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wipe before venepuncture
Pages 1  2  
rachael140272

13 Posts

Posted:  05-Jun-2018 17:17
Once again pt has asked should we wipe with alcohol prior to taking blood- i never have- is there any evidence to start?
cherus

42 Posts

Posted:  06-Jun-2018 15:00
In the royal marsden book it states that the RCN (2010) advise the skin should be rubbed with an alcohol based solution for 30 seconds and then allowed to dry. I always did do this but because others I work with didn't I did eventually stop.
alicog

424 Posts

Posted:  06-Jun-2018 18:45
WHO guidelines say we should dfisinfect
CrochetNurse

121 Posts

Posted:  06-Jun-2018 22:59
No ... there is guidance somewhere that says only wipe if visibly dirty skin ......think it causes all sort of issues... also says you should wear gloves.. does anyone do this?

Caz
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Lilywhite

1434 Posts

Posted:  08-Jun-2018 09:15
Can you post a link to the guidelines please alicog?

Please be aware this is my opinion only based on the evidence I have seen, and not meant to be taken as direction
JPEO

5 Posts

Posted:  11-Jun-2018 12:19
Hello,

I'm not a practice nurse just yet, but I've worked mainly in acute settings and I get very crossed when practice nurses and midwives do not disinfect to venepuncture.
I was always thought even in university to disinfect the skin and use ANPP technique to both blood sampling, cannulation or invasive procedures.
If you do attend any venepuncture course they will teach you to disinfect, no matter if you're in acute or community based setting.
Bacteria can be carried by the needle you insert in the skin to the circulatory system which is a main entrance for infection.
I've never seen any updated guidelines saying otherwise so far, but if anyone has updated guidelines on 'not to disinfect' please share.
Also came across several surgeries that don't even have means to disinfect, this is unbelievable as you get patients that are immunocompromised and all care is of the most importance.
As a patient myself I always ask my colleague nurses to do it, if they don't have proper equipment then to rub with hand sanitizer alcohol based. (Better than nothing)
Only if the patient is allergic to the components it shouldn't be used.
Checked with NICE, for blood donor it says to disinfect, I'm still looking for other references, will update found.
But if it makes you a bit more reassured, in every hospital you are thought to disinfect by the venepuncture course, so why would this change for community?

Hope I was usefull.
Dotty

1049 Posts

Posted:  11-Jun-2018 14:22 Log in to like this post
Follow the WHO (2010) Guidelines on drawing blood: best practice.in phlebotomy:

http://www.euro.who.int/__data/assets/pdf_file/0005/268790/WHO-guidelines-on-drawing-blood-best-practices-in-phlebotomy-Eng.pdf?ua-1

To swab prior to venopuncture with 70% alcohol  

Dotty
karen.rudd

12080 Posts

Posted:  11-Jun-2018 23:18 Log in to like this post
I have never been swabbed prior to having bloods taken even in an infectious disease clinic in secondary care in recent years though I have by gp practice phlebotomists .

When I have been swabbed I find the procedure hurts more (even when waiting 30 seconds. ) but I am extremely difficult to bleed and hospital tend to use butterflies for me which are not always available in primary care due to cost.

Every so often over the years someone writes an article about this describing how actually there is a dearth of research showing it is necessary in primary care but most seem to err on the side of caution and swab until that research base exists or is conclusive

Personally after decades in primary care I have never seen an infection after phlebotomy swabbing or not?

In a previous life in acute care was often dealing with immunosuppressed ill patients when bloods were taken from lines and obviously more bugs about.

Interesting thread



Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen
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daffodil

61 Posts

Posted:  12-Jun-2018 06:32 Log in to like this post
I have been nursing for 30 years in both secondary and primary care and have never been taught to swab prior to venepuncture. The HCAs who have done more recent training have never been taught to do this either, even on injection training last year. How has this been missed out I wonder?
karen.rudd

12080 Posts

Posted:  12-Jun-2018 06:40
There is no need to clean unless visibly dirty for immunisation which is what your hca will have been taught if giving immunisations. That is in black and white and where the phrase ‘unless visibly dirty is used in the green book regarding cleaning of the skin?

Page 29

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/147915/Green-Book-Chapter-4.pdf

Venepuncture appears to be different? but presumably your hca has had training separately regarding that?Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.karen
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Dotty

1049 Posts

Posted:  12-Jun-2018 13:25
I agree with you Karen on both posts and I have not swabbed/cleansed venepuncture site for long time (but started to again recently) - but with regards to venepucture sites only (not vaccines sites) there are guidelines out there for doing it but not seen any guidelines for not doing it.  I think if God forbid one of us is held to account for an impossible infection that may arise from the venepuncture site then legal bods be looking at what guidelines we are following and if we are not following any then does not sound like good practice.  I have written lots of protocols in my surgery and one of them is venepuncture and in writing this I had to have some sound advice or guidelines in which a protocol should incorporate rather than hearsay.  

Dotty
CrochetNurse

121 Posts

Posted:  12-Jun-2018 18:01
Green Book clear for vaccines... phew I knew it was written somewhere with reference to article/research


Where is the guidance for veneuncture?

Caz
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CrochetNurse

121 Posts

Posted:  12-Jun-2018 18:04
https://www.nursingtimes.net/clinical-archive/infection-control/venepuncture/204148.article



Caz
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CrochetNurse

121 Posts

Posted:  12-Jun-2018 18:06
https://www.transfusionguidelines.org/red-book/chapter-5-collection-of-a-blood-or-component-donation/5-4-preparation-of-the-venepuncture-siteThis is for blood transfusions

Caz
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angel66

1089 Posts

Posted:  13-Jun-2018 07:40
I always wipe with alcohol swab enetering blood stream. Not for injections.Guess you always have to consider litigation if pt contracted some infection( local or otherwise) post venepunture.I've also had lots of blood tests and always had swabbed too.
Dotty

1049 Posts

Posted:  13-Jun-2018 12:08
I have contacted the phlebotomy manager at the local hospital in what they do and what guidelines they use - here is the response:

We swab all venepuncture sites.  I do not agree with the papers that say only swab if the site is dirty.  It is not the visible dirt that is the problem but the other microbes that are on the skin.  Taking a blood sample is an invasive procedure which can introduce infection into the bloodstream.  Our Trust uses the ANTT technique for all blood sampling.


Dotty
JPEO

5 Posts

Posted:  21-Jun-2018 18:05
Hello,

Dotty I think you've done brilliantly in finding the WHO guidelines, after all it stand for WORLD Health Organization and we should be following their guidelines.
So, I think from there every practice should update their guidelines really.
If you're not doing it, you can consider that this is keeping yourselves updated with practices and competencies and should start doing it.
It's not just when the patient develop an infection that if should be worried, it's the fact that it's an invasive procedure where you as a healthcare professional should be using ANTT measures to reduce the risk of infection to a minimum.

Both my local Trusts also use this, I've worked for both of them and know for sure they do teach this.

Thanks, regards
karen.rudd

12080 Posts

Posted:  21-Jun-2018 18:58
Was speaking to a forensic dr the other day. They don’t cleanse for injections but they have to use alcohol free cleansing when cleaning prior to venapuncture so as not to contaminate the sample measuring blood alcohol.



Please be informed that the above is the opinion of the author and is in no way meant to be taken as instruction.

karen
iPhone App Posted on my iPhone
Dotty

1049 Posts

Posted:  25-Jun-2018 14:29
Since I have been cleansing with alcohol swab am amazed how much dirt come off - thus swab gets brown/black in colour.

Dotty
mika

466 Posts

Posted:  25-Jun-2018 17:35 Log in to like this post
following on from this thread I have received the following from our local infection control


We would advise that the skin is cleansed with 2% chlorhexidine gluconate in 70% isopropyl alcohol, this in the epic3 guidance and the Marsden Manual it is also referred to in national guidance re ANTT (aseptic none touch technique). If the staff have access to the Marsden Manual they could print the section re venepuncture for use

hope this helps
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