Venesection procedure - Step by Step

Haemochromatosis UK publish two guides, available free to nurses and healthcare practitioners explaining the step-by-step process for safe, best-practice venesection :

• RCN-endorsed Venesection Best Practice Guidance
• A Guide to Venesection for Nurses and Healthcare Practitioners

Both guides can be read online or ordered for free (allow 2-3 weeks for delivery).

Positively identify the patient with name, date of birth and hospital number if relevant.

1. Check the patient record for the reason for venesection, parameters to monitor and initial written consent (HCPC, 2016; NMC, 2018).
2. Make a brief clinical assessment including any new medical conditions, medications and record vital signs, confirming that that the patient has eaten and drunk sufficiently. Notify any concerns to senior nursing or medical staff.
3. If there is a history of fainting or other contra-indications such as low haemoglobin, abnormally high or low blood pressure or heart rate, heart disease or low body weight (less than 50Kg), proceed only with caution and approval of senior staff.
4. Wash hands apply apron and prepare equipment as per local infection control and phlebotomy policies.

• Vascular Access Device with Closed Drainage Collection Bag and Weighing Device
• Blood disposal bin
• Cleaning agent
• Tape
• Gauze/cotton wool
• Blood pressure manometer or tourniquet
• Needles
• Syringe
• Local anaesthetic if required
• Blood sample bottles (FBC and serum ferritin, transferrin saturation, if required)
• Gloves

6. Assess both arms for suitability for cannula insertion.
7. Consulting with the patient (who may have had regular venesections) select arm and vein for venesection, commonly in the antecubital fossa, and support with a pillow.
8. Lie patient at 45 degrees or flat if history of fainting.
9. Explain the procedure and answer any questions.
10. Apply local anaesthetic cream (if required). Please note this does need to be applied at least 30 minutes prior to the procedure.
11. Apply tourniquet or blood pressure cuff inflated to 40-60 mm/Hg (WHO 2010).
12. Clean the patient’s skin as per infection control guidelines. Insert venesection needle at 30 degrees angle ensuring the bevel is facing upwards. Secure the needle with tape and ensure good flow is established. Please note: if the patient has small veins, a different sized needle/ cannula may need to be used.
13. Take and label blood samples as appropriate. Position the collecting bag (on weigh scales if used) below the patient to facilitate drainage.
14. Once the desired amount has been taken (the amount of blood to be removed should be as prescribed but is typically 450 mls. On most vascular access devices (VADs) this is measured as 478grams weight which includes the weight of the removal bag, remove the tourniquet or blood pressure cuff, clamp the line, remove the needle and apply firm pressure with cotton wool or gauze to the puncture site for 2 to 5 minutes. Ideally the health care professional should do this, not the patient.
15. Check for haemostasis then apply a firm dressing.
16. Undertake simultaneous fluid replacement or reduce the amount to be removed as prescribed. Patients on Aspirin or anticoagulants may need special care afterwards to prevent excessive puncture site bleeding or haematoma formation.
17. Ensure oral fluid is available before, during and after the procedure.

After Venesection

• Dispose of needle, line and collection system in sharps bin.
• Dispose of blood as per local policy.
• The patient should remain reclining for 10-15 minutes then slowly adopt an upright position.
• Offer oral fluids and biscuits as appropriate.
• Record vital signs.
• Wash hands.
• Ensure follow up appointment for further treatment, blood tests or outpatient review with appropriate forms.

Next Steps

Risks & complications of venesection