 seconds and let it dry for 30 seconds.
After this do not touch the site. If you do, you will need to reclean the site.
7. If removed tourniquet reapply, then attached the needle to barrel (depends on equipment).
8. Ensuring your equipment in ready and blood bottles in the correct draw order, and are accessible, unsheathe the needle.
9. Anchor the vein by using your non-dominant hand to gently pull on the skin below the insertion site, exposing the vein more.
10. Warn the patient of a sharp scratch.
11. Make sure the bevel faces upwards and insert the needle at a 30-degree angle. Check for flashback and feel a decrease in resistance as it enters the chosen vein.
12. Insert only 1-2mm further in whilst lowering the wings using a butterfly needle or holding the needle in place, ensuring it doesn’t move.
13. Attach the blood bottles within the correct order of draw filling appropriately and use a twist to attach to the barrel and release.
14. When releasing ensure the needle doesn’t move. Repeat with other bottles.
15. When finished all bottle taking, release the tourniquet by quick release.
16. Then withdraw the needle out of the arm and apply gauze or cotton wool.
17. Ask the patient to hold pressure to the site whilst the sharp is safely disposed into the correct sharps bin.
18. Then apply plaster and check on the insertion site for any abnormalities. Then, safely discard the rest of the equipment, remove gloves, and wash hands.
19. Ensure patient is well, thank them for their time, and to seek review if the site becomes painful or inflamed.
Post-procedure
Number of Inversions:
Inverting the bottle allows the additives to mix the sample taken, aiding it in being correctly used. It is recommended that each bottle be inverted a specific number of times.
Light blue: 3-4 inversions
Red: 5-6 inversions
Gold/yellow: 5-6 inversions
Green: 8-10 inversions
Purple: 8-10 inversions
Pink: 8-10 inversions
Dark Blue: 5-10 inversions
Grey: 8-10 inversions
Labelling:
It is important to label bottles with the correct patient details and time of draw (when was the sample taken).
Note on labelling:
- Patient name
- Patient date of birth
- Patient NHS Number
- Time of sample taken and date
- All samples are labelled
Ensure that it matched the record again.
- Seal the bottles within the laboratory bag and ensure every bottle is labelled before sealing and sending samples.
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