The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [414]
30 Remove the needle, but do not apply pressure until the needle has been fully removed. To prevent pain on removal and damage to the intima of the vein. E
31 Activate safety device, if applicable, and then discard the needle immediately in sharps bin. To reduce the risk of accidental needlestick injury (NHS Employers 2007, C).
32 Apply digital pressure directly over the puncture site. Pressure should be applied until bleeding has ceased; approximately 1 minute or longer may be required if current disease or treatment interferes with clotting mechanisms. To stop leakage and haematoma formation. To preserve vein by preventing bruising or haematoma formation. E
33 The patient may apply pressure with the finger but should be discouraged from bending the arm if a vein in the antecubital fossa is used. To prevent leakage and haematoma formation (Ernst 2005, E).
34 Gently invert the tube at least six times. To prevent damage to blood cells and to mix with additives (manufacturer’s guidelines, C).
35 Label the bottles with the relevant details at the patient’s side. To ensure that the specimens from the right patient are delivered to the laboratory, the requested tests are performed and the results returned to the correct patient’s records (NMC 2009, C; NPSA 2007, C).
Postprocedure
36 Inspect the puncture point before applying a dressing. To check that the puncture point has sealed. E
37 Ascertain whether the patient is allergic to adhesive plaster. To prevent an allergic skin reaction. E
38 Apply an adhesive plaster or alternative dressing. To cover the puncture and prevent leakage or contamination. E
39 Ensure that the patient is comfortable. To ascertain whether patient wishes to rest before leaving (if an outpatient) or whether any other measures need to be taken. E
40 Remove gloves and discard waste, making sure it is placed in the correct containers, for example sharps into a designated receptacle. To ensure safe disposal and avoid laceration or other injury of staff (Fraise and Bradley 2009, E). To prevent reuse of equipment (MDA 2000, C).
41 Follow hospital procedure for collection and transportation of specimens to the laboratory. To make sure that specimens reach their intended destination. E
Action Figure 13 Palpating the vein.
Action Figure 19 Cleaning the skin.
Action Figure 21 Anchoring the skin.
Action Figure 26 Attach sample bottle to holder.
Problem-solving table 11.1 Prevention and resolution (Procedure guideline 11.1)
Postprocedural considerations
Immediate care
It is important to ensure that the needle is removed correctly on completion of blood sampling and that the risk of haematoma formation is minimized. Pressure should be applied as the needle is removed from the skin. If pressure is applied too early, it causes the tip of the needle to drag along the intima of the vein, resulting in sharp pain and damage to the lining of the vessel.
The practitioner should ensure that firm pressure is maintained until bleeding has stopped. The patient should also be instructed to keep their arm straight and not bend it as this also increases the risk of bruising (Ernst 2005). A longer period of pressure may be necessary where the patient’s blood may take longer to clot, for example, if the patient is receiving anticoagulants or is thrombocytopenic. The practitioner may choose to apply the tourniquet over the venepuncture site to ensure even and constant pressure on the area (Dougherty 2008). Alternatively, they can elevate the arm slightly above the heart to decrease venous pressure (Garza and Becan-McBride 2010).
The practitioner should inspect the site carefully for bleeding or bruising before applying a dressing to the site, and the patient leaving the department. If bruising has occurred the patient should be informed of why this has happened and given instructions for what to do to reduce the bruising and any associated pain. Initially the application of an ice pack may help to soothe and decrease bruising. The application of Hirudoid cream, which is used for the