1. Venipuncture Complications
Chapter 11

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

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

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

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

13. Hematoma

14. Hematoma

15. Hematoma

16. 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

17. 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

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

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

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

21. 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

22. 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

23. 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.

24. Long term complications
Anemia
Compartment syndrome
Nerve damage
infection

25. Compartment syndrome

26. Compartment syndrome

27. Infection due to venipuncture