The Procedure
Venepuncture protocol:
1. Get the necessary forms and tubes for the tests required. Most wards have a chart for what tubes contain what additives and the order the blood must be collected in.
2. Collect all of the equipment you require. Vacutainers are used more frequently these days as they are less prone to sharps injuries and spillages. For difficult veins, however, the standard needle and syringe is best as you get a flashback of blood when you are in the vein (you do not with a vacutainer). For small hand veins, use a butterfly needle and adaptor to attach to the syringe (use a small volume syringe or else the pressure will collapse the vein).
3. Introduce yourself to the patient, check their identity, explain what you are going to do, and obtain their consent.
4. Attach the tourniquet to the upper arm of the patient (preferably use their non-dominant arm), and ask them to open and close their fist so that the veins become more prominent. Lowering the arm can help, as can warm conditions (immersing the hand in warm water can also help in really difficult to find veins). Remember that the best veins are often more palpable than they are visible.
5. Select a suitable vein - the antecubital fossa (median cubital vein) is usually the best site. If there is an IV infusion running into the arm, make sure you take blood distal to it (not proximal to the infusion, or else you will get incorrect results).
6. Swab the skin over the vein with a single sweep of the alcohol swab, and allow it to dry so that it does not sting.
7. Put on your gloves, and inform the patient that they will feel a sharp scratch. Pull back the skin distal to the site of skin penetration and keep it held taut. Insert the needle at an angle of between 30-40 o to the surface. If you are using a vacutainer, support the reservoir with your left hand, and then insert the vacutainer bottles into the barrel with your right hand, making sure that you do not push the needle further into the patient's vein or else you will go through it. It can be best to hold the vacutainer barrel with your index finger on the underside and thumb on the top. Then curl your 3rd, 4th and 5th fingers into your palm, and rest these beneath the vacutainer, helping you to maintain the angle and 'supporting' the vacutainer from moving. If you are in the vein, then the tubes will rapidly fill with blood upon insertion. Be careful not to pull the needle out when you remove/switch the tubes. Fill all the bottles that you require. With a needle and syringe, make sure that you withdraw the plunger a little and suck some air in then completely pump it out before you begin, or else it will feel very stiff when you begin withdrawing blood.
8. Remove your tourniquet when you are done.
9. Hold your cotton wool over needle (do not touch the needle or you will cause unnecessary pain as you withdraw the needle) and swiftly withdraw it. Then press down the cotton wool and apply pressure for a few minutes.
10. Dispose of your sharps immediately. You used them, so it is your responsibility to dispose of them.
11. Label the blood bottles with the name, hospital number, date of birth and date of sample, and then place them into the appropriate bags.
12. Apply a small plaster to patient's arm if required (ensure that the patient does not have an allergy to glue or latex first!), and then thank the patient. Finally, as always, wash your hands.
