Venepuncture is the procedure of inserting a needle into a vein to obtain blood samples. To perform venepuncture safely, one must understand relevant anatomy, how to select an appropriate vein and device, potential problems that may occur, and health and safety risks. The document outlines the indications for venepuncture, vein anatomy, factors to consider when selecting a vein, potential hazards, required equipment, and steps to perform the procedure correctly.

1. Venepuncture
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2. Venepuncture is the procedure of inserting a needle
into a vein, usually to obtain blood
In order to do this safely the student must:
1. Know the relevant anatomy and physiology
2. Understand the criteria for selection of an appropriate vein and
device
3. Appreciate potential problems that may occur
4. Have an awareness of associated Health and Safety/ risks
involved in undertaking the procedure and correct disposal of
equipment
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3. Indications
• To obtain blood for diagnostic purposes
• To establish/ monitor levels of blood components
• To establish/ monitor levels of drugs
• To monitor response to medical treatments (e.g. fluids)
• To provide a sample to cross match prior to transfusion
• To screen for infection
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4. Vein construction: 3 Layers
Tunica adventitia
Connective tissue
Surrounds, supports
Tunica media
Muscular tissue
Contracts and relaxes
Tunica intima
Smooth endothelial cells
Valves
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5. Selecting a site
Usually those found in the antecubital
fossa
1. Median cubital vein
2. Cephalic vein
3. Basilic vein
Metacarpal veins should only be
utilised for venepuncture when
the other veins are not accessible
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6. Choosing a vein
• Accessible
• Unused
• Easily detected
• Appears healthy and patent
The most prominent vein is not necessarily the most
suitable vein
-Visual inspection
-Palpation
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7. Visually scrutinise the veins in both arms, avoiding:
• Evidence of infection, bruising and phlebitis
• An oedematous limb where there is status of lymph
• Areas of previous venepuncture. Repeated trauma
causes pain
Palpate veins too:
• Distinguish vein from arteries and tendons
• Identify deeper veins and presence of valves
• Use index finger, or fore finger, not thumb
• Healthy veins are soft, bouncy and refill when depressed
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8. Other factors influencing vein selection
? Injury, disease or treatment
? Position of patient
? Age of patient
? Weight of the patient
? Dehydration or Shock
? Medication/ condition that causes excessive bleeding or
delayed clotting (anticoagulants, steroids,
thrombocytopenia)
? Fear
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9. Hazards/ Risks
• Infection- adherence to an aseptic technique (thorough hand
washing and use of alcohol gel) required. Performed with single use
equipment, non- sterile gloves may be worn.
• Accidental damage- inadvertently punctured nerve, tendon or artery.
Spend time undertaking visual inspection and palpation.
• Haematoma- Caused by poor technique, failure to remove the
tourniquet before removing the needle and inadequate pressure on
the site. Patient/ Client must not flex arm on completion of the
procedure. Identify those with relevant medical history/ drug therapy.
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10. Associated hazards
• Incorrect or lack of details on request form and/or sample-
Increases likelihood of errors occurring. Sample will be rejected by
lab, necessitating repetition of the procedure. Always check details
with patient, request form and sample correspond.
• Insufficient sample/ wrong specimen bottle- necessitating
repetition.
• Needlestick injury- correct use of Vacutainer system and Sharps
policy help reduce this.
• Infected/ ‘High risk’ samples- correctly identified as such through
labelling so all those involved with handling are aware.
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11. Equipment list…..
Sharps bin
Procedure tray
Non-sterile gloves
Apron
Vacutainer device/ needle
Tourniquet
Alcohol hand gel
Patient identification labels
Specimen request
Specimen bottle
Gauze/ swab
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12. Procedure
• Correctly identifies patient/ gains consent
• Hand washing/ use of alcohol gel
• Supports chosen limb
• Applies Tourniquet
• Selects appropriate vein
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13. Technique
• Anchor vein
• Verbally warn patient
• Insert needle smoothly at angle of 15-30 degrees with bevel upwards
• Level off needle and advance approx 1mm
• Push specimen bottle into heamguard
• Allow vacutainer to fill specimen bottle
• Gently but firmly remove bottle
• Remove tourniquet
• Cover puncture site with gauze, remove needle, dispose of needle
into sharps bin
• Apply pressure to straight arm, apply plaster
• Correctly label sample
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14. References and further reading
Nottingham City Hospital/ queens Medical Centre/ Rushcliffe PCT Nursing
Practice Guidelines (2004) Venepuncture using the Vacutainer System
(*Accessible on Hospital intranet- contains extensive further reading list)
Nottingham City Hospital/ Queens Medical Centre Nottingham ‘Working in
New Ways’ (2004) Venepuncture and Cannulation: An educational Self-
directed Package for Registered Nurses, Midwives and Non- registered
staff.
Johnson and Johnson (1997) Practical Guide to Peripheral Cannulation
R.Seeley, T Stephens, P.Tate (1988) Anatomy and Physiology
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