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Venepuncture
for
1st Year Medical
Undergraduates

2. Request form and order of draw
This guide is aimed at 1st year students - after 1st year and
as you gain experience you will modify this technique. Look
out for later years guides AND DO
 Check local policies regarding venepuncture procedures.
 Check the request form ( These may vary )
 patient details and samples required.
 Check the „order of draw‟
 So that you know the order in which samples should be
taken.
 This may be different for different health trusts.
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Gather Equipment
Ensure all necessary equipment and materials are to hand
 Request Form
 Venepuncture system - bottles and needles
 Alcohol swab(s)
 Tourniquet
 Gauze balls
 Gloves
 Tray
 Portable sharps bin if available
 Hand wash

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The Sarstedt System
The advantage of this system over
syringe and needle or other
systems available
 The “syringe” is in effect a specific
sample bottle
 After taking the blood the “syringe”
can be changed for another type of
sample bottle
 There is no need to decant
samples
 The “plunger” is snapped off before
sending to the lab

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Sarstedt bayonet connection
 Push the syringe/sample bottle
into the hub of the needle
 The hub contains the second
part of a double ended needle
covered with a rubber sleeve
 The lugs should be aligned with
the channels in the hub
 The lugs are rotated into the
bayonet fitting to secure
 Sample bottles can be
interchanged with the needle in
the vein without leaking blood

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Tourniquet
 Tourniquet is applied to upper arm
 Tourniquet should not be so tight as to
cause pain or circulatory embarrassment
(check pulse is present if unsure)
 Tourniquet used should be capable of
being released with one hand
 May be applied twice once to assess
veins and to clean site then later just
prior to obtaining the sample.
 Many trusts use disposable „single use‟ –
tourniquets - these should be used if
available.

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Preparing the patient 1
 Wash your hands and introduce yourself.
 It is essential always to correctly identify patient
 Check
 request form
 patient‟s wrist band
 with patient
 Explain the procedure gain consent

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Preparing the patient 2
 Help them get into a comfortable position
 If patient is needle phobic, or has a history of
fainting it is best to lie the patient flat, or at
least put them in a chair with arms
 If necessary put the tourniquet on
 Assess the veins to establish the site for
sampling and check that you have
appropriate equipment - (a smaller needle
may be required).

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Examine vein
Cephalic
Basilic
Median cubital
Median antebrachial
Superficial veins of the right arm

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Choice of vein
 Vein should be readily palpable
 Compression of the vein should confirm bouncy
nature
 The median cubital vein in the ante cubital fossa is
preferred followed by the basilic vein, usually large
veins
 The dorsal veins of the back of the hand are
smaller and the area is more painful
 The median ante brachial is notoriously difficult to
obtain a sample from
 The Cephalic vein is used for cannulation so should
be preserved

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Raising the vein
 Ensure does not pulsate (feel for pulse and choose
a vein furthest away if unsure)
 Vein may be stroked to make it more prominent or
the limb warmed
 Hanging the arm below heart level helps dilate the
vein
 NEVER slap the vein
 Avoid sites which appear damaged or infected.
 Avoid sites in the same vein an infusion is sited
(this may create erroneous results)
 Do not take blood from an arterial/venous fistula.
 Remove or loosen the tourniquet

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Preparing the patient 3
 Skin flora is eliminated using a simple alcohol swab to
clean the skin at the chosen site.
 Swab in one direction.
 Never puncture skin through “wet” alcohol as this
increases pain.
 Time must be allowed for the alcohol to dry
 Please refer to Trust Policy regarding preparation of the
site.

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Preparing the patient 4
 Assemble equipment (if not
already )
 Reapply/tighten tourniquet
 Gloves are worn as part of
Universal precautions
 Employ a no-touch technique
 Warn the patient they will feel a
sharp scratch

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Angle the needle at 15-30
 The venepuncture
system is held firmly
and comfortably in the
dominant hand
 The vein is fixed by
applying gentle traction
at a point distal to the
intended point of
insertion (especially if
accessing the dorsal
veins)
15-30  from skin

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Puncture the skin
 The needle is
advanced into the skin
with one smooth
continuous movement
with the bevel (hole of
needle) of the needle
facing upwards.
 Venous access is often
accompanied by a
sensation of “giving
way”

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Expect “flash back”
 A Sarstedt system allows
the user to identify “flash
back” of blood into the
distal part of the syringe
or hub of the needle
 If you are unsuccessful –
you should gather fresh
equipment and start
again.
Small amount of blood seen
in distal portion of syringe on
gaining venous access

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Pull the plunger to obtain sample
 Hold the syringe (sample
bottle) steady whilst the
plunger is slowly pulled
to withdraw the venous
sample
 Each collection tube is a
sample bottle.
 If more than one sample
is required the full
sample must be
detached and further
bottles attached whilst
the needle remains
insitu.
Gentle traction
Steady

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Changing sample bottles 1
Hold needle securely
whilst detaching bottle
Hold needle securely
whilst attaching a new
bottle

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Changing sample bottles 2
 The colour of the sample bottles varies between different
manufacturers. It is therefore extremely important that you
familiarise yourself with the system used in each clinical
placement before taking any samples
 The order of attaching sample bottles „ order of draw‟ may
vary depending on local laboratory arrangements again it is
essential that you familiarise yourself with the order before
taking multiple samples.
 Always follow Trust guidelines
 You should tip sample bottles back and forth (gently) to
ensure the blood is adequately mixed with bottle contents.
Do NOT shake.

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Remove tourniquet first, then the needle
 NEVER LET GO OF A NEEDLE WHILST INSITU
 Remove collection bottle leaving needle in situ, gently mix
contents
 The tourniquet is released with one hand, whilst the other
steadies the needle.
 Place a piece of gauze over site of needle insertion
 Remove needle form vein – Dispose in SHARPS BIN
 Apply pressure to the insertion point once the needle
removed. Check -Is your patient OK?
 This reduces pain associated with needle removal.
 Dispose of all waste appropriately
 Wash your hands.

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Sample ready for analysis?
 Ensure the correct patient details are recorded on
sample bottle (Only label the sample bottles once
the sample has been obtained)
 Place bottle in plastic bag with request form(an
example of a request form is shown on the next slide)
ensuring any necessary biohazard warning
requirements are followed (see Trust guidelines)
 If unable to obtain a full sample bottle (don‟t throw it
away) ring and warn the lab staff, they may be able to
still analyse the sample if warned ahead of time (this
applies to accidental arterial stabs also).

22. BLOOD REQUEST FORMS
Clinical Skills Resource Centre
University of Liverpool
Telephone Enquiries 0151 …
Relevant clinical details
Date ………….
Time ………….
Specimen Type ………….
Name of M.O ……………
(Print)
Unit No ………………………
NHS No ………………………
Surname ……………………..
Forenames …………………..
Date of Birth ………………… M F
Consultant …………………. Hospital ……………
Ward / Clinic ……………….. NHS Private
Tick box as appropriate
This box will contain the tests
available on the specific form i.e.
FBC
U & E Profile
For Laboratory Use Only
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Safely dispose of waste and sharps
 Needle is disposed of
in sharps bin
 Clinical waste into
yellow bags
 Paper and wrappings
into black domestic bin
bags (clear bags within
the University)

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Complications of venepuncture
BAD TIP (Mnemonic)
 Bleeding, bruising, haematoma
 Arterial puncture
 Damage to adjacent tissues
 Thrombosis
 Infection
 Pain

25. Suggested order for performing venepuncture
 Check request form
 Clean tray
 Wash hands
 Gather equipment (can assemble here if you wish)
 Wash hands, before touching patient (if patient in same area
as equipment can omit this hand wash and wash before
donning gloves)
 Introduce self, Check ID against request form, verbally and
with the patient's wrist band
 Explain procedure, gain consent and position patient
 Assess veins (if necessary use tourniquet)
 Swab skin, loosen tourniquet.
 Assemble equipment if not already.
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26. Suggested order for performing venepuncture
 Wash hands
 Put gloves on
 Apply tourniquet (single use disposable)
 Warn Patient
 Introduce needle - gain sample or samples
 Tourniquet OFF
 Bottle OFF (gently agitate) then needle OUT
 Apply pressure
 Dispose of waste
 Gently agitate sample, fill out patient details on sample and
document.
 Wash Hands
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27. Alternative venepuncture
systems

28. Vacutainer system
 The system consists
of three separate
components
 Needle
 Holder
 Vacuum sample
bottle(s)

29. Vacutainer system
 The needle is screwed
into the base of the
container
 A rubber sleeve sits
within the container over
a second needle bevel
 This image shows the
needle pro safety device
which covers the needle
post insertion to reduce
needle stick injury.
Image supplied by Smiths Medical

30. Vacutainer system
 The vacuum sample bottle is pushed onto the
rubber covered needle after venous access is
obtained. (an adapter is available to enable the
user to see flash back)
 Blood is drawn by the vacuum into the bottle.
 Further samples can be taken by changing
vacuum bottle within the container
 Always check the order in which the sample
bottles should be taken as the solution in
certain bottles would alter results in
subsequent samples if taken in the wrong order

31. If using a traditional syringe and needle
 Use of the traditional syringe and
needle method necessitates the
decanting of blood into the
sample bottle.
 If this is necessary, remove the
needle and take the top off the
sample bottles to minimise risk of
needle stick injury and blood
spillage
 Always wear gloves when
decanting

32. Saf-T-Wing
 This system uses a
butterfly needle (the saf-t-
wing) the traditional
vacutainer holder and
sample bottle.
 On removal of the saf-t-
wing the needle withdraws
directly into the plastic
housing meaning the
sharp is never exposed
after insertion.
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