Indications
- • Routine investigations
- • Cross-match / culture
- • Drug levels
- • Coagulation
Contraindications
- ⚠ AV fistula limb
- ⚠ Limb with lymphoedema / mastectomy
- ⚠ Site infection
Equipment
- • Tourniquet, alcohol wipe, gauze
- • Vacutainer holder + 21G needle or butterfly
- • Blood bottles (correct order of draw)
- • Sharps bin
Technique
- • Identify patient, explain procedure, consent
- • Tourniquet 10 cm proximal — never >1 min
- • Palpate vein (antecubital fossa, dorsum of hand)
- • Clean 30 s, allow to dry
- • Insert needle bevel up at 15–30°, advance into vein
- • Order of draw: cultures → blue (coag) → red/gold (serum) → green (heparin) → purple (EDTA) → grey (fluoride)
- • Release tourniquet before removing needle
- • Pressure 1–2 min, label bottles at bedside, dispose sharps
Complications
- ⚠ Haematoma, infection
- ⚠ Nerve injury (esp. AC fossa)
- ⚠ Arterial puncture
- ⚠ Haemolysis (rough technique, wrong order)
Aftercare
- • Document samples sent + time
- • Chase critical results
Clinical pearls
- • Always label at bedside — never pre-label or label later (never event)
- • If difficult, use USS or call senior
- • Blood culture: 2 sets, separate sites, before antibiotics
Perform under supervision until competent. Follow local SOPs and consent policy.
