Venepuncture

Venepuncture is an invasive clinical procedure and refers to the letting of blood from a vein. It is undertaken to:

• take a sample of blood for diagnostic and analytical purposes
• check blood component levels

(Health and Safety Executive (HSE), 2017)

Assessment for venepuncture should begin with patient needs and preferences which includes establishing the need for the procedure (Royal College of Nursing (RCN), 2016).

Healthcare professionals should ensure that they have received appropriate venepuncture training, follow organisational policies and guidance, and work within their area of competence (RCN, 2016: HSE, 2017).

Site selection

The site of choice for venepuncture is the median-cubital vein which is located in the antecubital fossa (ACF) (World Health Organisation (WHO), 2010). 

There are many advantages of using the median-cubital vein for venepuncture, such as:

• wide lumens
• thick vessel walls that are easy to palpate
• close to the skin surface
• skin is less sensitive/painful
• minimal nerve supply meaning reduced risk of inadvertent nerve puncture
• more stable and easy to anchor

Practitioners should avoid sites with evidence of:

• multiple venepuncture attempts
• scarring
• bruising
• wounds/trauma
• infection
• phlebitis
• oedema
• vascular grafts or fistulas

Further consideration must be given in

Prior to the performing venepuncture, it is essential that the practitioner considers all the equipment required to carry out the procedure to ensure minimal disruption. Equipment required for the procedure will include:

• blood request form
• correct blood bottles
• wipeable tray
• blood-letting equipment and appropriate size needle (smallest possible to meet patient needs (RCN, 2016))
• skin preparation to be selected according to organisational policy and guidance (RCN, 2016). This is usually 70% alcohol
• gauze and tape or optional spot-plaster (check patient allergies)
• non-sterile, latex-free, well-fitting gloves (HSE, 2017)
• plastic apron
• latex free, cleanable, single use tourniquet
• sharps container
• hand sanitation products

Always prepare equipment under strict aseptic non-touch technique (Loveday et al, 2014; INS, 2021). Preparation of the equipment should ideally take place in a clean separate area such as a clinic room (HSE, 2017). Check expiry dates on all equipment prior to use (RCN, 2016).

1. Positively identify patient against the blood request form
2. Explain the procedure and gain informed or verbal consent. If you are unable to identify a patient, check the wristband with a family member or another member of staff
3. Identify any allergies or significant medical history
4. Check for any anxieties, such as needle-phobia, and provide reassurance as necessary
5. Cleanse hands by washing with soap and water and pat dry (World Health Organisation (WHO), 2009; Boswell and Longstaff, 2020)
6. Clean tray with 70% alcohol, wiping the entire surface and base, according to organisational decontamination of equipment policy
7. Assemble equipment, ensuring contents are intact and check expiry dates
8. Clean hands using alcohol gel or soap and water
9. Apply non-sterile gloves and plastic apron
10. Place equipment in clean tray, protecting key parts at all times
11. Remove gloves and clean hands. Make your way to the patient
12. Clean hands before patient contact (WHO, 2009)
13. Prepare the

1. Transfixing the vein
2. Advancing needle through a valve leading to excessive pain and inflammation
3. Fainting
4. Inadvertent arterial or nerve puncture
5. Wrong patient – wrong test – wrong sample bottles
6. Accidental needle stick injury
7. Haematoma
8. Infection/bacteraemia
9. Phlebitis 

Ensure personal/professional development and maintenance of competency in line with organisational policy and code of practice.

References

Boswell C, Longstaff J. Standard Infection Control Precautions (SICPs) Literature Review: Hand Hygiene: Hand washing, hand rubbing and indications for hand hygiene. 2020. https://www.nipcm.hps.scot.nhs.uk/media/1686/2020-07-13-sicp-lr-hand-washing-hand-rubbing-and-indications-v1.pdf

Hallam C, Weston V, Denton A, et al. Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborative. Journal of Infection Prevention. 2016; 17(2): 65–72. https://doi.org/10.1177/1757177415624752

Health and Safety Executive. Guiding Framework for the Education, Training and Competence Validation in Venepuncture and Peripheral Intravenous Cannulation for Nurses and Midwives. 2017. https://healthservice.hse.ie/filelibrary/onmsd/guiding-framework-training-competence-validation-in-venepuncture-and-peripheral-intravenous-cannulation-for-nurses-and-midwives-2017.pdf (accessed 16 January 2023)

Gorski LA, Hadaway L, Hagle ME et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs. 2021;44(1S Suppl 1):S1-S224. https://doi.org/10.1097/NAN.0000000000000396

Loveday HP, Wilson JA, Pratt RJ, et al. National Evidence-Based guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. J Hosp Infect. 2014; 86(S1): S1–S70. https://doi.org/10.1016/S0195-6701(13)60012-2 

Nursing and Midwifery Council. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018.