CSC NGH MM/JJ/MH/AB 1

Venepuncture, obtaining blood cultures and managing blood samples

Aims

• To ensure that students are able to demonstrate the safe and correct

technique for venepuncture, obtaining blood cultures and managing blood

samples.

• To provide an understanding of the importance of careful planning and

equipment preparation.

• To develop an understanding of the communication skills required while

interacting with the patient. These include the correct process of identification,

explanation of the procedure and consent to carry out the procedure.

• To develop an understanding of the importance of completing all relevant

documentation.

Learning Outcomes

• Demonstrate the correct process of patient identification, explanation of

procedure and obtaining consent to carry out the procedure.

• Identify the correct equipment for the task, safely prepare the equipment and

complete the procedure safely.

• Demonstrate the correct procedure of completing all relevant documentation.

• Show an appreciation regarding the importance of being familiar with local

trust policy.

.

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How to perform a venepuncture and obtain blood samples

You must be able to identify all relevant equipment that will be required to perform a

venepuncture and obtain blood samples. This is an invasive skill and all necessary

protocols from correct identification of the patient to documentation in patient’s notes

need to be followed.

Equipment

(Figure 1and 2)

1. Patient’s blood request forms and patient’s notes.

2. Butterfly device.

3. Vacutainer barrel.

4. Appropriate blood sample tubes/blood culture bottles for collection of

samples.

5. Non-sterile gloves.

6. Disposable plastic apron.

7. A clean receptacle to put the equipment in.

8. A sharps disposal bin.

9. Clinell wipe.

10. Tourniquet.

11. Gauze.

12. Cotton wool and tape.

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Figure 1: Venepuncture, obtaining blood cultures and managing blood

samples - Showing the equipment required and the set up in a clinical skills

laboratory.

Figure 2: Showing the different types of request forms used in clinical practice.

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Initiating the procedure – to include

• Introduce yourself by full name and post.

• Identify the patient by asking them to state their name, date of birth and first

line of address. Check name, hospital number and date of birth against

laboratory request forms, patient identification wrist band and patient’s notes.

This is to ensure that the venepuncture is carried out on the correct patient.

• Explain the procedure to the patient and gain the patient’s consent. Inform

them about potential complications (pain, bleeding, swelling/haematoma,

infection).

• Ask the patient if they have any known allergies to surgical tape.

Performance of task – to include

• Use alcohol gel to clean hands or

wash your hands as per local

guidelines. Don a pair of gloves and

an apron.

• Collect all required equipment

including sharps bin and request

forms.

• Position the patient’s arm and identify

a suitable vein. Support the arm using

a pillow.

• Check the site for any

contraindications to the procedure.

These include broken skin, an arterio-

venous fistula, local infection, hard or

cord like veins on palpation, or if the

patient had breast surgery /axillary

lymph node removal or radiotherapy

on that side.

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obtain

Obtaining blood cultures using a butterfly

device

• Remove protective cap from blood

culture bottle and disinfect rubber

septum with appropriate wipe (as per

local policy). Allow to dry.

• Apply tourniquet approximately 5- 10

cms above the intended site, using a

finger as a guide to avoid over

tightening. Recheck vein by palpation.

• Clean the site as per local policy

maintaining asepsis. Do not repalpate

the vein following cleaning.

• Open butterfly device and connect luer

lock to blood culture

adapter/Vacutainer adapter using an

aseptic technique.

• Prepare all other equipment as

needed.

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• Ensure that the patient is ready to

proceed. Explain to them that they

might feel a “slight scratch”.

• Remove safety sheath from butterfly

needle. Stretch the skin below the site

and insert the needle, bevel upwards,

in line with the vein at an angle of no

more than 45 degrees. Advance

needle until a flashback of blood

appears in the butterfly device.

• Secure butterfly to patient’s arm using

tape across the wings.

• Obtain blood cultures in the bottles.

Attach the adapter cap to the blood

culture bottle and allow required

amount of blood to collect (as

specified on the blood culture bottle).

• Obtain an aerobic and an anaerobic

sample in the respective bottles.

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Obtaining additional blood samples

using a butterfly device

• Collect additional blood samples

using correct order of draw. Urea

and electrolytes (yellow cap)

followed by full blood count (purple

cap). Invert the tube to mix the

sample (as per manufacturer’s

instructions).

• Once all samples have been

collected release the tourniquet

before removing the needle.

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• Remove the needle and discard

immediately into sharps bin.

• Check the venepuncture site for any

prolonged bleeding or hematoma

formation.

• Apply suitable dressing and ask

patient to apply pressure. Inquire

about any allergies to surgical tape

before applying it on the patient.

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• Document the procedure in patient’s notes.

• Label all blood samples correctly. Do not use addressograph labels.

Write the details by hand. Make sure that they are clearly written.

• Complete all laboratory request forms. Make sure you fill in the correct

details and investigation requested on the correct form.

• Sign and date the request forms.

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Aftercare

• Request patient to inform the staff members if they feel any discomfort, pain

or swelling around the venepuncture site.

• Remove gloves and apron.

• Thank the patient.

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Obtaining blood samples using a Vacutainer device and needle

Note: Please note that a variety of blood sample collections systems are available

and these may vary across different hospitals. Always follow the local policy of the

Trust and make sure that you familiarise yourself with the system being used in that

particular hospital.

The basic principles, preparation, protocols, documentation and aftercare are the

same regardless of what system of blood sample collection is in place. If using a

Vacutainer system the following steps will be different from the procedure described

earlier.

• Aseptically prepare the Vacutainer

collection system.

• Remove the needle sheath and

inspect needle to detect any faults.

• Inform the patient that they might

feel a “slight scratch” as the needle

is inserted into the skin.

• Remove the sheath from the needle.

• Insert the needle with the bevel

uppermost and at an angle of 30 to

45 degrees following the line of the

vein.

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• Support the barrel of the Vacutainer

and using the “wings” for extra

support attach the appropriate blood

collection tube.

• Take care not to push the needle

further into the vein as might cause

damage to the vein wall. Follow the

order of the draw, U and E before

FBC.

• When the blood collection is

complete carefully remove the blood

tube.

• Take care not to pull out the needle

from the vein.

• Invert the tube to mix the sample (as

per manufacturer’s instructions)

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The remainder of the steps would be as described earlier.

References

Dougherty, L and Lister S. (2008).The Royal Marsden Hospital Manual of Clinical

Nursing Procedures. 7th Ed. Oxford: Wiley-Blakewell.

• When all samples have been

collected, release tourniquet and

remove needle.

• Apply cotton wool and ask patient to

apply pressure. Inquire about any

allergies to surgical tape before

applying it on the patient.