Venepuncture is the procedure of inserting a needle into a vein to obtain blood. It requires knowledge of anatomy, selection of an appropriate vein and device, understanding potential problems, and awareness of health and safety risks. The document outlines the indications, vein anatomy, site selection, choosing a vein, hazards, risks, equipment, and technique for performing venepuncture.

1. Adult Venepuncture
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2. Venepuncture is the procedure of inserting a needle into a
vein, usually to obtain blood
In order to do this safely the student must:
1. Know the relevant anatomy and physiology
2. Understand the criteria for selection of an appropriate vein and device
3. Appreciate potential problems that may occur
4. Have an awareness of associated Health and Safety/ risks involved in
undertaking the procedure and correct disposal of equipment
Indications
• To obtain blood for diagnostic purposes
• To establish/ monitor levels of blood components
• To establish/ monitor levels of drugs
• To monitor response to medical treatments (e.g. fluids)
• To provide a sample to cross match prior to transfusion
• To screen for infection
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3. Vein construction: 3 Layers
Tunica adventitia
Connective tissue
Surrounds, supports
Tunica media
Muscular tissue
Contracts and relaxes
Tunica intima
Smooth endothelial cells
Valves
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4. Selecting a site
Usually those found in the antecubital fossa
1. Median cubital vein
2. Cephalic vein
3. Basilic vein
Metacarpal veins should only be utilised for venepuncture when the other veins are
not accessible
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5. Choosing a vein
• Accessible
• Unused
• Easily detected
• Appears healthy and patent
The most prominent vein is not necessarily the most suitable vein
-Visual inspection
-Palpation
Visually scrutinise the veins in both arms, avoiding:
• Evidence of infection, bruising and phlebitis
• An oedematous limb where there is status of lymph
• Areas of previous venepuncture. Repeated trauma causes pain
Palpate veins too:
• Distinguish vein from arteries and tendons
• Identify deeper veins and presence of valves
• Use index finger, or fore finger, not thumb
Healthy veins are soft, bouncy and refill when depressed
Other factors influencing vein selection
? Injury, disease or treatment ? Position of patient ? Age of patient ? Weight of the
patient ? Dehydration or Shock ? Medication/ condition that causes excessive
bleeding or delayed clotting (anticoagulants, steroids, thrombocytopenia)? Fear
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6. Hazards and Risks
• Infection- adherence to an aseptic technique (thorough hand washing and use
of alcohol gel) required. Performed with single use equipment, non- sterile
gloves may be worn.
• Accidental damage- inadvertently punctured nerve, tendon or artery. Spend
time undertaking visual inspection and palpation.
• Haematoma- Caused by poor technique, failure to remove the tourniquet
before removing the needle and inadequate pressure on the site. Patient/
Client must not flex arm on completion of the procedure. Identify those with
relevant medical history/ drug therapy.
Associated Risks
• Incorrect or lack of details on request form and/or sample- Increases
likelihood of errors occurring. Sample will be rejected by lab, necessitating
repetition of the procedure. Always check details with patient, request form
and sample correspond.
• Insufficient sample/ wrong specimen bottle- necessitating repetition.
• Needlestick injury- correct use of Vacutainer system and Sharps policy help
reduce this.
• Infected/ ‘High risk’ samples- correctly identified as such through labelling so
all those involved with handling are aware.
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7. Equipment list…..
Sharps bin
Procedure tray
Non-sterile gloves
Apron
Vacutainer device/ needle
Tourniquet
Alcohol hand gel
Patient identification labels
Specimen request
Specimen bottle
Gauze/ swab
Procedure
• Correctly identifies patient/ gains consent
• Hand washing/ use of alcohol gel
• Supports chosen limb
• Applies Tourniquet
• Selects appropriate vein
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8. Technique
• Anchor vein
• Verbally warn patient
• Insert needle smoothly at angle of 15-30 degrees with bevel upwards
• Level off needle and advance approx 1mm
• Push specimen bottle into heamguard
• Allow vacutainer to fill specimen bottle
• Gently but firmly remove bottle
• Remove tourniquet
• Cover puncture site with gauze, remove needle, dispose of needle into sharps
bin
• Apply pressure to straight arm, apply plaster
• Correctly label sample
References and further reading
Nottingham City Hospital/ queens Medical Centre/ Rushcliffe PCT Nursing
Practice Guidelines (2004) Venepuncture using the Vacutainer System
(*Accessible on Hospital intranet- contains extensive further reading list)
Nottingham City Hospital/ Queens Medical Centre Nottingham ‘Working in New
Ways’ (2004) Venepuncture and Cannulation: An educational Self-directed
Package for Registered Nurses, Midwives and Non- registered staff.
Johnson and Johnson (1997) Practical Guide to Peripheral Cannulation
R.Seeley, T Stephens, P.Tate (1988) Anatomy and Physiology
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