Top Ten Ways to Injure a Patient, Part 2

In this series, we're counting down the Top Ten Ways to Injure a Patient during venipuncture. Carefully consider every item in this list to determine your vulnerability to inflict a phlebotomy-related injury that could lead to serious complications and litigation. So far, we've covered the following: 10. reinventing the procedure; 9. Draw from unorthodox sites; 8. seat the patient anywhere.

Now, let's continue counting them down.

7. Turn your back on the patient

Statistics tell us that three to five percent of patients will pass out during or immediately following a venipuncture. The problem is, they don’t come with a sign on their forehead proclaiming “I will pass out.” If your staff is routinely vigilant for the signs of an imminent loss of consciousness, they won’t allow themselves to turn their back on patients before releasing them from their care. Such signs include pallor, perspiration, hyperventilation, and a patient who goes from talkative to silent. All of these may be clues that he’s going down. Should a legal proceeding unfold, the standard to which you will be held instructs all collectors to be prepared to react. Being inattentive by turning your back to the patient, or leaving the immediate area prematurely, is not consistent with the required vigilance.

6. Draw from an artery

Not only is arterial blood and venous blood different in terms of the concentration of some analytes, but drawing from an artery is riskier to the patient. Besides the risk of nerve injury, arterial punctures are slower to seal and much more likely to lead to hematoma formation if adequate pressure is not applied. According to the standards, arterial punctures should not be considered as an alternative to venipuncture in difficult draws.

5. Bandage in a hurry

This is the step of the venipuncture procedure that too many phlebotomists rush. Keep in mind that a bandage is not a substitute for pressure. The standards insist that we don’t bandage a patient unless we are assured stasis is complete. That means we need to slow down, remove the gauze, and perform a two-point check for bleeding. The first observation is for superficial bleeding from the skin; the second is for hematoma formation. Once pressure is released, observe the site for five to ten seconds to see what happens. If we only check for blood to ooze onto the skin, we’re not protecting the patient from a hematoma that would leave an unsightly bruise and exert pressure on the nerves in the area. Such “compression nerve injuries” often lead to Complex Regional Pain Syndrome, Type II, which can be disabling.

4. Disregard shooting pain

The “reasonable and prudent phlebotomist” (legalese for one who applies the standards every time she draws blood) knows that shooting, electric-like pain indicates a nerve has been provoked, and will remove the needle immediately. Those who disregard the patient in excruciating pain risk making a minor injury severe, and a temporary injury permanently disabling. If your staff is performing within the standard of care, they are removing the needle whenever the patient expresses unusual or extreme pain, tingling or numbness in the fingers or hand, and any electrical, shooting-pain sensation.

Part 1 of this series.