Nursing Practice: Reflection on Venipuncture and Tourniquet Use

This assignment is a written reflection by a nursing student on their experience performing venipuncture on a 72-year-old diabetic patient, Mr. Antonio Cabrini, who had undergone a total hip replacement. The student details the procedure, including the use of a closed vacuum system, adherence to NMBA guidelines, and ethical considerations like obtaining patient consent and maintaining hand hygiene. The reflection highlights the student's feelings of nervousness, particularly during tourniquet application, and how they overcame it with the help of their supervisor. The student evaluates the experience, discussing the importance of proper technique, site selection, and the use of appropriate equipment. The analysis section connects the experience to professional standards, emphasizing the nurse's responsibility for patient care and the importance of ethical principles. The student outlines an action plan to gain more practical experience, enhance knowledge through reading and research, and improve team development skills.

Running head: WRITTEN REFLECTION 1
Written Reflection
Student’s Name
Institutional Affiliation

WRITTEN REFLECTION 2
Description
In demonstration of the assessment requirements, I was required to take care of the 72-year-old
patient well known as Antonio Cabrini. Antonio is a diabetic man who undergone a surgery
(total hip replacement) and he was on insulin, 20 units Levemir. I was required to perform a
venipuncture on the patient to extract blood from the veins for diagnosis of diabetes. The
equipment that is required to take a venous sample is of two types. It is either the use of syringe
and needle or use of a closed vacuum system. I opted for the latter (closed vacuum system that is
also referred to as venipuncture vacuum system. Venipuncture is advantageous since it enables
extraction of several samples safely by lowering the risk of spillage of blood and needle stick
injury that I could be highly exposed. In accordance to NMBA guidelines, I was careful to
comply with ethical issues for example, I had to inform the patient what was going to be done
before I extract the blood so that I would obtain his consent. Also, I was careful to observe hand
hygiene including washing my hands before initiating the procedure and wearing fresh pair of
disposable gloves. Other equipment during the procedure that I utilized were alcohol swab,
tourniquet, specimen tubes, sharps box, cotton wool balls and adhesive tapes, forms and plastic
bags.
Feelings
It is interesting that I performed all other procedures on venipuncture and associated activities
perfectly well, however, some slight nervousness came in when it was time to clip tourniquet.
The nervousness grew even bigger especially with the most critical question in mind: is this the
right thing to do? What if I have forgotten to do the right thing? As a practicing nurse and
potential future nurse, I must recognize how tourniquet works, it works by squeezing down and
blocking blood vessels, thus it becomes easy to locate and define veins of periphery to achieving

WRITTEN REFLECTION 3
safe and successful venipuncture. As Lin et al. (2016) states, proper application of tourniquet
will temporarily impede blood in the veins to flow back towards the heart and cause pooling of
the blood in the vein so that the vein become more prominent for obtaining blood.
Standards of professionalism in nursing practice as outlined by NMBA (2016), highlights that
the professionals in nursing are required to practice their care within the scope of complex
knowledge of standards and accuracy regarding professionals in nursing. I am happy that even
though I was so nervous while clipping the tourniquet, my supervisor told me that I did it the
right way and in fact I did it so confidently like a practitioner who had been in the practice for
some time. It boosted my confidence.
Evaluation
Regarding the positive results of the experience, I gained experience in requirements for
tourniquet clipping including appropriate time and duration. Having done the clipping on my
own without the help of my supervisor or anyone whatsoever, my ability to correctly follow the
procedure especially in the case where blood sample is to be extracted was enhanced. In other
words, “experience is the best teacher.” My understanding on the site and time selection
improved because of the experience. Thus, I realized that it is important to understand that there
are tourniquets that are longer for the patients who are obese and smaller for petite adults and
pediatric patients. Also, it is important to ask the patient if they are sensitive to latex in cases
where tourniquets are not latex-free. Another important tip is that tourniquets are only to be used
once to avoid transmission infection that are acquired in the hospital.
Lastly, it is acknowledgeable that my overall confidence and courage was heightened since it
was for the first time that I was performing tourniquet clipping and I did it right. The overall

WRITTEN REFLECTION 4
confidence, skills and knowledge acquired through the experience are far much incomparable to
what I would have acquired in classroom set up. I am confident that the next time I encounter
such a scenario, I will not feel nervous again because I have gained the experience.
Analysis
In the analysis of my experience to the professional standard practice as outlined by NMBA
(2016), I recognize the fact that all the professionals in nursing are entitled to provide
comprehensive care to every patient that comes their way and being responsible for any action
that they initiate or any decision they make in relation to the patient care. It is notable that as
much as I was nervous to perform tourniquet clipping, I would not go on to perform without
being sure. I remember stopping and going back to the guiding templates on the table and
confirming just one more time on the clipping requirements. This made me recognize that ethical
principle in nursing practice are necessary because it demands that a professional should not
undertake any action that may cause harm to the patient. According to NMBA (2016), nurses
should be committed to learning and developing professionalism every day of their lives as
professionals and therefore, professionals should not fear but make the right choices and
appropriately follow the required professional standards in making sure that patients are not put
into situations that would worsen their state of health.
Additionally, self-assurance could be detrimental to patient care. Sometimes it takes humility to
be sure of something before executing it or before deciding on anything pertaining the patient. It
is not ethical to put a patient’s life at risk because of ignorance or assumption. Consultation and
confirmation are key in discharging the duties.
Action plan

WRITTEN REFLECTION 5
It is evident that as far as it concerns, I need to have more practical experiences in almost every
field of nursing that concerns my area jurisdiction. In this regard, I choose to involve myself into
vigorous practical activities to learn more and become competent professional. However, it is
notable that before I effectively administer practically, I should first have the upper hand
knowledge. It is because of the knowledge that a nurse has that enables him/her to effectively
handle patients. I would therefore like to commit myself to read and gain more knowledge as I
also indulge in more practice sessions. Reading journals, books and researches concerning
nursing current issues specifically in my area of profession is important to help shape me into a
reliable professional. During my clinical attachment, I would also interact more with other
professionals to learn from their experience and their day to day encounters before am finally
employed as a nurse. Most importantly, I would also love to challenge myself by becoming
intentional and deliberate in doing more research to establish best improvement practices
including future improvement plans. I would constantly engage specific journal or book of
interests that have whatever interests me as a nurse professional that I will keep on updating
myself on the basics and fundamentals that should be at the finger tips. Above all, it is important
to recognize that no man is an island and that nursing professional does not recognize the lone
rangers. Lone rangers can be very dangerous professionals, thus constant interaction,
communication with fellow nursing professionals is important to enhance adequate team
development and hence holistic improvement in skills and knowledge. Team development
promotes development in all the areas of nursing practice.

WRITTEN REFLECTION 6
References
Martinez-Perez, R., Pelz, D. M., & Lownie, S. P. (2018). De novo giant posterior cerebral artery
aneurysm developing 25 years after basilar bifurcation aneurysm treatment using a
Drake tourniquet: case report and implications for aneurysm follow-up. Journal of
neurosurgery, 128(4), 1028-1031.
Lin, C., Qi, Y., Jie, L., Li, H. B., Zhao, X. C., Qin, L., ... & Ma, L. (2016). Is combined topical
with intravenous tranexamic acid superior than topical, intravenous tranexamic acid
alone and control groups for blood loss controlling after total knee arthroplasty: a
meta-analysis. Medicine, 95(51).