Reflection on Clinical Skills Assessment in Acute Care Setting

This reflection is about the clinical skills assessment in acute care setting, specifically about venepuncture. It discusses the importance of adhering to standard protocols and the consequences of not doing so. It also provides an action plan to prevent such mistakes in the future.

Running head: REFLECTION
Part B: Written Reflection: Clinical Skills Assessment
Name of the Student
Name of the University
Author Note

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Description- Acute care setting is an umbrella term used for describing the healthcare
facilities where a patient is subjected to short-term treatment for an illness episode, recovery
from surgeries, or during severe injury. We had been assigned the task to perform
venepuncture in acute care setting for enhancing our clinical skills. Venepuncture commonly
refers to the procedure that is followed for getting intravenous access in order to administer
intravenous therapy to patients, or for performing blood sampling of the patient’s venous
blood (Skarparis & Ford, 2018). We were a group of three nursing students and the event
required us to show adherence to the standard protocol for venepuncture with the use of an
evacuated tube system. During the procedure, while I was able to correctly follow the steps
that involved application of pressure on the arm and removal of the needle, I mistakenly
punctured the evacuated tube prior to needle insertion and did not remove the filled tube,
prior to needle removal.
Feelings- For me the most significant part of the procedure was insertion of the
collection tube inside the holder until the former reached the needle. Initially I felt confident
while putting the tourniquet on the arm of the patient, few inches above the site of
venepuncture. I also felt self-assured while locating the vein and cleaning the site of
venepuncture. Moreover, successful removal of the needle and disposal of the sharps in a
container made me feel satisfied with my work. I felt that I was initially able to perform the
procedure by showing adherence to the standard protocols and was quite satisfied with my
performance. However, soon after I realised that the collection tube had been mistakenly
punctured at the time of removing cap from the needle. I immediately started to panic and
dreaded the consequences of this irresponsibly. Moreover, I felt extremely nervous and
concerned when I did not remove the tube filled with blood. We had been taught during our
classroom sessions that the order of drawing blood determines the sequence in which the
tubes need to be filled. Hence, failure to perform the steps accurately increased my fretfulness

2REFLECTION
over the fact that if I perform similar mistake in real-time settings, it might create adverse
health impacts, and might also produce wrong blood test results for the patients.
Evaluation- Having experienced this incident I feel that each and every step that are
encompassed in the procedure of venepuncture directly create an impact on the quality of the
blood specimen and is thus significant for averting any kind of laboratory error, events of
patient injury or even death. I realised that the practice of accurately drawing blood from
patients is a skill and clinical expertise that we must learn during our baccalaureate program.
In addition, my failure in performing the venepuncture steps accurately helped me
comprehend that venepuncture is imperative for a plethora of medical procedures and
diagnosis and without correct specimen, there might be the likelihood of implementing
harmful or unhelpful treatment. Moreover, I have learned that it is imperative for nurses to
learn venepuncture skills, with the aim of delivering best patient care, and enhancing patient
health outcomes.
Analysis- On conducting a comprehensive and thorough analysis of the clinical
practice incident described above, I can state that the practice of venepuncture is not a
nursing skill that can stringently be learned by viewing videos or thoroughly reading
guidelines framed by particular healthcare organisation, but is a skill that needs to be
practiced frequently in a controlled healthcare environment, in the presence of supervisors
and other trained healthcare professionals. The World Health Organisation has formulated
best practice guidelines for drawing patient blood and elaborated on completion of three steps
in sequence namely, (i) planning beforehand, (ii) selecting an appropriate site of blood
collection, and (iii) quality control (WHO, 2010). In addition, it has also been mandated by
the World Health Organisation (2010) that protective equipment and post-exposure
prophylaxis (PEP) must be available prior to blood collection, and that contamination of the
equipment used for venepuncture must be completely avoided. I also realised that one of the

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most common complication that might arise during and/or after a failed venepuncture is
hematoma, or accumulation of blood around the tissue (Kimori, Konya & Matsumoto, 2018).
In addition, such failed venepuncture attempt might also result in localised infection in the
patient, thus giving rise to septicemia or thrombophlebitis. Infection can also result in the
onset of phlebitis and trigger thrombus formation. The amount of blood that is generally
collected during venepuncture is vital for the optimal recovery of bacteria and other
microbes. Though 10mL of blood is generally collected from patients, the amount might vary
depending on the collection bottle recommendations (Skarparis & Ford, 2018). Therefore,
puncture in the tube might result in blood leakage, which might often go unnoticed. This in
turn would decrease the blood amount required for performing the necessary diagnostic tests,
thus producing incorrect results. Moreover, failure in performing the procedure also increases
the likelihood of the patient to suffer from nerve damage that is potentially life-threatening
and might also lead to malpractice lawsuits. Because I did not take out the blood filled tube
correctly and also punctured it, the specimen might have been destroyed due to insertion of
air bubble or contamination.
Action plan- As the succeeding step, I will now have to increase my proficiency in
performing this procedure to prevent any such mistake in my future practice. I would never
make a venepuncture attempt instinctively, without locating or feeling the presence of patient
vein in decent condition. The patient will be assessed for both the extremities for the over-all
number of sites that are available. On locating few sites, the infusion/VA nurse having more
experience need to be informed about the need of near-infrared light or ultrasound. The
features of prescribed medications and length of therapy also need to be considered. Presence
of appropriate labels on the blood collection tubes must also be ensured (WHO, 2010).
Following selection of a large vein from the antecubital fossa, a tourniquet will be applied for
making the vein more prominent. It is also necessary for disinfecting the selected site with

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soap and water, followed by insertion of a 16-gauge needle that is typically attached to the
blood collection tube (Skarparis & Ford, 2018). After removing the tourniquet when adequate
blood flow has been initiated, the injection site will be monitored for locating changes in
blood flow or hematoma formation. The tube needs to be removed first, followed by cutting
off and disposing the needle. Bandage will also be applied on the site of venepuncture to
prevent further bleeding. Besides ensuring correct implementation of venepuncture
procedure, the action plan will also encompass attending a workshop for phlebotomy. In
addition, future plans would also comprise of attending an accredited certification course that
not only provide training for performing phlebotomy, but also intravenous therapy and
conceivably management of central lines as well. On observing hematoma formation, RICE
steps will be followed in quick succession that comprise of rest, ice, compress, and elevate.
On making the patient rest, cold pack or ice will be applied for at least 20 times, more than
four times, following which elastic bandages need to be applied for achieving compression.
The injured area will also be elevated above the heart level to prevent further deterioration of
the condition. Thus, to conclude, the mistakes that had been conducted during the clinical
practice in the acute care setting can be prevented in future on showing strict adherence to the
action plan discussed above.

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References
Kimori, K., Konya, C., & Matsumoto, M. (2018). Venipuncture-Induced Hematomas Alter
Skin Barrier Function in the Elderly Patients. SAGE Open Nursing, 4,
2377960818782050. https://doi.org/10.1177%2F2377960818782050
Skarparis, K., & Ford, C. (2018). Venepuncture in adults. British Journal of Nursing, 27(22),
1312-1315. https://doi.org/10.12968/bjon.2018.27.22.1312
World Health Organization. (2010). WHO guidelines on drawing blood: best practices in
phlebotomy. Retrieved from
http://www.euro.who.int/__data/assets/pdf_file/0005/268790/WHO-guidelines-on-
drawing-blood-best-practices-in-phlebotomy-Eng.pdf?ua-1