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

Infection 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 implications to limit spread is effective hand washing.

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 circulatory system) therefore there is room for pathogens on the skin to be transferred 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 vigorously for 30 seconds and the area be allowed to dried before the procedure takes place. If less than 30 seconds of vigorous cleansing 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

Under normal circumstances, not skin cleaning needs to be undertaken as the arguments of flora disturbance over-ride the benefits of it. If the client has visibly contaminated skin, then there is an argument for skin preparation prior to venepuncture.

5

KE5

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

hazardous

non-hazardous

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 inapposite/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 individual’s 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 allergies to such things as the gloves worn by the worker when they touch the client or among other things, an allergy to the skin wipes.

• The client may become dyspnoeic and may start complaining of feeling short of breath and constriction of the throat
• Redding of the face
• Localized erythraemia

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 erythraemia 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 treatment 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. These 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 unhealthy, 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-vacuum method of venepuncture (i.e. use of a syringe rather than a needle
• Excessive tightness and prolonged use of a tourniquet can result in an alteration in blood cells thus altering any results of any tests that card taken.

15

KE15

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

Once I had obtained a valid consent from the client, I would ensure that they were either sitting comfortably in a chair or lying comfortably on the bed. Some individuals are very frightened at the thought of having blood taken. Because of this, I tried to remain calm and talked to the client to try to put them at their ease. I usually ask them if they have had blood taken in the past and, if so, which arm was used to best effect last time. I inspect both arms and so when I have selected a vein that I intend to use, I support that arm with a pillow to maximise comfort.

If the vein area is visibly dirty, I clean it use in the soap and water as the use of alcohol wipes can cause greater infection risk as the flora that lies on the skin is disturbed and to thus more likely to be inoculated on the commencement of the procedure.

16

KE16

Describe the steps you would take to detect suitable veins

See Trust Skills pack

17

KE17

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

Is it going to her it?

I feel that it is very important that I do not lie to clients. Yes, it is going to hurt. But the pain is only transitory, so that must be emphasised also.

Are you taking all those tubes of blood?

It is important to explain that the doctor has asked for different tests to be undertaken. If the individual goes on to ask what are the different tests being taken, I usually respond by saying "would you like me to get a doctor to come and explain it to you?” I feel that it is not my role to give an explanation of what bloods are being taken because there I implications into a clients diagnosis and, as diagnosis is not a subject that I would discuss with the client, I feel that a registered practitioner, I e, a doctor, is the best person to answer any more questions.

18

KE18

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

· The insertion of a needle into the skin causes pain receptors and nerve endings in the localised area to be activated and send a pain message to the brain. Even after the procedure has finished, the nerve endings continue to send pain messages to the brain as there has been damage to the localised area.

· Excessive pressure of a tourniquet can result in increased pain as; arterial blood flow can be occluded thus increased pain. This is why it is essential to check radial pulse after the application of a tourniquet. If radial pulse is detectable post application of tourniquet, then arterial blood flow has not been occluded.

· After the procedure has been completed, gentle pressure using a cotton-wool ball can help to prevent the formation of a haematoma and bruising. This pressure needs to be at an optimum level as excessive pressure can result in bruising and insufficient pressure can result in formation of a haematoma.

19

KE19

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

· If the client does not consent the procedure, then the procedure cannot be undertaken. In this case it is important that a doctor or registered nurses informed immediately.

·

· If the client has poor veins, then it is important to defer to a doctor who is a registered practitioner and has different skills and can use other methods to take blood that are outside the role of practice as designated within this unit

·

If the flow of blood stops once the needle has been inserted before the tube has filled sufficiently, the vein may be stroked gently further up the arm to encourage blood flow. The position of the needle may also be slightly moved to see if the flow will return. If there is a total cessation of blood flow, it may be necessary to try to take blood at another point of entry where a vein is visible and suitable. If there are no veins suitable, then to a situation must be referred to a doctor.

20

KE20

Why anticoagulants are 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?

Anti-coagulant is added to blood tubes to prevent the sample clotting. If this occurs, the tests cannot be carried out on they blood.

The quantity of anti-coagulant which is added to the tube has been specially titrated to the amount of blood that is to be expected to be taken. If insufficient blood is taken, then the percentage of anticoagulants or be too high for that sample thus causing invalidation of any tests that are undertaken.

21

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

See Trust Skill Pack

22

Describe how you would apply dressings.

See Trust Skills Pack

23

KE21

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

Within a hospital setting, cotton wall is the dressing of choice for all cases have been a puncture. It helps to absorb any excess haemorrhaging that can occur. It can be removed after 24 hours. In other settings, a standard when plaster can be applied and removed within the same time frame.

The site should be inspected for signs of infection (localised erythraemia and pain) or phlebitis (localised erythraemia, pain and a reddening and swelling tracking up the vein. In both cases, medical opinion should be sought.

24

KE23

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

25

Describe how you would recognise an arterial puncture

·The client suffers pain far beyond that of venepuncture

·Blood GUSHES out into the tube.

·After the procedure has finished, blood continues to gush from the site.

·The site is not easy to stop bleeding.

26

KE24

What action would you take if the above occurs?

·Apply direct pressure using clean padding.

·Elevate the arm

·Continue to apply pressure until the bleeding has stopped.

·Consult a registered practitioner

·Document the occurrence in the client’s care plan

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)

Within a community setting, samples can be kept confidential by storing them in a suitable container which is used for the purpose so that they are not only kept safe but the information on that remains confidential. Some blood forms have a seeing mechanism which allows information to be kept confidential. Others do not.

In a hospital setting, especially in an acute, busy area, confidentiality can be difficult to maintain it at all times. Preferably, all blood specimens should be so sent to the lab as soon as they are taken. A "pod" system can facilitate this immensely. A collection. Within a ward/Department may also be used however, this should not be in an area where other patients/individuals are able to access any information on any of the forms

29

How would you deal with any spillages of blood?

· Cover spillages with paper towels to mop up the excess blood.

· Poor neat "Milton" solution on top of the paper towels.

· Discard paper towels in yellow chemical waste bag.

· Dry floor using fresh paper towels

· Wash floor using standard hospital detergent

30

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

See trust skills pack