Rcn paed venepuncture handbook

Competences:an education and training

competence framework forcapillary blood sampling and

venepuncture in childrenand young people

RCN CompetencesRCN Competences

Acknowledgements

We would like to thank the NHS Modernisation Agencyfor sponsoring the development of the originalframework, first published in 2005. We are grateful tothe following people for their assistance in theproduction of the original framework document andthis updated version:

Expert group

Karen Bravery, Nurse Practitioner/PracticeDevelopment Lead Intravenous Therapy for Infection,Cancer and Immunity, Great Ormond Street Hospital forChildren NHS Trust

Pauline Brown, Lead Nurse IV Therapy, Royal LiverpoolChildren’s Hospital NHS Trust

Julie Flaherty, Children’s Nurse Consultant, UnscheduledCare, Salford Royal Foundation Trust

Liz Gormley-Fleming, Senior Lecturer, Children’sNursing, University of Hertfordshire

Alison Hegarty, Teacher Practitioner, IV Therapy,Central Manchester and Manchester Children’s HospitalNHS Trust

Valerie McGurk, Practice Development Facilitator,Paediatrics, Northampton General Hospital Trust

Louise Mills, Nurse Practitioner for IntravenousTherapy, Great Ormond Street Hospital for ChildrenNHS Trust

Sally Ramsay, Independent Nursing Adviser, RamsayConsulting

Jo Rothwell, Lead Nurse, IV Therapy, CentralManchester and Manchester Children’s Hospital NHSTrust

Review group

Anne Casey, Editor and Adviser, Royal College ofNursing

Jennie Craske, Pain and Sedation Clinical NurseSpecialist, Royal Liverpool Children’s Hospital NHSTrust

Annette K. Dearmun, Lecturer Practitioner, OxfordRadcliffe Hospitals NHS Trust

Ansley McGibbon, Senior Nurse, Practice, Research,Development and Education Unit, Lothian UniversityHospitals, Edinburgh

Steve McKenna, Charge Nurse, Paediatric AmbulatoryCare/Outpatients, Royal Free Hampstead NHS Trust

Fiona Smith, Adviser in Children and Young People’sNursing, Royal College of Nursing

We are also grateful to the Royal College of Paediatricsand Child Health for its support of the content of thispublication.

Disclaimer

This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers areadvised that practices may vary in each country and outside the UK.

The information in this booklet has been complied from professional sources, but it’s accuracy is not guaranteed. While every effort has beenmade to ensure that the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in whichit may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to becaused directly or indirectly by what is contained in or left out of this information and guidance.

Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN

© 2010 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmittedin any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers. Thispublication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in whichit is published, without the prior consent of the Publishers.

R O Y A L C O L L E G E O F N U R S I N G

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Competences: an education and training competence framework for capillary bloodsampling and venepuncture in children and young people

Introduction 2

1. Guidance for programme development 3

Education pathways 3

Teaching and learning strategies 3

Assessment 3

2. Competences, learning outcomes and indicative content 4

Domain 1: professional and legal issues 4

Domain 2: preparing self, child and family 4

Domain 3:performing capillary blood sampling and venepuncture 5

Domain 4: risks and hazards 6

3. References and further reading 8

4. Online resources 12

Approved by the RCN Accreditation Unit until 31 July 2011

Contents

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R C N C O M P E T E N C E S – C A P I L L A R Y B L O O D S A M P L I N G A N D V E N E P U N C T U R E

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Introduction

Developing skills in performing capillary blood samplingand venepuncture can facilitate holistic care and timelytreatment. For nurses working with children and youngpeople this is usually regarded as an expanded role. Beforestarting a programme of education and trainingpractitioners should be should be competent andconfident to care for children and young people.

Competence can be defined as: “The state of having theknowledge, judgement, skills, energy, experience andmotivation required to respond adequately to the demandsof one’s professional responsibilities” (Roach, 1992).

This education and training competence framework forcapillary blood sampling and venepuncture in childrenand young people is an important step forward. Firstpublished in 2005, it has been revised to reflect a numberof current political and professional issues and initiatives,including:

� Agenda for Change (DH, 1999)

� the need for leadership in specialist nursing

� the need for the development of standards

� High quality care for all: the NHS next stage review(DH, 2008) and its equivalents in Scotland, Wales andNorthern Ireland

� the increased focus on work-based and lifelonglearning plus supervision

� the changing focus towards professional rather thanacademic accreditation

� multi-skilling health care practitioners to effectivelymeet the needs of service users.

This framework describes the competences, learningoutcomes and the indicative content necessary foreducation and training programmes to meet the needs ofchildren and young people. It aims to support consistentcurriculum and practice development so that practitionerscan develop and, maintain the ability to carry out this task,regardless of where they work.

The framework should also be used to develop newprogrammes, and to review and revise existing ones. Byusing this framework, other professionals and employerscan be confident in the standard and proficiency ofpractitioners.

Developing competence within age bands

There are considerable differences between children ofvarying ages, and we recommend that practitionersdevelop competence within specific age bands accordingto their area of practice:

� 0 to 1 year

� 1 to 5 years

� 5 years and above.


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When either planning new courses or reviewing existingcourses, we recommend that hospitals and universities usethis as their competence framework.

Education pathways

This framework can be used to develop hospital-basedtraining programmes for nurses working with childrenand young people. Alternatively, it can be used to reviewexisting programmes to ensure that they meet the needs ofchildren and young people. Training may be linked toother competences, such as those required for cannulation.

Teaching and learning strategies

Capillary blood sampling and venepuncture in childrenand young people is a practical skill, which is underpinnedby theoretical knowledge. Teaching and learning strategiesshould focus on developing the competence andconfidence of the practitioner in performing the proceduresafely, and with minimum distress to the child or youngperson. Assessment of prior knowledge, particularly incaring for the child undergoing intravenous therapy, canbe useful in developing programmes that reflect theindividual needs of the practitioner.

A variety of new ways of learning can be used for theseprogrammes:

� workbooks

� problem-based learning

� taught provision

� scenarios

� supervised practice

� e-learning

� simulation

� blended learning.

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Assessment

As a minimum each programme needs to assesscompetence in practice. Practice assessments shouldreflect the competences and learning outcomes. There arevarious assessment methods that are appropriate:

� observation under supervision and demonstration

� reflective practice

� portfolio of evidence showing skills, experience anddevelopment

� formal examination.

Each of these relies on the use of practice assessors.Programme developers should consider who this may beand the criteria needed to become and maintain thisstatus. We recommend that an assessor should beexperienced in capillary blood sampling andvenepuncture in children and young people. Their abilityto assess others should be determined by a formalassessment process. We also advise that they receive clearguidance on their role and responsibilities.

Regular updating and assessment of skills can assist inensuring ongoing competence. We suggest that this takesplace annually.

Guidance for programme development

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Domain 1: professional and legal issues

Competences

� Performs capillary blood sampling and venepuncturein accordance with legal, professional and policyrequirements.

� Uses appropriate evidence to underpin best practice incapillary blood sampling and venepuncture in childrenand young people.

� Records and reports information in a manner that isclear, concise, timely and accurate.

� Reflects on own practice and takes action to developand improve knowledge and skills.

� Describes circumstances where it is inappropriate toperform capillary blood sampling and venepunctureand the alternative action to take.

� Demonstrates best practice in gaining informedconsent from the child and family.

� Demonstrates awareness of the limits of ownskill/competence/knowledge.

Learning outcomes

At the end of a course of study and period of supervisedpractice the nurse will be able to:

� discuss the legal and professional issues associatedwith performing capillary blood sampling andvenepuncture

� outline current evidence to support best practice incapillary blood sampling and venepuncture

� describe the process for obtaining informed consentfrom the child/young person and family

� give an account of professional and local policiesrelevant to performing capillary blood sampling andvenepuncture

� describe the legal requirements for good recordkeepingin relation to capillary blood sampling andvenepuncture

� reflect on own practice, identifying accountability andcompetence issues.

Indicative content

� Department of Health requirements for record-keeping.

� The Nursing and Midwifery Council Code (NMC, 2008).

� Legal, professional and local policies regardingenhanced nursing roles.

� Accountability when performing capillary bloodsampling and venepuncture.

� Local policies and procedures for capillary bloodsampling and venepuncture in children and youngpeople.

� Evidence base for good practice in capillary bloodsampling and venepuncture.

� Policies and good practice guidance in obtaininginformed consent.

� Policies and good practice guidance for holding andrestraining children.

Domain 2: preparing self/child/family

Competences

� Performs the preparatory processes for capillary bloodsampling or venepuncture in a safe and effectivemanner.

� Uses appropriate procedures for correctly identifyingthe patient.

� Describes the anatomy and physiology applicable tocapillary blood sampling and venepuncture.

� Assesses the child’s physical and psychological needsbefore, during and after capillary blood sampling andvenepuncture and uses these in preparing a care plan.

� Employs appropriate methods to select and preparesuitable sites for capillary blood sampling andvenepuncture selects suitable collection devices andequipment and gives rationale for choice.

Competences, learning outcomesand indicative content


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� Demonstrates knowledge of pharmacological and non-pharmacological pain relief.

� Applies local anaesthetic cream correctly to anappropriate site.

� Identifies when other health professionals e.g. playspecialist, child psychologist, should be involved inpreparation.

� Uses strategies to minimise the risk of injury to otherswho may be present.

Learning outcomes

At the end of a period of study and supervised practice thenurse will be able to:

� give an account of the anatomy and physiology ofcapillaries and veins, and describe the relevance forcapillary blood sampling and venepuncture

� explain the theory of capillary blood sampling andvenepuncture in children and young people

� describe the methods used to identify appropriate andinappropriate sites for capillary blood sampling andvenepuncture

� develop a care plan appropriate to the child’s physicaldevelopmental and psychological needs before, during,and after capillary blood sampling and venepuncture

� demonstrate good practice when preparing self, childand family for capillary blood sampling andvenepuncture

� create a safe environment for performing capillaryblood sampling and venepuncture

� identify the various devices and equipment used forcapillary blood sampling and venepuncture forchildren of different ages

� explain the interventions that minimise a child oryoung person’s pain and anxiety during capillary bloodsampling and venepuncture

� describe the roles of other health professionals inpreparing children or young people for painfulprocedures

� give an account of the use of patient group directives.

Indicative content

� Anatomy and physiology of capillaries, veins, arteriesand nerves.

� Theory of capillary blood sampling and venepuncture.

� Devices and equipment for capillary blood samplingand venepuncture and their use.

� Cognitive development, and a child or young person’sperception of pain.

� The use of play to communicate with children.

� Distraction techniques.

� Role of the play specialist and psychologist inpreparing children for blood sampling procedures.

� Needles: helping to take away the fear (Action for SickChildren, 1994).

� Creating a safe, comfortable, calm and child-focusedenvironment.

� Importance of the practitioner’s attitude (empatheticrather than directive).

� Patient group directives.

� Local anaesthetic preparations.

� Vein selection: influencing factors and methods.

� Cleaning the skin.

Domain 3: performing capillaryblood sampling andvenepuncture

Competences

� Demonstrates the safe application of the principles of“restraining, holding still and containing children”(RCN, 2003b).

� Demonstrates the correct procedures for minimisinginfection, including hand washing, use of gloves, apronand aseptic technique.

� Uses appropriate strategies for minimising painassociated with capillary blood sampling andvenepuncture.

� Applies pressure or a tourniquet appropriately andsafely.

� Takes appropriate action to prevent iatrogenicanaemia.

� Demonstrates practical ability and dexterity duringcapillary blood sampling and venepuncture.

� Responds appropriately to troubleshoot or overcomeany difficulties experienced during the procedure.

� Identifies the appropriate blood container and reagentfor the tests required, and fills them in the correctorder.

� Fills, labels and dispatches containers correctly,demonstrating knowledge of factors that can adverselyinfluence the results.

� Identifies reasons why capillary blood sampling and

venepuncture may be unsuccessful and describesactions to address this.

� Describes correct care of the site following theprocedure.

� Removes and disposes of devices and equipment inaccordance with infection control and health andsafety policies.

� Communicates with the child and family during andafter the procedure in a manner that minimisesanxiety and encourages compliance.

� Describes the indications for some frequently usedblood tests.

Learning outcomes


� perform checking procedures that maximise patientsafety

� wash his/her hands in accordance with good practiceguidance

� demonstrate good practice when holding the child oryoung person still during the procedure

� identify the containers and volumes required foreffective blood sampling in children and young people

� demonstrate knowledge of the correct sequence forfilling blood containers to avoid contaminatingspecimens

� calculate the maximum amount of blood that shouldbe taken from a child

� perform capillary blood sampling and venepuncturesafely on children and young people of varying ages

� identify strategies for minimising anxiety and painwhen performing capillary blood sampling andvenepuncture

� demonstrate knowledge of the indications for certaincommonly used blood tests

� access reference ranges to compare blood results

� describe factors that can lead to erroneous test results

� describe techniques for encouraging and rewarding thechild undergoing peripheral venous cannulation.

Indicative content

� Effective hand washing.

� Restraining and holding still.

� Communication strategies.

� Applying pressure and tourniquets.

� Blood volumes.

� Containers, reagents, order of filling.

� Laboratory requirements.

� Emergency situations: their prevention and resolutione.g. patient moving, arterial puncture, fainting.

� Labelling specimens.

� Completing investigation request forms.

� Problems with sample quality that could lead toerroneous results.

� Encouraging and rewarding children.

Domain 4: risks and hazards

Competences

� Describes the risks and complications to self and childassociated with capillary blood sampling andvenepuncture, and acts to prevent these

� Explains the infection control and health and safetyprocedures required for safe capillary blood samplingand venepuncture

� Recognises, reports and records errors or adverseincidents associated with capillary blood sampling andvenepuncture

� Follows appropriate policies and procedures whendisposing of equipment and hazardous substances

� Takes action to maximise the safety of the child, familyand self when performing capillary blood samplingand venepuncture.

Learning outcomes


� outline the risks and complications associated withcapillary blood sampling and venepuncture, theirprevention and treatment

� discuss infection control and health and safety policiesand procedures applicable to capillary blood samplingand venepuncture

� describe the procedures for reporting errors andadverse incidents

� give account of relevant health and safety and infectioncontrol policies

� demonstrate knowledge of factors that influence thesafety of the child, family and self during capillaryblood sampling and venepuncture

� create a safe environment for performing capillary

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blood sampling and venepuncture.

Indicative content

� Safe practice in handling and disposing of sharps.

� Role of the National Patient Safety Agency andMedicines and Healthcare Products RegulatoryAgency, and equivalent organisations in Scotland andNorthern Ireland.

� Right patient – right care (NPSA, 2004a).

� Health and Safety at Work Act 1974 and otherregulations (HSE).

� Government and NHS guidance on preventinginfection.

� Needlestick injuries: the point of prevention (RCN,2009).


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References and further reading

Action for Sick Children (1994) Needles: helping to takeaway the fear, London: AfSC.

Arrowsmith J and Campbell C. (2000) A comparison oflocal anaesthetics for venepuncture, Archives of Disease inChildhood, 82, pp.309-310.

Bellieri CV, Cordelli DM, Rafaelli M, Ricci B, Morgese G andBuonocore G. (2006) Analgesic effect of watching TVduring venepuncture, Archives of Disease in Childhood,91, pp.1015-1017.

Bijttebier P and Vertommen H (1998) The impact ofprevious experience on children’s reactions tovenepunctures, Journal of Health Psychology, 3, 1, pp.39-46.

Boie ET, Moore GP, Chad BS, Nelson D (1999) Do parentswant to be present during invasive procedures performedon their children in the emergency department? A surveyof 400 parents, Annals of Emergency Medicine, 34(1),pp.70-74.

British Medical Association (2001) Consent, rights andchoices in health care for children and young people,London: BMJ Books.

Brook G (2000) Children’s competence to consent: aframework for practice, Paediatric Nursing 12(5) pp.31-34.

Broome ME (1990) Preparation of children for painfulprocedures, Paediatric Nursing, 16(6), pp.573-541.

Brykczynska G (1987) Ethical issues in paediatric nursing,Nursing, 23, pp.862-864.

Buckbee K (1994) Implementing a pediatric phlebotomyprotocol, Medical Laboratory Observer, 26(4), pp.32-35.

Caws L and Pfund R (1999) Venepuncture and cannulationin infants and children, Journal of Child Health Care, (2),pp.11-16.

Coates T (1998) Venepuncture and intravenouscannulation or: how to take blood and put up a drip, ThePracticing Midwife, 1(10), pp.28-31.

Collier J and Robinson S (1997) Holding children still forprocedures, Paediatric Nursing, 9(4), pp.12-14.

Collins M, Phillips S and Dougherty L (2006) A structuredlearning programme for venepuncture and cannulation,Nursing Standard, 20(26) pp.34-40.

Cooke DA (1994) Potential inaccuracy of finger prickblood samples, British Journal of General Practice,44(378), p.42.

Currer M (2008) Use of simulators in paediatric andneonatal training, Infant, 4(4), pp.132-136.

Department of Health (1999) Agenda for Change:modernising NHS pay systems, HSC 1999/227, London:DH.

Department of Health (2000) NHS plan: a plan forinvestment, a plan for reform, London: DH.

Department of Health (2001a) Reference guide to consentfor examination or treatment, London: DH.

Department of Health (2001b) Seeking consent: workingwith children, London: DH.

Department of Health (2001c) Building a safer NHS forpatients: implementing an organisation with a memory,London: DH.

Department of Health (2002) Guidance for clinical healthcare workers, London: DH.

Department of Health (2003a) Getting the right start:National Service Framework for children Standards forhospital services, London: DH.

Department of Health (2003b) Winning ways: workingtogether to reduce health care associated infection inEngland. London: DH.

Department of Health (2004a) National ServiceFramework for children and young people who are ill,London: DH.

Department of Health (2004b) The NHS Knowledge andSkills Framework (KSF) and development review process,London: DH.

Department for Education and Skills (2005) Common coreof skills and knowledge for the children’s workforce,London:DfES.

Eriksson M, Gradin M and Schollin J (1999) Oral glucoseand venepuncture reduce blood sampling pain innewborns, Early Human Development, 55, pp.211-218.

Fernald CD and Corry JJ (1981) Empathetic versusdirective preparation of children for needles,Children’sHealth Care, 10(2), pp.44-47.

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Franck L and Jones J (2003) Computer-taught copingtechniques for venepuncture: prelimanry findings fromusability testing with children, parents and staff, Journal ofChild Health Care, 7(1), pp.41-54.

Franklin L (1998) Skin cleansing and infection control inperipheral venepuncture and cannulation, PaediatricNursing, 10, 9, pp.33-34.

Frost S and Kelsey K (2008) ‘Venepuncture’, in Kelsey J andMcEwen G (editors) Clinical skills in child health practice,London: Churchill Livingstone Elsevier.

Gaskell S, Binns F, Heyhoe M and Jackson B (2005) Takingthe sting out of needles: Education for staff in primarycare, Paediatric Nursing, 17(4), pp. 24-28.

Goodenough TB, Perrott DA, Champion DA and ThomasW (2000) Painful pricks and prickle pains: is there arelation between children’s ratings of venipuncture painand parental assessments of usual reaction to other pains?Clinical Journal of Pain, 16(2), pp.135-143.

Goren A, Laufer J, Yativ N, Kuint J, Ackon MB, RubinshteinM, Paret G and Augarten A (2001) Transillumination of thepalm for venipuncture in infants, Pediatric EmergencyCare, 17(2), pp.130-131.

Halimaa SL (2003) Pain management in nursingprocedures on premature babies, Journal of AdvancedNursing, 42(6), pp.587-597.

Health and Safety Executive (2002) Control of substanceshazardous to health, London: HSE.

Health Protection Scotland (2009) Occupational exposuremanagement including sharps policy and procedure.Available from www.documents.hps.scot.nhs.uk(Internet).

Higgins D (2004) Practical procedures - venepuncture,Nursing Times 100(39), pp.30-31.

Hobson P (2008) Venepuncture and cannulation:theoretical aspects, British Journal of HealthcareAssistants, 2(2), pp.75-78.

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Jeffery K (2008) ‘Supportive holding of children duringtherapeutic interventions’, in Kelsey J and McEwen G(editors) Clinical skills in child health practice, London:Churchill Livingstone Elsevier.

Kolk AM, van Hoof R and Fiedeldij Dop MJC (2000)Preparing children for venepuncture. The effect of anintegrated intervention on distress before and duringvenepuncture, Child: Care, Health and Development, 26(3),pp.251-260.

Kayley J, Bravery K and Dougherty L (2006) Strategies toreduce the risk of needle and sharps injuries, NursingTimes, 102(10), pp.30-32.

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venepuncture, cannulation and intravenous therapy(draft), Edinburgh: NES.

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Online resources

� Action for Sick Children

www.actionforsickchildren.org

� Department for Education and Skills

www.des.gov.uk

� Department of Health, Social services and Public

safety, Northern Ireland

www.dhspsni.gov.uk

� Department of Health (England)

www.dh.gov.uk

� Evidence-based Practice in Infection Control

www.epic.tvu.ac.uk

� NHS Evidence

www.evidence.nhs.uk

� Health and Safety Executive

www.hse.gov.uk

� National Association of Hospital Play Staff

www.nahps.org.uk

� UK Health and Safety legislation

www.coshh-essentials.org.uk

� Health Care Standards Unit

www.hcsu.org.uk

� National Patient Safety Agency

www.npsa.gov.uk

� NHS Litigation Authority

www.nhsla.com

� Infection Prevention Society

www.ips.uk.net

� Joanna Briggs Institute

www.jbi.edu.au

� National Patient Safety Agency

www.npsa.nhs.uk

� Northern Ireland Practice and Education Council for

Nurses and Midwives

www.nipec.n-i.nhs.uk

� NHS Education for Scotland

www.nes.scot.nhs.uk

� NHS Scotland

www.show.nhs.uk

� NHS Wales

www.wales.nhs.uk

� Nursing and Midwifery Council

www.nmc-uk.org

� Royal College of Nursing

www.rcn.org.uk

� Royal College of Paediatrics and Child Health

www.rcpch.ac.uk

� Skills for Health

www.skillsforhealth.org.uk

� Hand hygiene, Scotland

www.washyourhandsofthem.com

The RCN represents nurses and nursing, promotesexcellence in practice and shapes health policies

November 2005, revised July 2010

RCN Onlinewww.rcn.org.uk

RCN Directwww.rcn.org.uk/direct0345 772 6100

Published by the Royal College of Nursing 20 Cavendish SquareLondon W1G 0RN

020 7409 3333

Publication code 003 004

ISBN 978-1-906633-45-5

Documents

Rcn paed venepuncture handbook