Standards Update: A new unacceptable site

The newly revised venipuncture standard released by the Clinical and Laboratory Standards Institute in April, 2017 is the most comprehensive revision in the document's history. With over 140 new mandates, facilities have a lot of changes to implement. This series discusses one or more substantive changes each month.

Pop quiz: name the four sites previous versions of the CLSI venipuncture standard listed as unacceptable sites for performing a routine blood draw. If you answered the following, you're correct:

• front of the wrist (palm side)
• the same side as a mastectomy without physician's permission
• feet and ankles without physician's permission
• any artery

Now there's one more. When the industry's standard was revised and released in April of last year, the lateral wrist (thumb side) was added to the list. That's because the committee revising the document found numerous studies published since the 2010 revision that identify the site as prone to nerve injuries during vascular access procedures. 

The vein in the lateral wrist that many are tempted to access is the accessory cephalic vein. Unfortunately, the superficial radial nerve passes through the same area, often nestled against the vein or traversing over it, putting it at risk of needle penetration. Because there is so much support in the peer-reviewed journals to avoid this site, the standard now includes the lateral wrist on its list of unacceptable sites.  

Editor's note: Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions immediately. The document, Collection of Diagnostic Venous Blood Specimens (GP41-A7), is the standard to which all facilities will be held if a patient is injured during the procedure or suffers from the consequences of an improperly performed venipuncture. It can be obtained from CLSI or the Center for Phlebotomy Education, Inc.

Read an interview by CLP Magazine with Dennis J. Ernst MT(ASCP), NCPT(NCCT) about the revised standard.