Venepuncture, obtaining blood cultures and managing blood samples

Transcription

1 Venepuncture, obtaining blood cultures and managing blood samples Aims To ensure that students are able to demonstrate the safe and correct technique for venepuncture, obtaining blood cultures and managing blood samples. To provide an understanding of the importance of careful planning and equipment preparation. To develop an understanding of the communication skills required while interacting with the patient. These include the correct process of identification, explanation of the procedure and consent to carry out the procedure. To develop an understanding of the importance of completing all relevant documentation. Learning Outcomes Demonstrate the correct process of patient identification, explanation of procedure and obtaining consent to carry out the procedure. Identify the correct equipment for the task, safely prepare the equipment and complete the procedure safely. Demonstrate the correct procedure of completing all relevant documentation. Show an appreciation regarding the importance of being familiar with local trust policy.. CSC NGH MM/JJ/MH/AB 1

2 How to perform a venepuncture and obtain blood samples You must be able to identify all relevant equipment that will be required to perform a venepuncture and obtain blood samples. This is an invasive skill and all necessary protocols from correct identification of the patient to documentation in patient s notes need to be followed. Equipment (Figure 1and 2) 1. Patient s blood request forms and patient s notes. 2. Butterfly device. 3. Vacutainer barrel. 4. Appropriate blood sample tubes/blood culture bottles for collection of samples. 5. Non-sterile gloves. 6. Disposable plastic apron. 7. A clean receptacle to put the equipment in. 8. A sharps disposal bin. 9. Clinell wipe. 10. Tourniquet. 11. Gauze. 12. Cotton wool and tape. CSC NGH MM/JJ/MH/AB 2

3 Figure 1: Venepuncture, obtaining blood cultures and managing blood samples - Showing the equipment required and the set up in a clinical skills laboratory. Figure 2: Showing the different types of request forms used in clinical practice. CSC NGH MM/JJ/MH/AB 3

4 Initiating the procedure to include Introduce yourself by full name and post. Identify the patient by asking them to state their name, date of birth and first line of address. Check name, hospital number and date of birth against laboratory request forms, patient identification wrist band and patient s notes. This is to ensure that the venepuncture is carried out on the correct patient. Explain the procedure to the patient and gain the patient s consent. Inform them about potential complications (pain, bleeding, swelling/haematoma, infection). Ask the patient if they have any known allergies to surgical tape. Performance of task to include Use alcohol gel to clean hands or wash your hands as per local guidelines. Don a pair of gloves and an apron. Collect all required equipment including sharps bin and request forms. Position the patient s arm and identify a suitable vein. Support the arm using a pillow. Check the site for any contraindications to the procedure. These include broken skin, an arteriovenous fistula, local infection, hard or cord like veins on palpation, or if the patient had breast surgery /axillary lymph node removal or radiotherapy on that side. CSC NGH MM/JJ/MH/AB 4

5 Obtaining blood cultures using a butterfly device Remove protective cap from blood culture bottle and disinfect rubber septum with appropriate wipe (as per local policy). Allow to dry. obtain Apply tourniquet approximately 5-10 cms above the intended site, using a finger as a guide to avoid over tightening. Recheck vein by palpation. Clean the site as per local policy maintaining asepsis. Do not repalpate the vein following cleaning. Open butterfly device and connect luer lock to blood culture adapter/vacutainer adapter using an aseptic technique. Prepare all other equipment as needed. CSC NGH MM/JJ/MH/AB 5

6 Ensure that the patient is ready to proceed. Explain to them that they might feel a slight scratch. Remove safety sheath from butterfly needle. Stretch the skin below the site and insert the needle, bevel upwards, in line with the vein at an angle of no more than 45 degrees. Advance needle until a flashback of blood appears in the butterfly device. Secure butterfly to patient s arm using tape across the wings. Obtain blood cultures in the bottles. Attach the adapter cap to the blood culture bottle and allow required amount of blood to collect (as specified on the blood culture bottle). Obtain an aerobic and an anaerobic sample in the respective bottles. CSC NGH MM/JJ/MH/AB 6

7 Obtaining additional blood samples using a butterfly device Collect additional blood samples using correct order of draw. Urea and electrolytes (yellow cap) followed by full blood count (purple cap). Invert the tube to mix the sample (as per manufacturer s instructions). Once all samples have been collected release the tourniquet before removing the needle. CSC NGH MM/JJ/MH/AB 7

8 Remove the needle and discard immediately into sharps bin. Check the venepuncture site for any prolonged bleeding or hematoma formation. Apply suitable dressing and ask patient to apply pressure. Inquire about any allergies to surgical tape before applying it on the patient. CSC NGH MM/JJ/MH/AB 8

9 Document the procedure in patient s notes. Label all blood samples correctly. Do not use addressograph labels. Write the details by hand. Make sure that they are clearly written. Complete all laboratory request forms. Make sure you fill in the correct details and investigation requested on the correct form. Sign and date the request forms. CSC NGH MM/JJ/MH/AB 9

10 Aftercare Request patient to inform the staff members if they feel any discomfort, pain or swelling around the venepuncture site. Remove gloves and apron. Thank the patient. CSC NGH MM/JJ/MH/AB 10

11 Obtaining blood samples using a Vacutainer device and needle Note: Please note that a variety of blood sample collections systems are available and these may vary across different hospitals. Always follow the local policy of the Trust and make sure that you familiarise yourself with the system being used in that particular hospital. The basic principles, preparation, protocols, documentation and aftercare are the same regardless of what system of blood sample collection is in place. If using a Vacutainer system the following steps will be different from the procedure described earlier. Aseptically prepare the Vacutainer collection system. Remove the needle sheath and inspect needle to detect any faults. Inform the patient that they might feel a slight scratch as the needle is inserted into the skin. Remove the sheath from the needle. Insert the needle with the bevel uppermost and at an angle of 30 to 45 degrees following the line of the vein. CSC NGH MM/JJ/MH/AB 11

12 Support the barrel of the Vacutainer and using the wings for extra support attach the appropriate blood collection tube. Take care not to push the needle further into the vein as might cause damage to the vein wall. Follow the order of the draw, U and E before FBC. When the blood collection is complete carefully remove the blood tube. Take care not to pull out the needle from the vein. Invert the tube to mix the sample (as per manufacturer s instructions) CSC NGH MM/JJ/MH/AB 12

13 When all samples have been collected, release tourniquet and remove needle. Apply cotton wool and ask patient to apply pressure. Inquire about any allergies to surgical tape before applying it on the patient. The remainder of the steps would be as described earlier. References Dougherty, L and Lister S. (2008).The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7 th Ed. Oxford: Wiley-Blakewell. CSC NGH MM/JJ/MH/AB 13