What Should We Do?

Dear Center for Phlebotomy Education:

I have a former student who is being pressured to perform blind-sticking. In my opinion, this is a poor practice that could cause patient injury even in cases where the phlebotomist is well-versed on vascular anatomy. Do you have any references to point me to? What should we do?

My response:

Blind sticking is well outside of the standard of care for phlebotomy. Permitting it puts a facility at great risk for liability for patient injury. The Clinical and Laboratory Standards Institute's (CLSI) venipuncture standard (GP41-A7) clearly states that a calculated needle relocation is acceptable (to a limited extent in the area of the basilic vein), but only if the exact location of the vein is known. Not knowing where the vein lies and relocating the needle anyway is considered blind probing, which is not permitted. It can be painful and may produce arterial perforations, resulting in a hematoma and nerve compression or direct nerve injury.

CLSI illustrates two drastically different orientations of the vascular anatomy in its venipuncture standard. In some patients, antecubital veins are arranged in an "H" pattern, while in others it's an "M" pattern. How does the blind-sticker know which anatomy they're dealing with?

Being well-versed in vascular anatomy isn't enough. Does the person who performs blind-sticking know where the nerves are that pass through the antecubital area? If he/she is blind-sticking, probably not. So make sure you articulate to your former student that blind sticking is wrong on many levels, and is without support in reputable textbooks or the standards.

Got a challenging phlebotomy situation or work-related question? Email us your submission at Phlebotomy.Today@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)