The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [412]
Venepuncture itself may cause the vein to collapse or go into a spasm. This will produce discomfort and a reduction in blood flow. Careful preparation and choice of vein will reduce the likelihood of this and stroking the vein or applying heat will help resolve it (Dougherty 2008).
Involving patients in the choice of vein, even if it is simply to choose the non-dominant arm, can increase a feeling of control which in turn helps to relieve anxiety (Hudak 1986).
The environment is also another important consideration. In the inpatient and outpatient setting, lighting, ventilation, privacy and position must be checked and optimized where possible. This will ensure that the patient and the operator are both comfortable. Having adequate lighting is also beneficial as it illuminates the procedure, ensuring the operator has a good view of the vein and equipment (Dougherty 2008).
Procedure guideline 11.1 Venepuncture
Essential equipment
Clean tray or receiver
Tourniquet or sphygmomanometer and cuff
21 swg multiple sample needle or 21 swg winged infusion device and multiple sample Luer adaptor
Low-linting gauze swabs
Sterile adhesive plaster or hypoallergenic tape
Specimen request forms
Plastic tube holder, standard or for blood cultures
Appropriate vacuumed specimen tubes
Swab saturated with chlorhexidine in 70% alcohol, or isopropyl alcohol 70%
Non-sterile, well-fitting gloves
Plastic apron (optional)
Sharps bin
Preprocedure
Action Rationale
1 Approach the patient in a confident manner and explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008b, C).
2 Allow the patient to ask questions and discuss any problems which have arisen previously. Anxiety results in vasoconstriction; therefore, a patient who is relaxed will have dilated veins, making access easier. E
3 Consult the patient as to any preferences and problems that may have been experienced at previous venepunctures. Check if they have any allergies. To involve the patient in the treatment. To acquaint the nurse fully with the patient’s previous venous history and identify any changes in clinical status, for example mastectomy, as both may influence vein choice (Dougherty 2008, E). To prevent allergic reactions, for example to latex or chlorhexidine (McCall and Tankersley 2008, E).
4 Check that the identity of the patient matches the details on the request form by asking for their full name and date of birth and checking their identification bracelet. To ensure the sample is taken from the correct patient (NPSA 2007, C; RCN 2010, C).
5 Assemble the equipment necessary for venepuncture. To ensure that time is not wasted and that the procedure goes smoothly without unnecessary interruptions. E
6 Carefully wash hands using bactericidal soap and water or bactericidal alcohol handrub, and dry before commencement. To minimize risk of infection (DH 2007a; Fraise and Bradley 2009, E).
7 Check hands for any visibly broken skin, and cover with a waterproof dressing. To minimize the risk of contamination to the practitioner (DH 2007a, C; Fraise and Bradley 2009, E).
8 Check all packaging before opening and preparing the equipment on the chosen clean receptacle. To maintain asepsis throughout and check that no equipment is damaged. E
Procedure
9 Take all the equipment to the patient, exhibiting a competent manner. To help the patient feel more at ease with the procedure. E
10 Support the chosen limb on a pillow. To ensure the patient’s comfort and facilitate venous access. E
11 Apply a tourniquet to the upper arm on the chosen side, making sure it does not obstruct arterial flow. If the radial pulse cannot be palpated then the tourniquet is too tight (Weinstein and Plumer 2007). The position of the tourniquet may be varied; for example, if a vein in the hand is to be used it may be placed on the forearm. A sphygmomanometer cuff may be used as an alternative. To dilate the veins by obstructing the venous return (Dougherty 2008, E).
To increase the