Makindo Medical Notes

⚠️ Important: Never take blood from the arm with an arteriovenous (AV) fistula, or from an arm that may need one for renal replacement, unless senior advice confirms it is safe. 👉 An AV fistula often feels like a gentle “cat purring” beneath the skin due to turbulent flow.

👋 Introduction

• 🧼 Wash hands and use appropriate PPE.
• Ensure your name badge is visible; introduce yourself clearly.
• ✅ Confirm correct patient identity (name, DOB, hospital number).
• Explain the procedure, why it is necessary, and obtain verbal consent.

🧰 Equipment

• Sterile gloves & apron.
• Tourniquet.
• Alcohol wipes / 2% chlorhexidine wipes.
• Green needle or vacutainer system, syringes, and appropriate blood bottles.
• Cotton wool/gauze and plaster or tape.
• Sharps bin.

💉 Technique

• Apply the tourniquet to the upper arm and allow veins to dilate.
• Select a suitable vein (usually forearm or antecubital fossa).
• Clean the site with alcohol wipes and avoid re-touching the skin.
• Insert the needle at ~30° angle – you may feel a “give” when entering the vein. Look for flashback.
• Attach vacutainer tubes/syringe and allow to fill to the correct volume.
• Release the tourniquet before removing the needle – failure to do so can cause bruising/haematoma.
• Remove the needle, apply pressure with gauze until haemostasis, then dress with plaster.
• Thank the patient.

😰 Difficult Venous Access

• If multiple attempts in forearm/antecubital fossa fail → pause, rehydrate patient, or ask a colleague.
• If urgent: femoral vein access may be considered. 👉 Lies medial to femoral artery at inguinal crease. Clean meticulously; use green needle/syringe at 90°.
• In IV drug users, veins may be scarred/thrombosed – patients may help identify usable sites.

✅ Aftercare & Safety

• Dispose of sharps immediately in correct bin.
• Label bottles at the bedside with patient identifiers (never pre-label).
• Document procedure and answer any patient questions.

⚠️ Complications

• Failure: After 2–3 failed attempts, seek help or return later.
• Haematoma: Commonly from not releasing tourniquet before removing needle. Apply pressure.
• Arterial puncture: Recognised by bright red pulsatile blood. Withdraw immediately and apply firm pressure.

📚 Teaching Pearls

• Always check which arm NOT to use (AV fistula, post-mastectomy, lymphoedema).
• Order of draw matters for certain tests – follow local guidelines.
• Good communication and reassurance reduce patient anxiety and improve success.