Peripheral venepuncture

Peripheral venepuncture is a common procedure used to gain access to an individual’s circulation for the purposes of taking blood for:

• blood tests 
• blood donation
• therapeutic purposes (Gallagher, 2022)

Other forms of venepuncture are undertaken to establish venous access for the delivery of medications and to undertake clinical procedures, such as haemodialysis. Access to the blood for other forms of blood tests include:

• capillary blood test using lances, eg for blood glucose monitoring
• arterial blood gas testing

Central vein venepuncture is a medical procedure which is used to establish good quality access for the delivery of medication, the monitoring of physiological parameters and dialysis. The procedure discussed here only addresses peripheral venepuncture, which is undertaken for the purposes of taking blood for blood testing.

Prior to undertaking venepuncture, questions need to be considered such as:

• Is the test necessary?
• Are there alternatives tests?
• Can all the tests needed be done in one go?
• How does the patient react to blood tests?
• Is the patient on blood thinners and are they likely to bruise and/or bleed?

The nurse also needs to consider issues such as the infection status of the patient, for example whether they have any blood borne viral infections. Previous experiences with venepuncture should also to be considered, especially where an individual is known to have veins which are difficult to access.

Prior to undertaken a peripheral venepuncture, the nurse needs to gather the equipment which may be needed, this includes:

• A disposable, or cleanable, torniquet (according to local policy and the infection status of the patient)
• A clean tray or receptacle for the blood bottles and other equipment
• Vacuum blood bottles according to the tests which need to be undertaken
• The correct needles considering the system in use and the size of the veins of the individual (21 g is a standard size). Butterfly needles may be an option depending on the physical characteristics of the person whose blood is being taken and the site of the vein to be accessed (Shaw, 2018)
• Tube holder depending on the system in use
• Sharps bin which has the capacity for additional needles
• Disposable gloves – latex or nitrile offer the best protection against inoculation injury (be aware of latex allergy in the patient)

Only nurses who are trained and deemed competent in venepuncture should undertake it. As venepuncture involves the handling of blood and sharp medical implements, it should be undertaken carefully while observing standard precautions (World Health Organization, 2010).

1. The identity of the person whose blood is being taken needs to be established according to local policy
2. Gain consent (Skarparis and Ford, 2018)
3. Ensure the person is comfortable
4. Undertake hand hygiene (the use of alcohol-based sanitiser is adequate if hands are visibly clean) (National Institute for Health and Care Excellence, 2014)
5. Don apron
6. Open equipment into the clean tray and assemble the venepuncture needle and tube holder as per the manufacturer’s instructions
7. Apply the tourniquet 5-10 cm above the proposed venepuncture site
8. Palpate the vein; the choice of veins for venepuncture are usually the superficial ones in the antecubital fossa area of the arm:
   • median cubital
   • cephalic
   • accessory cephalic
   • basilic
   • other veins should

Bruising is the most common complication for patients undergoing venepuncture. Sometimes the needle will extravasate (go through the back or side wall of the vein in this case) causing blood to leak into the surrounding tissue (Buowari, 2013) causing bruising. This requires that the procedure be stopped, the needle withdrawn and the selection of another site for venepuncture.  It is good practice to apply pressure to the site for some minutes after extravasation as internal bleeding cannot be seen. 

Sometimes extravasation will happen repeatedly because the patient has diseased vasculature, or they are unable to cooperate with venepuncture. In such cases, it is always best to ask another, experienced, colleague to try to undertake the procedure. After a few failed attempts, the medical team should be asked to undertake the venepuncture.

Infection at the site of venepuncture is rare and are more likely to be seen following the use of

Nurses who are charged with venepuncture should ensure they have the knowledge and skills to perform this procedure. Refresher training should be undertaken according to the local training and development policy in order to stay up to date on procedural guidelines and meet revalidation requirements. 

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

2.2 undertake venepuncture and cannulation and blood sampling, interpreting normal and common abnormal blood profiles and venous blood gases

Part 2: Procedures for the planning, provision and management of person-centred nursing care

9. Use evidence-based, best practice approaches for meeting needs for care and support with the prevention and management of infection, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

9.6 use evidence-based hand hygiene techniques

Buowari OY. Complications of venepuncture. Adv Bioscience and Biotech. 2013;4:126-128. http://dx.doi.org/10.4236/abb.2013.41A018.

Dougherty L, Lister S. The Royal Marsden Hospital manual of clinical nursing procedures. 9th edn. West Sussex: Wiley; 2015

Lister S, Hofland J, Grafton H. The Royal Marsden Manual of clinical nursing procedures: professional edition. 10th edn. Chichester: Wiley-Blackwell; 2020

Gallagher R. Aseptic technique and specimen collection. In: Delves-Yates C (ed). Essentials of nursing practice. 10th edn. London: Sage; 2022:403-422

National Institute for Health and Care Excellence. Infection prevention and control. 2014. https://www.nice.org.uk/Guidance/QS61 (accessed 1 February 2024)

Peate I. Anatomy and physiology for nurses and nursing students at a glance. Oxford: Wiley Blackwell; 2022

Shaw SJ. How to undertake venepuncture to obtain venous blood samples. Nurs Stand. 2018;14;32(29):41-47. https://doi.org/10.7748/ns.2018.e10531

Skarparis K, Ford C. Venepuncture in adults. Br J Nurs. 2018;27(22):1312-1315. https://doi.org/10.12968/bjon.2018.27.22.1312

World Health Organization. WHO guidelines on drawing blood: best practices in phlebotomy. 2010. https://iris.who.int/bitstream/handle/10665/44294/9789241599221_eng.pdf?sequence=1 (accessed 1 February 2024)