CLINICAL I Best practice

Venepuncture— taking blood with care Paul Burgess, Discharge Case Manager and Health Care Assistant for NHS Professionals, Derriford Hospital, University Hospitals Plymouth NHS Trust, Devon

Contents What is venepuncture? Box 1. How to perform venepuncture Troubleshooting guide ● Needle phobia ● Needle penetrates the artery instead of the vein ● Patient complains of tingling sensation in hand/fingers ● Needle enters the skin and stops drawing blood ● No blood seen in the blood specimen bottle once needle has penetrated in the patient Tips Blood specimen bottles ● Light blue ● Black ● Red ● Gold ● Lavender ● Pink ● Grey ● Royal blue Other blood tests ● Short synacthen test ● C-peptide Therapeutic drug monitoring Blood cultures ● Aerobic ● Anaerobic ● How to obtain blood cultures Special transportation of blood samples ● Ice ● Warmth Role of the phlebotomist Final notes Conclusion

What is venepuncture? I used to be a doctor’s assistant (DA) for the acute care team (ACT), and also worked as a healthcare assistant (HCA) when I worked on various wards/ departments—and I still do for NHS

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Professionals (NHSP), as I can still maintain my physical side of nursing by using this skill.

I first learnt this skill of venepuncture— which I wanted to learn and to perform—in order to enhance my care to all patients on a daily basis, because obtaining bloods is the basic diagnostic test in order to start treatment early and to get the patients’ bloods within their recommended parameter, as well as diagnosing patients’ illnesses.

‘Peripheral venepuncture/ phlebotomy is the withdrawal of blood from the vein. ‘

Dougherty et al, 2010

This practical procedure is to obtain various blood samples for analysis. Venepuncture is also known as phlebotomy, drawing of blood, taking blood or venesection (see Box 1). Troubleshooting guide Needle phobia Normally, either the ward or the patient will tell you about their fear of needles prior to the procedure. Some patients might have Ametop prescribed: it is numbing cream that needs up to an hour for the numbing sensation to take effect.

Alternatively, it is a good idea to have a second person to hold the patient’s hand for TLC and distraction, while you obtain their blood samples. It is best to get the patient to lie on their bed if they are mobile and/or sit in their chair in case they feel faint, light-headed and/or dizzy.

The trust mainly uses the Ametop Gel 4% 1.5g, which is a local anaesthetic that contains tetracaine and is formulated to numb the skin, to relieve the pain of injections. It is manufactured by Smith & Nephew (see Picture 10, and S&N leaflet in Resources).

Needle penetrates the artery instead of the vein You can tell when this happens when you observe red pulsing blood entering the blood specimen bottle. The blood from the artery tends to be bright red, as it has been oxygenated, unlike the blood from the vein, which is dark red, since it is deoxygenated. When this happens, remove the blood specimen bottle, loosen the tourniquet, and carefully remove the needle—but be aware that the blood may splash you. Then apply direct pressure on the puncture site for about 10 minutes.

Explain to your patient, nurse and doctor about what happened and document it in the clinical and nursing notes. Then complete an incident form (in my trust, we use DATIX, an online incident form). If you still feel confident, re-attempt the venepuncture with new and sterile equipment. If not, gain further assistance from a more experienced healthcare professional.

Patient complains of tingling sensation in hand/fingers This tingling sensation could indicate that the needle has either touched or penetrated a nerve. When this happens, remove the blood specimen bottle, loosen the tourniquet and remove the needle, and then apply direct pressure on the puncture site for about 2 minutes.

Inform the nurse and doctor, and document in the clinical and/or nursing notes, and complete an incident form, as above. Then re-attempt the procedure with new and sterile equipment.

Needle enters the skin and stops drawing blood This could occur when the needle might have touched the valve inside the vein (see Picture 11). If this happens, remove

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April 2022 Vol 16 No 4 British Journal of Healthcare Assistants