Blood sampling from a vein with a S-Monovet vacuum set

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• Workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions) including
  • venous tourniquet
  • venipuncture pad
• Monovet vacuum set
• Items for storing and transporting blood
• test tube rack
• container for transporting samples of biological material
• marker or stick labels
• Medical records 
• Blank of a referral for blood test

Clinical situation:

• You are a nurse at a hospital's therapeutic department. The doctor ordered to the patient a venous blood sampling. Follow doctor's orders with a Monovet vacuum set

Order of the skill performance:

Preparatory stage:

• check a patient: surname, first name, date of birth (perhaps: admission number, ward, room number)
• record the patient's information in the referral blank
• inform the patient about the forthcoming procedure and why it is needed, get verbal consent to giving it, ask him to take a required position
• check correspondence between medical records and sample tube types

• check the integrity of the package of sterile medical items and dressings, their expiry dates
• prepare the workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions)
• prepare test tubes rack
• take a test tube-syringe (Monovet set) and mark it with marker or stick a label on it

Maine stage:

• ask a patient to sit next to the intravenous injection table and place his hand on it
• place a pad under a patient's shoulder
• put a tourniquet on patient's shoulder over clothing
• make 2-3 massaging movements with the edge of the palm in the direction from the periphery to the center (with poorly contoured veins)
• ask the patient to clench fingers in a fist

• select, examine and palpate a injection site (vein) with your dominant hand
• take two swabs with your dominant hand, wet it with skin antiseptic;
• treat the skin at the injection site 2-3 times in one direction:
  
  • with one swab a “large field” (10x10 cm in size);
  • wtithe second one the "small field" (size 5x5 cm) ;
• place the used swabs in the container “Disinfection of dressings, PPE”;
• wait until the disinfectant has completely evaporated from the surface of the skin;
• take the swab with your non dominant hand, moisten it with an antiseptic, put it in the palm of your non dominant hand, holding it with the fourth and fifth fingers

Aspiration technique

• just before puncturing the skin, lock the needle to the the Monovette tube-syringe by twisting it clockwise slightly

• use the thumb of the free hand to pull the skin taut
• hold the vein in place
• forwan  the patient and puncture the vein
  • hold the needle lengthwise vein when the needle bevel looking up
  • pierce the skin at a slight angle (no more than 15°)
  • as soon as the vein is successfully punctured, the first drop of blood enters the Monovette - this lets the user know that the vein has been reached

• loosen the tourniquet
• slowly withdraw the planger
• wait until the blood flow stops

• if you want to change the Monovette for multiple collection
  • remove the Monovette tube from the needle by turning it slightly anticlockwise
  • remain the needle in the vein
  • lock a new Monovette tube to needle by twisting it clockwise slightly
  • withdraw the blood
• remove the Monovette from the vein after blood collection
  
  • first remove the Monovette tube from the needle by turning it slightly anticlockwise
  • then put a swab moistened with an antiseptic to the venipuncture site, withdraw the Monovette needle from the vein
  • press the swab for 3-5 minutes. For puncture of the ulnar vein, suggest that the patient bend the arm at the elbow joint.

• when blood collection is complete, withdraw the plunge into the 'snap' position and break off

• after ending the entire blood collection, thoroughly invert all Monovette test tubes

• put the test tubes in the tube rack

Vacuum technique

• Fill the first Monovette with the Aspiration technique
• Prepare the Monovette for vacuum technique - produce a fresh vacuum
  • pull the plunger back and lock the piston into the base of Monovette ('click')
  • break off the planger ('snap')
• Push the available Monovette tube onto the needle and secure by twisting clockwise

• if you want to change the Monovette for multiple collection
  • remove the Monovette tube from the needle by turning it slightly anticlockwise
  • remain the needle in the vein
  • lock a new Monovette vacuum tube to needle by twisting it clockwise slightly
  • wait until blood flow stops
• remove the Monovette from the vein after blood collection
  
  • first remove the Monovette vacuum tube from the needle by turning it slightly anticlockwise
  • then put a swab moistened with an antiseptic to the venipuncture site, withdraw the Monovette needle from the vein

• • press the swab for 3-5 minutes. For puncture of the ulnar vein, suggest that the patient bend the arm at the elbow joint.
• after ending the entire blood collection, thoroughly invert all Monovette test tubes

• put the test tubes in the tube rack

Final stage:

• put the needle into the container "Disinfection of sharp medical devices"
• take off the gloves, place it in the container “Disinfection of dressings, PPE” (see Removal contaminated gloves); 
• place the test tube rack in the container for transportation of biological material samples 
• wash your hands (see Hygienic hand washing)