How to Perform a Venesection, Detailing Vein Selection and Patient Care

V3.0 05.02.13

Table of Contents 1. Introduction ................................................................................................................... 3 2. Purpose of this Policy ................................................................................................... 3 3. Scope ........................................................................................................................... 3 4. Definitions / Glossary .................................................................................................... 3 5. Ownership and Responsibilities .................................................................................... 3 5.1. 5.2. 5.7. 6.2. Role of the Nominated Director ............................................................................. 3 Role of the Managers ............................................................................................ 3 Role of Individual Staff ........................................................................................... 3 VENESECTION PROCEDURE ............................................................................. 4

6. Standards and Practice ................................................................................................ 4 7. Dissemination and Implementation ............................................................................... 6 8. Monitoring compliance and effectiveness ..................................................................... 6 9. Updating and Review.................................................................................................... 7 10. Equality and Diversity................................................................................................ 7 Equality Impact Assessment .............................................................................. 7 10.2.

Appendix 1. Governance Information .................................................................................. 8 Appendix 2.Initial Equality Impact Assessment Screening Form ....................................... 10

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1. Introduction
1.1. Venesection is a clinical procedure commonly performed in the Haematology setting. A therapeutic venesection is the removal of a volume of blood as a treatment for certain blood disorders. 1.2. This version supersedes any previous versions of this document.

2. Purpose of this Policy

This policy outlines the minimum standard expected from clinical staff who perform venesection as part of their duties within Haematology. The primary purpose of this policy is to ensure that practice is safe and based on best possible evidence.

3. Scope
This policy applies to all clinical staff regardless of grade or profession who undertake venesection within Haematology. This includes permanent, temporary, locum and bank health care staff working in both clinical outpatient and inpatient areas.

4. Definitions / Glossary
Therapeutic Venesection - the removal of a volume of blood as a treatment for certain blood disorders.

5. Ownership and Responsibilities

5.1. Role of the Nominated Director
The Nominated Director is responsible for authorising final approval of the Document.

5.2. Role of the Managers

5.3. Senior Clinical staff have overall clinical responsibility over patients. 5.4. Consultants and/or The Clinical Nurse Specialist will ensure that the procedure is performed as clinically required and a valid prescription is available. 5.5. Nurse Managers are responsible for ensuring Healthcare staff undertaking venesection are appropriately trained and assessed. 5.6. Nurse Managers must ensure this policy is available to clinical staff performing venesection and that appropriate equipment is available.

5.7. Role of Individual Staff

All staff members who perform venesection are responsible for ensuring that: They are competent, within their scope of professional practice, to safely and competently carry out the procedure. They abide by this policy.

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6. Standards and Practice

6.1. The Policy and Procedure (See below) support proper preparation of the patient and aim to ensure safe practice and high quality patient care. The skill must be performed in accordance with RCHT policies and procedures, guidelines and protocols. Staff must have access to policies and procedures via the document library. There is education and support in place to enable to staff to attain competency in the skill.

6.2. VENESECTION PROCEDURE

Equipment 1. Valid prescription with the patients name, date of birth, hospital number, amount to venesected and doctors signature 2. Non-sterile low protein powder free latex gloves 3. Apron 4. Local anaesthetic spray or local anaesthetic cream if required. 5. Tourniquet 6. Cotton wool balls 7. Venesection pack with integral needle and no anticoagulant in bag 8. Tape 9. 10cm cling bandage 10. Intravenous fluid giving set, cannula and replacement fluid, if required. 11. Spring balance to weigh the bag of blood 12. Chloraprep Procedure ACTION 1. RATIONAL E So that the patient understands what will happen and informed verbal consent can be obtained This is in case the patients blood pressure drops during the procedure This is to establish a base line blood pressure pre-procedure. The doctor should be told of any abnormal readings before the procedure begins. It is also so that the information is available for future reference.

Explain the procedure to the patient

2.

Lie the patient on a bed or couch and make them comfortable

3.

Take the patients blood pressure and record it on a TPR sheet and the patients nursing notes, clearly, accurately and legibly.

4.

Apply tourniquet and ensure arterial flow is not compromised Select a large palpable vein, avoiding any well used areas if at all possible. Negotiate with the patient a mutually acceptable site. Remove the tourniquet To get the best flow of blood possible, avoiding areas of scar tissue. Patients who have repeated procedures often know

5.

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until just prior to venepuncture

which veins are the best to use. To promote comfort for the patient.

IF THERE DOES NOT APPEAR TO BE A SUITABLE VEIN, PLEASE SEE THE NOTE AT THE END OF THE PROCEDURE 6. Local anaesthetic cream may be prescribed and applied prior to venesection to give anaesthesia. If the patient has regular venesections this could be applied while they are waiting to see the doctor 7. If any replacement fluid has been prescribed if should be started now, slowly through a cannula in the opposite arm. Apply tourniquet. Clean the site according to RCHT Asceptic Technique Guidelines. The integral needle is used to puncture the vein and secured with tape. A flow is established by positioning the bag on the scales. The higher the bag is, the slower the flow. The bag must never be placed higher than the needle If the blood is flowing too quickly release The tourniquet, if it is flowing too slowly Increase the pressure to obtain a faster flow, making sure this does not cause the patient discomfort or impede the radial pulse. The flow may also be helped if the patient opens and closes their fist. 10. When the specified amount of blood has been venesected, release tourniquet. The needle is removed while the puncture site is covered with a cotton wool ball and pressed firmly until the bleeding stops, before being bandaged firmly. When the replacement fluid has been completed, the cannula should be removed according to Trust policy When the procedure has been completed the patient rests to recover for 20 minutes or until they feel able to go. A drink should be given to them during this time After checking the patients blood pressure on the opposite arm to the To terminate the venesection safely and prevent further haemorrhaging To minimise any drop in blood pressure or reaction to lowered blood volume in the patient To ensure the patients comfort at the time of the procedure

8.

To avoid introducing infection with the needle puncture

9.

To establish a flow of blood from the vein into the collection bag while the patient remains comfortable

11.

To allow the body to recover from the change in blood volume

12

To check that there has not been a drop in the patients blood

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venesection puncture, the patient is helped off the bed or couch, and if there are no apparent problems they may leave. Any abnormalities should be reported to a doctor immediately and the patient should be seen by the doctor. The blood pressure reading is Recorded clearly, accurately and legibly in the patients nursing notes and on the TPR chart 13. When the patient leaves they should be advised to contact the unit if they are worried or have any problems following this procedure

pressure. To prevent haemorrhage from the needle puncture site To minimise any potential complications

To give the patient a point of contact should they experience any problems following this procedure

NB: Some patients have veins which are too small for the needle attached to the donor bag. In this a case a butterfly needle (19g or 21g) may be used with syringes to draw off the required amount. Any small amounts of replacement fluid prescribed may also be given slowly this way, amounts over 50ml should be given via the IV infusion. Other parts of the procedure should be carried out as stated above. The amount of venesected blood should be weighed for accuracy. 100mls of blood weighs 109gms.

7. Dissemination and Implementation

7.1. This policy will be available on the document library when it has been ratified. 7.2. All staff have access to this document. 7.3. The nurse in charge of the clinical area will be responsible for ensuring the practitioner has been suitably trained before delegating this task.

8. Monitoring compliance and effectiveness

Element to be monitored Lead Tool Frequency Reporting arrangements Acting on recommendations and Lead(s) Change in practice and lessons to be shared Compliance with procedure Headland managers and Haematology CNS Staff training records and documentation Compliance should be audited annually. Report will be used to identify gaps in staff training and the results fed back to staff to reinforce good practice. The Headland managers and Haematology CNS will be responsible for implementing any actions or changes recommended to improve the service. The Headland managers and Haematology CNS will be responsible for implementing any actions or changes recommended to improve the service.

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9. Updating and Review

9.1. This document will be reviewed every three years 9.2. Revisions can be made ahead of the review date is necessary

10. Equality and Diversity

10.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement.

10.2. Equality Impact Assessment

10.3. The Initial Equality Impact Assessment Screening Form is at Appendix 2.

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Appendix 1. Governance Information

Document Title Date Issued/Approved: Date Valid From: Date for Review: Directorate / Department responsible (author/owner): Contact details: Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Date revised: This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Related Documents: Training Need Identified? Version Control Table How to perform a venesection, detailing vein selection and patient care. February 2013 February 2013 February 2016 Sarah Caskey Headland Manager Caroline Edwards Haematology CNS 01872 258095 / 253239 Defines safe practice with regard to performing venesection. Venesection RCHT Director for Nursing February 2013 How to perform a venesection, detailing vein selection and patient care. Renewal of existing document. No consultation required as no changes to existing policy. Diagnostics Therapeutics and Cancer Not Required {Original Copy Signed} Internet & Intranet Intranet Only PCT CFT

Clinical / Nursing Generic None None No

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Date Oct 2000 June 2010 Feb 2013

Versio n No 1 2 3

Summary of Changes Initial Issue Updated to comply with trust documentation policy Format updated to comply with Trust documentation policy

Changes Made by (Name and Job Title) ? Sarah Caskey Caz edwards Sarah Caskey Caz edwards

All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager.

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Appendix 2.Initial Equality Impact Assessment Screening Form

Name of service, strategy, policy or project (hereafter referred to as policy) to be assessed: How to Perform a Venesection, Detailing Vein Selection and Patient Care Directorate and service area: Is this a new or existing Procedure? Diagnostics Therapeutics and Cancer Existing Name of individual completing Telephone: 01872 253239 assessment: Caroline Edwards 1. Policy Aim* To ensure patient safety and best practice when performing venesection. 2. Policy Objectives* To ensure patient safety and best practice when performing venesection. 3. Policy intended Outcomes* 4. How will you measure the outcome? 5. Who is intended to benefit from the Policy? 6a. Is consultation required with the workforce, equality groups, local interest groups etc. around this policy? b. If yes, have these groups been consulted? c. Please list any groups who have been consulted about this procedure. Staff are competent to perform venesection and patients are not put at risk. By auditing practice.

Patients and staff involved with venesection. No

*Please see Glossary 7. The Impact Please complete the following table using ticks. You should refer to the EA guidance notes for areas of possible impact and also the Glossary if needed. Where you think that the policy could have a positive impact on any of the equality group(s) like promoting equality and equal opportunities or improving relations within equality groups, tick the Positive impact box. Where you think that the policy could have a negative impact on any of the equality group(s) i.e. it could disadvantage them, tick the Negative impact box. Where you think that the policy has no impact on any of the equality group(s) listed below i.e. it has no effect currently on equality groups, tick the No impact box. Page 10 of 11

How to Perform a Venesection, Detailing Vein Selection and Patient Care

Equality Group Age Disability Religion or belief Gender Transgender Pregnancy/ Maternity Race Sexual Orientation Marriage / Civil Partnership

Positive Impact

Negative Impact

No Impact x x x

Reasons for decision Procedure will be performed if clinically indicated.

x x x x x

You will need to continue to a full Equality Impact Assessment if the following have been highlighted: A negative impact and No consultation (this excludes any policies which have been identified as not requiring consultation). 8. If there is no evidence that the policy promotes equality, equal opportunities or improved relations - could it be adapted so that it does? How? Full statement of commitment to policy of equal opportunities is included in the policy

Please sign and date this form. Keep one copy and send a copy to Matron, Equality, Diversity and Human Rights, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Chyvean House, Penventinnie Lane, Truro, Cornwall, TR1 3LJ A summary of the results will be published on the Trusts web site.
Signed ____Caroline Edwards____________________________________ Date _________________________________________

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