NVQ evidence

1

KE3

Discuss why a doctor may refer a patient for Venepuncture

• As a diagnostic tool to discover if a client's blood levels are deranged from normal levels
• As a benchmark against which any changes may be measured.

2

Describe how infection is spread

In fection requires a chain of factors to be in place to spread.

These include:-

• A sufficient number of pathogenic micro-organisms/viruses
• A suitable vector to transfer the infection
• A host
• A portal of entry into the host
• A suitable environment in the host to encourage the micro-organisms to multiply

3

KE1

How may its spread be limited?

Eliminate one at least one of the above factors may limit spread. In the care setting, one of the most important implimations to limit spread is effective handwashing.

4

KE4

Why is it important to clean Venepuncture sites effectively, how and when should this be carried out?

Why is it important to clean Venepuncture sites effectively

A foreign body (a venepuncture needle) is being introduced into a sterile system (through the skin and into the cirulatory system) therefore there is room for pathogens on the skin to be transfered into the body. However, it has been shown that the small amount of pathogens on the skin that are introduced on venepuncture represent a small infection risk. If the skin is visibly dirty, then it could be argued that this represents an excessively higher risk thus cleansing action needs to be taken.

how

Soap and water is a very effective way of cleaning the site. Alcohol wipes use is of limited use. If required, these should be used vigourously for 30 seconds and the area be allowed to dried before the procedure takes place. If less than 30 seconds of vigorous cleasning with an alcohol wipe are taken, then the natural flora on the skin are not eliminated but are disturbed, increasing their likely hood of inoculation on venepuncture. If the area is not allowed to dry adequately for 30 seconds, then the procedure is more likely to cause stinging

when

5

KE5

In relation to Venepuncture, what is hazardous and non-hazardous waste? How would you dispose of each?

hazardous

Needle	Place in sharps bin when used
Blood bottles that have been pierced or do not contain sufficient blood thus need to disguarded	Place in sharps bin when used

non-hazardous

Outside needle cover	Place in clinical yellow waste bag
Used cotton wool with blood on	Place in clinical yellow waste bag

6

KE6

Why is correct labelling important and what are the possible consequences of muddling samples?

Why is correct labelling important

• So the specific blood corresponds to that patient

what are the possible consequences of muddling samples

• The patient could receive inapproiate/dangerous/fatal care as a result of the misattributed blood.

7

KE2

Describe the legal and organisational requirements regarding health and safety and infection control when working with blood (e.g. COSHH, DoH guidelines and local policies

Covered in Trust skills pack

8

KE7

Which types of sample have particular storage and transfer requirements (e.g. temperature dependant tests) and what are the requirements?

Covered in Trust Skills pack

9

Why is it important to get positive confirmation of individuals identity and consent before starting the procedure?

• See Q 6
• To ensure that valid consent can be obtained. If this is not undertaken, then any action undertaken could be considered as assault.

10

KE8

Describe effective ways of getting positive identification.

• Checking a client's name band
• Asking the client's name and date of birth
• Asking a relative/significant other.

It can sometimes be very difficult to obtain a one hundred percent positive identification as some client's lie or are disorientated. Also, third party identification can also be invalid

11

KE10

Describe the contra-indications and changes in behaviour and condition, which indicate that the procedure should be stopped, and advice sought. (e.g. allergies, skin problems, incorrect presentation such as non – fasting.)

allergies

There can be alergies to such things as the gloves worn by the worker when they touch the client or among other things, an alergy to the skin wipes.

• The client may become dispneoic and may start complaining of feeling short of breath and constricion of the throat
• Redding of the face
• Localized erythaema

Client may become restless or may even loose consciousness. A sever reaction may result in apnoea

skin problems

• Over use of the same area for repeated venepuncture may cause skin problems
• A less marked but still significant reaction to gloves and skin preparations may result in erythaema and or hives forming

incorrect presentation such as non – fasting

If there is non-compliance with such prerequisite regimens, then this can invalidate test findings thus the true picture is not given. This can result in inappropriate or even fatal treatement being given.

12

KE12

What sites may you choose for Venepuncture and why.

Within my role as a Support Worker, I am able to use the accessible veins at the Antecubital Fossa crease. This are used as they are the most accessible and easy to use. Other veins are usually used by other care professionals such as Doctors and Phybotomists. In some cases, a butterfly needle is used for very small lumen veins the use of which requires extra training, which, at this time, I have not yet taken.

13

KE13

What factors would you consider when choosing the best site to use (including the individuals own preference)

• Degree of compliance and orientation of the client. If the client is non-compliant or disorientated, then I would refer them to a Doctor to undertake the procedure.
• General condition of the veins. If the veins were not suitable or unheathy, then I would refer the situation to a Doctor.

14

KE14

What factors can affect the quality of the sample (e.g. prolonged use of a tourniquet)

• Lumen of the needle. If this is too small, then the blood cells can be altered and sample will be invalid
• The type of needle used. If a butterfly needle is used, then the cells can be denatured as above.
• The non-vaccum method of venepuncture (ie use of a syringe rather than a needle

15

KE15

Describe how you would prepare individuals for Venepuncture; include how their personal preferences may effect their preparation.

16

KE16

Describe the steps you would take to detect suitable veins

17

KE17

Describe the possible concerns individuals may have in relation to Venepuncture and blood sampling.

18

KE18

What is likely to cause discomfort to individuals during and after the collection of blood samples? Describe how such discomforts can minimised. E.g. applying correct pressure to tourniquet and puncture site to avoid bruising)

19

KE19

What remedial action can be taken if there are problems in obtaining blood?

20

KE20

Why are anticoagulants added to blood samples and why is it important to collect the right volume of blood when it is to be mixed with anti-coagulant?

21

Describe the dressings needed for the different types of puncture sites.

22

Describe how you would apply dressings.

23

KE21

What advice would you give individuals on caring for the site? (Ke21)

24

KE23

How would you recognise the common adverse reactions which individuals may have (e.g. fainting, bruising) What action would you take if they occurred.

25

Describe how you would recognise an arterial puncture

26

KE24

What action would you take if the above occurs.

27

KE25

What equipment and materials are needed for venous sampling, and how would you check and prepare them (including protective clothing for the worker and/or the individual.

28

How would you maintain confidentiality whilst transporting blood samples (i.e. from patients home to the surgery)

29

How would you deal with any spillages of blood?

30

Describe the procedure you would follow if you sustain a needlestick injury