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Venepuncture Training

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Presentation on theme: "Venepuncture Training"— Presentation transcript:

1 Venepuncture Training
Give out Quiz Sheets Welcome to 3 hour session Housekeeping Structure of session –, What it is, why it is performed, our legal and health and safety responsibilities and how we should perform it safely to protect ourselves, our patient and the Trust. 1

2 Aim of The Session To ensure staff will have the knowledge and skills to perform venepuncture safely and effectively The aim of the session today is ………………………….. We should always keep in mind Harm Free Care 2

3 Learning Objectives Outline current legislation, local policies and procedures relevant to venepuncture practice Distinguish between when to perform venepuncture and when it should not be performed Describe the relevant anatomy and physiology of the arm and name the common veins used for venepuncture. Demonstrate the correct procedure for obtaining venous blood samples After the training you should be able to…………………………………. 3

4 Venepuncture Competency Requires You to
Understand your Role & Responsibilities Knowledge of Procedure and all related Policies Trained to Undertake Venepuncture Assessed prior to undertaking Venepuncture Record your competency and keep Updated Being Competent means we have knowledge, judgement, ability (skills), energy, experience and motivation to respond adequately to the demands of ones professional responsibilities. In venepuncture we are required to …………… 4

5 responsibility to deliver high quality safe care to required standard
Legal Framework Duty of Care responsibility to deliver high quality safe care to required standard Accountability being responsible for acts or omissions All healthcare workers are required to deliver care to an acceptable standard and should ensure they have the required knowledge and practical skills to undertake the required procedure safely and competently. It is also a requirement that we take responsibility for anything we do and remember we are also responsible for any ommissions we make. 5

6 Underpinning Policies and Guidelines
To undertake venepuncture you will need to have knowledge and understanding of a number of other policies and guidelines to support you to undertake safe practice, including…………………………………. All of the policies are available on the intranet for you to refer to and in addition you will have undertaken specific training either at induction or as part of your continuous professional development through mandatory training. Any questions? 6

7 Introduction of a needle into a vein in order to obtain a blood sample
Venepuncture Introduction of a needle into a vein in order to obtain a blood sample What is venepuncture? 7

8 >Investigative purposes
Reasons For Undertaking Venepuncture >Investigative purposes >To detect a disease or illness >Monitoring clinical conditions or medications Why do we undertake venepuncture 8

9 Venepuncture Knowledge
ANATOMY & PHYSIOLOGY OF BLOOD AND BLOOD VESSELS DIFFERENT APPROACHES BLOOD COLLECTION SYSTEMS UNIVERSAL PRECAUTIONS RIGHT EQUIPMENT CONTRAINDICATIONS POTENTIAL PROBLEMS WHEN TO SEEK ASSISTANCE REPORT INCIDENTS 1. Understand the anatomy and physiology of veins, arteries and nerves in the arm and hand which is where venepuncture is normally performed 2. Blood systems used to perform venepuncture which is particularly important when working for LCH because we send our samples to different laboratories who use different systems. 3. How to keep ourselves and our patients safe from injury or infection 4. When and when not to perform 5. How and Where we take blood samples from including the mid arm and the hand 6. Although we aim to never have a problem occasionally they can occur and we need to know what to do if something happens during the procedure 7. Know when to seek assistance if any adverse incidents occur and how to record and report incidents AND 8. How to perform the Procedure effectively and safely. PROCEDURE 9

10 1.Transports oxygen, waste products and nutrients
Blood - Three Main Functions 1.Transports oxygen, waste products and nutrients 2. Regulates body temperature 3. Protects against blood loss through clotting mechanisms Review the Quiz 10

11 Blood Vessels ARTERIES To The Heart VEINS From The Heart
Oxygenated Blood Thicker Wall Muscular VEINS From The Heart Deoxygenated Blood Thinner Wall Less Muscular We have two blood vessels in our body Arteries - carry oxygenated blood towards the heart, thicker wall, muscular, Veins – carry deoxygenated blood from the heart, thinner wall, less muscular 11

12 Accessory Cephalic Basilic
Veins commonly used Median Cubital Accessory Cephalic Basilic Easily Accessible Less Painful. There are many veins where blood can be taken from but in LCH the ones you will be trained and expected to use are in the upper limb only. The names of the veins are ………………………….. The vein you normally access is the median Cubital in the arm. Note here experienced staff might access veins in the back of the hand but only ever after further training, will look at this in a minute This is usually easy to access and less painful than other ones. 12

13 Number of Attempts People look for the best veins, Think palpation over visual. Stop and practice on each other 3 attempts only 13

14 Median Nerve Special Precautions Shooting Pain in arm
> Abnormal sensation (Dysethesia) As well as the veins and arteries in the arm you also have nerves and they run parallel with blood vessels. Because of this it is easy to hit a vein. Venepuncture is uncomfortable for most patients but it should not be very painful. I f a patient complains of severe, shooting pain the procedure should be stopped immediatley. 14

15 Alternative Sites used in LCH but only after training !
Where else can you possibly take blood from?.... when venepuncture from the antecubital fossa has failed and urgent bloods have been requested. a last option for urgent bloods can be taken using a winged infusion device and adaptor, if unable to obtain blood from the anti cubital fossa.  Aware that old methods did not recommend the use of the hand and there has been limited research on such devices however general findings (Hefler et al (2004) showed success in reducing discomfort and obtaining samples especially with high risk patients such as older people and the Royal advocate this in their training also. Metacarpal veins in the hand are easily visualised and palpated but the use of these vessels may be contraindicated in patients with poor skin turgor and diminished subcutaneous tissue. Veins in the hand may swell during venepuncture. If this occurs, withdraw and apply pressure to the site. Patients should be informed that bruising may occur. 15

Slide Practical Considerations when working in LCH Two systems Two labs 16

17 Attend Mandatory Training 2 yearly Follow LCH Trust Policy
Infection Control Attend Mandatory Training 2 yearly Follow LCH Trust Policy Decontamination Clinical Area Decontamination of Hands Use of PPE Disposal of Waste To be compliant to undertake venepuncture you also need to be up to date with other training and have a good working knowledge of other policies 17

18 Attend Health and Safety Training 3 yearly Follow LCH Trust Policy.
Waste Disposal Attend Health and Safety Training 3 yearly Follow LCH Trust Policy. Safe Use and Disposal of Sharps Reminders - Do not attempt venepuncture if you do not have a sharps box to hand Needles must never be re-sheathed Never overfill a sharps box - Note fill line on box, closures , signing and dating etc 18

19 Characteristics of Veins
GOOD Soft Bouncy Refills when depressed Visible POOR Firm Roll easily Feel Cord Like CAUTION HERE if it PULSATES, feels ELASTIC (ARTERY) As discussed, do not have x ray vision so cannot always see the best veins However, when we feel veins we can determine if they are good by feel as well as vision Remember, if you feel a pulse its an artery. 19

20 X X Sites to Avoid Scars from burns and surgery
Arm on side of a Mastectomy Haematoma/ Bruising IV / Transfusion arm Oedema Site of previous venepuncture attempts ( RCN 2003) Some sites or situations would make venepuncture more painful or difficult and they should be avoided. These include 20

21 X X When Not Perform if …………… Blood Form not Completed in full
Patient is Unwell Child under ?? Patient cannot consent to procedure 3 attempts have been made Venepuncture should not always be performed and the following should be considered. 21

22 Tourniquet – (disposable or decontaminate between use)
Equipment Gloves Tourniquet – (disposable or decontaminate between use) Needles butterflies /adapters Blood Collection system Alcohol hand gel/rub Receivers Sharps box Adhesive Spot Plasters Low Linting gauze Equipment demonstration here 22

23 Testosterone take sample before noon.
Order of Draw RLBUHT – Handout 1 AINTREE – Handout 2 Specific Test Testosterone take sample before noon. Carbamazepine, Phenobarbitone and Phenytoin ranges are for pre dose samples Lithium range is for 12 hours post dose Digoxin at least 6 hours post dose. 23

24 Bevel near or in vein wall
Trouble Shooting - No blood flow Bevel near or in vein wall Hematoma formed Needle passed through vein Vein collapsed If there is no blood flow, don’t panic. Adjust position of needle Check equipment (is tourniquet too tight or loose) ( is needle or vacuum device faulty) Is the vein too mobile Try another site If all else fails ask another colleague. Do not have more than two attempts because you will be anxious and so will the patient, remember anxiety causes vasoconsrtction 24

25 Used when vacuum in evacuated system may be too much for fragile veins
Trouble shooting - Small veins Costly Safety device Used when vacuum in evacuated system may be too much for fragile veins If veins are too small you can use butterfly system 25

26 Adverse Events Possible Causes First Aid
Bright Red Blood. Arterial Puncture Remove needle Tube fills fast quickly, apply pressure IR1 Uncontrolled Bleeding Anticoagulant therapy Apply Pressure at puncture site Haematoma Trauma to vein or late Apply pressure release of tourniquet Pain Needle hits nerve STOP PROCEDURE seek advice form senior colleague IR1 26

27 Adverse Events Possible Causes First Aid
FAINTING Nausea, Giddiness Needle phobia Don’t Panic, Stop Sweating, Pallor Anxiety, Stress procedure. Sit or lie Rapid Pulse, sudden Heat, Pain, Hunger down if possible, raise loss of consciousness Medical Conditions legs, loosen clothing, call for assistance, monitor airway until patient recovers, give water, reassure, contact relative to accompany home. IR1 27

28 Specific Individual Needs
Alternative or Additional Communication Needs Adjustment to Appointments Alternative types of appointments Different Practitioners Disabled access Best Interest Assessment Other Contact Equality and Diversity Team either via the internet or Tel: Patients attending Trust services may have alternative or additional needs to enable them to uptake appointments and receive the most appropriate care when required. This could include people who are deaf or have a hearing impairment, blind or have visual impairment, those with learning difficulties and people who do not use English as a first language. Staff need to be aware that reasonable adjustments might have to be made to accommodate specific needs. This might include Face to face interpreting, telephone interpreting, sign language, lip readers, translated information., CD /DVD, Large Print, Braille Easy read. 2. Longer time, choice of venue, alternative days 3. Clinic / Home 4. Non uniformed HCP 5 Disabled access 6. HCP to make decisions and act in best interest 7 Referral to specialist services Reasonable adjustments should be made at all times and if service users need additional help and support you should refer them on to the most appropriate service. We should promote inclusion at all times and seek to help our patients to access the care they need, when they need it in the most appropriate place 6 Other 28

29 Before You Begin - Prepare and Protect
YOU Request Form is completed Collect equipment Infection Control Procedures ENVIRONMENT Clean, Well lit Appropriate PATIENT Consent and Agree to procedure Positive Patient Identification No Contraindications 29

30 Step by Step Guide to Venepuncture
Step by step – practical HERE Break it down into Assembly of needle and bottle Checking of Blood Form Application of Tourniquet Hand Gel / Gloves Palpation of Vein Taking blood Over To You 30

31 Venepuncture is a common Procedure
Summary Learning Venepuncture is a common Procedure Undertaken by a Range of Healthcare Staff Duty of Care to provide High Quality Safe Care Practical skill requires updating and assessing regularly Work within Policy and Guidelines Summary of learning after practical 31

32 Laboratory Test Results are only as good as the specimen and the specimen is only as good as the method by which it is collected, handled and processed. It is worth noting here that ………………………………… 32

33 Competency Assessment Practice, Practice, Practice

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