Venipuncture Complications Chapter 11

Patient is not in their room Go to the nurses station to locate the patient If it is a timed or STAT draw go to the location of the patient and complete the draw

Patient ID Lab req information vs. patient ID band Missing ID band- Contact the nurse on duty to have one attached. ID bracelet must be on patient not just in the room Blood bank patients & their ID’s

Sleeping or unconscious pt’s Always attempt to awake your patient If unable to awake patient do not draw! Contact supervisor for proper procedure instructions. Unconscious patients- go through same process as if they were conscious, they may still be able to hear you.

Physicians or Clergy Never draw if either are in the patients room If either enter during a draw ask for a few minutes to complete the draw. Never interrupt unless it is a STAT draw then explain the reason for the interruption

Visitors When visitors are in the room, greet them as you would the patient, and ask them to step out of the room so that you can complete the draw

Apprehensive pt’s Communicate with the patient Set them at ease Ask for family if the patient is a child Ask for nurse assistance to calm the patient

Language problems If you cannot communicate with the patient you cannot get consent You may need a translator to explain the procedure to the patient and gain consent to draw

Patient refusal Stress the importance of the draw and that the samples are needed for treatment If the paitent still refuses then document it in the patients req form and contact the MD. NEVER force a draw on a patient

Problems in site selection Antecubital fossa is the most common site for routine venipuncture

Occluded veins Occluded-blocked Sclerosed-hardened Can be caused by: Inflammation Disease Chemotherapy Repeated venipunctures Erroneous test results

Hemotomas Caused by the needle going through the vein Failing to apply enough pressure after the draw Alter test results

Hematoma

Hematoma

Hematoma

Do not draw Edmatous Tissue-swollen due to accumulation of tissue fluid Burns/scars-painful & difficult to penetrate Mastectomies-affect test results, risk of infection increases, painful, must have MD consent to draw from same side mastectomies Avoid open wounds, recent tattoos, rashes

Enhance Vein prominence Massage gently upward from the wrist to the elbow Dangle arm downward Apply heat Rotate the wrist Gently tapping the antecubital area with the index and middle finger

Alternate sites Back of the hand Use a winged infusion set Using a syringe to control the suction of the blood

Tourniquet applied too tight No arterial pulse Pinching or numbing of the arm Loosen it slightly before proceeding

Changes in patient status Syncope- fainting Seizures Nausea and vomiting (emesis) Warn patient before you stick

Most common causes of hematoma Excessive probing to obtain blood Failure to insert the needle far enough into the vein Needle going through the vein Failure to remove the tourniquet before the needle Inadequate pressure on the site after the draw Bending the elbow while applying pressure

Lack of blood flow Defective evacuated tube Improper needle position Collapsed vein-too much vacuum on a small vein Your only allowed 2 attempts on a blood draw Bleeding should cease within 5 minutes

Factors that affect sample integrity Hemolysis – destruction of blood cells – appears pink or reddish color in the serum. Blood from a hematoma- hematoma blood is older Seated & supine patients Reflux- flow of blood from collection tube back into the needle.

Long term complications Anemia Compartment syndrome Nerve damage infection

Compartment syndrome

Compartment syndrome

Infection due to venipuncture