Barnsley/Rotherham Integrated Laboratories
Filename : 533580554
Department: Phlebotomy
QMS No : SOP-PHLEB-10
Title: Adult Venepuncture Procedure
No.of copies :
Location of copies :
Q-pulse only
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Contents
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Risk assessment/Safety controls ..................................................................................................... 2
Purpose ........................................................................................................................................... 3
Principle .......................................................................................................................................... 3
Order of Draw ................................................................................................................................. 3
Patient preparation ......................................................................................................................... 3
Type of sample bottle ..................................................................................................................... 3
Equipment ....................................................................................................................................... 3
Procedural steps ............................................................................................................................. 4
Quality control procedures ............................................................................................................. 6
References .................................................................................................................................. 6
Summary of revisions.................................................................................................................. 6
Version : 1.1
Author : Carol Heritage
Active Date : 14/05/2015
Page 1 of 6
Approved by : Linda Dyer
Review due : 14/05/2018
Barnsley/Rotherham Integrated Laboratories
Filename : 533580554
1.
Department: Phlebotomy
QMS No : SOP-PHLEB-10
Risk assessment/Safety controls
All Phlebotomists based in Phlebotomy Outpatients are trained in the following Risk
Assessments and Safe Systems of Work relate to this SOP:
Adult Venepuncture Risk Assessment (HS-RP-D-26)
Adult Venepuncture Safe System of Work (HS-RP-D-27)
Manual Handling Assessment: Bleed Patient in Phleb OPD (HS-ASS-MH-PHLEB-2)
Manual Handling Assessment: Moving patients in a wheelchair from A to B
Phlebotomy OPD (HS-ASS-MH-PHLEB-4)
Conflict Resolution Risk Assessment (HS-ASS-MH-PHLEB-7)
SSW Conflict Resolution Phlebotomy OPD (HS-ASS-MH-PHLEB-8)
1.1 Chemicals to be used, hazards and control measures
Chemicals to be used
Body Fluids - Bloods
Hazards
Biological agent
Control measures
1. COSHH Data sheet
2. PPE
3. Trust Clinell spill
kit/wipes
1.2 Other hazards (e.g. physical, electrical, biological, hot or cold burns etc.) and control
measures. Please delete the examples and enter appropriate hazards.
Hazard type
Description
Sharps/contamination Contamination injury via
injury
percutaneous, mucocutaneous
or contact with broken skin
Control measures
1. Staff trained in Trust
Contamination injury
procedure
2. Staff trained in
Venepuncture
3. Trust Safe Handling and
Disposal of Sharps Policy
Electrical
Electric shock
Manual handling
injury
Musculoskeletal injuries e.g.
repetitive strain, static posture,
bending stooping and twisting
1. Portable appliance testing
(PAT).
2. Regular servicing
1. Staff receive patient manual
handling theory and practical
training.
1.3 Disposal methods
 Sharps disposed of via sharps containers.
 Clinical waste via clinical waste stream.
 Spills managed via Trust Spill Kit/Wipes
1.4 Assessment of staff exposure: Consequence score (1-5) x likelihood score (1-5).
ASSESSMENT: 2 x 2 = 4 (Moderate Risk)
Version : 1.1
Author : Carol Heritage
Active Date : 14/05/2015
Page 2 of 6
Approved by : Linda Dyer
Review due : 14/05/2018
Barnsley/Rotherham Integrated Laboratories
Filename : 533580554
Department: Phlebotomy
QMS No : SOP-PHLEB-10
2. Purpose
To safely obtain a sample of venous blood from an adult
3. Principle
This procedure may only be undertaken by a registered nurse or appropriately trained
designated person who has been specifically and adequately trained to undertake the
procedure and agrees to undertake it.
Skills competencies must be re-assessed every 3 years.
If the procedure has not been carried out for three years, refresher training must
be undertaken.
Strict principles of ANTT must be followed.
Only one patient to be bled at a time.
For patients presenting with a blood borne virus-please attached a ’Danger of Infection’
label to the specimen collection bag and container. Do not send samples with ‘Danger of
Infection’ label through the POD System.
Handle and dispose of sharps safely to avoid injury. If an injury occurs refer to the
contamination incident procedure.
The closed circuit system must be maintained and blood must never be decanted from a
syringe to a bottle as this damages the blood cells and effects the results.
The person taking the sample must always be the person labelling the bottle.
4. Order of Draw
Order in which to take Blood Samples (colour of bottles as per Sarstedt Monovette Blood
Collection System :
Serum - Brown/White/Blood gases
Citrate - Green
Heparin - Orange
EDTA - Red/Blue
Glucose - Yellow
5. Patient preparation
Ensure the patient attends with a correctly completed request form with minimum patient
data set.
Ensure the patient data set on the request card matches the patient to be bled. If multiple
request cards are presented by the patient ensure all the request cards are for that patient
and that the data is correct on all the forms.
Check that the patient has followed and pre-test requirements e.g. fasted, date and time of
last dose of drugs, 21day or 09:00 hormone checks etc.
6. Type of sample bottle
Sample bottle type, required for test/s, will be shown on the Sunquest ICE Ordercomms
form if requested via ICE
Sample bottle type can be found on the Pathology intranet site
(http://www.barnsleyhospital.nhs.uk/pathology/) under test repertoire for each specialty
7. Equipment
Sharps disposal container
Tourniquet
2% chlorhexidine in 70% alcohol impregnated wipes
Appropriate sized Sarstedt Monovette needle
Version : 1.1
Author : Carol Heritage
Active Date : 14/05/2015
Page 3 of 6
Approved by : Linda Dyer
Review due : 14/05/2018
Barnsley/Rotherham Integrated Laboratories
Filename : 533580554
Department: Phlebotomy
QMS No : SOP-PHLEB-10
Appropriate Sarstedt Monovette blood collection tubes (check expiry dates)
Cotton wool swab
Adhesive/hypoallergenic tape
Non sterile exam gloves
Apron (optional)
8. Procedural steps
Action
Assemble all equipment necessary
Check the identity of the patient by
asking them to state their full name,
date of birth and 1st line of address, and
check these details match the request card.
If multiple request cards are presented then
ensure all the request cards are for that
patient and all details are correct on all the
request cards.
Check the patient has followed
any specific pre-test requirements as
detailed on the request card e.g.
fasting, date and time of last dose of
drugs, 21 day or 09:00 hormone checks
etc.
Explain the procedure to the patient
Wash and dry hands thoroughly or use
Alcohol Hand sanitizer if hands are visibly
clean. Put on gloves.
Patient may be asked to wash the
chosen arm if visibly dirty or phlebotomist
wipes patient arm with appropriate skin
wipes
Hyperextend and support the chosen
arm
Apply the tourniquet 3-4 inches above
the chose site and ask the patient to
clench his/her fist
Palpate the selected vein, main veins
of choice are the median cubital,
cephalic and basilic veins situated
within the ACF
Using a Non- touch technique clean the
skin with alcohol wipe using a
downward direction motion. Allow to
air dry or dry with a clean cotton wool swab.
Assemble the needle and the first tube
to be drawn. Staff need to be aware of
the order that the blood samples
should be taken
Version : 1.1
Author : Carol Heritage
Active Date : 14/05/2015
Rationale
To ensure all equipment is at hand
To ensure the sample is obtained from
the correct patient.
Staff need to be extra vigilant with
vulnerable patients.
To ensure an accurate blood result
To ensure the patient understands the
procedure and gives his/her informed
consent
To remove transient micro-organisms
To remove transient micro-organisms
To identify the veins and promote
patient comfort
To increase prominence of the vein by
restricting venous return
To distinguish it from other structures,
i.e. arteries and tendons
To ensure that the puncture site is
clean and dry and maintain asepsis
To ensure equipment is ready to use.
To ensure sample is not contaminated with
citrate/ heparin from other tubes.
Page 4 of 6
Approved by : Linda Dyer
Review due : 14/05/2018
Barnsley/Rotherham Integrated Laboratories
Filename : 533580554
Grasp the arm firmly using the thumb
to draw the skin taut and anchor the
vein
Insert the needle at an angle of 30
degrees with the bevel facing up.
Level off the needle when ‘flashback’ of
blood is seen.
Obtain the blood sample by pulling
back gently on the plunger while
holding the syringe barrel securely.
Ensure the needle is secured whilst
changing sample tubes
Gently invert each tube as draw is
completed
When the last tube to be drawn is
filling, release the tourniquet. Remove
the tube from the needle and then
remove the needle from the arm and
immediately apply pressure to the
venepuncture site with the cotton wool
swab.
Pressure should be applied until
bleeding has ceased approx. 1 minute
and may be longer if patient has any clotting
disorder.
Dispose of the needle directly into a sharps
container as per Trust policy for safe
disposal of sharps
Label all samples immediately with the
patients details and complete date,
time bled and initial. Sunquest ICE labels
may be used on any sample except blood
transfusion samples which must be
hand written.
Sign the request card.
Place specimens in the correct coloured
specimen collection bag (green for routine,
red for urgent, yellow for Microbiology
samples) and attach the bag to the request
card
Place samples in appropriate pod for
transportation to the laboratory either by
the pneumatic chute system or by hand in
the metal tin
Clear away equipment and dispose of
all waste in accordance with the
relevant Trust waste disposal policies
Version : 1.1
Author : Carol Heritage
Active Date : 14/05/2015
Department: Phlebotomy
QMS No : SOP-PHLEB-10
To immobilise the vein.
To provide counter tension which will
facilitate a smoother needle entry.
To reduce damage or trauma to the
Vein
To keep the needle in place in the
Vein
To prevent the needle from being
accidently retracted
To ensure tubes with additives are
thoroughly mixed
To prevent bleeding and bruising at
the venepuncture site.
To prevent needle stick injuries
To ensure that specimens are labelled with
the correct patient details and results
returned to the correct patients notes.
Hand written tubes must be legibly
and accurately completed, in ball point
pen to avoid smudging. ZERO
tolerance – inaccurate or inadequate
labelling will result in the rejection of
samples.
Identification of who bled the sample.
Samples are delivered to the
Laboratories safely and are filtered by lab
reception according to importance/relevant
laboratory
To make sure that the specimens
reach the intended destination safely
To ensure a safe and clean
environment and the safe disposal of
waste.
Page 5 of 6
Approved by : Linda Dyer
Review due : 14/05/2018
Barnsley/Rotherham Integrated Laboratories
Filename : 533580554
Remove gloves. Wash and dry hands
thoroughly or use alcohol hand rub
Department: Phlebotomy
QMS No : SOP-PHLEB-10
To remove transient micro-organisms
9. Quality control procedures
Staff have to be competency assessed, by the Phlebotomy Service Manager or the Trust
Clinical Skills Trainer, against this procedure every 3 years.
10. References
Blood transfusion Nursing Procedure BHNFT July 2010
Campbell H, Carrington M, Limber C, (1999) A practical guide to venepuncture
Dougherty L Lister S (2008) The Royal Marsden Hospital Manual of Clinical
Nursing Procedures 7th Edition Wiley- Blackwell Oxford. Chapter 46 p 924-930.
11. Summary of revisions
Version
1
1.1
Summary of change
Not applicable – first issue.
Added that staff must check patient demographics on all request cards if
multiple request cards are presented by the same patients.
Version : 1.1
Author : Carol Heritage
Active Date : 14/05/2015
Page 6 of 6
Approved by : Linda Dyer
Review due : 14/05/2018