We have a regular patient who comes in with arms that are filthy dirty. The last time I had to do a venipuncture on him, I used five alcohol swabs to clean the site. How can I tactfully tell him to wash his arms before he comes in next time without embarrassing him?

Our response: A venipuncture is not a sterile procedure (unless blood cultures are being drawn). But we still want to practice good hygiene. The potential consequences of a drawing from a visibly contaminated site include an increased risk of infection, which could lead to more serious issues. On the other hand, a venipuncture site which is not visibly dirty could be harboring just as many germs and disease as an obviously contaminated area.

The current practice of cleansing an area with an alcohol swab or prep prior to venipuncture is still the proper protocol. For excessively soiled skin, use a soapy antibacterial wipe or scrub that can clean a greater area more deeply. Then follow with a final alcohol prep before performing the venipuncture. If the pad looks dirty, apply another or repeat the friction scrub with a second soapy antibacterial prep. Continue cleansing until an alcohol wipe is not visibly dirty after the prep.

Whether or not you should suggest the patient cleanse his arm before coming in is a tough call. It may not be a personal hygiene issue, but the conditions where he works. If he comes to your draw station after his shift, it's just normal for his arms to be dirty and he gives it no thought. If that's the case, suggesting he cleanse the site before arriving may not be offensive. If it is a hygiene issue, that's a little more delicate. Since the main concern is for the patient's safety, it doesn't matter who cleanses the site as long as it's cleansed thoroughly. Since the patient is a regular, it shouldn't take long to establish a rapport that might make the suggestion easier to phrase properly.