How to take blood

Guidance for doctors on taking blood [pdf] 10KB

Collection of blood using a vacutainer

Equipment:

• specimen bags
• gauze
• alcohol gel
• gloves [latex-free]
• tissues
• non-allergic tape
• appropriate request forms
• sharps bin
• tourniquet
• vacutainer bottle/s
• vacutainer needle and holder/guard
• sterilizing fluid for potential blood spills

Procedure

1. Accurately identify patient using verbal confirmation.
2. Explain reason for procedure to patient and gain consent.
3. Collect together all material and bottles required for the venepuncture.
4. Examine patient’s arm to identify the most easily accessible vein for venepuncture. To avoid contamination of the sample do not take blood from an arm containing a drip or transfusion.
5. Place tourniquet in position on upper arm without applying pressure (to allow for patient comfort).
6. Position arm comfortably on a support.
7. Alcohol gel or hand washing should be used in between each patient. Gloves (latex free) may be worn if necessary.
8. Tighten tourniquet to facilitate distension of vein.
9. Palpate for distended vein.
10. Attach vacutainer needle to holder and remove shield.
11. Insert needle into distended vein.
12. Gently but firmly push vacutainer bottles, in the appropriate order, into the needle holder whilst keeping the holder steady with the other hand.
    The bottles should be filled in the following order, to minimise risk of contamination with anticoagulants. If in any doubt, check with the laboratory. These colours refer to Becton Dickinson (BD) vacutainers only:
    blood culture bottles - please refer to culture bottle kit insert supplied with each kit for full instructions. Please note phlebotomists do not take blood cultures
    blue – coagulation tests
    red – no anti-coagulant
    yellow – gel clot activator
    pink 7ml size – blood grouping and cross-matching
    purple 4.5ml size – full blood count
    grey – glucose.
    Please note that paediatric specimen bottles have different colour tops; the anti-coagulant inside should be stated on the label.
13. Gently invert all bottles as they are removed from the holder, to ensure blood and anticoagulant are mixed to avoid clotting.
14. When all bottles are filled, release and remove tourniquet.
15. Remove final bottle from vacutainer holder before removing needle from vein, to reduce risk of haematoma.
16. Place a piece of folded gauze over needle injection site. Withdraw the needle and apply pressure to prevent haemorrhage from puncture wound in vein.
17. Discard needle and guard into sharps bin immediately.
18. Ask patient to maintain pressure on needle site for five minutes minimum.
19. Label all bottles with surname, forename, date of birth and hospital number, source and date of sample collection to ensure accurate identification of sample by laboratory. If no hospital number is available please use NHS number. Place bottles in specimen bag and seal.
    Note: GP barcoded samples (DART samples) barcode have encrypted identifiers contained within it and therefore the barcode itself can be considered an identifier, along with the patient name and NHS number or date of birth. The barcode must be analyser readable.
20. Remove gauze from site and check for bleeding. If bleeding occurs, reapply pressure until bleeding stops. Cover needle site as appropriate using a fresh piece of folded gauze and micropore tape.
21. Use disinfectant alcohol gel to sanitise your hands between patients. If your hands have become contaminated with blood wash them with soap and water immediately.
22. Ensure patient is comfortable.
23. Date, time and initial the request form.
24. Transport specimen to pathology reception.

Collection of blood using a needle and syringe

• If using a syringe and needle dispose of the unit as a whole into a sharps bin.
• Do not disconnect the needle.
• Do not thread the sheath back onto the needle before discarding it.

Needle stick injury

Always follow good practice to avoid needlestick injury.

Collection of high risk blood specimens

These guidelines supplement the general phlebotomy protocol.

1. Specimens should be collected by the medical officer requesting the test or an experienced and fully trained phlebotomist.
2. Wear a plastic disposable apron and disposable gloves. Goggles and eye protection are not strictly necessary but may be worn if available. There is no need to wear a mask.

Always follow ward instructions.

1. A waterproof disposable sheet should be placed under the patient's arm.
2. Clean the skin and venesect in the usual way, using vacutainer or syringe.
3. Clean up any spillage with freshly made 3% hypochlorite solution and discard used swabs into the sharps disposal bin.
4. Discard the gloves and apron into the yellow plastic sack for incineration.
5. Wash your hands, using elbow taps and dry with disposable paper towels in the usual way.
6. Stick 'danger of infection' labels on request forms and samples. Place in plastic specimen bags and seal in the normal way.