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Venepuncture is a relatively common OSCE station.  You’ll be expected to demonstrate your clinical skills and ability to communicate effectively. This venepuncture OSCE guide provides a clear step by step approach to venepuncture, with an included video demonstration. This guide discusses venepuncture using vacutainer bottles, so steps may differ if you are using different equipment (e.g. needle and syringe). Check out the venepuncture OSCE mark scheme HERE.

Introduction

Wash hands (use alcohol gel or soap and water if your hands are visibly soiled)

Introduce yourself

Confirm patient details – name / DOB 

Check if the patient has any allergies

 

Explain procedure:

I need to take a blood sample which will involve inserting a needle into your vein.

It will feel like a sharp scratch and shouldn’t take too long

 

Check understanding and gain consent:

“Does everything I’ve said make sense?”

“Do you have any questions?”  

“Are you ok for me to go ahead with the procedure?”

Gather equipment

Collect all equipment needed for the procedure and place it within reach on a tray or trolley, ensuring that all the items are clearly visible.

  • Clean procedure tray
  • Non-sterile gloves
  • Tourniquet 
  • Blood sampling device (e.g. butterfly needle and barrel) – size appropriate to the vein and sample needs
  • Blood specimen bottles 
  • Sharps container
  • Alcohol swab (2% chlorhexidine gluconate in 70% isopropyl)
  • Gauze or cotton wool ball
  • Sterile plaster
  • Laboratory forms, labels and transportation bag
  • Gather equipment

Preparation

Ensure the patient is lying or sitting comfortably (place a pillow under the arm if possible).

1. Wash hands again 

2. Position the patient’s arm in a comfortable extended position that provides adequate exposure of the planned venepuncture area

3. Inspect the antecubital fossa or forearm for a suitable vein (it should ideally be visible without applying the tourniquet)

4. Apply the tourniquet about 4-5 finger widths above the planned venepuncture site

 

5. Palpate the vein:

  • Choose a vein has a sizeable lumen and feels “springy”
  • Tapping a vein gently can make it easier to visualise and feel

 

Things to avoid when performing venepuncture:

  • Pre-existing medical conditions may prevent particular limbs from being used (e.g. arterio-venous fistula, lymphoedema, previous mastectomy)
  • Avoid areas of broken, bruised or infected skin (cellulitis)
  • Do not use veins that feel hard feel hard or cord like (thrombosis / thrombophlebitis)
  • Do not perform venepuncture on an arm that has an intravenous infusion in progress as this may alter blood test results
  • You should avoid areas where two veins are joining as valves are often present

 

6. Wash hands again

7. Don gloves (gloves don’t need to be worn for cleaning the site, but they should always be donned prior to performing venepuncture itself)

 

8. Clean the site with an alcohol swab for 30 seconds and then allow to dry completely over 30 seconds:

  • You should start cleaning from the centre of the venepuncture site and work outwards to cover an area of 2cm or more
  • DO NOT touch the cleaned site afterwards at any point, otherwise the cleaning procedure will need to be repeated prior to venepuncture
  • Wash hands

Insertion of the needle

1. Attach the needle to the barrel (some blood collection systems come pre-assembled, such as the butterfly needle with barrel shown in the video)

2. Unsheathe the needle

3. Anchor the vein from below with your non-dominant hand by gently pulling on the skin distal to the insertion site

4. Warn the patient of a sharp scratch

5. Insert the needle through the skin at a 30 degree angle or less, with the bevel facing upwards (you should feel a decrease in resistance as the needle enters the vein)

6. Advance the needle a further 1-2 mm into the vein after the decrease in resistance is felt

7. Lower and anchor the needle to the patient’s skin

8. Fill the blood sample bottles by attaching each in turn to the collection system

9. Release the tourniquet

10. Withdraw the needle and then apply gentle pressure to the site with some gauze or cotton wool

11. Ask the patient to hold the gauze or cotton wool in place whilst you dispose of the needle into a sharps container

12. Apply a dressing to the patient’s arm (cotton wool / gauze / plaster)

13. Discard the used equipment into the appropriate waste bin

  • Unsheathe the needle and ensure the bevel is pointing upwards

To complete the procedure…

Thank the patient and ensure they are comfortable

Wash hands

Complete the patient details on the blood sample bottles at the bedside (either pre-printed labels or handwritten).

Send the blood samples to the lab for analysis in an appropriate plastic leak-proof bag with the completed laboratory request form.

CONTENT REVIEWED BY

Graham Bone Senior Clinical Lecturer in Medical Education

References

1. WHO guidelines on drawing blood: best practices in phlebotomy. Published 2010. [LINK]

2. WHO Guidelines on Hand Hygiene in Healthcare: a Summary. Published 2009. [LINK]

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