Practitioners

Phlebotomy Policies

Phlebotomy

For all matters on this page, please contact Natalie Burrows at clinic@integralwellness.co.uk.

 


 

Venepuncture is the procedure of entering a vein with a needle. The circulation is a closed sterile system and any venepuncture, however quickly and carefully completed, is a breach of this system, providing a means of entry for bacteria and potential infection, and there is potential to cause harm to the patient unless the procedure is undertaken in accordance with this policy. 

 

Venepuncture should be carried out in a confident and unhurried manner by a suitably trained phlebotomist from the antecubital fossa area and care must be taken at all times to ensure the wellbeing of the patient, the safety of the phlebotomist, and the integrity of the sample. 

 

Venepuncture must only be undertaken using the equipment provided for that purpose and under no circumstances should non-standard equipment be used when undertaking a collection. 

 

Staff undertaking venepuncture must hold a relevant accredited certificate and must hold valid insurance cover to undertake the procedure and have had the appropriate immunisations (primarily Hepatitis B).

 

Staff carrying out venepuncture are expected to have the knowledge and skills to undertake the procedure safely and to undertake the procedure in accordance with this policy 

Staff must be appropriately dressed at all times, including closed-toe shoes and must use all PPE supplied in an appropriate fashion.

 

Staff must comply with any and all Health and Safety regulations in force at the point of collection and must be supplied with equipment that includes a safety device. In particular, all staff must comply with the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, and must be familiar with and comply with any and all stipulations set out in Health Service Information Sheet 7 and successor documents.

 

Prior to any procedures being carried out the phlebotomist should verify the patient’s identity and obtain and record the patient’s informed consent to the procedure being undertaken. If a patient lacks the mental capacity to consent to care and treatment, a best interests process must be followed in accordance with the Mental Capacity Act 2005, and other forms of authority such as advance decisions must also be taken into account. 

 

Difficulties in obtaining blood :

 

No more than 2 attempts at venepuncture be undertaken on any patient by a single phlebotomist but, with the patient’s consent, a second phlebotomist may make 2 further attempts.

 

The needle must not be readjusted after insertion. If the vein is not punctured in the first instance the needle must be withdrawn and disposed of and a second attempt made using a new needle and holder.

 

If after 2 attempts, the required blood samples have not been successfully obtained, the phlebotomist must make a new appointment to collect the sample or arrange for the patient’s own GP to collect the sample.



Venepuncture Procedure:

 

  1. Ensure that the area to be used for collection is suitable for venepuncture and clean and that the patient is comfortable with their arm well supported so that it will remain stable during the procedure. If a pillow is used it should be capable of being wiped down as per Cleaning Policy.

 

  1. Prepare specimen containers and equipment, ensuring that all equipment (including an appropriate sharps container) is within easy reach and is placed on the prepared surface.

 

  1. Confirm the identity of the patient and record their forename, surname and date of birth in the Consent Form

 

  1. Explain the procedure to the patient, detailing the tests that are to be undertaken and the associated risks and side effects, and document their consent for the procedure to take place

 

  1. Obtain information from the patient concerning any relevant allergies – primarily to elastoplast or latex.

 

  1. Wash hands using an appropriate technique, dry thoroughly and use alcohol gel.

 

  1. Put on well-fitting latex-free gloves, and a face mask

 

  1. Commence the collection, assembling the needle and holder if required, but without unsheathing the needle. If the needle is accidentally unsheathed it must be disposed of into an appropriate sharps bin as a unit.

Under no circumstances should a needle ever be resheathed.

 

  1. Place a clip tourniquet around the patient’s arm approximately 75mm (3”) above the site of the proposed venepuncture and identify a suitable vein

 

  1. Swab the selected with a 70% alcohol swab for 30 seconds in all directions

Do not re-palpate the selected site

 

  1. Unsheath the needle and insert it into the vein using the dominant hand in one smooth movement. Once the insertion is complete, support the needle and holder with the sub dominant hand

 

  1. The first sample tube is inserted into the holder with the thumb on the end of the tube and with the index and second fingers of the dominant hand on the lugs of the holder so that the double ended needle punctures the rubber diaphragm of the lid and blood flows into the tube.

 

  1. When the first tube is full and the blood flow has ceased, the tube should be withdrawn from the holder, supporting the hub with the index finger of the dominant hand to prevent it moving backwards while holding the tube between the thumb and second finger of that hand.

 

  1. Observe “Order of Draw” as required by the analysing laboratory

 

  1. Each subsequent tube is placed into the holder and removed using the technique set out above.

 

  1. The tourniquet is released once the penultimate bottle has filled and been removed from the holder

 

  1. When the last tube has filled and been removed from the holder the collection site is covered with cotton wool or a non-woven swab and the needle is removed from the vein. The needle is shielded using the integral safety device as soon as it is removed from the skin and, together with the holder, is immediately discarded into the sharps container, point down, as a single unit.

 

  1. The patient is asked to apply steady pressure to the site for a minimum of two minutes and must be discouraged from bending their arm

 

  1. Tubes containing dry anti-coagulant (additives) are mixed by gentle inversion at least 5 times and tubes with liquid additives inverted 6 to 8 times.

 

  1. The blood tubes are labelled immediately once the collection is complete, with the patient’s surname, first name, date of birth, and any other relevant data, and each bottle is initialled by the phlebotomist.

 

  1. Under no circumstances should the names be written on the tubes prior to venepuncture.

 

  1. The completed collection form should be signed by the phlebotomist and placed along with the sample in the envelope provided

 

  1. When the puncture site has stopped bleeding, apply a sterile dressing such as an Elastoplast, or cover the site with a clean piece of gauze or cotton wool held in place with micropore tape (e.g. in the case of allergy to Elastoplast/latex). This dressing should remain in place for a minimum of 30 minutes

 

  1. Once the collection is complete all equipment is cleared away
  2. Any used but failed draw bottles should be placed in the sharps bin together with the used needle. All PPE should be removed and placed in clinical waste.
  3. Tourniquet should be placed in wash bag, as per cleaning policy
  4. Pillow and all high-touch surfaces to be cleansed as per Cleaning Policy.

 

  1. Wash hands with soap and water

 

  1. Blood specimens must be transported safely in a suitable container carrying biohazard markings and dispatched directly to the analysing laboratory at the earliest opportunity





Infection Prevention

 

Policy Summary:

 

Natalie Burrows is committed to maintaining a safe and healthy environment for our staff, patients, and visitors. This infection prevention and control policy for phlebotomy outlines the guidelines and procedures to minimize the risk of infections associated with phlebotomy procedures. All phlebotomists are expected to adhere to these guidelines to ensure the highest standard of infection prevention and control.

 

  1. Hand Hygiene:

 

1.1. Phlebotomists must perform hand hygiene before and after every patient contact, using soap and water.

 

1.2. Hands should be washed thoroughly with soap and water for at least 20 seconds, paying particular attention to the areas between fingers, under nails, and the wrists.

 

1.3. If hands are visibly soiled, handwashing with soap and water is mandatory.

 

1.4. Hand hygiene should also be performed after removing gloves, handling contaminated items, and before leaving the patient’s area.

 

  1. Personal Protective Equipment (PPE):

 

2.1. Phlebotomists must use appropriate PPE based on the anticipated exposure risk and procedure being performed.

 

2.2. Gloves should be worn during all phlebotomy procedures and changed after each patient.

 

2.3. Phlebotomists should wear a disposable gown or apron when there is a risk of splashes or contamination.

 

2.4. Face masks or respirators should be worn when there is a risk of respiratory droplets or aerosols.

 

2.5. Eye protection (goggles or face shield) must be used when there is a risk of splashes or sprays.

 

  1. Needlestick and Sharps Injury Prevention:

 

3.1. Phlebotomists must follow safe needlestick and sharps disposal practices.

 

3.2. Sharps containers must be easily accessible, closable, and puncture-resistant.

 

3.3. Needles and other sharp instruments should never be recapped, bent, or broken by hand.

 

3.4. Phlebotomists should use needlestick prevention devices whenever available and appropriate.

 

  1. Patient Identification and Site Preparation:

 

4.1. Phlebotomists must correctly identify patients using at least two patient identifiers (e.g., name, date of birth) before performing any phlebotomy procedure.

 

4.2. The phlebotomist should explain the procedure to the patient, ensuring informed consent and addressing any questions or concerns.

 

4.3. Proper site preparation should be performed using approved antiseptics (e.g., isopropyl alcohol, povidone-iodine) to disinfect the puncture site before venipuncture.

 

  1. Handling and Transportation of Specimens:

 

5.1. Phlebotomists should handle all specimens with care and ensure proper labelling, documentation, and transportation according to established protocols.

 

5.2. Specimens must be placed in appropriate leak-proof and labelled containers.

 

5.3. Phlebotomists should follow laboratory’s guidelines for transporting specimens to the laboratory, ensuring timely delivery to maintain sample integrity.

Phlebotomists should adhere to routine cleaning and disinfection protocols for equipment, work surfaces, and patient care areas as detailed in the cleaning policy.

 

6.2. All reusable phlebotomy equipment must be properly cleaned and disinfected after each use.

 

6.3. Single-use items must be discarded appropriately after use and not reused.

 

  1. Vaccination:

 

7.1. Phlebotomists should maintain up-to-date immunizations as recommended by local health authorities, including vaccinations for Hepatitis B and other relevant vaccines.

 

  1. Education and Training:

 

8.1. All phlebotomists must receive initial and ongoing training in infection prevention and control practices.

 

8.2. Training should cover hand hygiene, proper use of PPE, needlestick injury prevention, patient identification, site preparation, specimen handling, cleaning and disinfection procedures, and relevant updates in infection prevention guidelines.

 

  1. Compliance Monitoring:

 

9.1. Compliance with this infection prevention and control policy will be regularly monitored through audits, observation, and feedback mechanisms.

 

9.2. Non-compliance will be addressed through appropriate corrective actions, which may include retraining, counselling, or disciplinary measures.

 

  1. Review and Updates:

 

10.1. This policy will be reviewed annually or as needed to ensure compliance with current best practices and guidelines.

 

10.2. Any updates or changes to the policy will be communicated to all phlebotomists in a timely manner.

 

Natalie Burrows is committed to providing a safe and infection-free environment for all individuals. It is the responsibility of each phlebotomist to adhere to this policy and actively participate in the prevention and control of infections during phlebotomy procedures.




Needle stick and Sharpes Policy

 

This policy provides a clear, evidence-based framework to ensure safe practice when sharps are used, thereby minimising injuries caused by contaminated sharps. It provides guidance to ensure that when inoculation or contamination incidents do occur; the incident is promptly risk assessed and the healthcare worker is offered appropriate treatment to reduce the risk of infection and counselling support to reduce distress.

 

For quick reference, the guide below is a summary of actions required. This does not negate the need for the people involved in the process to be aware of and to follow the detail of this policy.

 

  1. Wherever possible the use of Sharps should be avoided, and safer Sharps Devices used where available. Sharps injuries and contamination incidents should be prevented wherever possible by appropriate use and implementation of Standard Precautions such as good hand hygiene; appropriate use of personal protective equipment (e.g. gloves) and safe handling and disposal of needles and other sharp instruments. The HSE regulations, the Health and Safety (Sharp Instruments in Healthcare) Regulations 2013, outline the following: the need to avoid the unnecessary use of sharps; use safer sharps which incorporate protection mechanisms; prevent recapping of needles; place secure containers and instructions for safe disposal of medical sharps close to the work area.

 

  1. After a Needlestick injury (NSI) / other type of sharps injury or contamination incident there is a risk of transmission of Blood Borne Viruses (BBV) from affected patients to health care workers (HCW) (and vice versa to a lesser extent) and the incidents must therefore be managed correctly. The viruses include hepatitis B, hepatitis C and Human Immunodeficiency Virus (HIV).

 

  1. After an NSI / sharps injury or contamination incident: allow the puncture site to bleed; wash the wound / exposed area with soap and water; in the case of a splash to the eyes, irrigate eyes with sterile water (before and after contact lens removal); record the incident in the Accident File located securely with Natalie Burrows

 

  1. All NSI / sharps injuries and contamination incidents recorded will be fully assessed and managed as set out below. This will include a risk assessment of the incident and referral to the nearest hospital emergency department for relevant blood screening of both the source and the recipient.

 

  1. If the source patient is known to be HIV positive or at high risk of HIV, the recipient must be assessed for the provision of HIV Post Exposure Prophylaxis (PEP). If the NSI / sharps injury is ‘high risk’ (deep injury; visible blood on the device causing injury) and the source is HIV positive or at high risk of HIV, the recipient should visit the nearest hospital emergency department for PEP to be prescribed by a medical professional.

 

  1. If HIV PEP is required, timing is crucial and ideally, it should be started within 1 hour of the incident (but can be given up to 48-72 hours), and this should be considered as a ‘medical emergency’. Overall, however, the risk of acquiring HIV infection following occupational exposure to HIV-infected blood is low (approximately 1 in 300).

 

  1. If the source patient is a carrier of hepatitis B, the recipient must receive a booster dose of Hepatitis B vaccine or, if unvaccinated, must commence an accelerated course of Hepatitis B vaccine and be considered for hepatitis B immunoglobulin.

 

  1. There is a requirement for Natalie Burrows to report cases with a BBV-positive source patient to the Health and Safety Executive (HSE) via Reporting Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) and to Public Health England.




Accident Policy

 

This accident reporting policy is designed to outline the purpose and procedure for reporting any on-the-job accidents. The company is committed to enforcing all health and safety guidelines to avoid such occurrences and expects employees to comply. However, accidents are sometimes inevitable. Our provision in this case is to ensure all accidents are reported timely so they can be investigated properly, and preventative measures can be reviewed and reinforced.

 

Scope

 

This accident report policy affects all employees of, sub-contractors of, and visitors to, Natalie Burrows, as well as independent contractors.

 

Policy elements

 

On-the-job accidents that must be reported include any incidents that may cause minor or severe injuries or incidents that are results of negligence or inadequate safety precautions. The victims may be employees who were injured while performing their duties or other people who were on company premises or vehicles.

 

Accidents must be reported as soon as possible to expedite the investigation and increase the likelihood of important findings. The sooner the cause or details of the accident are identified, the sooner the company can establish preventative measures for the future.

 

What should be reported under the Accident Reporting Policy?

 

The company encourages employees to report all accidents no matter how minor. Accidents that involve very minor injuries like small cuts, non-extensive bruises etc. and would not normally require any action on behalf of the company (e.g. the breaking of a drinking glass) do not have to be reported (although employees could report them if they want). On the other hand, accidents that involve (or could have involved) more severe injuries and require investigation and action from the company must be dutifully reported. 

 

Employees are obliged to report any of the following:

  • Needlestick accidents
  • Fatalities
  • Damage to the head, skull and face
  • Damage to any of the senses (e.g. partial or complete loss of hearing, sight etc.)
  • Incapacitation or dislocation of limbs that hinder functionality and movement (including paralysis and amputation)
  • Damage to the skin (e.g. extensive burns, bruises or cuts)
  • Blows or injuries to the spine, back and ribs
  • Harm to the nervous system or loss of consciousness through electrocution, hypothermia etc.
  • Poisoning
  • Contamination from hazardous substances or transmission of diseases
  • Any other injury that requires hospitalization or medical care

 

Especially when an employee needs medical coverage, the accident must be reported immediately since insurance benefits may have to be approved after the investigation.

 

Employees are also required to report occurrences that may not have involved injuries or victims but could be potentially dangerous in that respect if repeated. These include but are not limited to:

  • Explosions
  • Slippery surfaces
  • Water or gas leaks
  • Inadequate insulation of circuits
  • Collapses of walls, ceilings etc.
  • Breaking of window glasses or frames

 

Procedure

 

When an employee witnesses or is involved in an incident they must record it, in writing, within one week of occurrence. If the employee anticipates an accident due to perceived negligence or inadequate safety, they must record it in writing and take appropriate action as soon as possible so the accident can be prevented.

 

Depending on the incident, official forms may have to be completed and submitted.

The accident and any sustained injuries must be recorded to the accident file located in the cleaning cupboard in the clinic room.

 

The officials responsible must initiate an investigation or request an investigation from authorities if appropriate.

 

The employee who reported the accident has to cooperate if called in for questioning to provide the details needed. As a general rule, the employee must provide information in the incident report as accurately as possible on the following:

  • The place of the accident
  • The date and time of the accident
  • The people involved or injured
  • Their position or involvement in the accident
  • Their actions immediately after the accident

 

Disciplinary Consequences

The company places great importance on this policy. All employees are obliged to comply. Any employee who is discovered to have been aware of a serious accident and failed to report it will face appropriate disciplinary consequences. When employees are the cause of an accident they must report it immediately to minimize legal repercussions.