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.

For many years, CLSI and other agencies have required facilities to monitor the volume of blood withdrawn from neonates and other patients susceptible to iatrogenic anemia without recommending a limit. With the release of the latest version of CLSI's venipuncture standard, we now have guidelines. 

Until now, only two charts were available for facilities to reference. They appeared in Phlebotomy Handbook (Pearson) And So You're Going to Collect a Blood Specimen (College of American Pathologists). In both cases, the charts were reprinted from those in use at two respective hospitals, but neither publication mentioned the basis on which the limits were established.

In 2010, the World Health Organization researched the limits in use at 30 healthcare facilities in Europe, and published their recommendation that facilities should establish a limit of between 1-5 percent of the patient's total blood volume during a 24-hour period and 10 percent over an eight-week period. The revised venipuncture standard also makes this recommendation.

Since 90 percent of critical-care patients develop iatrogenic anemia by their third day in a critical care unit, it is essential for facilities to comply with this new standard provision.

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.