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Never take blood from the arm with an AV fistula or who may need an AV fistula for renal replacement unless senior advice says it is ok. It feels like cat purring beneath the skin,

Introduction

• Wash hands, ensure name badge visible, Introduce yourself, ensure correct patient
• Ask if you may take a blood sample. Explain why it is necessary and ensure verbal consent obtained

Equipment

• Sterile Gloves, Tourniquet, Alcohol wipes or equivalent
• Green needle and syringe and vacutainers

Technique

• Place tourniquet around upper arm and wait until veins dilated. Find a decent vein often in the forearm. Clean the skin with several alcohol wipes and avoid touching the skin again
• Insert needle into vein and watch for flash back. The angle to skin is about 30 degrees and you may feel a give as it enters the vein. Connect up bottles and allow them to fill
• Before removing the needle, release the tourniquet. This is a common beginners mistake. You will leave a big bruise. Remove needle and apply pressure with cotton wool ball or gauze. Wait until haemostasis achieved and apply plaster if needed. Thank patient

Difficult

• You have tried in the forearm and antecubital fossa and no luck despite several attempts. Assuming the bloods are important for care. It might be useful to come back later or ask someone else.
• If urgent consider the femoral vein. Use green needle and syringe. Make sure you clean the site well. Go in at 90 degrees. The femoral vein lies medial to the artery in the inguinal area.
• IV drug users often have damaged veins. They may be able to help you get venous access as they will know which veins are not thrombosed

Finally

• Dispose of sharps used tidily. This is not the nurses or others job
• Label bottles at bedside with patient identifiers
• Answer any questions from patient

Complications

• Failure: try 2-3 times and if failing ask for help or come back later
• Haematoma: usually because needle removed from vein before tourniquet removed
• Arterial puncture: remove needle and apply pressure