EQUIPMENT REQUIRED USING THE VACUTAINER SYSTEM A Tourniquet which should be applied at a pressure which is high enough to impede venous distension but not restrict arterial flow (Mallett & Dougherty 2000). This allows blood to flow into the arm but stops it from leaving, causing the veins to fill with blood and become prominent. A sterile alcohol swab to clean the puncture site. The area must be allowed to dry first otherwise the alcohol base may seep into the puncture site causing the patient discomfort. Research has shown that although cleansing of the skin reduces the number of bacteria present on its surface, it is not necessary to prevent infection prior to parenteral procedures (Campbell 1995) A vacutainer system sample bottle holder An appropriately sized needle designed for use with the vacuum system Cotton wool to apply to the puncture site following the procedure A sterile plaster or hypoallergenic tape to secure the cotton wool Specimen bottles and requisition form correctly filled in with the patients details, Diagnosis, G.Ps /Consultants details and signed. Sharps disposal bin for the safe disposal of the specimen tube holder and needle
PREPARATIONS PRIOR TO CARRYING OUT THE PROCEDURE It is important that patient distress and inconvenience is minimised, and it must always be remembered that painful venepuncture and unsightly bruising can leave a lasting impression. Careful and unhurried preparation will all help to alley the patients fears/anxieties (Millam 1992) With the patient seated, begin by explaining the procedure to him/her, answering any questions they may have and ensuring that the patient has given their verbal consent for you to carry out the procedure. The patient should be asked whether or not they have had any blood taken in the past, and when (as any recent sites should be avoided). Whether they are aware of any particular problems encountered and of the best sites available. After checking that the light is adequate and all the written information has been obtained, the procedure can be carried out.
CARRYING OUT THE PROCEDURE After washing her hands, the practitioner should apply the tourniquet to the patients upper arm. If the arm is placed in a dependent position and the patient asked to clench and release their fist this will help to increase the prominence of the veins. The nurse should then palpate the area with her index and middle finger to select a vein and also to allow her to distinguish such structures as arteries, tendons etc. The selected vein should be firm and bouncy. After the area has been cleaned with the alcohol swab and dried, the vein is then "anchored" by applying manual traction a few centimetres below the proposed insertion site. The needle should be inserted along the length of the vein at an angle of approximately 30 degrees. The tip of the needle should be inserted through the skin into the vein in one continuous movement. Once the needle is in the correct position, the required vacuumed bottles are then attached will each then draw up the required amount of blood for each test. Once the required amount of blood has been collected into the bottles, and the last bottle detached from the needle, the tourniquet should then be released and a cotton wool ball placed over the point of entry. At the point the needle should then be removed and discarded. "white finger-nail pressure" should be applied by the nurse over the entry site for approximately 2 minutes to stop any further bleeding. The arm should be kept straight and not bent, as the latter enlarges the entry hole causing more bleeding and bruising (Goodwin et al 1992). A sticking plaster or hypo-allergenic dressing may then be a applied to the site once the bleeding has stopped. NB. Care should be taken with patients who have a history of bleeding disorders or who have been taking warfarin or other anti-coagulants, as this may increase the time it takes for the bleeding to stop.
IMPORTANT POINTS TO REMEMBER   If the tourniquet has been on for longer that 2 minutes prior to insertion of the needle, then it should be released to allow blood to return to the hand before reapplying, and attempting the procedure again. If a venous valve is entered during the procedure the patient will experience sudden, acute pain. The procedure should be then discontinued immediately. If after 2 attempts the procedure has been unsuccessful, then assistance should be sought from a colleague. The Patient should be observed throughout the procedure for signs of dizziness or fainting. BE AWARE, the Brachial Artery is sited near the sites most commonly used for venepuncture.