What Should We Do?

Dear Center for Phlebotomy Education:

I am the Phlebotomy team leader and would like to inquire about the usage of surgical skin markers for use in phlebotomy. Specifically, to help assist with drawing accuracy by marking on the skin where you find the vein. We're concerned about the potential for cross contamination from one patient to the other. I want to update our procedures with the latest thinking on this. What should we do?

My Response:

I understand the difficulty with some patients to relocate the vein once we've found it. I take my time palpating and palpating, and finally locate what I think is a vein. But the tourniquet has been on so long I have to release it to prevent hemoconcentration from corrupting the sample. So I let two minutes pass as the standards require, reapply the tourniquet and palpate all over again, trying desperately to find the vein again and insert the needle within the one-minute window. It's frustrating.

I realize how tempting it is to mark the skin, making it easier to relocate the vein after we cleanse the site, but I'm not sure marking up the patient is the best strategy. Surgical pens are for surgery, not phlebotomy. That said, the standards do not prohibit it, and I've yet to see anything in the literature about transmitting infections, although it's plausible. Nor am I aware of any facility that has adapted surgical markers for phlebotomy. So I wonder if it's really necessary. Because of these reservations, I advocate locating skin markers and making note to where the veins lie in relation to them instead of marking up the patient. An alcohol prep can also be used as a "pointer" after locating the vein. After locating the vein, cleanse the site and place the pad on the skin with the corner pointing towards where the vein was located.

Remember, surgical sites are prepped extensively with strong antimicrobial solutions after the site is marked. Not so for venipunctures, which are not considered sterile procedures (unless blood cultures are being drawn). Fungus and yeast, which may not be affected by an alcohol prep, could be transferred. So I have more questions than answers for you about this, and for that reason I'm hesitant to advocate the use of skin markers for phlebotomy.