Healthcare and Medicine Reference
In-Depth Information
Figure 5.5 Loading of the vacutainer bottle into the tube holder.
Wear gloves and apron at all times.
Inquire whether the patient is left- or right-handed and attempt
venepuncture initially in the non-dominant arm.
Place the tourniquet above the site of venpuncture (usually this
is above the antecubital fossa) (Figure 5.6a).
Leave for at least 20 seconds for the veins to fi ll; often it is
helpful at this stage if the patient makes repetitive fi st actions
with their hand.
Feel and look for access sites. Often a 'bouncy' vein that is easily
palpable is far easier and generally more successful for phlebot-
omy rather than a visible 'thready' vein. Usually the antecubital
fossa is a good starting point. If no obvious vein is found, work
down the arm feeling and looking for a more suitable vein, or
alternatively try the other arm.
Once a site of access has been decided upon, wipe the skin care-
fully with a antiseptic wipe (2% chlorhexidine in 70% alcohol),
working in circles from the centre outwards (Figure 5.6b).
With the needle attached to either a Vacutainer™ system or
syringe, insert the bevel upwards, passing through the skin and
into the vein (Figure 5.6c).
Attach collecting bottles or withdraw the plunger of the syringe.
Collect blood.
Once enough blood has been collected, loosen the tourniquet.
Withdraw the needle and place a cotton ball over the access site.
Secure with tape.
Dispose of the needle appropriately in a sharps box. Never leave
sharps lying around.
If blood has been collected in a syringe, this will now need to be
Figure 5.6 Step-by-step guide: venpuncture. (a) Apply a tourniquet to the
upper arm. (b) Sterilise the skin using 2% chlorhexidine in 70% alcohol
solution. (c) Attaching a collecting bottle to the Vacutainer™ system.
transferred to bottles.
Label bottles with patient details. Group and save samples or
cross-matching samples must always be handwritten at the
patient bedside, correlating information transcribed on the
bottle with the patient themselves, their hospital wrist band and
the collecting form.
Pain. This may be from the tourniquet or from venepuncture. A
local anaesthetic cream may be applied to the skin to reduce the
pain incurred.
Complications and how to avoid them
Blood cultures
Infection at the puncture site. This can be minimised by clean-
To culture bacteria in cases of infection. The chances of successful
ing the skin with an antiseptic wipe (e.g. 2% chlorhexidine/70%
alcohol solution).
Haematoma. This occurs more frequently if patients are on
culture are greatly improved if taken at the time of pyrexia.
In the case of suspected endocarditis it is important to obtain
warfarin or steroid therapy. To avoid a haematoma, apply gen-
tle pressure for 1-2 minutes after the procedure and release the
tourniquet before removing the needle. Advise the patient to keep
their arm straight.
blood from three different sites and at different times.
If severe sepsis is present, at least one set should be drawn
percutaneously and one from each indwelling vascular access
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