Specifications: The
station consists of an anatomical arm and all the equipment that might be
required.
Assume that the anatomical arm is a patient and take blood from it.
Before starting
•
Introduce yourself to the patient.
• Confirm
his name and date of birth.
• Explain
the procedure and obtain his consent. For example, “I would like to take a blood sample
from you to check how your kidneys are
working. This is a quick, simple, and routine procedure
which involves inserting a small needle into
one of the veins on your arm. You will feel a sharp
scratch when the needle is inserted, and
there may be a little bit of bleeding afterwards. Do you have
any questions?”.
• Ask him
from which arm he prefers to have (or normally has) blood taken.
• Ask him
to expose this arm.
• Gather
the equipment in a clean tray.
The equipment
In a
clean tray, gather:
• A pair
of non-sterile gloves
• A
tourniquet
• Alcohol
wipes (sterets)
• A 23G
(blue) needle/‘butterfly’ and
Vacutainer holder
• The
bottles appropriate for the tests that you are sending for (these vary from
hospital to
hospital,
but are generally yellow for biochemistry/U&Es, purple for haematology,
pink for
group
and save and crossmatch, blue for clotting/coagulation, grey for glucose, and
black
for
ESR)
• Cotton
wool, swab, or gauze
• Tape or
plaster
Make sure you have a yellow sharps box close
at hand. The key to passing this station is
to be seen to be safe.
The procedure
• Wash
your hands (see Station 1).
• Position
the patient so that his arm is fully extended. Ensure that he is comfortable.
• Apply
the tourniquet proximal to the venepuncture site.
• Select a
vein by palpation: the bigger and straighter the better. The vein selected is
most commonly
the
median cubital vein in the antecubital fossa.
• Don a
pair of non-sterile gloves.
• Clean
the venepuncture site with an alcohol steret. Explain that this may feel a
little cold.
• Once the
alcohol has dried off, attach the needle to the Vacutainer holder.
• Tell the
patient to expect a ‘sharp scratch’.
• Retract
the skin to stabilise the vein and insert the needle into the vein at an angle
of 30–45
degrees
to the skin.
Clinical Skills for OSCEs
6 Station 3 Venepuncture/phlebotomy
• Keeping
the needle still, place a Vacutainer tube on the holder and let it fill.
• Once all
the necessary tubes are filled, release the tourniquet. Remember that the tubes
need
to be
filled in a certain order (bottles with no additives first). See the guide to
Vacutainer tubes
in Station 111.
• Remove
the needle from the vein and apply pressure on the puncture site for at least
30
seconds
(the patient may assist with this, or you may use tape or plaster).
•
Immediately dispose of the needle in the sharps box.
• Remove
and dispose of the gloves in the clinical waste bin.
Ensure that you release the tourniquet before removing the needle, and that you
immediately dispose of the needle in the sharps box.
After the procedure
• Ensure
that the patient is comfortable.
• Thank
the patient.
• Label
the tubes (at least: patient’s name, date of birth, and
hospital number; date and time of
blood
collection).
• Fill in
the blood request form (at least: patient’s name, date
of birth, and hospital number; date
of
blood collection; tests required).
• Document
the blood tests that have been requested in the patient’s notes.
Examiner’s questions
If the veins are not apparent
• Lower the arm over the
bedside.
• Ask the patient to
exercise his arm by repeatedly clenching his fist.
• Gently tap the
venepuncture site with two fingers.
• Apply a warm compress to
the venepuncture site.
• Do not cause undue pain to
the patient by trying over and over again (more than 2–3
times) –
call a more experienced
colleague instead.
• Use femoral stab only as a
last resort (usually in CPR situations).
In the event of a needlestick injury
• Encourage bleeding, wash
with soap and running water.
• Immediately report the
injury to your supervisor or the occupational health service.
• If there is a significant
risk of HIV, post-exposure prophylaxis should be started as soon as
possible.
• Fill out an incident form.
For
more information on the management of needlestick injury, refer to local or
national protocols.