Work Instruction Title: Obtaining Blood Samples by Venepuncture
Work Instruction Number: 24
Version Number: V.1
Effective Date: 25 November 2013
Author
Name: Brenda Deboys
Title: Obtaining Blood Samples by Venepunture
Date: 25 November 2013
Approved by
Name: Helen Macdonald
Title: Network Manager
Date: 25 November 2013
Review date: 24 November 2015
Review History
Version No.
date
amendments
WI 24 Obtaining Blood Samples
by Venepuncture
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Approved V.1
1. Introduction, Background and Purpose
The CRN Primary Care supports many studies that require research nurses and other
practitioners to obtain venous blood samples from study participants. Standardisation
of technique is essential to ensure blood is obtained safely, in line with Good Clinical
Practice (GCP) guidelines and current approved practice.
The purpose of this Work Instruction (WI) is to describe the correct technique for
obtaining a venous blood sample, in a way that minimises discomfort to the patient
and ensures the safety of the practitioner and the quality of the samples obtained.
2. Abbreviations
See Reference Document: CRN Primary Care Abbreviation List and Glossary of
Terms.
3. Scope
This WI applies to any research nurse or other practitioner, obtaining a blood sample
from an adult patient, in line with a research protocol, who has previously undertaken
venepuncture training, is considered competent to perform this procedure and
considers themselves competent.
Existing site specific policies or study specific SOPs must be followed.
4. Responsibilities
Managers are responsible for ensuring that staff within their teams have the
knowledge and skills to comply with specific requirements of this WI. Staff must
ensure that they have read and understood this WI and phlebotomy training must be
recorded in the individual’s training record.
All practitioners are also responsible to be aware of the local/Trust policies
regarding Infection Control, Sharps Injury, Contamination with Blood or Blood
Stained Fluid and other related local guidance.
5. Procedures
5.1 Preparation
5.1.1 Read the study specific instructions regarding the samples required.
Staff performing the procedure must be familiar with the blood collection
system to be used, order of draw and handling instructions as required by the
protocol.
Ensure the correct equipment is available, including a rigid sharps container.
5.1.2 Hand hygiene should be performed before undertaking the procedure.
If staff have skin lesions these should be covered with an occlusive waterproof
dressing.
Well-fitting powder-free latex gloves (or equivalent) must be worn
5.2 Procedure
5.2.1 Explain the procedure to the patient and request permission. Confirm
patient name/study ID/date of birth as required.
WI 24 Obtaining Blood Samples
by Venepuncture
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Approved V.1
Check for patient preference concerning which arm is used and make sure that
he/she is sitting or lying comfortably. If possible, avoid areas of irritation/swelling/or
frequently used for venepuncture. Ensure clothing is loose around the arm.
Support the arm on bed, pillow or arm of chair so that it is stable. Identify any
cautions for example if patient has fainted/become dizzy previously while having
blood taken, take precautionary measures – ensure support available, use
bed/reclining chair if available.
5.2.2 Place prepared blood bottles, needle/adaptor, alcohol wipe and cotton
wool close to patient.
5.2.3 PUT ON GLOVES.
5.2.4 Place visibly clean tourniquet on upper arm and tighten (the degree of
tightness will affect the substance of the veins). Stained tourniquets should be
destroyed.
5.2.5 Palpate to identify optimal vein in the ante-cubital fossa . There is often
more than one to choose from and the vein does not have to be visible. Check
the orientation of the vein, and confirm that this is not a superficial Brachial
Artery. (No pulse should be palpable)
5.2.6 Wipe the area to be used with alcohol wipe and allow to dry.
5.2.7 Pull the skin tight below chosen site. Holding the hub of the needle,
gently insert along the lumen of the vein, at approx. 30 degree angle, bevel
side up. Maintain contact between your hand and patient’s arm as this keeps
needle steady for changeover procedures. Do not press too hard on arm as
this may restrict blood flow. Squeezing or clenching fist while taking the
sample is generally not recommended unless the sample is slow.
5.2.8 When the first container is filled, remove and replace with next container.
It is essential to hold the hub of the needle firmly during this process, to avoid
further penetration of the vein. Repeat the process until all containers are
filled.
Mix each sample by inverting gently, as specified. DO NOT SHAKE.
5.2.9 When complete, remove the last blood bottle from the needle. Loosen
the tourniquet before withdrawing the needle and place cotton wool lightly
over the puncture site. When needle is free from arm, apply pressure to
venepuncture site, by pressing firmly on cotton wool. If patient is able, ask
him/her to apply pressure. Do not bend the arm.
5.2.10 As soon as the needle is removed, place in sharps box. NEVER leave
needles lying around. DO NOT RESHEATH as there is a danger of needle
stick injury.
5.2.11 Label all samples immediately while the patient remains in the clinic
room - as per study protocol/study SOP’s, including date and time. Complete
forms/study documentation and place samples in appropriate specimen bag(s)
5.2.12 Check patient’s arm has stopped bleeding and apply plaster or cotton
wool and micropore tape.
5.2.13 Remove all waste and dispose appropriately. Remove gloves and wash
hands.
WI 24 Obtaining Blood Samples
by Venepuncture
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5.2.14 Check that patient is feeling well.
5.2.15 As a general rule, if the first attempt is unsuccessful , one, or at the
most two further attempts may be made with patient consent. If no veins are
palpable in the ante-cubital fossa, experienced and trained practitioners may
use a vein in the back of the hand, using butterfly and/or needle syringe, with
patient consent.
5.3 Safety
Staff should take care to avoid accidental injury from needles as gloves do not
protect from a penetrating injury.
Should an accidental injury occur, follow the Local Trust Infection Control
Policy/Procedure for Sharps Injury/Contamination with Blood or Blood Stained
Fluid.
Using the system provided, the only spillage of blood is normally a small droplet
leakage after removal of the needle from the puncture site. This may be absorbed
by the application of the cotton wool ball.
5.4 Blood spillages
Any spillage should be cleaned according to local guidance, or as below:
5.4.1 Wearing latex gloves or equivalent and apron, cover the spillage with
disposable paper towels.
5.4.2 Carefully pour on neat Hypochlorite (Milton/Actichlor/equivalent10,000
ppm) and leave for three to five minutes.
5.4.3 Clean up spillage and discard paper towels into yellow clinical waste bag.
5.4.4 If the area of spillage is large, notify site staff for further assistance.
5.5 Incident reporting
Incidents involving sharps Injury or contamination with blood should be reported
according to local policy.
6. Related SOPs, Work Instructions and Reference Documents
Reference document: Transporting Specimens
7. Appendices
None
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by Venepuncture
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