Venepuncture: taking blood from an anxious patient
PLAB 2 & PRES 3 · practical skills · medium · 8 minutes
Candidate brief
You are an FY2 doctor on a surgical ward. Mrs Sandra Whitfield, 58, is having an elective knee replacement tomorrow morning and needs her pre-operative bloods taken today: full blood count, urea and electrolytes, and a group and save sample. The request form is with you. She has told the nursing staff she is "terrified of needles". Please take the blood samples. Verbalise each step as you perform it, and explain to the patient what you are doing and why.
What examiners look for
The highest-stakes step in venepuncture is not the needle — it is identity. A mislabelled group and save sample can lead to a patient being crossmatched with someone else's blood group, with fatal consequences. Label at the bedside, with the patient, against the wristband, every time. Ask about fainting before you start, and believe the answer. A patient with a vasovagal history is bled lying flat, with the bed down and time to recover — prevention is a positioning decision made in the first minute, not a rescue performed in the fifth. Veins are chosen by feel, not by eye. A vein that looks beautiful but does not palpate as bouncy and refillable will disappoint; examiners watch for the palpation, and the tourniquet comes off again while you prepare so the arm is not left congested. Antisepsis is undone by a fingertip. Once the site is cleaned and dry, re-palpating it without re-cleaning converts a sterile field into a contaminated one — aseptic non-touch technique is a chain of small disciplines, and this is the link that most often breaks. The tourniquet comes off before the needle comes out. Reversing the order produces the haematoma the patient then shows every nurse on the ward — and, for a needle-phobic patient, the bruise that confirms every fear she brought in with her. Consent in a frightened patient is a process, not a signature. Warning before the needle, narrating what she will feel, and stopping instantly if she asks are what turn a phobic patient into a cooperative one — and proceeding after a withdrawn consent is both an ethical and a legal failure. Sharps discipline is a single motion: needle out, straight into the bin at the point of use. Every intermediate step — tray, bed, hand-to-hand — is where needlestick injuries actually happen.
Guideline references
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