Drawing Blood Explained, Attempts and Complications
Phlebotomy, or the process of drawing blood, has been done for centuries and remains to be one of the most invasive health care procedures. Collection and processing of blood specimen can be done in many ways, the most common of which is routine venipuncture. The fingerstick and heelstick procedures, on the other hand, are only used for certain patients and under special circumstances, including patients who are considered difficult draws.
To ensure the safety of both the phlebotomists and patients, guidelines are set and codes of practice must be strictly followed. The best practices in drawing blood include planning ahead, using an appropriate location, ensuring quality assurance and control, providing quality care for patients, and ensuring quality control of laboratory sampling.
Despite how careful a phlebotomist is certain complications can arise before, during and after the procedure. Some patients feel anxious prior to venipuncture, with some even passing out. It is then the responsibility of the phlebotomy technician to ease their worries and fears.
Number of Drawing Blood Attempts
There are also cases when drawing blood fails at the first or second attempt, even if the patient is not a difficult draw. This begs the question: how many attempts are allowed on a single patient? There is no specific policy as to the number of venipuncture attempts, but a phlebotomist must know when to stop.
- When a patient refuses, any additional attempts must be avoided until permission is again granted. A refusal is a clear and absolute contraindication that a phlebotomy technician must respect.
- When a patient is showing signs of direct nerve trauma, drawing blood must be stopped immediately, and a second attempt on the same site must be avoided.
- When there is significant local bleeding, venipuncture must be stopped right away to prevent possible occurrence of nerve compression. No further attempts should be made until the patient is evaluated based on the complication that has already occurred.
Most patients do not require a second blood draw, but the common standard limits in venipuncture are up to two attempts only.
Drawing Blood Complications
Whether blood collection is done once or twice, there is a possibility of complications, which make phlebotomy quite challenging. In some cases, complications arise due to errors on the part of a phlebotomist.
- Bruising, transient pain and hematoma are three of the local and relatively common problems of venipuncture. Bruising, for example, occurs about five times more in women than men. The good news is they resolve completely and without the need for medical intervention.
- Bleeding longer than normal following a blood draw usually occurs in patients with certain conditions, such as hemophilia, and those that are taking aspirin, blood thinners and other drugs.
- Infection and inflammation are likely to occur whenever skin is broken. Although rare, cellulitis, phlebitis and sepsis may happen following a venipuncture procedure. The likelihood, however, depends on various factors, including patients with compromised immune system.
- Nerve injury may happen as a result of compression due to hematoma or direct trauma. Such injuries are relatively common, but increase the risk of permanent nerve damage.
To avoid such complications and many other more serious injuries, it is vital that phlebotomists must undergo good training in drawing blood, always avoid oversight, and to have an experienced phlebotomy technician on standby to ensure that second attempts will be successful. It is also important that every occurrence of a complication is reported and tracked to identify which phlebotomist need additional training.
