Phlebotomy is the introduction of a needle into a vein to withdraw a sample of blood for haematology (to assess blood cell composition eg. Complete Blood Count CBC), biochemistry (to assess electrolytes) or bacteriology (blood cultures) reasons.
Venepuncture is a highly invasive common diagnostic advanced skill regulated by institutional or ward protocols.
Blood investigations are required for:
- evaluating treatment progress
- screening for specific diseases
- ensuring that a drug is within its therapeutic level (eg. checking digoxin levels to prevent digoxin toxicity)
- checking for the patient’s wellbeing
Venepuncture Preferred Sites:
- Basilic Vein
- Cephalic Vein
- Medial-Cubital Vein
The basilic vein on the dorsum of the hand can also be accessed, whilst foot veins should be accessed only as a last resort.
AVOID:
- amputation, mastectomy or lymphoedema sides
- fractured limb
- paralysis sides
- AV graft or fistula
- IV infusion sites
- frequently used areas for venepuncture
DO NOT USE:
- pulsating vessels (they are probably arteries)
- haematoma
- oedema
- inflammation or infection
- fibrous veins (rigid, cordlike veins that roll)
Factors Influencing Venous Circulation
- VASOCONSTRICTION – anxiety, stress, shock, cold
- VASODILATION – warm, mechanical irritation, chemical irritation
- BLOOD PRESSURE DROP
- THROMBOSIS
- LOW IV COMPONENT – dehydration, haemorrhage
Phlebotomy Procedure
Equipment Needed for Venepuncture
- tourniquet
- alcohol swabs
- non-sterile gloves
- vacutainer OR syringe & needle
- blood sample bottles
- sharps container
- gauze swab
- adhesive dressing
Nurse Safety Procedures:
- hand hygiene
- gloves
- dispose of used items correctly
- handle needles safely
- dispose of needles in the sharps box
Patient Safety Procedures:
- confirm patient identity
- perform skill only if needed
- cross-contamination prevention
- disinfect skin
In the case of difficult venous access:
- tap gently onto the vein
- put arm in warm water to encourage vasodilation
- lower arm below the level of the heart
- ask for assistance
- use advanced imaging techniques
NOTES:
When taking blood, mix sample bottle between 8-10 times after withdrawal.
Bleeding following venepuncture can take up to 10 minutes to stop, thus, tell patient to apply pressure to avoid haematoma formation.
Phlebotomy Problems:
ARTERIAL STAB:
- immediately remove needle
- apply firm pressure and elevate for more than 5 minutes until bleeding stops
- assess movement, sensation and circulation of affected limb
- consult physician
NERVE DAMAGE:
- immediately remove needle
- examine movement, sensation and circulation of affected limb
- consult physician
HAEMATOMA PREVENTION:
- insert needle at correct angle to avoid opposite vein wall perforation
- hold vacutainer and needle steadily whilst taking blood
- remove tourniquet prior to removing needle
- apply pressure on puncture site immediately following needle removal
Below you can find a collection of videos that can help provide a more visual approach to Phlebotomy.
Phlebotomy
Special thanks to the creators of the featured videos on this post, specifically Youtube Channels OSHVideo08 and RegisteredNurseRN.
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