Flashcards in Venepuncture Deck (35)
A term used to describe the procedure of entering a vein with a needle to obtain blood
What are the indications for venepuncture?
1. Diagnostic purposes (haematological, biochemical, bacterial or viral)
2. To monitor levels of blood components via laboratory testing
What is venepuncture used for in midwifery?
- Antenatal booking bloods
- Assessment of FBC and presence of rhesus antibodies
- Tests for pre-existing conditions or conditions arising in pregnancy
- Antenatal screening for abnormalities
- Blood grouping or cross-matching
- Emergency access for drug administration
Give some examples of pre-existing conditions tested for in midwifery
- Thyroid function test
- Blood glucose monitoring
- Sickle cell
Give some examples of conditions arising in pregnancy that are tested for
- Gestational diabetes
What are the legal responsibilities to be considered in venepuncture?
- Vicarious liability (someone is held responsible for actions or omissions of another person)
- Expected standard of care
What are the ethical responsibilities to be considered in venepuncture?
- Do not harm/ do good (non-maleficence, beneficence)
- Promote autonomy
Give 3 other things that should be considered when performing venepuncture
1. Informed consent
2. Local policies and guidelines
3. Personal accountability and professional responsibility
How should a vein be selected?
- Take time to assess
- Most common site = antecubital fossa (elbow pit)
- Do not infiltrate brachial artery
Why is the antecubital fossa usually chosen for venepuncture?
Contains 3 major veins:
3. Median cubital
-All are easily accessible and well supported
- Median cubital best because its the most stable, least sensitive area and close to surface
How should the vein be assessed?
- Visual inspection and palpation
- Palpation determines position and condition of vein and distinguishes between veins and arteries/tendons
What should veins be chosen based on?
- Easily detected on inspection and palpation
- From unused area
- Soft and bouncy
- Refills easily when depressed
Give some areas that should be avoided
- Veins adjacent to bruising, phlebitis or infected areas
- Thrombosed/ fibrosed veins
- Thin, fragile veins
- Veins over bony prominences
- Arms affected by medical conditions
What is phlebitis?
Inflammation of a vein
What equipment is required?
- Non-sterile gloves
- Alcohol swabs
- Needle for blood collection system
- Appropriate blood bottles/ collection devices
- Cotton wool/ gauze swab
- Sharps bin
- Appropriate blood forms and transport bag
Name the different types of collection devices
- Monovettes and wing devices
How should the client be prepared?
- Identify women with name and hospital number
- Put woman at ease
- Informed consent
- Ask if bloods have been taken before
- Woman should lie down if particularly anxious
- Inform women of procedure
How should the environment be prepared?
- Woman should be comfortable
- Adequate lighting
- Warm environment
- Limbs supported
- Equipment at hand
How can venous access be improved?
- Application of tourniquet
- Opening/closing fist
- Lowering arm below heart level
- Use of warm pack/ warm water
- Do NOT tap veins as this may cause bruising and pain
Give steps 1-9 of the venepuncture procedure
1. After client is prepared and identified, wash hands
2. Prepare environment
3. Assemble equipment
4. Assess veins
5. Apply tourniquet to assess veins
6. When vein is identified, release tourniquet
7. Wash hands and use aseptic technique
8. Put on gloves
9. Reapply tourniquet
Give steps 10-14 of the venepuncture procedure
10. Clean skin with alcohol swab for 30 secs
11. Allow skin to dry
12. Stretch skin over chosen site to anchor vein
13. Ensure bevel of needle is uppermost and smoothly insert needle into vein at 30 degree angle
14. Observe for flashback, reduce angle and advance needle slightly
Why should the needle not be inserted too fast/slow?
Too fast = may go through vein
Too slow = increases discomfort
Give steps 15-20 of the venepuncture procedure
15. Stabilise needle and syringe and either withdraw plunger or attach pre-vacuumed bottle
16. Collect blood sample
17. If unsuccessful after 2 attempts, seek midwife assistance
18.If successful, release tourniquet before removing needle
19. Cover needle with cotton wool/ gauze and remove from vein
20. Invert tube at least 6 times
In what order should blood samples be taken?
1. Blood culture
3. Serum tube
4. Additive tubes
5. All other tubes
Give steps 21-28 of the venepuncture procedure
21. Ensure patient is comfortable
22. Do not apply pressure when removing needle
23. After needle is removed, apply pressure with arm straight for 30-60secs
24. Apply plaster
25. Discard needle appropriately and safely
26. Complete relevant forms and blood bottles and sign at bed side
28. Send specimens to lab
What are the potential problems caused?
- Infection (poor aseptic technique)
- Limited venous access
- Bruising haematoma
- Vasovagal reaction/ fainting
- Blood stops flowing
- Needlestick injury
- Accidental blood spillage
- Missed vein
- Spurt of blood on entry (superficial vein used)
How might pain be caused during venepuncture?
- Puncturing an artery
- Touching a nerve or valve
- Use of vein in a sensitive area
Why might limited venous access be an issue?
- Repeated use of vein
- Peripheral shut down
- Sclerosed veins
How might a bruising haematoma be caused?
- Needle punctured both sides of the vein
- Inadequate pressure on needle removal
- Forgetting to remove tourniquet before needle removal