Patients Self Obtaining Blood for Laboratory Analysis - Procedure for the Management and Regulation of

Publication: 24/06/2010  --
Last review: 20/08/2018  
Next review: 30/04/2020  
Clinical Policy
CURRENT 
ID: 2106 
Approved By: Executive Team 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Clinical Policy is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Please check the patients allergy status, as they may be allergic to Chlorhexidine, and alternative ( Providine iodine) solution will be required.
Be aware: Chlorhexidine is considered an environmental allergen.
Refer to the asepsis guidance.

  1. Purpose
  2. Scope
  3. Definitions/Abbreviations
  4. Procedure to be Followed
  5. Roles and Responsibilities
  6. Links to Other Documents
  7. References

Appendix A - Patient Agreement Form - Obtaining my own blood samples

STAFF SUMMARY

Venepuncture (Puncture of a vein, as for drawing blood, intravenous feeding, or administration of medicine) is an essential procedure that is undertaken to assist in the diagnosis and treatment of patients. It is usually carried out by trained phlebotomists, or clinical staff who have been trained in venepuncture. Although it is usually well tolerated by patients, difficulties may be encountered by some specific patient groups.

On these occasions, patients themselves may be better placed than trained practitioners to obtain samples of blood, and the risk of physical and/or psychological harm to both the professional and the patient may be reduced.

In these circumstances, self-obtaining blood has considerable benefits for the patient, the practitioner and for the organisation.

This procedure outlines

  • the circumstances under which patients may self-obtain blood for laboratory analysis
  • the supervision and consent procedures
  • links to other relevant policy documents.

Failure to follow this procedure could result in the instigation of disciplinary procedures.

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1. PURPOSE

This guidance enables self-phlebotomy in some inpatient and outpatient areas of the Trust where suitable supervisory arrangements are in place, providing that consent has been obtained, and the patient has completed and signed the consent form (Appendix 1) whilst ensuring that the patient has the capacity to do this and are competent to undertake the procedure.

The objectives of the procedure are to

  • Reduce patient distress and obtain the specimen required
  • To establish patient awareness and understanding of the risks associated with self-phlebotomy
  • To ensure harm and risk reduction and support patient safety
  • To ensure the safety of others
  • To ensure that the patient is physically and psychologically capable of carrying out the procedure
  • To safeguard patient confidentiality and dignity

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2. SCOPE

Patients who may be suitable to self-obtain blood include;

  • Those who have extensive venous collapse and who are experienced in the use of needles and syringes to gain venous access, for example intravenous drug users
    AND
  • Who would refuse to allow others to obtain blood from them
    AND
  • For whom refusing self-phlebotomy would cause distress and potential harm

Self-phlebotomy should only be undertaken on the initial request of the patient following a dialogue with a healthcare practitioner trained in phlebotomy, about the patients previous experiences of blood taking and the current state of their veins

OR

On the request of the patient following unsuccessful attempts by the health care professional (this must also include following a more senior and more experienced health care professional review and attempt at phlebotomy) which leads to patient distress.

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3. DEFINITIONS/ ABBREVIATION

Venepuncture - Puncture of a vein, as for drawing blood, intravenous feeding, or administration of medicine

Phlebotomy - The act or practice of opening a vein by incision or puncture to remove blood.

Phlebotomist - a person with special training in the practice of drawing blood

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4. PROCEDURE TO BE FOLLOWED

  1. Ensure that the reasons for requesting self-phlebotomy are compliant with the document – Procedure for the Management and Regulation of Patients Self Obtaining Blood for Laboratory Analysis.
  2. Ensure that the patient understands the reasons, implications and risks involved in the procedure by confirming that they have read the patient information booklet - ‘Taking your own blood: Self Phlebotomy’ and answering any questions they may have .
  3. Establish with the patient that the procedure will be supervised throughout to ensure patient and practitioner safety
  4. Assess the patients mental and physical ability to conduct the procedure by establishing
    a. Previous experience with needles and syringes in obtaining venous access
    b. Manual dexterity
    c. Capacity sufficient to ensure consent and safety – including the absence of withdrawal symptoms due to substance misuse, and the absence of signs of psychosis, whether psychiatric or drug-induced
    If in doubt the health care professional may seek a medical assessment to confirm the above.
  5. Ensure that the patient has the capacity to consent and where this is established ensure consent is obtained and that patients taking their own blood must also take the responsibility for any complications associated with the procedure using the patient agreement form.
  6. Ensure that the patients confidentiality and privacy is maintained through the use of single rooms or appropriate screening
  7. Ensure the absence of infection or inflammation at the proposed access site
  8. Provide sterile needles, syringes and associated equipment along with an appropriate point of use sharps disposal container
  9. Ensure hand hygiene is performed by the patient immediately before and after the procedure (Ref: LTHT Hand Hygiene in Practice policy
  10. Maintain standard infection prevention and control precautions throughout the procedure (Ref LTHT Standard Infection Prevention and Control Precautions policy)
  11. Skin at the access site should be decontaminated for 30 seconds using an appropriate preparation (e.g. 70% isoprophyl alcohol or chlorhexidine in 70% alcohol) and allow to dry
  12. Supervise the procedure and ensure that this is halted if there are concerns for patient or practitioner safety in line with the policy
  13. Ensure haemostasis has been achieved
  14. Ensure that contaminated equipment is safely removed from the area and dispose of in accordance with the waste management policy (Ref: LTHT Waste Management Policy)
  15. Ensuring that the patient removes the needle from the syringe and disposes of in the sharps container at point of use
  16. Ensure the patient then transfers the blood into the appropriate vials as soon as possible by removing the lid off the blood tube and decanting the blood into the tube then replacing the lid before handing the tubes to the practitioner and disposing of the syringe.
  17. Dispatch the vials with the appropriate documentation to the laboratory as soon as possible, ensuring that the request form and vials are labelled in accordance with the Policy for Safer Transfusion Procedures. If required ensure high risk notification labels are attached to the sample and request form and are double bagged.(Ref:)
  18. Ensure that the patient is comfortable
  19. Ensure that the appropriate records are maintained throughout
  20. In the event of patient distress or prolonged difficulty gaining venous access i.e. after two attempts, discontinue the procedure and refer to a medical practitioner of appropriate seniority.
  21. In the event of a needlestick/sharps injury the process described in the LTHT Needlestick Prevention and Actions to be taken after Exposure to Blood and Body Fluids (including HIV Post-Exposure Prophylaxis) policy must be followed 

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5. ROLES AND RESPONSIBILITIES

It is the responsibility of practitioners and the organisation to identify a safe procedure to protect patients, guide practitioners and minimise risk. However, there are potential risks associated with patients self-obtaining blood, which may include mistakenly hitting arteries and/or nerves. This may have the potential to result in temporary or permanent physical and psychological damage to the patient.

For these reasons self-phlebotomy should never be routinely or automatically offered to patients.

It is essential that a trained and experienced practitioner is available to supervise all aspects of the procedure. This must be a health care worker trained in phlebotomy. The responsibilities of the practitioner are

  • That they are proficient in the skills of observational assessment
  • They are aware of all the risks and safety aspects of the procedure
  • To consult with others regarding the clinical condition and competency of the patient in taking their own blood
  • To be skilled in the education of patients in the techniques of phlebotomy
  • To be aware of their own responsibilities in ensuring the safety of patients
  • To be present to supervise and support the patient throughout the procedure
  • To ensure patient consent and adherence with completion of the consent form prior to the procedure
  • To ensure the sample is obtained from the right patient, dispensed into the correct containers, complies with the LTHT labelling standards, and is dispatched promptly to the appropriate laboratory

Self-phlebotomy must only be performed after the appropriately trained practitioner has consulted with relevant others involved in the patient’s care, and is satisfied regarding the patient’s ability and understanding to conduct the procedure, and the patient has provided written consent to obtaining their own blood samples.

If self-phlebotomy has been agreed and the appropriate consent has been obtained, but the practitioner witness’s poor technique, the practitioner has a duty of care to stop the procedure. The patient will be offered an explanation, and the practitioner may attempt to complete the procedure depending on the urgency of the blood tests and the patient’s wishes.

If the patient insists on taking their own blood but the practitioner does not feel that they are competent and/or capable of doing so then:

  • If the blood tests are not urgent, the patient may be offered an opportunity to return at another time when their ability to undertake the procedure will be reassessed OR
  • If the blood tests are urgent and if venous access is essential then the clinician in charge may be summoned and the patient’s blood will be taken by the health care professional with the patient’s agreement. Duplex directed venepuncture (centrally if necessary) should be considered.
  • Under no circumstances should a third party be allowed to obtain or supervise the obtaining of a patient’s blood, for example, relatives or visitors.

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6. LINKS TO OTHER DOCUMENTS

  1. LTHT Policy for Safer Transfusion Procedures
  2. LTHT Waste management Policy
  3. LTHT Hand Hygiene in Practice policy
  4. LTHT Standard Infection Prevention and Control Precautions policy
  5. LTHT Needlestick Prevention and Actions to be taken after Exposure to Blood and Body Fluids (including HIV Post-Exposure Prophylaxis) policy

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Provenance

Record: 2106
Objective:
Clinical condition:
Target patient group:

Patients who may be suitable to self-obtain blood include;
Those who have extensive venous collapse and who are experienced in the use of needles and syringes to gain venous access, for example intravenous drug use
Who would refuse to allow others to obtain blood from them
For whom refusing self-phlebotomy would cause distress and potential harm

Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Allied Health Professionals
Adapted from:

Evidence base

  1. LTHT Policy for Safer Transfusion Procedures
  2. LTHT Waste management Policy
  3. LTHT Hand Hygiene in Practice policy
  4. LTHT Standard Infection Prevention and Control Precautions policy
  5. LTHT Needlestick Prevention and Actions to be taken after Exposure to Blood and Body Fluids (including HIV Post-Exposure Prophylaxis) policy

Approved By

Executive Team

Document history

LHP version 1.0

Related information

Not supplied

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