Clarification of the characteristics of needle-tip movement during vacuum venipuncture to improve safety

Figures & data

Figure 1 Location of the marker used and itemization of vacuum blood collection tube movement in the venipuncture procedure.

Notes: (A) The welded part of the needle at the needle base; (B) the needle base attached to the collection tube holder; (C) a point indicating where the blood collection tube holder was placed; (D) the point where the needle punctured the skin; (E) temporary point, interior angle of AED at 90°. The venipuncture procedure was divided into the following four steps based on the sequence of events: S-1: puncture; S-2: needle enters the vein; S-3: first collection tube; S-4: removal and insertion of collection tube.

Table 1 Subjects undergoing venipuncture, distance of needle movement, and puncture angle

	Nurse A		Nurse B		Nurse C		Nurse D		Nurse E		Nurse F		Total
Number of subjects	n = 13		n = 11		n = 9		n = 7		n = 4		n = 2		n = 46
Sex
Male	4	(30.8%)	4	(36.4%)	4	(44.4%)	3	(42.9%)	1	(25.0%)	0	(0.0%)	16	(34.8%)
Female	9	(69.2%)	5	(45.5%)	4	(44.4%)	4	(57.1%)	3	(75.0%)	2	(100%)	27	(58.7%)
No mention	0	(0.0%)	2	(18.2%)	1	(11.1%)	0	(0.0%)	0	(0.0%)		(50.0%)	4	(8.7%)
Age (years, mean ± standard deviation)	41.7 ± 12.5		42.3 ± 13.7		43.3 ± 10.3		43.4 ± 14.7		35.8 ± 7.6		52.0 ± 17.C		42.3 ± 12.2
Circumference puncture site (cm, mean ± standard deviation)	23.2 ± 1.6		23.9 ± 1.8		23.5 ± 1.4		22.8 ± 1.7		25.0 ± 7.2		21.3± 1.1		23.4 ± 2.5
Changed hands
After puncture	13	(100%)	11	(100%)	9	(100%)	0	(0.0%)	3	(75.0%)	2	(100%)	38	(82.6%)
Tourniquet removal	11	(84.6%)	11	(100%)	5	(55.6%)	0	(0.0%)	3	(75.0%)	2	(100%)	32	(69.6%)
Distance of the needle (cm, mean ± standard deviation)
From puncture to entry into vein	n = 3		n = 8		n = 8		n = 6		n = 4				n = 29
	2.4 ± 0.3		1.3 ± 0.4		2.8 ± 1.1		1.9 ± 0.6		0.9 ± 0.3				1.9 ± 1.0
From entry into vein to entry into first tube	n = 3		n = 10		n = 8		n = 6		n = 4				n = 31
	0.8 ± 0.2		0.6 ± 0.2		0.8 ± 0.4		0.3 ± 0.2		0.3 ± 0.1				0.6 ± 0.3
Angle of puncture (mean ± standard deviation)	n = 11		n = 10		n = 9		n = 7		n = 4		n = 2		n = 43
Mean (°)	14.4 ± 3.0		16.6 ± 2.8		16.2 ± 2.8		12.3 ± 1.1		15.3 ± 3.7		18.4 ± 4.9		15.2 ± 3.1
Maximum (°)	20.8		19.7		21.4		13.9		19.8		21.8		21.8
Minimum (°)	10.8		11.1		13.1		10.7		11.4		14.9		10.7

Note: *Estimated angle using temporary point.

Table 2 Summation of total needle movement distance

	S-1		S-2		S-3		S-4		Total
Movement distances (cm)	n = 33		n = 35		n = 46		n = 46		n = 33
X-axis
Mean (Standard deviation)	2.3	(1.3)	1.2	(0.6)	0.6	(0.3)	1.1	(1.7)	4.9	(2.2)
Maximum	5.3		2.8		1.5		11.8		12.4
Minimum	0.8		0.3		0.1		0.2		0.4
Y-axis
Mean (Standard deviation)	1.1	(0.6)	1.1	(0.6)	0.5	(0.3)	0.8	(1.4)	3.2	(1.4)
Maximum	3.2		2.4		1.4		9.6		10.3
Minimum	0.4		0.4		0.2		0.2		0.6
Movement distances (a subject case) cm
X-axis	3.0		1.4		0.8		1.1		6.3
Y-axis	0.9		1.7		0.5		0.6		3.7

Notes: S-1: puncture; S-2: needle enters the vein; S-3: first collection tube; S-4: removal and insertion; Total, subjects that were measured from S-1 to S-4.

Figure 2 X-axis: maximum of accumulated movement. (a) shows the start and (b) shows the end of the movement.

Notes: S-1: Needle was pressed from top to bottom by the first finger of the left hand. S-2: Holder traveled up and down during use of the first collection tube with the collection tube attached to the upper opening of the holder. S-3: Nurse changed hands after inserting the blood collection tube into the holder using the nondominant hand. S-4: The holder was pushed down during removal of the blood collection tube from the upper opening of the holder.

Figure 3 Y-axis: maximum of accumulated movement. (a) shows the start and (b) shows the end of the movement.

Notes: S-1: The needle moved up and down. S-2: The holder was pressed from the top to the bottom using the first finger of the left hand. S-3: Needle was pushed by the left thumb with the collection tube attached to the upper opening of the holder. S-4: The holder was pushed down during removal of the blood collection tube from the upper opening of the holder.

Figure 4 Searching: location of the welded part of the needle at the point where the blood collection tube entered the tip of the holder, and the location of the sticker placed on the holder. (1) the first puncture is not successful; (2) the second puncture is not successful; (3) the third puncture is successful.

Figure 5 A case in which the hands were not changed.

Notes: Pulling of the skin or bending of the needle was observed. The position of the holder is unstable.