Policy and Procedure for Venepuncture by Clinical Staff

Title: /

Policy and Procedure for Venepuncture by Clinical Staff

Policy Ref: /

GUH/ALL/POL/0007

Across NHS
Boards / Organisation
Wide /

Directorate

/ Clinical Service / Sub Department
Area
Yes
This controlled document shall not be copied in part or whole without the express permission of the author or the author’s representative.
Review date: / 31 May 2004
Author: / Gillian McKenzie Murray, Mr Paul Murray
Policy application: / NHS Grampian
Purpose: / To instruct clinical staff in the performance of venepuncture in line with best practice
Responsibilities for implementation:
Organisational: / Trust Management Teams and Chief Executives
Clinical group: / Clinical Group Co-ordinators
Corporate: / Senior Managers
Departmental: / Heads of Service / Clinical Leads
Area: / Line Managers
Policy statement: / It is the responsibility of supervisory staff at all levels to ensure that their staff are working to the most up to date and relevant policies and procedures. By doing so, the quality of the services offered will be maintained, and the chances of staff making erroneous decisions which may affect patient, staff or visitor safety and comfort will be reduced.
Review: / This policy will be reviewed annually.
Approved by: / Date:
Signature:
Designation:

Contents

Page 4
/ Policy for Venepuncture being performed by Clinical Staff
Page 6
/ Staff Roles
Page 7
/ Instruction Phase
Page 8
/ Documentation
Page 10
/ Procedure for Venepuncture being performed by Clinical Staff
Page 13
/ Blood Cultures
Page 14 / References

Policy for Venepuncture being performed by Clinical Staff

In this document Nurses and Midwives will be referred to as practitioners

Medical staff will be referred to as clinicians

This policy relates to Venepuncture being performed on the upper limbs only.

Accountability

Practitioners must adhere to the relevant current copy of professional guidance from their own professional body

1. Code of Professional Conduct, (Nursing and Midwifery Council 2002 Edition)

2. Guidelines for Records and Record Keeping, (NMC 2002 Edition)

3. Midwives Rules and Code of Practice UKCC (1998)

Prior to Venepuncture being performed, it is recommended the Practitioners have:-

1. Acquired the relevant education and training through attending an appropriate venepuncture study session.
2. Undergone a successful specified period of supervised practice, eg a minimum of 6, or until competent.
3. Awareness of their own accountability in relation to undertaking venepuncture.

PLEASE NOTE

All health care workers undertaking venepuncture are accountable for their own actions.

To practice competently, you must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision. You must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those activities in which you are competent (Code of Professional Conduct NMC 2002 Edition)

·  Practitioners who wish to continue to perform Venepuncture must demonstrate the ability and knowledge if there is a gap of more than three months between training and practice.

·  Theoretical and practical competence will be assessed locally

·  Venepuncture by Practitioners may only be performed on adult patients.

·  Paediatric Venepuncture may only be undertaken following specific training.

Important: It is recommended that practitioners review their theoretical knowledge and practical skill annually. The Clinical Competency Self-Assessment Tool (Professional and Practice Development Nurses’ Forum Scotland) is recommended for use.

Performing Venepuncture Rationale:

Venepuncture is performed to obtain venous blood for a wide range of laboratory tests either: haemotological, biochemical, bacteriological or other specialist tests. These tests may be requested by the doctor to form the basis for diagnosis or treatment, or as part of the ongoing disease management of a patient.

Venepuncture is a competency that must be achieved by midwives by the point of registration and is an integral part of their total management of a pregnant woman.

Venepuncture should only be performed in the following instances by an experienced practitioner with the relevant training:-

·  Children

·  Blood gas analysis

NB: Dr Grays site: Emergency bloods, Cross matching and Blood Cultures should be taken by Medical staff only.

ie: patient is admitted as an emergency and/or in any emergency situation.

Midwives however may perform Venepuncture for routine tests and cross matching.

Failure to Comply with Policy

Failure to comply with Policies and Procedures stated in this document will be investigated by Line Managers immediately after ensuring:-

·  Patient Safety/Practitioner Actions

·  Medical Staff Notification

·  Accident Form Completion

·  Advising Senior Nurse

Accident/Incident/Near miss must be reported and duly investigated as per Trust Policy.

Staff Roles

Venepuncture is a shared responsibility of medical and nursing staff. Individual patients should be assessed and the most appropriate health care professional perform the procedure for that patient.

1. Role of the Clinician

Venepuncture is a shared responsibility therefore Clinicians will continue to perform the procedure in both emergency and elective situations. The Clinician will be available to support routine/emergency venepuncture where the two attempts are not successful, thus ensuring the patient has this procedure performed as required with minimal delay or discomfort.

“Medicines injected by direct venepuncture (not through a cannula) must be administered by appropriate medical staff” – Code of Practice for the Administration of Intravenous Medicines and Infusion Fluids in Clinical Areas, Grampian Medicines Committee (2002).

* Midwifery – Ergometrine may be given in an emergency situation by direct venepuncture

2. Role of the Practitioner

If an aspect of practice is beyond your level of competence or outside your area of registration, you must obtain help and supervision from a competent practitioner until you and your employer consider that you have acquired the requisite knowledge and skill, reference; (Code Of Professional Conduct, NMC 2002)

Any expansion of practice to incorporate changing boundaries such as venepuncture is supported by the above document.

The practitioner must inform the patient what the blood sample is being taken for.

3. Legal issues

Staff are reminded that all practice should be carried out with the Grampian Health Services Policy and Guidelines. Issues to be explored should include:-

·  Vicarious Liability

·  Duty of care

·  Negligence

·  Accountability

4. Newly Qualified Practitioners

Must attend appropriate training and gain competence as required by the relevant Trust

5. Return to Practice Practitioners

Must attend the appropriate training and can obtain supervised practice, however, cannot, perform this skill unsupervised until registered with the Nursing and Midwifery Council

6. Other Clinical Staff

Other clinical staff e.g. (nursing auxiliaries etc), may take on the role of venepuncture at the discretion of the Ward/Dept manager. The clinical staff member having clearly been informed of his/her role and responsibilities in relation to this role.

The staff member will also have to attend a recognised course in the given skill to obtain the appropriate underpinning knowledge and successfully complete supervised practice in the given skill.

7. Bank Nurses / Agency Nurses

Grampian Health Services’ Bank Nurses may undertake venepuncture by fulfilling the following criteria:

·  Attend appropriate training and gain competence as required by the relevant Trust

·  Must be able to demonstrate maintaining competence in the given skill

·  Individual claims to competence must be made to individual Ward Managers who will then liase with the relevant Professional Development/Clinical Training Staff who will review the evidence presented for this claim

Agency Nurses may perform venepuncture if they have worked regularly in a specific area. The decision will be made in conjunction with the Individual concerned, the Ward Manager and the Clinical Nurse Manager.

Individual claims to competency made to the Ward Manager must also be reviewed by the relevant Professional Development/Clinical Training Staff

In Grampian Primary Care Trust, the Learner demonstrates competency with support from their Supervisor, using the ‘3C’ Approach. GPCT have a checklist that is used by all staff undertaking Venepuncture as a new skill, which is based on National Occupational Standards

Instructional Phase

Gaining consent

During the period of supervised practice when a practitioner is learning to become competent in the procedure of Venepuncture permission must be gained from the patient/ parent/guardian.

The following Criteria must be followed:-

·  The selection of the patient involved in the teaching must be an individual who is able to understand and give consent or that consent can be obtained by the following as appropriate i.e. a relative, next of kin or by staff when it is justified

·  The “learning” situation must be explained clearly to the patient, i.e. the practitioner is learning to perform Venepuncture and requires occasions of supervised practice to be considered competent.

·  The supervisor’s role and competence must be explained clearly to the patient i.e. the supervisor is a Senior Practitioner who has successfully gained competence in the process of Venepuncture and is required to supervise other Nursing staff to achieve competence.

·  The patient must then be asked if he/she agrees to the “learner” (qualified practitioner under instruction) administering the medications.

a)  If Yes - The practitioner may proceed with the supervised practice with this patient.

b)  If No - The patient’s decision must be respected and the supervisor or Medical staff will perform Venepuncture.

c)  The patient’s decision to participate or not participate must be documented.

d)  On each occasion that a practitioner requires to be supervised performing venepuncture, the patient’s permission must be obtained.

PLEASE NOTE

Whenever a blood sample is required from a patient, consent must be obtained.

Documentation

Practitioners are reminded of their responsibilities in “the activity of making and keeping records as an essential part of care, and not a distraction from its provision”. (Guidelines for Records and Record Keeping (NMC 2002 Edition) Paragraph 13 is of specific relevance in this situation.

For the purposes of practitioners performing venepuncture for cross matching the Scottish National Blood Transfusion Service - Blood Transfusion Manual (2000) should be referred to.

Specimen Request Forms

The following must be completed on request forms before venepuncture is performed:

·  Patient’s Surname

·  Patient’s First Name

·  Sex

·  Hospital Number or CHI (Community) number

·  Date of Birth

·  Ward/Department/Clinic/Hospital

·  Sender/Clinician if appropriate

·  Date and Time of Collection

·  Type of Specimen (Venous Blood)

·  Test(s) Required

·  Clinical Details

·  Private Patient if applicable

Specimen Labelling

The following details must be noted on each specimen tube immediately after this sample has been taken:

·  Patient’s Full Name/Sex

·  Date of Birth and Unit Number

·  Ward / Department / Clinic & Hospital

·  Date of Collection

·  Time of Collection

·  Signature of person taking blood specimen

As per Guidelines for Records and Record Keeping (NMC 2002 Edition), Specimen labelling should be written clearly and in such a manner that the text cannot be erased e.g. black ink.

Important: Avoid contaminating specimens / specimen labels, request forms, tubes and surfaces with blood splashing.

Specimen Bags

Important: Specimen bags not appropriately labelled, bagged or provided with the appropriately completed matching form will not be dealt with by the laboratory, causing inconvenience to the patient as well as staff.

Transport of Biohazard “Danger of Infection” Specimens

·  Preferably double bagged, sealed in both

·  The sample and request form must be clearly marked with a “Danger of Infection” label (ensuring request form folded inward not exposing patients details)

·  The request form and sample must be in separate compartments of a polygrip bag

Labelling for Danger of Infection

Hepatitis B

Hepatitis C

HIV and other Hazard Group 3 Pathogens (details available from Pathology Laboratory)

Disposal of Sharps

All sharps should be placed directly into a sharps box at the point of use i.e.: bedside.

The sharps box must be replaced when ¾ full or after a maximum of 1 month.

Do not overload.

VENEPUNCTURE

THIS IS A CLEAN PROCEDURE PERFORMED BY CLINICAL STAFF WHO HAVE RECEIVED THE APPROPRIATE TRAINING

Definition

The planned introduction of a sterile needle into a vein to obtain a blood sample.

Indications

1.  For diagnostic purposes

2.  To monitor the effectiveness of drug therapy

Requirements

1.  Tourniquet

2.  Disposable gloves – unsterile (latex/vinyl)

3.  Alcohol swab

4.  Vacutainer holder and needle or butterfly

5.  Blood sample tubes - for the appropriate laboratory test(s)

6.  Anaesthetic cream pack (Emla) - for children / adults if required (prescribed)

7.  Request form completed and signed by doctor/ other recognised signatory i.e. Medical Support / District or Practice Nurse

8.  Double pocketed specimen bag(s)

9.  Cotton wool

10. Injection tray

11. Small waterproof dressing

12. Polythene bag for waste (orange)

13. Variable height arm rest - if requested

14. Sharps container

15. Hand disinfection solution

Outpatient/patient in the community:

1.  Ask patient to identify themselves by stating their name, date of birth and check that the Information corresponds with the doctor’s form.

2.  In children/adults anaesthetic cream is applied to the intended puncture site at least one hour prior to venepuncture and covered with waterproof dressing.

3.  Immediately prior the procedure remove waterproof dressing and remaining cream from the intended puncture site.

In patient

1.  Ask patient to identify themselves by stating their name.

2.  Check the patient’s name and unit number on their identity band corresponds with the doctor’s request form.

PROCEDURE / RATIONALE
1. / Explain procedure to patient/parent and gain their co-operation / 1. / Informed patient
2. / Wash and dry hands thoroughly / 2. / To minimise risk of cross-infection
3. / Gather equipment and proceed to patient / 3.
4. / Visually inspect both upper limbs / 4.
5. / Position tourniquet loosely 5-6cm above site to be punctured / 5.
6. / Wash and dry hands thoroughly / 6. / To minimise risk of cross-infection
7. / Place disposable gloves on a clean surface / 7.
8. / ADULT
Place fingers between skin and tourniquet and tighten tourniquet
CHILD
Tighten tourniquet or request assistance to apply pressure to the child’s limb above intended puncture site / 8. / Prevent pulling of patients skin
9. / Palpate site and identify vein to be punctured / 9. / Ensure correct choice of vein
10. / Open alcohol swab and clean over chosen site / 10. / Minimise introduction of micro-organisms
11. / Allow skin to dry passively for a minimum of 30 seconds. DO NOT REPALPATE / 11. / Enhance microbial destruction
12. / Put on disposable gloves / 12. / See Trust Glove Policy & Standard Infection Control Precautions
13. / (a) Vacutainer / 13.
(i) / Twist collection needle cover to break seal and screw the multi-sample (rubber covered) end into the holder
(ii) / Remove needle cover and hold needle bevel upwards
(iii) / With the skin below the puncture site held taut, insert the needle at a 15 - 30º angle / (iii) / To prevent the vein rolling and to facilitate ease of access
(iv) / Level off needle when puncture of the vein wall is felt
(v) / Advance needle one millimetre approximately into the vein
(vi) / Insert collecting tube into holder (see Box A)
(vii) / Blood will continue to flow until collecting tube vacuum is exhausted
(viii) / Repeat procedure (vi) for any further samples that may be required (see Box A)
(ix) / Remove last tube
(x) / Release tourniquet (see note) / (x) / To allow unrestricted flow of the venous circulation
(xi) / Place cotton wool ball over puncture site and slowly remove needle – discard directly into sharps container at bedside / (xi) / To minimise the risk of blood spillage and needlestick injury
(xii) / Apply digital pressure until bleeding has ceased. Do not request patient to flex arm / (xii) / To prevent bruising and haematoma
(xiii) / Cover puncture site with small waterproof dressing
(xiv) / Wash and dry hands thoroughly

BOX A