Competences:

an education and training competence

framework for capillary blood sampling
and venepuncture in children and
young people
Acknowledgements
Contributors Cancer and Immunity, Great Ormond Street Hospital for
Children NHS Trust
This document was revised in 2016, by the review team:
Pauline Brown, Lead Nurse IV Therapy, Royal Liverpool
Jude Taylor, Advanced Nurse Practitioner, Children's Children’s Hospital NHS Trust
Hospital, Oxford
Julie Flaherty, Children’s Nurse Consultant,
Neil Fletcher, Clinical site manager Barts NHS Trust Unscheduled Care, Salford Royal Foundation Trust
Jenny Edmonds, Advanced Nurse Practitioner/ENP Ipswich Liz Gormley-Fleming, Senior Lecturer, Children’s
Emergency department. Nursing, University of Hertfordshire
Melanie Chipendale, Advanced Nurse Practitioner/ Alison Hegarty, Teacher Practitioner, IV Therapy,
children's clinic manager Worcestershire Acute Hospital Central Manchester and Manchester Children’s Hospital
NHS Trust NHS Trust
Jackie Campbell, Advanced Nurse Practitioner, Valerie McGurk, Practice Development Facilitator,
Children's Hospital, Oxford Paediatrics, Northampton General Hospital Trust
The Royal College of Nursing would like to thank the Louise Mills, Nurse Practitioner for Intravenous Therapy,
following members for support in publishing the Great Ormond Street Hospital for Children NHS Trust
revised 2013 edition of this document:
Sally Ramsay, Independent Nursing Adviser, Ramsay
Jessica Higson, Sister and Advanced Nurse Practitioner Consulting
for Children, Royal Berkshire Hospital, Reading
Jo Rothwell, Lead Nurse, IV Therapy, Central Manchester
Tony Knox, Practice Educator (paediatrics) Royal and Manchester Children’s Hospital NHS Trust
Berkshire Hospital, Reading
Review group
Jude Taylor, Advanced Children’s Nurse Practitioner,
Oxford Children’s Hospital Anne Casey, Editor and Adviser, Royal College of Nursing
Dawn Williams, Advanced Children’s Nurse Jennie Craske, Pain and Sedation Clinical Nurse
Practitioner, Alderhey Hospital, Liverpool Specialist, Royal Liverpool Children’s Hospital NHS Trust
Jeanette Pearce, Resuscitation Officer – Paediatric Lead Annette K. Dearmun, Lecturer Practitioner, Oxford
and Sister, Paediatrics and Emergency Department, Radcliffe Hospitals NHS Trust
Gloucestershire Hospitals NHS Foundation Trust Ansley McGibbon, Senior Nurse, Practice, Research,
Neil Fletcher, Senior Nurse, Paediatrics, Imperial Development and Education Unit, Lothian University
Hospital, London. Hospitals, Edinburgh
We would also like to thank the NHS Modernisation Steve McKenna, Charge Nurse, Paediatric Ambulatory
Agency for sponsoring the development of the original Care/Outpatients, Royal Free Hampstead NHS Trust
framework, first published in 2005. We are grateful Fiona Smith, Adviser in Children and Young People’s
to the following people for their assistance in the Nursing, Royal College of Nursing
production of the original framework document.
We are also grateful to the Royal College of Paediatrics
Expert group and Child Health for its support towards the content of
this publication.
Karen Bravery, Nurse Practitioner/Practice
Development Lead Intravenous Therapy for Infection,

This publication is due for review in August 2017. To provide feedback on its contents or on your
experience of using the publication, please email [Link]@[Link]

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This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers
are advised that practices may vary in each country and outside the UK.
The information in this booklet has been complied from professional sources, but it’s accuracy is not guaranteed. While every effort has
been made to ensure that the RCN provides accurate and expert information and guidance, it is impossible to predict all the
circumstances in which it may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or
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Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN
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 ROYAL COLLEGE OF NURSING

Contents
Introduction 4

1. Guidance for programme development 5

Education pathways 5
Teaching and learning strategies 5
Assessment 5

2. Competences, learning outcomes and indicative content 7

Domain 1: professional and legal issues 7
Domain 2: preparing self, child and family 7
Domain 3: performing capillary blood sampling and venepuncture 8
Domain 4: risks and hazards 9

3. References and further reading 10

4. Online resources 15

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 RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE

Introduction
Developing skills in performing capillary blood
sampling and venepuncture can facilitate holistic
care and timely treatment. For nurses working with
children and young people this is usually regarded
as an extended role. Before starting a programme
of education and training, practitioners should be
competent and confident to care for children and
young people.
Competence can be defined as: “The state of
having the knowledge, judgement, skills, energy,
experience and motivation required to respond
adequately to the demands of one’s professional
responsibilities” (Roach, 1992).
This education and training competence
framework for capillary blood sampling and
venepuncture in children and young people is
an important step forward. First published in
2005, it has been revised in 2013 and again in
2016 to reflect a number of current political and
professional issues and initiatives.
This framework describes the theoretical and
practical competences, and the overall indicative
content necessary for education and training
programmes to meet the needs of children and
young people. It aims to support consistent
curriculum and practice development so that
practitioners can develop and maintain the ability
to carry out this task, regardless of where they
work.
The framework should also be used to develop
new programmes and to review and revise
existing ones. By using this framework, other
professionals and employers can be confident in
the standard and proficiency of practitioners.

Developing competence within

age bands
There are considerable differences between
children of varying ages, and we recommend that
practitioners develop competence within specific
age bands according to their area of practice:
• 0 to 1 year
• 1 to 5 years
• 5 years and above.

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 ROYAL COLLEGE OF NURSING

1. Guidance for programme development

When either planning new courses or reviewing • Right patient – right care (NPSA, 2004a)
existing courses, we recommend that hospitals,
• Health and Safety at Work Act 1974 and other
community services, and universities use this as
regulations (HSE).
their competence framework.

Education pathways Teaching and learning

This framework can be used to develop hospital-
strategies
based training programmes for nurses and health Capillary blood sampling and venepuncture in
care support workers working with children and children and young people is a practical skill,
young people. Alternatively, it can be used to which is underpinned by theoretical knowledge.
review existing programmes to ensure that they In England (and equivalents in NI, Scotland
meet the needs of children and young people. and Wales) teaching and learning strategies
Training may be linked to other competences, such should focus on developing the competence and
as those required for cannulation. confidence of the practitioner in performing the
procedure safely, and with minimum distress to
Indicative training content should encompass:
the child or young person. Assessment of prior
• Department of Health requirements for knowledge, particularly in caring for the child
record-keeping undergoing intravenous therapy, can be useful in
developing programmes that reflect the individual
• the Nursing and Midwifery Council Code
needs of the practitioner.
(NMC, 2015)
It is recommended that practitioners first develop
• legal, professional and local policies
their practical skills on older children where
regarding enhanced nursing roles
appropriate as they may be more likely to remain
• accountability when performing capillary still during blood sampling. This will ensure
blood sampling and venepuncture they learn the dexterity necessary before being
• local policies and procedures for capillary introduced to the clinical holding aspects required
blood sampling and venepuncture in children for younger children.
and young people A variety of ways of learning can be used for these
• evidence base for good practice in capillary programmes:
blood sampling and venepuncture • workbooks
• policies and good practice guidance in • problem-based learning
obtaining informed consent
• taught provision
• policies and good practice guidance for
• scenarios
therapeutic holding of children
• supervised practice
• anatomy and physiology of capillaries, veins,
arteries and nerves • e-learning
• devices and equipment for capillary blood • simulation
sampling and venepuncture and their use
• blended learning.
including the use of safety devices where
possible
• distraction techniques
• safe practice in the handling and disposing of
sharps
• role of the NHS Improvement and Medicines
and Healthcare Products Regulatory Agency,
and equivalent organisations in Scotland and
Northern Ireland

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 RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE

Assessment
Each programme needs to assess competence in
practice. Practice assessments should reflect the
competences and learning outcomes. There are
various assessment methods that are appropriate:
• observation under supervision and
demonstration
• reflective practice
• portfolio of evidence showing skills,
experience and development – supported by
supervisors
• formal examination (objective structured
clinical examination).
Each of these relies on the use of practice assessors.
Programme developers should consider who
this may be and the criteria needed to become
and maintain this status. We recommend that an
assessor should be experienced in capillary blood
sampling and venepuncture in children and young
people. Their ability to assess others should be
determined by a formal assessment process. We
also advise that they receive clear guidance on their
role and responsibilities.
Regular updating and assessment of skills can assist
in ensuring ongoing competence. We suggest that
this takes place at least annually.

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 ROYAL COLLEGE OF NURSING

2. Competences and learning outcomes

Domain 1: Domain 2:
professional and legal issues preparing self, child and family
Practical competences Practical competences
• Performs capillary blood sampling and • Performs the preparatory processes for
venepuncture in accordance with legal, capillary blood sampling or venepuncture in a
professional and policy requirements. safe and effective manner.
• Uses appropriate evidence to underpin best • Uses appropriate procedures for correctly
practice in capillary blood sampling and identifying the patient.
venepuncture in children and young people.
• Describes the anatomy and physiology
• Records and reports information in a manner applicable to capillary blood sampling and
that is clear, concise, timely and accurate. venepuncture.
• Reflects on own practice and takes action to • Assesses the child’s physical and
develop and improve knowledge and skills. psychological needs before, during and after
capillary blood sampling and venepuncture
• Describes circumstances where it is
and uses these in preparing a care plan.
inappropriate to perform capillary blood
sampling and venepuncture and the • Employs appropriate methods to select and
alternative action to take. prepare suitable sites for capillary blood
sampling and venepuncture and selects
• Demonstrates best practice in gaining
suitable collection devices and equipment,
informed consent from the child and family.
giving rationale for choice.
• Demonstrates awareness of the limits of own
• Demonstrates knowledge of pharmacological
skill/competence/knowledge.
and nonpharmacological pain relief, including
• Demonstrate awareness of local aseptic non- the correct application of local anaesthetic
touch technique (ANTT) policy. cream to an appropriate site.
• Identifies when other health professionals eg
Theoretical competences hospital play specialist or child psychologist,
At the end of a course of study and period of should be involved in preparation and
supervised practice the nurse will be able to: explains the potential for therapeutic holding,
and checks that the child and/or parents are
• discuss the legal and professional issues happy with this.
associated with performing capillary blood
sampling and venepuncture • Uses strategies to minimise the risk of injury
to others who may be present.
• outline current evidence to support best
practice in capillary blood sampling and • Performs procedure using ANTT principles.
venepuncture • Selects the most suitable equipment available
• describe the process for obtaining informed and uses safety devices , if appropriate.
consent from the child/young person and
family Theoretical competences
• give an account of professional and local At the end of a period of study and supervised
policies relevant to performing capillary blood practice the nurse will be able to:
sampling and venepuncture
• give an account of the anatomy and
• describe the legal requirements for good physiology of capillaries and veins, and
recordkeeping in relation to capillary blood describe the relevance for capillary blood
sampling and venepuncture sampling and venepuncture
• reflect on own practice, identifying • explain the theory of capillary blood sampling
accountability and competence issues. and venepuncture in children and young people

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 RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE

• describe the methods used to identify • Takes appropriate action to prevent iatrogenic
appropriate and inappropriate sites for anaemia.
capillary blood sampling and venepuncture
• Demonstrates practical ability and dexterity
• develop a care plan appropriate to the child’s during capillary blood sampling and
physical, developmental and psychological venepuncture.
needs before, during, and after capillary
• Responds appropriately to troubleshoot or
blood sampling and venepuncture
overcome any difficulties experienced during
• demonstrate good practice when preparing the procedure.
self, child and family for capillary blood
• Identifies the appropriate blood container
sampling and venepuncture, including ANTT
and reagent for the tests required, and fills
• create a safe environment for performing them in the correct order.
capillary blood sampling and venepuncture
• Fills, labels and dispatches containers
• identify the various devices and equipment correctly, demonstrating knowledge of factors
used for capillary blood sampling and that can adversely influence the results.
venepuncture for children of different ages
• Identifies reasons why capillary blood
• whenever possible consider the use of safety sampling and venepuncture may be
devices as they become available for children unsuccessful and describes actions to
and are fit for purpose, according to local address this.
hospital policy/guidelines
• Describes correct care of the site following
• explain the interventions that minimise a child the procedure.
or young person’s pain and anxiety during
• Removes and disposes of devices and
capillary blood sampling and venepuncture
equipment in accordance with infection
• describe the roles of other health control and health and safety policies.
professionals in preparing children or young
• Communicates with the child and family
people for painful procedures
during and after the procedure in a manner
• give an account of the use of patient group that minimises anxiety and encourages
directives. compliance.
• Describes the indications for some frequently
used blood tests.
Domain 3:
performing capillary blood Theoretical competences
sampling and venepuncture At the end of a period of study and supervised
practice the nurse will be able to:
Practical competences • perform checking procedures that maximise
• Demonstrates the safe application of the patient safety
principles of restrictive physical intervention • wash their hands in accordance with good
and therapeutic holding in children and young practice guidance
people (RCN, 2010).
• demonstrate good practice when holding
• Demonstrates the correct procedures for the child or young person still during the
minimising infection, including hand washing, procedure
use of gloves, apron and aseptic technique.
• identify the containers and volumes required
• Uses appropriate strategies for minimising for effective blood sampling in children and
pain associated with capillary blood sampling young people
and venepuncture.
• demonstrate knowledge of the correct
• Applies pressure or a tourniquet appropriately sequence for filling blood containers to avoid
and safely. contaminating specimens

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 ROYAL COLLEGE OF NURSING

• calculate the maximum amount of blood that • discuss infection control and health and
should be taken from a child safety policies and procedures applicable to
capillary blood sampling and venepuncture
• perform capillary blood sampling and
venepuncture safely on children and young • describe the procedures for reporting errors
people of varying ages and adverse incidents
• identify strategies for minimising anxiety • give account of relevant health and safety
and pain when performing capillary blood and infection control policies
sampling and venepuncture
• demonstrate knowledge of factors that
• demonstrate knowledge of the indications for influence the safety of the child, family and
certain commonly used blood tests self during capillary blood sampling and
venepuncture
• access reference ranges to compare blood
results • create a safe environment for performing
capillary blood sampling and venepuncture.
• describe factors that can lead to erroneous
test results
• describe techniques for encouraging and
rewarding the child undergoing capillary
blood sampling and venepuncture.

Domain 4:
risks and hazards
Practical competences
• Describes the risks and complications to self
and child associated with capillary blood
sampling and venepuncture, and acts to
prevent these.
• Explains the infection control and health and
safety procedures required for safe capillary
blood sampling and venepuncture.
• Recognises, reports and records errors or
adverse incidents associated with capillary
blood sampling and venepuncture.
• Follows appropriate policies and procedures
when disposing of equipment and hazardous
substances.
• Takes action to maximise the safety of the
child, family and self when performing
capillary blood sampling and venepuncture.

Theoretical competences
At the end of a period of study and supervised
practice the nurse will be able to:
• outline the risks and complications
associated with capillary blood sampling and
venepuncture, their prevention and treatment

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 RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE

3. References and further reading

Arrowsmith J and Campbell C (2000) A comparison working together to reduce health care associated
of local anaesthetics for venepuncture, Archives of infection in England, London: DH.
Disease in Childhood, 82, pp.309-310.
Department of Health (2004a) National Service
Bearden DJ, Feinstein A, Cohen, LL (2012) the Framework for children and young people who are
influence of parent preprocedural anxiety on child ill, London: DH.
procedural pain:mediation by child procedural
Department of Health (2004b) The NHS
anxiety. Journal of pediatric psychology 37(6),
Knowledge and Skills Framework (KSF) and
680-686.
development review process, London: DH.
Bellieri CV, Cordelli DM, Rafaelli M, Ricci B,
Department for Education and Skills (2005)
Morgese G and Buonocore G (2006) Analgesic
Common core of skills and knowledge for the
effect of watching TV during venepuncture,
children’s workforce, London: DfES.
Archives of Disease in Childhood, 91, pp.1015-
1017. Duff AJA, Gaskell SL, Jacobs K and Houghton JM
(2012) Management of distressing procedures in
Biswas, J (2007) Clinical audit documenting
children and young people: time to adhere to the
insertion date of peripheral intravenous cannulae,
guidelines, Archives of Disease in Childhood 97. 1
British Journal of Nursing 16. 5 (March 8, 2007):
(January 2012): pp.1-4.
pp.281-283.
Duffin C and Walker C (2012) Not just fooling
Bowden, T (2010) Peripheral cannulation: a
around: how play can help young patients
practical guide. British Journal of Cardiac Nursing
overcome their fears. Nursing Children & Young
5. 3 (March 2010): pp.124-131.
People 24. 10 (December 2012): pp.6-7.
Brenner M, Treacy MP, Drennan J, Fealy G. (2014)
Frost S and Kelsey K (2008) ‘Venepuncture’, in
Nurses perceptions of the practice of restricting a
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child for a clinical procedure. Qualitative Health
in child health practice, London: Churchill
Research, 24(8), 1080-1089.
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and choices in health care for children and young
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premixed nitrous oxide and oxygen for procedural
Collins M, Phillips S and Dougherty L (2006) A sedation in children, Lancet, 358, 9292, pp.1514-
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care, Paediatric Nursing, 17(9), pp.15-18.
Uman LS, Chambers CT, McGrath PJ, Kisely
S (2008) A systematic review of randomized
controlled trials examining psychological
interventions for needle related procedural pain
and distress in children and adolescents; an
abreviated Cochrane review. Journal of Pediatric
Psychology 33(8), 842-854
Welsh Assembly Government (2005) National
Service Framework for children, young people and
maternity services in Wales. Available from
[Link]
Willock J, Richardson J and Brazier A (2004)
Peripheral venepuncture in infants and children,
Nursing Standard, 18, 27, pp.43-50.

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 RCN COMPETENCES – CAPILLARY BLOOD SAMPLING AND VENEPUNCTURE

4. Online resources
• Action for Sick Children • NHS Improvement
[Link] [Link]

• ANTT • NHS Litigation Authority

[Link] [Link]

• Department for Education • NHS Scotland

[Link] [Link]

• Department of Health (England) • NHS Wales

[Link]/dh [Link]

• Department of Health, Social services and • Northern Ireland Patient Safety Forum
Public safety (Northern Ireland) [Link]
[Link]
• Northern Ireland Practice and Education
• Evidence-based Practice in Infection Control Council for Nurses and Midwives
[EPIC 2] [Link]
[Link]/pubmed/11161888
• Nursing and Midwifery Council
• Hand hygiene (Scotland) [Link]
[Link]
• Royal College of Nursing
• Health and Safety Executive [Link]
[Link]
• Royal College of Paediatrics and Child Health
• Health Care Standards Unit [Link]
[Link]
• Scottish Patient Safety Programme
• Infection Prevention Society [Link]
[Link]
• Skills for Health
• Joanna Briggs Institute [Link]
[Link]
• UK Health and Safety legislation
• National Association of Hospital Play Staff [Link]
[Link]
• Vascular access and infusion related policies
• National Patient Safety Agency and guidelines (Health Service Executive
[Link] Republic of Ireland)
[Link]
• NHS Education for Scotland
[Link] • E-book by Sarah Phillips
[Link]
• NHS Evidence venepuncturecannulation/id426639682?mt=11
[Link]

14
 ROYAL COLLEGE OF NURSING

15
The RCN represents nurses and nursing, promotes
excellence in practice and shapes health policies

November 2005, revised August 2016

Review date: August 2018

Published by the Royal College of Nursing

20 Cavendish Square
London
W1G 0RN

020 7409 3333

RCN Online
[Link]

RCN Direct
[Link]/direct
0345 772 6100

Publication code: 005 700

[Link]/royalcollegeofnursing

[Link]/rcnonline
[Link]/thercn