Venepuncture (1952)

V puncture is one of the most common procedures a doctor has to carry out in the course of his day's work patients don't like having ven punctures and are greatly relieved when they're done quickly and expertly this film shows some of the faults that all too frequently occur and correct technique let's first take a look at a doctor at work in his Consulting room he's taking a specimen of blood to send to the path lab and his patient who hasn't had a ven puncture before is naturally nervous about it however she's happy to find that after all it's quite painless and soon over thanks to the professional skill of her doctor a well performed V puncture gives the doctor considerable cudos with his patients however it isn't always like this by any means here we have a patient who's had many ven punctures before and isn't in the least Disturbed at the prospect of having another although it is his first visit to this particular doctor let's see how he fares this time oh yeah he won't come back here in a hurry now let's see what can go wrong one very common fault is a bad needle only if you magnify the point can you really appreciate the defects this needle has a blunt point and a blunt Cutting Edge as well here's one with a nasty looking hook on it hooks however small tear the skin and vein and are particularly painful this one is hooked in the opposite direction this needle is not only blunt but the bevel is too short it's almost certain to cause Hemorrhage or Hema this excessively long bevel may go right through the vein and now you see a really good needle for ven puncture its tip is just as sharp as a scalpel point the bevel is hollow ground and of medium length and is honed smooth in such a way as to impart a razor sharp Cutting Edge from the tip to The Middle on both sides sharp needles will soon be ruined if they're treated like this when carried in a kidney dish they should be protected in this way they will also be ruined if treated like this instead of like this don't put too many needles into the sterilizer at one time and space them well apart on lint another fault is a blocked needle you may feel Shore or in the vein but embarrassed to find that the needle is blocked owing to the fact that it wasn't washed out after its last use the unfortunate patient has to be punctured again the syringe and needle should be washed out in cold water or in Weak Lysol solution if the blood is likely to be infected immediately after use this time the fault is a leaking syringe which may only yield half the blood you want this means having another go and the patient won't like that to avoid this test your syringes periodically by pressure this is how not to do it yet another fult which may result in laceration of the vein and a hematoma is changing hands like this first be sure you select the correct needle this is an intradermal needle which is not generally used for ven puncture these are used for subcutaneous injection the larger can be fitted to a 2 cc syringe when only a small volume of blood is required this intravenous needle can be fitted to a 5 cc syringe or to a 10 Cc or in fact to any size of syringe such a needle will allow blood to flow quickly into the syringe a larger needle can be used on a 20 cc syringe if desired larger needles are quite painless when rarely sharp a good intravenous needle should be not less than .9 mm in external diameter and about 35 millimet long it's of great importance to choose a good vein these veins in the anticubital fossa are generally the best they are prominent and usually well fixed by connective tissue these superficial veins are far too mobile they tend to slide away from the needle here the superficial vein is bound down by connective tissue and this is the puncture site of choice in this arm some prefer to use the point of branching as there is less likelihood of sideways Movement by the vein fat arms are often very difficult superficial veins such as these are too small and those suitable for Vena puncture lie much deeper they can only be discovered by careful palpation many a vein is missed by not having the arm fully extended or by the patient drawing away see that the patient is comfortable and extend the arm fully supporting the elbow on a pad or pillow if necessary it's important to hold the syringe correctly never have your fingers underneath it leave a window so that you can see the graduations keep your thumb and fingers along the sides if you hold it in this way the syringe will be nice and flat on the arm if you're fortunate enough to have a central syringe service at your disposal you can insist on airtight syringes and sharp needles which are supplied already assembled and sterilized it is essential first to dilate the veins by compressing the arm above the elbow a Cooperative patient can do this himself with the other hand a spigo monometer though rather cumbersome is the most accurate method as it can be pumped up to just above the diastolic pressure a simple rubber tube and clip is very convenient you must however be sure that you can easily and quickly release your tour clean the skin with a colorless disinfectant such as 70% alcohol tense the skin with the thumb of the left hand and push the needle steadily into the middle of the vein your movement should be fairly quick through the skin as you proceed you will feel a give when you enter the vein don't change hands pull the Piston with your other hand keep the syringe perfectly still on the arm to prevent the needle slipping out of the vein when you have the amount of blood required release the T first then apply a swab then remove the needle before sending the patient away see that there is no Hemorrhage from the sight of the puncture in contrast to the last patient here is a lady whose arms are not going to be easy for ven puncture suitable veins are often quite invisible and these faintly visible ones can be very misleading being in fact much smaller than they look find a good vein by palpation you do this lightly with the tips of your fingers when dealing with difficult veins and fat arms you can only become proficient and confident at ven puncture by constant practice of course ven puncture is not done solely for the purpose of obtaining blood specimens many drugs are administered by the intravenous root some are highly destructive to tissue if they get outside the vein therefore be sure that the needle is in the vein by withdrawing a small amount of blood into the syringe and release the T before the injection an accurate technique is vital on such occasions remember then see your syringe does not leak by testing it in this manner choose the right needle and make sure it is razor sharp extend the arm fully choose a good V pain hold the syringe correctly and firmly and don't change hands when you have the amount of blood required first release the Tay apply a swab and then remove the needle apply these principles always and you will have little difficulty with ven puncture