Venepuncture - blood cultures and blood samples

Question 1

Equipment

Answer 1

• Hand gel
• Clean receptacle to put equipment in
• Gloves
• Apron
• Tourniquet
• Antiseptic wipe (x3 - 1 for aerobic culture bottle, 1 for anaerobic, 1 for skin)
• Butterfly device
• Vacutainer barrel
• Blood culture bottles and blood sample tubes
• Cotton wool
• Tape (if allergic to tape - just use cotton wool and hold it on manually)
• Sharps disposal bin
• Patient’s blood request forms and notes
• Label for blood bottles (depends on trust)

Question 2

Complications

Answer 2

• Pain
• Bleeding
• Swelling
• Haematoma (press hard on site)
• Infection (low risk but still do process aseptically)
• Hitting artery (would see bright red blood appear) - apply firm pressure for 5 mins if occurs and inform senior)
• Going through vein or missing it

Question 3

Performance of Task (butterfly)

Answer 3

• Clean hands with alcohol gel
• Collect equipment
  Note: get tape ready and open packaging (easier without gloves)
• Clean hands with alcohol gel
• Don gloves and apron
• check again about allergy to tape
  ON PATIENT
• Position arm - state which arm to pick (non writing/ doesn’t have IV fluids running distally to proposed site/ no arterio-venous fistula/ breast surgery/ axillary lymph node removal/ radiotherapy on that side) and that would support arm with pillow if necessary
• Apply tourniquet and Identify suitable vein (palpate) - Check site for broken skin, local infection, hard/cord-like veins
• Release tourniquet
  Move to MANIKIN
• Apply, check, and release tourniquet
• Flick off cap of aerobic blood culture bottle
• Disinfect rubber septum using wipe
• State that you would allow this to dry for 30 secs/ air dry
• Using a separate wipe, repeat with anaerobic bottle
• Reapply tourniquet (5-10cm above site)
• Recheck vein by palpation
• Clean site using wipe with concentric circle or crosshatch technique (Maintain asepsis - do NOT re-palpate vein once cleaned)
• State that you would allow this to dry for 30 secs/ air dry
• Connect ‘luer-lock’ to vacutainer (aseptically - don’t touch large grey needle that goes inside the vacutainer)
• Remove sheath from butterfly needle
• Warn patient of slight scratch
• Stretch skin below site
• Insert needle, bevel up, in line with vein (angle no more than 45 degrees)
• Advance needle until flashback seen in butterfly body
• Apply tape to one wing (definitely not across puncture site)
• Keep one finger on other wing
• Insert first the aerobic then anaerobic bottles into the vacutainer
• Bottles are pre-vacuumed so will collect correct amount (but amount is specified on bottle too)
• THEN, (or instead of blood cultures), collect blood samples in correct order
• Invert tubes to mix as per instructions
• Release tourniquet BEFORE…
• Remove needle
• Push body of butterfly over needle (hold and move wings) and dispose of needle (vacutainer attached) in sharps bin
• Apply cotton wool / pressure
• Tape cotton wool to site
• State that would check for prolonged bleeding/haematoma and get patient to continue applying pressure

Question 4

After the procedure (butterfly)

Answer 4

• Label all samples correctly (still wearing gloves!)
  (write by hand, clearly/ sign and date)
  -State that would then fill in lab request forms (may have to do this)
• Thank patient

Question 5

Aftercare (same for both butterfly and normal needle)

Answer 5

• Ask patient to tell staff if any discomfort, pain or swelling arises
• Remove gloves and apron
• Thank patient
• Document procedure in notes (state this)

Question 6

Performance of task (samples using needle)

Answer 6

• Clean hands with alcohol gel
• Collect equipment
  Note: get tape ready and open packaging (easier without gloves)
• Clean hands with alcohol gel
• Don gloves and apron
• Position EXAMINER’S arm - state which arm to pick (ask examiner about: non writing arm/ doesn’t have IV fluids running distally to proposed site/ no arterio-venous fistula/ breast surgery/ axillary lymph node removal/ radiotherapy on that side) and that would support arm with pillow if available
• Apply tourniquet TO EXAMINER and Identify suitable vein (palpate) - check site for broken skin, local infection, hard/cord-like veins
• Move to manikin and Repeat step above on MANIKIN
• Clean site ON MANIKIN using wipe with concentric circle or crosshatch technique (Maintain asepsis - do NOT re-palpate vein once cleaned)
• State that you would allow this to dry for 30 secs/ air dry
• Remove clear needle sheath and inspect large grey need for faults (state)
• Insert large grey needle into vacutainer (twisting motion) (aseptically)
• Remove green needle sheath from thin needle
• Insert needle, bevel up, in line with needle (at an angle of approx. 30 degrees)
• Support barrel of vacutainer using it’s wings
• Attach blood collection tube (careful not to push needle further into vein)
• Remove tube carefully once filled (careful not to pull needle out)
• Insert additional tubes in correct order
• Invert tubes to mix as per instructions (state)
• Release tourniquet BEFORE…
• Remove needle and apply cotton wool simultaneously
• Dispose of needle (vacutainer attached) in sharps bin
• Apply cotton wool / pressure
• Tape cotton wool to site
• State that would check for prolonged bleeding/haematoma and get patient to continue applying pressure

Question 7

After procedure (samples using needle)

Answer 7

• Label all samples correctly (still wearing gloves!)
  (write by hand, clearly/ sign and date) - state that would do this
  -State that would then fill in lab request forms
• Wash hands
• Thank patient

Question 8

What is the order of draw for blood samples?

Answer 8

Order to take blood so that the additives of one bottle don't affect results of next when taking multiple samples
Blue
Yellow
Red 
Green
Purple
Pink
Grey

Blood cultures: always before samples
Aerobic before anaerobic

Question 9

Where do you take blood from?

Answer 9

Antecubital fossa (leaving dorsum of hand for cannulas etc)
Blood can also be taken from a fresh cannula (before its flushed), an arterial line or a central line

Question 10

What would you say to ‘inform’ the patient about this procedure?

Answer 10

‘I’ve been asked to take a small blood sample from you today. That will involve my putting one small needle into a vein on the inside of your elbow and will feel like a sharp scratch’.
Then warn the patient about potential complications.