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.