CLINICAL GUIDELINES/NURSING

Guideline for Venepuncture Using the Vacutainer System

Reference
1438
Date approved
Approving Body
Matrons Forum
Supporting Policy/ Working in Venepuncture using vacutainer system
New Ways (WINW) Package
Implementation date
January 2013
Supersedes
Version 1
Consultation undertaken
Nursing Practice Guidelines Group, Ward
Sisters/Charge Nurses, Practice
Development Matrons (PDMs), Clinical
Leads, Matrons
Target audience

All Clinical Nursing Staff

Document derivation /
evidence base:
Review Date
Lead Executive
Author/Lead Manager

See main references

January 2016
Director of Nursing
Di Ryan, Colorectal Chemotherapy CNS,
Oncology

Further Guidance/Information
Distribution:
Ward Sisters/Charge Nurses, PDMs, Clinical
Leads, Matrons, Nursing Practice Guidelines
Group (includes University of Nottingham
representative)
This guideline has been registered with the Trust. However, clinical
guidelines are guidelines only. The interpretation and application of
clinical guidelines will remain the responsibility of the individual
clinician. If in doubt contact a senior colleague or expert. Caution is
advised when using the guidelines after the review date.

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NOTTINGHAM UNIVERSITY HOSPITALS NHS

CLINICAL GUIDELINES

Venepuncture Using the Vacutainer System

for Adults
"This guideline has been registered with the Trust. However, clinical
guidelines are guidelines only. The interpretation and application of
clinical guidelines will remain the responsibility of the individual
clinician. If in doubt contact a senior colleague or expert. Caution is
advised when using guidelines after the review date."
Please note: These guidelines outline the method to obtain blood using
the vacutainer system. It is recognised, however, that in extreme cases
and in some specialist areas, the use of a needle and syringe maybe
required.
A competent practitioner who is also aware of the
implications of using this method should only undertake this.
INTRODUCTION
Venepuncture is one of the most commonly performed invasive procedures
(Centre for Disease Control, 1997,Doherty 2008, McGowan 2010.Gabrielle
2011). But for the patient it is often a frightening experience and this should
not be underestimated
Litigation involving injuries that have occurred as a result of venepuncture
have increased over recent years (McConnell & McKay, 1996; Price & Moss
1998). It is therefore of paramount importance that health care practitioners
undertaking this procedure have received appropriate training and education
together with a period of supervision and assessment to ensure that they are
competent to undertake this invasive procedure (Dimond 2011, Royal College
of Nursing (RCN), 2010 ; Dougherty, 2008; ).
Within the Nottingham University Hospitals and the wards at Lings Bar
Hospital and Highbury Hospital, the procedure of venepuncture may be
performed by a health care practitioner who has been assessed as
competent in accordance with the Working in New Ways - policy and
guidelines 2011. A self-directed learning package has been developed to
facilitate this.
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DEFINITION OF VENEPUNCTURE
Venepuncture is the procedure of inserting a needle into a vein, usually to
obtain blood.

In order to do this safely, the Intravenous Nursing Society (1998) Lavery I.

Ingram P, (2005), and the RCN (2010) suggests the practitioner must have a
basic knowledge of the following broad aspects:

The relevant anatomy and physiology

The criteria for selection of an appropriate vein and device
The potential problems that may be encountered, how to prevent or
minimise them and how to manage them if they occur
The associated health and safety/risks involved in undertaking the
procedure and the correct disposal of equipment.

INDICATIONS FOR VENEPUNCTURE

Venepuncture is carried out for the following reasons:

To obtain a sample of venous blood for diagnostic purposes

To establish and subsequently monitor levels of blood components
To establish and subsequently monitor levels of drugs
To monitor response to medical treatments (e.g. fluids, drugs)
To provide a sample of blood to cross match for a blood transfusion
To screen for infection.

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ANATOMY AND PHYSIOLOGY

Texas Heart Institute (2008)

VEIN CONSTRUCTION -Veins consist of three layers: the tunica adventitia,

the tunica media and the tunica intima
The tunica adventitia is the outer layer of the vein and consists of
connective tissue, which surrounds and supports the vessel. Its role is
protective and in some patients/clients this can make penetration of the vein
difficult.
The tunica media is the middle layer of the vein and is composed of
muscular tissue and nerve fibres that can stimulate the veins to contract or
relax in response to stimuli from the vasomotor centre of the medulla. The
muscle is not as well developed as that of an artery and therefore the veins
can distend or collapse as blood pressure rises or falls (Weinstein, 2007).
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Stimulation of this layer by changes in temperature, mechanical stimulation

(e.g. introducing the needle into the vein) or chemical stimulation (e.g. drugs)
can produce spasm which can make venepuncture more difficult.
Additionally, if the patient is anxious or clinically unwell (dehydrated,
hypotensive) the blood vessel will constrict also causing the procedure to be
more difficult to perform.
The tunica intima is the inner lining of the vein and is constructed of smooth
endothelial cells which facilitates the passage of blood cells etc. Damage to
the tunica intima results in the internal lumen of the vein becoming roughened
and increases the risk of thrombus formation. In addition, the endothelial
layer develops folds, which are known as semilunar valves. The purpose of
the valves is to ensure that the blood moves towards the heart by preventing
backflow. They are present in larger blood vessels and at points of
branching. These can sometimes be seen visually by noticeable bulges in
the veins; the practitioner needs to learn to palpate the vein to check for the
presence of valves and ensure that venepuncture occurs above the valve in
order to facilitate collection of the blood sample (Weinstein, 2001).

SELECTING A SITE FOR VENEPUNCTURE -The veins normally used for

venepuncture are those found in the antecubital fossa because they are
usually of a good size and are capable of providing copious and repeated
blood specimens (Weinstein, 2007; Phillips, Collins and Doherty 2011) );
They are also easily accessible thus ensuring that the procedure can be
performed safely and with the minimum of discomfort for the patient/client
(Marieb, 1998). The main veins of choice are:

The median cubital vein

The cephalic vein
The basilic vein

The median cubital vein may not always be visible, but its size and location
make it easy to palpate. It is also well supported by subcutaneous tissue,
which prevents it from rolling under the needle.
On the lateral aspect of the wrist, the cephalic vein rises from the dorsal
veins and flows upwards along the radial border of the forearm, crossing the
antecubital fossa as the median cephalic vein. Care must be taken to avoid
accidental arterial puncture, as this vein crosses the brachial artery. It is also
in close proximity to the radial nerve (Perucca, 1995).

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The basilic vein, originating in the ulnar border of the hand and forearm
(Wilson & Waugh, 2001), is often overlooked as a site for venepuncture: this
is for good reason. Although the basilic vein may be prominent (particularly in
men), it is awkward to access and it is not well supported by subcutaneous
tissue and tends to roll easily. These features make venepuncture of the
basilic vein difficult. Care must also be taken to avoid accidental puncture of
the median nerve.
The metacarpal veins are easily visualised and palpated. However, the use
of these veins is contraindicated in the elderly where the skin turgor and
subcutaneous tissue are diminished (Weinstein, 2007; Lister and and
Dougherty 2011,)
Occasionally the veins of a lower limb may be used for venepuncture,
although the practitioner must understand the relevant anatomy and specific
problems associated with these sites. Venepuncture of veins in the lower
limbs is associated with a higher risk of complications due to the increased
presence of valves and the fact that, comparatively, the blood flow in the
lower limb is diminished (Weinstein, 2007).

CHOOSING A VEIN
The choice of vein must be that which is best for the individual patient/client.
The best veins are those where the vein is accessible, unused, easily
detected and appear healthy and patent. However, the most prominent vein
is not necessarily the most suitable vein for venepuncture (Weinstein, 2007 ).
There are two stages involved in locating a vein:
1.
2.

Visual inspection
Palpation

Visual inspection involves scrutinising the veins in both arms and is

essential prior to choosing a vein. The following areas should be avoided:

Veins adjacent to foci of infection, bruising and phlebitis due to the risk
of causing more local tissue damage or systemic infection.
An oedematous limb as there is danger of stasis of lymph that
predisposes to such complications as phlebitis and cellulites (Hoeltke
2006, Smith, 1998).
Areas of previous venepunctures, where possible, as repeated trauma
to the vein can result in pain (Ahrens et al, 1991).

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Palpation is an important assessment technique, as it determines the

location and condition of the vein. It assists in distinguishing a vein from
arteries and tendons, identifies the presence of valves and can detect deeper
veins (Scales (2008). The practitioner should use the same fingers for each
palpation to increase the sensitivity and ability of the practitioner in detecting
the appropriate site to use ( Phillips,Collins and Dougherty, 2011 ). The
thumb should not be used as it is not as sensitive and has a pulse, which may
lead to confusion in distinguishing veins from arteries in the patient/client
(Weinstein, 2007 ). Healthy veins feel soft and bouncy and will refill when
depressed (Weinstein, 2007 ).
VEINS TO AVOID

Thrombosed veins these feel hard and cord-like

Tortuous, sclerosed, fibrosed, inflamed, fragile veins these may
not be able to accommodate the device being used
Veins that cross over joints, bony prominences and those with little
subcutaneous cover (e.g. the inner aspect of the wrist) these can
subject the patient/client to more discomfort
For renal patients with an arterio-venous fistula/graft, the nonfistula/graft arm should not be used as this increases risk of stenosis
and thus decreases the success of future venous access for
haemodialysis.

OTHER FACTORS INFLUENCING VEIN SELECTION

Injury, disease or treatment may prevent the use of a limb for

venepuncture by reducing the venous access (e.g. amputation,
fracture, cerebrovascular accident). Use of a limb may be
contraindicated because of an operation on one side of the body, for
example, mastectomy and axillary node dissection, as this can lead
to impairment of lymphatic drainage, which can influence venous
flow regardless of whether there is obvious lymphoedema (Smith,
1998; Rowland, 1991).

Position of the patient/client, for example, having to lie on a

particular side, may also dictate the site of the venepuncture
(Millam, 1992; Rowland, 1991).

The age of the patient/client the elderly may have prominent veins
but they are often fragile. The largest vein should be selected along

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with the smallest gauge device to reduce the amount of trauma to

the vessel.

The weight of the patient/client malnourished patients/clients will

often present with friable veins. Obese patients/clients may cause
practitioners to have difficulty in locating the vein due to extra
subcutaneous tissue being present.

Patients/clients who are dehydrated or in shock there will be

poor superficial peripheral access. It may be necessary to take
blood after the patient is rehydrated as this will promote venous
filling and blood will be obtained more easily (Mallett & Dougherty,
2000).

Medications or conditions that cause bleeding or slow healing

(e.g. anticoagulants, steroids, thrombocytopenia) these situations
predispose the patient/client to having more risk of bruising both
during venepuncture and on removal of the needle; this then limits
the availability of veins that are not damaged.

IMPROVING VENOUS ACCESS

The success of venepuncture is influenced by a number of factors related to
the patient/client and the practitioner. The more experienced the practitioner
is the easier venepuncture becomes. However, no matter how experienced
the practitioner is, factors that cause the blood vessels to vasoconstrict will
make the procedure of venepuncture more difficult. A number of approaches
to improve venous access and thereby facilitate the procedure being
successful are identified below.
1.

Fear about the procedure of venepuncture may itself result in

vasoconstriction. The practitioners manner and approach will have a
direct bearing on the patients experience (Weinstein, 2007 ).
Approaching the patient/client with a confident manner, giving an
adequate explanation of the procedure together with careful preparation
and an unhurried approach may help to reduce anxiety which will in turn
increase vasodilation.

2.

Ensuring the correct ambient temperature of the environment is

important if it is cold the blood vessels of the patient/client may
vasoconstrict to compensate.

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3.

Application of a tourniquet this promotes venous distension. The

tourniquet should be tight enough to impede venous return but not
restrict arterial flow.

4.

Opening and closing the fist ensures the muscles will force the blood into
the veins and encourage distension.

5.

Lowering the arm below heart level may also increase blood supply to
the veins.

6.

The use of heat in the form of a warm pack or by immersing the arm in a
bowl of warm water for 10 minutes helps to encourage vasodilation and
venous filling.

7.

Ointments or patches containing small amounts of glyceryl trinitrate have

been used to cause local vasodilatation to aid venepuncture. A
prescription is required to enable this technique.

8.

Stroking the vein (rather than patting it) can also assist with venous
dilation.

HAZARDS ASSOCIATED WITH VENEPUNCTURE

1.

Infection the circulation is a closed sterile system and a venepuncture,

however quickly performed, is a breach of this system providing a means
of entry for bacteria. Adherence to an Aseptic None Touch Technique
(ANTT) will minimise the risk of cross infection from practitioner to
patient/client (e.g. thorough hand cleansing using soap and water
followed by alcohol hand rub). Non-sterile gloves may be required to
protect the practitioner from cross infection from the patient/client but all
other equipment should be sterile and single use only.

2.

Accidental damage the nerve, tendon or artery might be inadvertently

punctured if these have not been identified during visual
inspection/palpation. This can result in pain, damage and haemorrhage
for the patient/client as well as loss of confidence for the practitioner.

3.

Haematoma this is the commonest complication arising from

venepuncture (Weinstein, 2007 ). There are a number of factors that
influence the development of a haematoma poor technique on the part
of the practitioner, failure to release the tourniquet before removing
needle and inadequate pressure on the venepuncture site once the

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needle has been removed. A haematoma may also occur if the

patient/client is asked to flex the arm on completion of the procedure
(Weinstein, 2007 ).
4.

Prolonged bleeding time this may be due to a medical condition or drug

therapy (e.g. anticoagulation medication). It increases the risk of
bruising/haematoma formation and worsens the consequences of
inadvertent arterial puncture. Practitioners should ensure they are aware
of the patient/clients relevant drug and medical history prior to
performing venepuncture to reduce this risk.

5.

Incorrect or lack of details on the request card and/or sample this

increases the likelihood of errors occurring and therefore any
discrepancies will cause the sample to be rejected by the laboratory,
necessitating repetition of the procedure.
WARNING: the wrong patient details on the card can result in a
patient receiving unnecessary or dangerous treatment. All samples
must be correctly labelled and the details must correspond with those on
the request card. The patients details, both on the request form and the
specimen bottle should be ascertained using the Trust policy for the
positive identification of Patients.

6.

All cross match samples the bottle and form should be checked for
correct labelling by 2 Registered nurses. The patient should already have
an identity band on. If not, attach one to the patient that states the
patients last name, first name, gender, date of birth and NHS number.
(NUH 2012)Check these details are correct with the patient and the
patients hospital notes. Patient labels should not be applied to cross
match bottles- both the cross match form and the blood bottles should
have hand written details on them.

7.

Insufficient sample/wrong specimen bottle the laboratory will not be

able to process the sample necessitating repetition of the procedure
However, if the patient/client was difficult to bleed, check with the
laboratory staff whether they might be able to process the smaller
sample without it compromising the results.

8.

Needlestick (sharps) Injury use of vacutainer systems helps to reduce

the incidence of this occurring ( Centre for Disease Control, 1997).
However, the use of a needle and syringe may be preferential to obtain
blood from poor veins as it applies less pressure on the vein and thus
has a higher success rate. Needles, if used, must not be resheathed,
and practitioners must adhere to the Trust sharps policy. In the event of

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10

a needlestick injury the practitioner must follow the NUH Safe handling,
disposal and reporting of sharps and blood borne exposure injuries
policy (2008).
9.

Infected samples whether known or suspected, these pose a health

risk to any staff that have to handle them this includes porters and
laboratory staff. Appropriate identification through labelling and
transportation of infected samples is covered in other documents which
should be read by the practitioner (refer to Trust Policy and guidance as
appropriate, e.g. Infection Control Guidelines).

10. Blood spillage use of the vacutainer system reduces the risk of blood
spillage since the blood is drawn directly into the evacuated sample tube.
However, there is a risk of blood spurting from the vein when
venepuncture commences. For those blood samples that cannot be
taken using the vacutainer system there is a risk of blood spillage when
decanting blood from the syringe to the sample tube. Blood spillage kits
are available in all clinical areas (refer to Trust Policy). Staff should be
using goggles if there is any risk of the practitioner being splashed by
blood
11. Needle or Blood Phobia if the patient/client has a needle or blood
phobia it might make their behaviour difficult to manage. They might
also faint at some point during the procedure. It is important to establish
whether the patient/client has had previous problems with venepuncture
and to take appropriate action.

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11

EQUIPMENT LIST

Alcohol hand gel

Plastic apron
Non-sterile gloves
Goggles if required
Clean tray or receiver
DisposableTourniquet
Low linting swab (e.g. gauze)

Tape
Vacutainer device
Sharps container
Patient identification labels (if
available/appropriate)
Specimen request form
Specimen bottles

See General Principles for all Procedures.

PRIOR TO COMMENCING VENEPUNCTURE

PRINCIPLE / ACTION

RATIONALE

Assemble the equipment

necessary for venepuncture.

To ensure that time is not wasted

and that the procedure goes
smoothly without unnecessary
interruptions.

You should contact the

pathology department if you are
unsure what bottles are
required for the blood samples
requested
2

Check all packaging and expiry

dates before use.

To ensure the sterility of the products

prior to use.

Select appropriate size device

based on vein size and number
of samples required (21g is the
most frequently used size).
Discuss any previous
experiences of
venepuncture;

To reduce damage or trauma to the

vein.

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This might reduce anxiety which can

reduce vasoconstriction. If the
patient/client has a history of fainting,
the practitioner can put measures in
place to reduce/prepare for this.

12

Make the patient/client

comfortable (with back well
supported) in an environment
that is suitable in terms of
lighting, ventilation, privacy,
positioning and safety.

These factors will assist the

practitioner to be successful with the
procedure.

PRINCIPLE

RATIONALE

Discuss the procedure with the

patient/client to include:
Information about the
procedure and obtain
consent;

To ensure that the patient/client

understands the procedure and gives
informed consent.

What test(s) is (are) being

done and why;

In addition to the patient/client

understanding the procedure, the
practitioner needs to ensure that the
requirements of the test are met (e.g.
if fasting blood sugar is being taken
the patient needs to have fasted).

Relevant medical history

(and allergies);

This might influence choice of limb

for venepuncture (e.g. if the
patient/client has had surgery or ever
suffered from lymphoedema) or
choice of occlusive dressing.
The practitioner may need to take
additional precautions if the patient is
known to have a blood borne
infection (see relevant policy).
The patient/client will be at higher
risk of bleeding and therefore need
to apply pressure on the
venepuncture site for longer post
procedure.

Relevant drug history (e.g.

anticoagulant therapy);

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13

8.

PRINCIPLE

RATIONALE

Check that the patient/client

identity matches the details on
the venepuncture request form
and label the sample tubes with
patient details at the bedside.
If patient expresses
anxietyrelating to a phobia
about needles or concerns
about pain offer local
anaesthetic and apply prior to
procedure,
Emla cream, 45 minutes before
Ametrop 15 minutes before

To ensure that the correct sample is

taken from the correct patient/client
and comply with SHOT (Serious
Hazards of Transfusion) guidelines.
To ensure the comfort of the
patient/client and increase venous
access.

COMMENCING VENEPUNCTURE USING THE VACUTAINER SYSTEM

PRINCIPLE

ACTION

Wash and dry hands thoroughly To reduce the risk of cross infection.
using antiseptic soap and dry.
NUH Hand Hygiene Policy (2011)
Check hands for any broken
areas, and cover with an
Pratt et al (2007)
occlusive dressing.
DoH (2007)

Break seal on vacutainer

needle, remove clear plastic
cover and screw disposable
syringe barrel onto the
vacutainer needle (leave the
coloured shield on the needle
as this will be inserted into the
patient/clients vein).

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In preparation for venepuncture of

the patient/clients vein.

14

PRINCIPLE
Extend the upper limb (full
elbow extension) and support it
on a pillow.
Gel hands with alcohol hand rub
and put on gloves (see Best
Practice Box Glove Use) and
apron.

ACTION
To ensure the comfort of the
patient/client and increase venous
access.
To reduce the risk of cross infection
and potential contamination of the
practitioner
NUH Hand Hygiene Policy (2011)
Pratt et al (2007)
DH (2007)

Apply tourniquet to chosen limb

in appropriate location.
It may be necessary to utilise
other methods to facilitate
venous distension (See
IMPROVING VENOUS
ACCESS page 6).

Best Practice

Dilates the veins by obstructing

venous return.
Increase the prominence of the veins
and/or promote blood flow

USE OF TOURNIQUETS

Single-use tourniquets should be used for all patients.

The use of reusable tourniquets as well as other reusable equipment
(sphygmomanometer cuffs etc.) is starting to be questioned, as they are a
potential source of infection. Single use tourniquets have financial
implications but this could be offset against the increasing problem of
iatrogenic infections occurring in hospitals. If using reusable tourniquets then
it must be cleaned between each patient.
The tourniquet should be applied with enough pressure to impede venous
flow if the radial pulse cannot be felt the tourniquet is too tight. (Weinstein,
2007 ).

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15

PRINCIPLE
7
Select an appropriate vein in
relation to size, location and
condition. Refer to the following
sections:
Anatomy and physiology
Selecting a site,
Choosing a vein
appendix 1
Veins to avoid

RATIONALE
To complete procedure successfully

page 6

Best Practice

GLOVE USE

Non sterile gloves are to be used when undertaking venepuncture and

handling blood and body fluids (NUH, 2011). This may help prevent
contamination from blood spills and cross infection but does not prevent
needlestick injuries and prevent cross infection. Please refer to NUH Glove
selection guidelines (2011)

Best Practice
SKIN CLEANSING
cha
The use of skin cleansing remains controversial. A study by Sutton et al
(1999) concluded that there was no difference with respect to complications
at the site of venepuncture that received skin cleaning when compared to
those that had not. A cursory wipe is known to do more harm by disturbing
the patient skin flora, thus increasing the risk of infection (Wilson, 2006). In
addition alcohol that is left on the skin that has not completely dried can
cause haemolysis of the sample (Perry and Potter, 2002.) See NUH
Infection Prevention and Control intranet site for information on the use of
Sanicloth
Venepunctureand
2013Chloraprep decontamination products.
16

PRINCIPLE
7
Remove the coloured needle
shield and hold the syringe
barrel with the needle bevel
uppermost.
8
Anchor the vein by applying
manual traction on the skin of
the upper limb a few centimetres
below the proposed insertion
site
9
Insert the needle smoothly at an
angle of approximately 15 30
depending on the vein location
(degree of superficiality) and
advance slowly into the vein
with experience it is possible to
distinguish when the vein wall
has been punctured.

11

Introduce the blood bottle tube

into the vacutainer holder.
Placing forefinger and middle
finger on the flange of the holder
and the thumb on the bottom of
the tube, push the tube to the
end of the holder puncturing the
stopper on the blood bottle.
If venepuncture has been
successful, the bottle will
automatically fill to its required
volume.
If nothing happens,
draw the needle back slightly
as long as the needle remains
under the skin the tube will
retain its vacuum and when the
vein is found, blood will
immediately flow into the tube.

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RATIONALE
This provides the cutting edge to
incise through skin and tunica layers
of the vein.
To immobilise the vein and prevent it
from rolling. Traction also provides
a counter-tension to the vein, which
will facilitate a smoother needle
entry.
To promote a successful, pain-free
venepuncture.
Advancing the needle stabilises the
device within the vein preventing it
from becoming dislodged during
withdrawal of blood.

It is important to retain the position

of the needle in the vein whilst
pushing the tube home in the
vacutainer holder.

17

Best Practice

ATTEMPTS AT VENEPUNCTURE

There should be no more than 2 unsuccessful attempts by the same practitioner

on one patient at any given time. If the attempts are unsuccessful the patient
must be reassured and a more experienced practitioner should undertake
subsequent venepuncture attempts.

PRINCIPLE
12 If more than one sample is
required, remove filled tube by
applying soft pressure with the
thumb against the flange of the
holder to disengage stopper
from the needle.
Introduce next tube as in step
11.
(See Best Practice Box Order of
Fill)

RATIONALE
To obtain all the samples necessary
from the one venepuncture
procedure.

Best Practice
ORDER OF FILL
In order to prevent haemolysis, the recommended order of fill is as follows:
1. Bottles with no additives
2. Coagulation samples
3. Bottles with additive
(Becan-McBride, 1999)

13

PRINCIPLE

RATIONALE

Bottles with additives should be

mixed well by gently
rolling/inverting the tube do not
shake the tube.

Additives must be mixed to ensure

that the chemicals in the tubes are
distributed evenly through the blood
sample which will facilitate accurate
laboratory assessment.
Shaking of the tubes may cause
haemolysis of the sample.

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18

ON COMPLETION OF VENEPUNCTURE

PRINCIPLE / ACTION
1
Once all the samples have been
obtained, remove the last tube
and release the tourniquet
before withdrawing the needle
from the vein.
2
Place a low lint swab over the
puncture site applying pressure
to site AFTER the needle has
been removed.
3
Discard needle and vacutainer
barrel in sharps container.
4
Check that the tubes and
request documentation are
correct. Check cross match
samples with second nurse.
5
Check puncture site has sealed
before applying an occlusive
dressing to the puncture site.
(NB check that the patient/client
is not allergic to the occlusive
dressing to be applied).
Instruct the patient/client to
remove the occlusive dressing
after 24 hours.
6
Discard waste into appropriate
receptacles (in accordance with
Trust policies and procedures).
7
Record type of blood sample
taken and any complications
that occurred with the procedure
in the appropriate
documentation.

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RATIONALE
To reduce the risk of:
blood spillage
discomfort for the patient/client
damage to the vein/development
of haematoma.
To prevent pain on removal and
damage to the intima of the vein.

To prevent needlestick injury.

To reduce the risk of incorrect or
unnecessary treatment being
initiated.
To prevent the risk of blood spillage
by ensuring the patient/client does
not bleed after leaving the clinical
area.

To reduce the risk of contamination.

Medico-legal reasons.

19

PRINCIPLE
Ensure samples are sent via the
air tube system. At present,
glass bottles (e.g. blood
cultures) or high-risk specimens
should not be sent via the air
tube system but taken to the
labs as soon as possible.
Community samples are
collected by van and taken to
the appropriate laboratory.
Urgent requests require a P1
priority number which can be
obtained from the P1 line
(55084) and written on the
request form
Advise the patient/client when
the blood results will be
available and what action is
required (if any) to obtain the
result.

Best Practice

RATIONALE
The air tube system provides the
quickest route to the laboratories
and rapid processing of the
samples.

Effective communication

PATHOLOGY REQUESTS

A role expansion package now exists in Nottingham University Hospital

Trust to allow nurses and/or other health professionals to request pathology
tests directly under certain circumstances. This package meets the
requirements set out in the Working in New Ways Policy and Guidelines
(NUH 2011).

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REFERENCES
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Inwood S (1996) Designing a nurse training programme for venepuncture.

Nursing Standard. 10 ( 21) pp 40 42
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Nottingham University Trust (2008) Working in New Ways: Policy and
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Pratt, R, Pellowe, C Wilson, J, Loveday, H, Harper, P, Jones, S, McDougall, ,C,

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Author: Diane Ryan,Colorectal Chemotherapy Nurse Specialist ,CAS

Directorate
NPGRG Link: Vivian Blackburn
January 2013
Review: March 2015

SUGGESTED AUDIT POINTS

1. Has a suitable vein been chosen, using the criteria outlined in the
guidelines?
2. Are all relevant details, including correct identification information, on
the request card/sample bottles?
3. Has an appropriate size device been chosen?
4. Did the practitioner discuss the procedure with the patient?
5. Has the patients identity been confirmed?
6. Have gloves been used appropriately?
7. Has the skin been cleansed according to guidelines?
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8. Has no more than two unsuccessful attempts at venepuncture been

attempted?
9. Has the puncture site been sealed correctly?

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