PROS & CONS IN VENIPUNCTURE
EASY STEPS TO VENIPUNCTURE
ETHICS AND PREPARATION
Pre-test Preparation –
1. Give thoroughly an idea about the test you perform. Sos need of fasting with resting sample needed. (BSL –F, Hemogram with ESR.) Give all instruction of Nil By Mouth (NBM). With post prandial sample needed then further more for the tiffin to bring by patient as well its contents too.
2. Give clear idea about venipuncture and its necessity & its test
sample in ml.
3. Always start the process with oral consent.
4. Whereas, test may affect patient’s social, economic and
family aspect should be taken in written consent. (HIV, VDRL Test).
5. Always ask where to hand over the report to relatives? or it should be collected personally.
Mid test precaution
Mid test Precautions – Ask for the patients to be in supine position mostly whom’s veins are not visible. Or a comfort back-rest supine position with arm rest chair. (To avoid prick shock/ Vagal shock.) In normal individual backrest semi sleeper arm rest pad chair is also good for venipuncture.
Anatomy – Watch for forearm for Volar aspect with prominent and palpable veins. Volar aspect is well distance space between two prominent veins. Easily palpable and non-slippery.
If patient will be obese, myxedemic (Severe hypothyroidism), Any kind of drug allergy, swelling, anaphylaxis skin rash and severe anaemia can not trace the veins…
PROCEDURE OF VENIPUNCTURE
Procedure – To avoid Prick shock, patient should always in back rest posture. Empty stomach morning sample for ESR, Bsl-F, Immunology & serological test (To avoid chime clogging) is recommended. Which aborted the monochromatic light readings.
When veins are not visual due to earlier said causes.
It is always recommended to be in supine position with use of Blood pressure apparatus-cuff at 70 mm of mercury pressure throughout the procedure instead of Tourniquet.
Patience with certain time is recommended with keen observation for subcutaneous bleeding like Petechiae, ecchymosis and erythema for fragile vessel wall.
Steps to Venipuncture.
Steps – 5 steps should be followed to trace the impossible vein for good sample collections.
1. Use of gravitational force with combine force of distal blood flow below heart level. Wait for 5 mins in such posture.
2. Bind BP cuff / Tourniquet at maintain pressure of 70 mm of Hg.
3. Add collateral pressure by making a tight fist.
4. Adduction & abduction of forearm muscle work increases blood flow to distal organs. Which will engorge the blood vessels.
5. Use wet spirit swab to rinse and increase contrast of veins as well valvular uniflow of vein blood.
- Combine force of Gravity & Heart pumping.
Use of gravitational force with combine force of distal blood flow below heart level pressure – Definitely, When heart pump the blood. The hanging organs lower than heart level will get more blood flow with resists valvular uniflow due to Gravity makes engorgement of veins. It will helps in certain manner for partial obstruction in vein flow and encourage lower down fast flow in arteries results in veins tracing and its roots too. Some time it doesn’t work but accelerate the vein tracing steps.
- Venous blocking 70 mm of Hg pressure theory.
Anatomy- cells contents 3-4 mm of Hg pressure with albumin (protein) oncotic pressure interstitial fluid contents 7-8 mm of Hg pressure. Interstitial fluid flows towards blood capillary is near about 16 mm of hydrostatic pressure. From
Blood capillary towards venules having furthermore hydrostatic & Oncotic Pressure which is up to 32 mm of Hg and the final end up of tiny veins to mainstream veins contents 64 mm of Hg to 70 mm of Hg Pressure. And heart in resting pressure to conduct venous blood is resides between 70-90 mm of Hg. Henc.to obstruct the venous flow, 70 mm of Hg is recommended.
Don’t do this – Never apply force more than
70 mm of Hg on Tourniquet or By using BP apparatus or with the help of handgrip by assist. It will obstruct the brachial artery if exceed pressure. And Venipuncture will be failed with several attempts. Or vein may be counter to form erythema under the skin.
- Collateral Pressure –
It can be created by forearm’s muscles in contracts position which equilaterally produces pressure over veins.
For collateral pressure, it will increase to engorgement of forearm veins by asking the patients to make a clenching of fist tightly. Which is 3rd step.
Don’t do this – It is not in use to ask the clenching of a fist in the first step before tying up tourniquet or BP cuff at 70 mm of Hg. Bcz, it will drain out venous blood before pressure applies and delay the process or even partially not allow the backflow from the distal part toward the heart with a narrowing path.
- Adduction & abduction of forearm muscle work – It will increase muscle work when it did vigorously for a couple of minutes. When there is tie up for venous flow. Hence it should be followed at 4th place.
After that slightly patting over ventral part of forearm to trace the
veins with its valvular uniflow nature.
Now slight patting will help to rule out a venous zigzag route which gives you an idea about at what angle to introduce needle lumen sharp edge. It is in practice not to counter the vein with its exact position .. Patting should help to that lowest 30-degree angle.
Don’t do this – Without knowing the vein path introducing needle will make vein’s counter-puncture. i.e. not in situ position for vein blood drawn.
R5. Use wet spirit swab to rinse and increase the contrast of veins as well valvular uniflow of vein blood. Its wet picture clears up vein edge too. As well sterilized the area of pricking. Sometimes 1 st swab is used with two side surface to clean up the pricking area and & put it in the garbage with again single direction single use of a second swab will be used to cleansing the veins.
Don’t do this – After applying spirit, alcohol base, don’t blow up mouth air to dry up the spirit. Which is not in use again. Or making venepuncture before drying up the spirit will create erythema due to direct pricking spirit which adheres with needle shaft to skin.
Bleeding should be watched carefully. Care for excessive bleeding with a dry cotton swab. As the patient to adduct elbow joint with dry cotton on pricking lesion. The patient should not allow as soon after venepuncture. He should wait there (Sample collection waiting room) minimum of 10 minutes. & then by applying cotton tape overwound will allowed to leave the waiting room.
Don’t do this – Never use a wet swab to stop the bleeding. The patient should weigh a minimum of 10 min. for any kind of possibility of Bleeding disorder. The patient should advise to drink enough water and avoid smoking, caffeine & alcohol consumption with strenuous exercise for a day.
“Success depends on -What you think and what you apply”
I Mrs. Alka D. Tajne is Ph.D. scholar in the field of nursing & currently working as a professor cum principal in vibrant nursing college Masma, Surat. I have 5 years of clinical and 15 years of teaching experience. I have presented 5 papers in the various national webinars. I am a gold medallist in M.Sc. Nursing in my subject. I have organized & moderate 3 international and 4 national webinar & 4 state-level webinars. I have membership in a professional organization in this association. I am having life membership in TNAI, CNRS, NTAI & now newly form society NSS. I am a founder member & Joint secretary. I am a guide of research to graduate and post graduate students. I have achieved the best staff nurse & best teacher award in the years 1997 and 2005.