Advice From an OSHA Expert

Phlebotomists work in many environments, including outpatient draw centers, doctor’s offices, law enforcement centers, nursing homes, public health facilities, and hospitals. Combative patients can be encountered in all of these settings, creating dangerous situations for everyone involved. So how do you prevent a needlestick or other injury when dealing with a potentially combative patient? In most cases, combative patients can be drawn safely if the right steps are taken.

The first step involves communication. If family members are present, ask them (politely and discreetly) if there may be potential issues when collecting from the patient. Ask the patient’s nurse as well, if possible. Knowing about your patient before you attempt a blood draw can make the procedure go much more smoothly.

Communicating directly with the patient is also key to gaining and assessing cooperation. For example, when approaching dementia patients or those with poor eyesight, make sure that the room is well lit so that the patient can better interpret what they are seeing. An unfamiliar figure standing in the shadows can be frightening to cognitively impaired individuals. Also, speaking calmly and clearly to patients hard of hearing or with mental impairment can be comforting, and may make them less hostile to the procedure.

In an outpatient collection area, a family came in with a mentally-challenged child. They did not inform the staff of the possibility of combative behavior. When the patient became violent, a phlebotomist sustained a needlestick exposure, and the patient was injured as well. Having the information and the correct safety measures in place could have helped to prevent that incident.
Never attempt to draw a known combative patient by yourself. If help is not available, then postpone the collection until adequate assistance can be obtained. In addition to gloves and a lab coat, face protection should be considered necessary PPE, particularly if the patient is likely to spit during the procedure. In terms of equipment, using a winged collection set or “butterfly” needle may provide the phlebotomist more control and maneuverability over the needle.

The dangers of drawing a combative patient are many. Even with the proper information, approach, equipment, and assistance, there are some draws that cannot be safely performed without physician intervention. In such situations, physician notification is necessary. To attempt a blood draw when the patient cannot be adequately and safely subdued places the patient and collector at risk for injury, and the facility at risk for legal liability.