Venipuncture Information and Courses from MediaLab, Inc.

A technologist performs a venipuncture for glucose testing on the wrong patient. This medical error leads to the patient receiving an incorrect dose of insulin and the patient goes into a coma--this medical error led to an adverse event. Analysis without RCA: Determines the technologist should have checked the patient's wristband (the immediate reaction).Questions why the technologist did not also verbally identify the patient (the subsequent reaction).Restates these reactions (in the internal follow-up review).Misses causes discoverable by a detailed and open investigation. Analysis with RCA: Includes descriptions of events leading up to a "wrong person procedure" in its reports.Describes 17 separate errors identified in the follow-up investigation.Recommends actions that should avoid reoccurrence of the error.

Excessive bleeding after a venipuncture can occur as a preventable or an unpreventable adverse event. Laboratory professionals might or might not have control over this situation because of the factors involved. For example: Bleeding due to failure to apply immediately pressure on the venipuncture site is a preventable adverse event. Bleeding due to later injury to the venipuncture site is an unpreventable event. Circumstances that cause the bleeding determine whether it is a preventable or unpreventable adverse event.

Julie Smith was a newly certified phlebotomist and had been working at Northwood Hospital for several months. As she approached room 825, she looked on her collection list to verify this was the correct room for her first collection. Indeed it was, even though there was no patient name on the door. Her collection list told her the patient in room 825 was a 55 year old male named John Ready. After knocking several times, Julie entered the room to find a middle aged man who appeared to be sleeping. Julie approached the patient and said, “Good day Mr. Ready. My name is Julie and I am from the lab. I need to draw blood for some tests ordered by your doctor.” The man awoke and seemed irritated as Julie repeated herself. The patient responded and told Julie to do whatever she needed to do so he could go back to sleep Julie then proceeded to do the venipuncture.

Bobby Jones, a phlebotomist at Georgetown Hospital, entered the room of Mrs. Mary Grayson with a physician's order to draw some blood work. After properly greeting Mrs. Grayson, identifying himself and checking her armband, Bobby prepared for the venipuncture. He suddenly notice a sign posted above the bed that read: “Restricted left arm usage. Previous mastectomy - Do no use left arm for venipuncture.” Bobby set up his equipment to use her right arm and noticed an IV line in Mrs. Grayson’s right arm positioned in a vein slightly above her wrist on the dorsum (top) of her forearm.

Julie Smith, a newly certified phlebotomist at Northlake Hospital, entered a patient’s room on the third floor for a routine blood draw. The patient was an elderly woman who had very small fragile veins. Julie therefore decided to use a safety butterfly needle attached to a Vacutainer tube in order to draw the blood. When Julie was finished with the venipuncture, she detached the butterfly needle from the Vacutainer, and approached the Biohazard needle disposal box. She noticed that the disposal box was full , but decided to try to fit the butterfly into the box anyway. Holding the butterfly by the tubing, she tried to push the butterfly into the box. The needle suddenly recoiled and stuck Julie’s finger. Julie left the patient’s room in a panic and headed back to the lab to report the needle stick injury.

The phlebotomist should always carefully observe the patient for clues about his mental and physical condition. In this case, the patient verbally expressed her fear of needles. In other cases, such fear may be expressed on the patient’s face or through other clues. It may help to engage apprehensive patients in conversation during the venipuncture to keep their mind off the procedure.As soon as the patient stated that she felt faint, the procedure should have been terminated. If a sitting patient faints, placing her head between her knees will help to revive her. Make sure the patient does not injure herself. Ammonium (smelling) salts, if in use at your institution, should be used cautiously, since they can be irritating. Get help from the nursing staff or a physician. Stay with the patient at least 15 minutes. The patient should not leave the area for at least 30 minutes. Make sure other appropriate institutional procedures are followed after fainting.Relevant topics:Fainting, Fainting continued

Two examples of butterfly needles with built-in safety devices are shown.The Punctur-Guard™ (Bioplexus), shown above, uses an internal blunt needle which is activated after blood is drawn. The activated device showing the blunt internal needle is shown in the inset on the upper right. The Angel Wing ™ (Monoject), is activated by sliding a safety shield over the needle after venipuncture.

Multiple draw needles are used with vacuum collection tubes.They allow the collection of blood into multiple vacuum collection tubes during a single venipuncture. They have a retractable sheath over the portion of the needle that penetrates the blood tube.

Use an isopropyl alcohol swab to clean the site.Move the swab in an outward expanding spiral starting with the actual venipuncture site.

Basic equipment must be in close proximity to the venipuncture site for easy access.

You may now hold the patients arm below the venipuncture site.Pull the skin below the vein to anchor it and keep it from rolling.

If possible, use the fourth (ring) finger or the middle finger.Many patients prefer that you use fingers on their nondominant hand. Choose a puncture site near the right or left edge of the finger tip.Clean the site as you would for routine venipuncture.

Clean the venipuncture site with alcohol to remove all the iodine from the patients arm, then apply a bandage.

Rarely, patients will faint during venipuncture.  It is therefore important that patients are properly seated or lying in such a way during venipuncture so that if they do faint, they won’t hurt themselves.A typical fainting spell is self-limited, and the patient usually “comes-to” in a few minutes or less.

The needle may not be in a vein. Try slightly manipulating the needle. If no blood flows, withdraw the needle and repeat the venipuncture. Never probe the patient’s arm with the needle. The bevel of the needle may be compressed against the inside of the vein wall. Slightly manipulating the needle should result in blood flow.  The needle may have passed entirely through the vein. Pull it back slightly, and blood should flow.

Phlebotomy, also known as venipuncture, means collecting blood from veins.Phlebotomists, by definition, collect venous blood, but perform a variety of other important medical tasks as well.

Collect the blood specimen next, if required.Be sure to use the iodine swab provided in the collection kit to disinfect the venipuncture site.Do not use an alcohol swab, as this might lead to suspicion of a falsely elevated blood alcohol result.