A+Acute Medical TakeUK Acute Medicine Clinical Guide
Clinical evidenceNICE · Specialist guidance · UpToDate
Current languageEnglish
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STAND-ALONE BEDSIDE PROCEDURE PATHWAY

Venepuncture

Positive identification, correct tube order, gentle sampling and safe sharps disposal
Adult venepuncture sequence showing patient identification, vein selection, skin preparation, tube collection and aftercare
1Identify2Select vein3Clean + dry4Collect tubes5Release + label

Indications

  • Diagnostic blood sampling and timed/therapeutic monitoring
  • Crossmatch/group-and-save using strict identity requirements
  • Cultures require their own enhanced aseptic pathway

Stop / escalate

  • Never use an AV fistula/graft, infected/burned area or arm restricted by local lymphoedema/surgical policy
  • Avoid sites proximal to an infusion where contamination/dilution is possible
  • Escalate difficult access rather than repeated traumatic attempts

Illustrated step sequence

1Explain/consent; two-identifier check and request-to-patient match
2Position, inspect/palpate vein, hand hygiene and gloves; tourniquet briefly
3Clean per policy and allow to dry; enter bevel-up, release tourniquet once flow established
4Fill correct tubes to marks in local order of draw and gently invert—do not shake
5Pressure, dressing, bedside labels, sharps bin and specimen transport

Samples / technical essentials

  • Order of draw follows local laboratory policy—culture, citrate, serum, heparin, EDTA and fluoride is a common framework
  • Citrate tubes must be filled correctly; note difficult/line/infusion sampling
  • Avoid fist clenching, prolonged tourniquet and forceful syringe transfer to reduce haemolysis

Aftercare and complications

  • Confirm haemostasis, especially with anticoagulation/thrombocytopenia
  • Record unsuccessful attempts and escalate to experienced/ultrasound-guided access
  • Manage needlestick exposure immediately through the occupational-health pathway

Supervised clinician education. Use the current local checklist, competency standard, consent policy, infection-control procedure and escalation route. This pathway does not certify procedural competence.

Other bedside procedures

Lumbar puncture→Abdominal paracentesis→Blood cultures→Chest-drain insertion→Arterial blood gas sampling→