CLINICAL SKILLS

Split group into two smaller groups. Ask each group to consider:

1. Indications and explanation of procedure
2. Risks and safety considerations

Allow 5 minutes for group discussion and to write notes on flipchart paper, 2 minutes to feed back from each group and briefly discuss consent.

Tutor to demonstrate procedure below, with the group contributing to suggest next steps and ask any questions they have about the procedure.

1. Collect appropriate equipment checking expiry dates and integrity of packaging. Clean procedure tray.
2. Introduce yourself, correctly identify the patient, explain procedure to patient and obtain consent.
3. Discuss previous patient experience and lay patient back if anxious or has fainted previously.
4. Wash hands using alcohol foam/gel according to local policy.
5. The patient’s arm should be resting on a pillow and exposed.
6. Apply tourniquet on the patient’s upper arm and identify a suitable vein.
7. Ask patient to clench fist to increase vein visibility.
8. Release tourniquet.
9. Wash hands using alcohol foam/gel according to local policy, assemble appropriate equipment.
10. Reapply tourniquet.
11. Put on gloves and clean area using a circular motion starting over chosen venepuncture site.
12. Warn the patient to expect a slight sharp scratch.
13. Using the thumb of the non-dominant hand to anchor the skin below the venepuncture site insert the needle at an angle of 15-20 degrees.
14. If using a safety needle with wings and tubing lower the angle once flashback is seen.
15. Slightly advance the needle if needed 16. Attach the bottles in the correct order of draw, according to local NHS policy.
16. When enough blood has been taken directly into the blood tubes using the vacutainer method release the tourniquet before removing needle from the vein (ensure the tourniquet is on for a max of 1-2 mins only).
17. Remove needle, use safety device according to manufacturer instructions to enclose needle and dispose of in a sharps bin.
18. Apply a clean cotton wool ball or folded gauze to the puncture site after the needle is withdrawn. Apply pressure for 1 minute.

Split the group into pairs/small groups and allow students opportunity to practice procedure on a mannequin. Tutor to observe and sign off if meets competencies.

Brief discussion of management of blood samples, including:

• Labelling with at least three patient identifiers
• Requesting appropriate tests
• Labelling of hazardous samples
• Ensuring appropriate transport to the lab

Ask the student(s) to suggest key steps in the procedure of managing a needlestick. Once a few suggestions have been made, ask them to order in terms of highest priority e.g.

1. Rinse the wound, encourage it to bleed
2. Note the patient ID
3. Report to Occupational Health
4. Incident report form
5. Gain consent to take blood from the patient for viral testing
6. Follow up for blood tests and psychological support

1. https://geekymedics.com/venepuncture-how-to-take-blood/
2. https://geekymedics.com/blood-bottles-guide/