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Case Study
Group 1
Daniel Daye
Shanique Beharie
Kacey Witter
TAsia Dallas
Christal Walsh
Chevelle Senior
Naomi Hall-Lodenquai

Case study

74 year old John James visited the

ambulatory care unit for follow up care
for a deep vein thrombosis. He has
history of peripheral arterial disease &
diabetes. He has been taking warfarin
at home. Nurse Jennings was asked to
do a venepuncture for lab work up.
After one unsuccessful attempt to take
blood from his left arm she withdrew
the needle and applied pressure 3mins.

She then successfully took blood from

the patients right arm. The returned
to the unit later that afternoon with a
swollen painful left arm and it was
noted that blood leaked at the site of
the attempted venepuncture. He was
complaining of pain. It was noted that
blood and localized around his elbow.
Panadol was prescribed. It was thought
however that the bleeding had
stopped. The patients left arm was put
in a sling.

Three days later the patient returned with

considerable swelling in his left arm and
bruising in the region of the antecubital fossa,
spreading down to his hand. At the time there
was no suggestion of nerve compression or
that the vascular supply was in jeopardy. Six
days later however he developed severe pain
in his left arm and numbness in his fingers.
He was admitted to hospital and the affected
limb was treated with elevation and
physiotherapy. Despite treatment the patient
still had pain in his left arm and hand which
was attributed to compression of the median
nerve by hematoma

Assessment of a patient receiving


Assessing mental capacity

The Mental Capacity Act (2005)
assumes that a person has capacity
(the ability to make decisions) unless
proved otherwise. Staff should assess a
patients capacity to consent to
Venepuncture should never be done on
a patient that is asleep

Before selection and assessment of

venepuncture site the nurse must first
assess the environment in which the
procedure will be done to ensure both
self and clients safety, proper lighting
Ensure all necessary equipment is
Assess for evidence of an infection
Oedematous limbs

Areas of previous venepuncture

Thrombosed veins,
The affected arm in CVA or
mastectomy patient
lump in the area

Identify the errors if any that nurse Jennings/

health team made during the venepuncture
attempt. Please include rationales to support
your answer

Puncture of vein or artery and damage to

The nurse punctured the vein or artery in the
clients left arm and also caused damage to
the nerve. This was evident in the scenario as
it stated that patient had a swollen painful
arm after the venepuncture was done and
which resulted in hematoma formation.

Image depicting Hematoma of

venepuncture site

Poor skills of the Nurse

Poor technique on the part of the
practitioner can cause hematoma,
(Weinstein, 2007).The nurse may not be
have qualified or skilled enough to carry
out the venepuncture procedure.

Pressure to venepuncture site was

Inadequate pressure to a venepuncture
site can lead to development of
hematoma, (Weinstein, 2007). Following
a puncture of an artery or vein
Pressure should be applied for a
of five (5) minutes, (Whitehead, 2010).

Applying pressure to venepuncture site

Explain the ethical principles of

venepuncture and legal
implications of nurse Jenningss
actions with this case

According to Miller (2003), ethics in

nursing can be describes as a set of
rules, principles or guidelines
governing nursing practice, conduct
and relationships with client and
colleagues. Venepuncture; an aspect of
nursing, is not excused from these
guidelines which stipulate the degree
of right or wrong of an action as well as
the level of good or bad that results
from such an action.

There are numerous ethical principles to be

followed during venepuncture similar to
other nursing practices. They are as

Inform and Consent

Maintaining patient confidentiality and
Explain Procedure
Following the procedure
Prevent injury or harm to the client
Documentation and reporting


Whitehead, E. (2010). Venepuncture. Retrieved


Arbique, J.C. (2008).Venipuncture module 6:

venipuncture complications and special
circumstances. Retrieved from:

Nottingham University hospitals. (2013). Clinical

nursing ethics. (n.d.)Miller-Keane Encyclopedia and

Dictionary of Medicine, Nursing, and Allied Health,
Seventh Edition. (2003). Retrieved February 20 2016

Venepunctuire In Adults. ( 2012 , February). Retrieved

from Brighton and Sussex University Hospital NHS Trust:

Venepuncture. (2010). Retrieved from Eileen Whitehead

2010 East Lancashire HC NHS Trust: