Venepuncture and a nurse at work

[Shiningstarr]

Hi, just wondered if I am being unreasonable or not. Any nurses or healthcare professionals that can advise me would be great.

A nurse I work with seems to have an unusual way of taking bloods. She is regularly unsuccessful, and I observed her on a few occasions recently doing this...

1. glancing at the patient's arm, doesn't palpate the area to feel for a suitable vein.

2. attaches tourniquet and cleans area

3. always chooses GREEN butterfly (thicker one), and inserts... no flashback. Even though there is no flashback, attaches the vaccutainer... no success.

4. starts fishing around for a vein, digging the green butterfly in further and in different directions. Patient squirming in pain.

Surely this is not best practice? I do this..

1. put the tourniquet on, palpate the area and find a suitable vein.. should feel bouncy. If no vein is found, remove the tourniquet until one is found.

2. clean area

3. insert needle, if there is flashback, attach vaccutainer, remove tourniquet etc etc.

A lot of our patients are teenagers and they are fainting when she is fishing around with the huge needle. What should I do?

Using a green butterfly is fine for reasons already mentioned. I only use a blue if a patient has particularly hard to find veins. The rest is awful. I always palpate - some veins look great but move easily and the needle can slip to the side. As for the digging around, I was told when I did my training that, if you don't get the vein right away you should remove the needle. No repositioning allowed at all. In practice I might try to reposition slightly but certainly no "digging" and I stop right away if it's painful for the patient. You need to report your colleague. I'd be complaining if I was her patient.

Flashback is a small amount of blood visible in the needle's chamber when you insert the needle. It's how we know whether or not the needle is in the vein. If there's no flashback then you've missed!

You have a professional duty to report her under the NMC code of conduct (if you are a qualified nurse)
She is causing patients harm

Hungover isn't necessarily under the influence though.

I don’t think that op can be a qualified nurse. Maybe a student?

This. You need to report unsafe practice. It’s under your duty of care and PIN. I lead the training team in a hospital and we will retrain people or refresh if asked gladly.

Student nurses do not undertake venepuncture!

They do in our trust. They start them early these days.

Students definitely undertake venepuncture in our trust.

Why are you not challenging poor practice? You are the patients advocate and this should have been raised at the time or immediately after.

Would you honestly take the word of untrained folk on a chat board before touching base with the nurse/your own management team about this?

Perhaps it’s time for a re-read of the code of conduct?

Speak to the ward manager/matron/NIC. Are the fainting incidents being correctly documented? Is there and ed team?

There is no need for discussion or opinions of others, OP. You are professionally obligated and have a duty to report.

You do not need to specualte on whether she needs retraining, or on the procedure she is using, you only have to report your concern that she is not efficiently finding veins and is causing people to faint. Of course you can report your concerns about the procedure at the same time, but her line manager will deal with all of that.

I was a physio manager, and if I'd caught any of my staff speculating on social media rather than reporting a concern for patient safety, I'd be having a stern word. So you may want to report your post and ask for it to be removed in case you are recognised!

Please report. The midwife at my Drs surgery was one of these. I'm totally non-squeamish about having blood taken but it was awful

Vet nurse here so different species, but we use the same method as you (but using a human as the tourniquet 😂).

We use a 2 attempt method - if you can't get the vein on 2 attempts, you pass it to a colleague.

Your colleague sound like she needs some additional training/practice. I would definitely report to your line manager OP. Your poor patients!

As a well grown adult I would be complaining vociferously - not all teenagers would have the confidence to and/or ask for someone else.

I'm surprised that noone has complained to the clinic or ward.

If people have complained that you're aware of raise it

That is a terrible way of trying to get blood. No flashback, you aren't in a vein, don't waste a vaccutainer.
Rummaging around with a needle just causes damage under the skin and massive bruising.