UNIT 3: VENEPUNCTURE

Hours: 6
6

Theory
Hours practical

Specific Objectives
At the end of the unit, the student will be able to:
1.

Define the relevant terms as listed.

2.

Explain the rationale for venepuncture.

3.

Describe the structure and functions of selected body systems.

Cardiovascular

Respiratory

Renal

Integumentary

4.

Explain the importance of fluid and electrolytes in the management

of homeostasis.

5.

Explain the physiology of fluid and electrolytes in the maintenance of

homeostasis

6.

Demonstrate knowledge of the prevention of nosocomial infection.

7.

Outline the principles of venepuncture in adults and children

8.

Describe the roles of the nurse in venepuncture.

9.

Describe the qualities of a venepuncturist/phlebotomist.

10.

Describe the management of patient/client undergoing venepuncture

using the Nursing process.

11.

Describe the dangers of venepuncture to client and self.

12.

Explain the complications of venepuncture.

13.

Select sites for venepuncture.

14.

Demonstrate the venepuncture procedures with the aid of a

mannequin.

15.

Demonstrate beginning skills in performing venepuncture on a least

five (5) patients/clients.

16.

Explain the principles of documentation of venepuncture.

CONTENT
1.0

DEFINITION OF TERMS
Anticoagulant,
Intravenous , Artery , Lumen, Asepsi, Nosocomial
infections, Bevel, Pulse , Blood Pressure (BP), Phlebotomy , Bore,
Sclerosis,
Branula/Cannula, Syringe, Catheter, Tourniquet, Cephalic,Vacutainer ,
Central Venous Pressure, Valve, Gauge, Vein, Haematoma,
Venepuncture Homeostasis, Hypodermic.

2.0

RATIONALE FOR VENEPUNCTURE

Fluid replacement

Drug Therapy

Hyperalimentation

Collection of blood/samples

Others

3.0

REVIEW HUMAN BIOLOGY

3.1

CARDIOVASCULAR SYSTEM

Divisions:
o Heart
o Blood
o Blood vessels
o Circulation blood

Heart:
o Location

o Structure
o Function
o Conduction mechanism
Blood:
o Constituents
o Groups
o cells
o plasma
o coagulation

Blood vessels:
o Types
o Structure
o Function

Circulation:
o Pulmonary
o Systemic
o Portal
o cerebral

RESPIRATORY SYSTEM

3.2

Divisions:
o Nose
o Pharynx
o Trachea
o Bronchi
o Bronchioles
o Lungs
Location
Structure
Function
Physiology of respiration
Role of the respiratory system in maintaining acid-base
balance
RENAL SYSTEM
Divisions:
o Kidney
o Structure-urethra
o Function-bladder

o Urethra
o Role in fluid and electrolyte balance
3.3

INTEGUMENT SYSTEM

4.0

Divisions:
o Epidermis
o Dermis
o Structure and function

REVIEW NOSOCOMIAL INFECTIONS

Nosocomial infections
Universal precautions

PRINCIPLES OF VENEPUNCTURE
Veins are thin walled therefore care must be taken in puncturing the

5.0

veins so that the needle does not go through the entire vein.
Maintaining aseptic technique throughout the procedure.
Application of tourniquet must be just enough to slow venous
return.
Visualize/palpate vein before attempting to puncture vein.
Gently lift skin (getting under the skin) before puncturing vein to
prevent spurting of blood.
Always enter vein with needle bevel side uppermost at an angle of
15-30.
If possible, use non-dominant limb (less activity).
Venepunctue is contraindicated in site that has signs of infection,
infliltration and thrombosis.
Administer drugs safely in an existing intravenous system
Homeostasis
Others

ROLE OF THE NURSE IN VENEPUNCTURE

Respect patient/client rights

Maintain asepsis
Prevent injury to self and client
Act according to policy/guidelines if injury occurs
Counsel client and family
Document data

6.0

QUALITIES OF THE VENEPUNCTURE

The nurse performing venepuncture should be:

Patient explain reasons for and details of the procedure.

Tolerant willing to answer clients questions simply and
appropriately
Kind ability to approach the client in an unhurried manner gaining
clients full cooperation.
Knowledgeable must know the principles of venepuncture and
able to carry out procedure safely and effectively.
Competent displays self assurance and competence in carrying
out tasks and in relating to patients.

7.0 MANAGEMENT OF THE VENEPUNCTURE USING THE NURSING

PROCESS

Assessment

Nursing diagnosis

Planning

Implementation

Evaluation
8.0

DANGERS OF VENEPUNCTURE TO CLIENT/HEALTH CARE

PROVIDER

Physical trauma

Exposure to infection

9.0

COMPLICATIONS OF VENEPUNCTURE

Oedema

Infections

Necrosis

Embolism

Phlebitis

Others: Antigen/antibody reaction etc.

10.0 SITES FOR VENEPUNCTURE

Antecubital fossa
Anterior aspect of the forearms
Dorsum of hands and feet
Area covering saphenous vein research
Scalp vein.

11.0-12.0 PROCEDURE

13.0 14.0

PRINCIPLES OF DOCUMENTATION IN VENEPUNCTURE

15.0

Select sites for venepuncture

Demonstration of procedures using mannequin
Perform venepuncture on a client/patient for blood letting
and/or initiation of intravenous therapy
Administration of drug in an existing intravenous system.

Type and amount of fluid or drug administered

Date and time of administration
Effects or adverse reaction (Date and time)
Signature and title of venepuncture

VENEPUNCTURE SKILLS
Perform unaided a minimum of five venepunctures.

PERFORMANCE EVALUATION
In the initial contact hours student would have performed five
(5) venepunctures
Demonstrate competence in performing thirty (30) successful
venepunctures before screening for Nursing Council
Examination
These experience for gaining competence is ongoing after the
completion of
the initial eighteen hours and should include a minimum of:
five initiation of intravenous infusion,
five withdrawals of blood samples,

five administration of drugs in an existing intravenous infusion

system
Documentation of competency in performing thirty (30)
venepunctures.

RELATED NURSING SKILLS

Management of patients with anaphylactic shock

Cardio-pulmonary resuscitation
Application of splints
Locating pressure points
Bandaging
Aseptic technique
Sterilization of equipment
Preparation of antiseptics and disinfectants
Disposal of used sharps and other disposable articles
Collection of specimen for laboratory.

PROCEDURE FOR ADMINISTERING INTRAVENOUS THERAPY (IV)

ASSESSMENT
1.

Assess need for I.V. therapy:

Health

history- ask about:

Loss of fluid,
Diarrhea
Fever
Fluid intake
Urinary output
Allergy to tape/antiseptic

Determine clients need for psychological support.

Assess need for client teaching about IV therapy.

Physical Examination
Determine vital signs: temperature, pulse, respiration, blood
pressure for baseline
data.
Evaluate skin turgor (eyes, tongue, lips), to determine hydration
status.

To test urine not only for specific gravity.

Identify appropriate site for venepuncture.
a.
Vein should be superficial, readily palpable, easily followed
and large enough for the needle to be inserted smoothly.
b.
Placement of cannula is based on joints, e.g. antecubital
space, wrist.
c.
If possible, the cannula is not placed on joints, a splint
must be used to immobilize the joint.
d.
Assess type and size of cannula necessary. (Blood requires
a large size cannula, at least # 18).
Determine the length of time necessary for therapy so that the
appropriate equipment can be selected.

PLANNING
1.0

Goals/Outcomes

2.0

IV therapy initiated and maintain without difficulty.

Catheter inserted into selected vein without complications.
Fluids, additives and medications administered without adverse
effects on the
client.
Blood and Blood products administered through appropriate tubing
and
equipment.
IV site remains free from redness, edema, and purulent discharge.
IV infusion rate accurately calculated and reassessed throughout
the therapy.
IV equipment removed without complications.

Equipment
Prepare try or trolley with the following:
Tourniquet or blood pressure cuff
Antimicrobial wipe for example 70% ethyl alcohol.
Sterile cannula or needle; winged-tipped needle; intermittent
infusion set or overthe-needle catheter.

IV solution in either bottle or bag, as ordered by physician/health

agency policy.

Administration set: drip system, which includes drip chamber

and IV tubing.

Extension tubing to lengthen the original tubing or to provide

extra ports for the
administration of additional medication.

IV pole freestanding, bed-attached, or ceiling-affixed.

Sterile 2x2 gauze square.

Tape (ask client about adhesive tape allergy)

Sterile two-by-two inch strips of adhesive dressing.

Filter to be used whenever the IV system has been entered to

administer drugs or
whenever an infusion catheter is to be inserted into large central
vein.

Arm board for immobilization.

3.0

Additional Equipment
For intermittent infusion

4.0

Three syringes with needles

Several extra needles
Vials of saline solution

Preparation
For selection of puncture site
Vein should be superficial, easily palpated and followed, and large
enough for
a needle to be smoothly inserted.
Veins should be free of sclerosis, hematomas, pain and redness.
Veins should be free of sclerosis, hematomas, pain and redness.
Veins should be selected according to the IV solution that will be
infused. Larger veins are preferable for caustic solutions blood and
viscous fluid.
Distal end of veins should be punctured first. Proximal ends should
be preserved for further IV therapy.
Cannula or needles should be placed in the arm that is not used for
writing.
Cannula or needles should not be placed near joints, which require
immobilization.

5.0

For Selection of Cannula or Needle

Winged-tipped needles: these are to be used short-term therapy
with adults and in normal therapy with children, infants, and elderly
clients who have small or fragile veins.
For neonates, use a 25-27 gauge needle; for older children, use a
21-25 gauge needle.
Intermittent infusion set is used in short-term therapy to permit the
intermittent administration of drugs directly into clients vein
without exposing the client to the expensed and annoyance of
continuous intravenous drip. This system allows blood to be
withdrawn and blood transfusions to be performed without the pain
of repeated venepuntures.

6.0

For Selection of IV Fluid and Tubing for Infusion

Wash your hands before preparing IV equipment.
Compare the type and amount of solution with physicians
orders/health agency
policy.
Check IV solution container for expiration date and for signs of
contamination or
deterioration.
Hold in both a dark and bright light to examine for discoloration,
cloudiness, or
particulate matter, which indicates a problem.
Examine glass bottles for cracks or leaks; examine bags for tears.
Inject any required additives through the medication port in the
container before
inserting IV tubing.
Select IV tubing according to the viscosity of the solution that will
be infused.

7.0

For Setting up Administration Set with Glass Container

Remove metal cap, metal disc, from IV bottle.
Close control clamp on IV tubing administration set and insert the
spike into the port, holding the neck of the port tightly to prevent
slipping and possible contamination.
Invert the IV container and fill the drip chamber.
Hang the IV container on the IV pole.
Open the IV tubing control clamp and clear the tubing of air by
allowing fluid to run through.

 Readjust the adaptor cap or place covered needle over tubing

insertion site to maintain sterility before infusion is established.
Before taking IV equipment to clients room, tell client what you will
be doing and what type of equipment you will be using.
INTERVENTION
1.0

Performing a venepuncture with an over-the needle catheter

Inform patient/client of procedure.

Wash hands.
Prepare IV equipment.
Select a moderate to large vein and apply tourniquet.
Just prior to insertion of catheter, carefully remove needle cover.
Inspect both needle and catheter.
With bevel of needle up, insert needle and catheter together as one
unit into the clients skin.
Insert the cannula into the vein.
Advance catheter and needle gently as one unit into the lumen and
observe for flash back of blood in the hub.
As soon as the catheter and needle are fully in place, release the
tourniquet.
Gently withdraw the needle from inside the catheter with one hand
placing your fingertip firmly above the catheter tip to occlude the
vein and prevent sudden bleeding.
Connect hub to administration set.
Open clamp on set briefly and observe drip chamber. Fluid should
flow rapidly
without obstruction, and there should not be any sudden swelling
at IV site.