Phlebotomy Complications
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Sleeping patients should be gently
awakened
Unavailable Patient
-Seek assistance from attending nurse/ nurse station to locate patient
Young and Cognitively Impaired Patients
-Ask the patient’s nurse, relative, or a friend to identify the patient
Patient Preparation Pre-examination variables associated with the patient’s activities before sample collection can affect the quality of the sample. Variables include:
• Diet • Posture • Exercise • Stress • Alcohol • Smoking • Time of the Day • Medication
Patient Preparation Physiological variables include:
• Age • Altitude • Gender affect normal values
Patient Preparation • patient has refrained from strenuous exercise and has not ingested food or beverages except water for 12 hours fasting. • The ideal time to collect blood from a patient
BASAL STATE
Patient Complication • those who are anxious or fearful must be calm down. • Assistance from a nurse or parent is frequently required
APPREHENSIVE PATIENTS
Patient Complication • spontaneous loss of consciousness caused by insufficient blood flow to the brain. Remedy: Patient’s head is lowered between legs & instructed to breath deeply; Give spirit of ammonia
Syncope (Fainting)
Patient Complication SEIZURES (what to do)
• Tourniquet and needle should be removed, pressure applied to the site, and summon help. • Restrain the patient only to the extent that injury is prevented. • Document the time the seizure started and stopped according to institutional policy.
Patient Complication • Small, nonraised red hemorrhagic spots • May have prolonged bleeding following venipuncture. • Additional pressure should be applied to the puncture site following needle removal.
PETECHIAE
If the patient is nauseated,
instruct the patient to breathe deeply and slowly apply cold compresses to the patient’s forehead.
If the patient vomits,
stop the blood collection and provide an emesis basin or wastebasket and tissues
Areas to be avoided (phlebotomy)
• Damaged Veins • Hematoma • Edema • Burns, Scars, and Tattoos • Mastectomy • Obesity • IV Therapy • Cannulas and Fistulas
Technical Complication (Failure To Obtain Blood)
• Needle Position • Bevel Against the Wall of the Vein • Needle Too Deep • Needle Too Shallow • Collapsed Vein • Faulty Evacuated Tubes
Technical Complication NERVE INJURY SIGNS
• Shooting pain • Electric-like tingling/numbness running up or down the arm or in the fingers of the arm
can be caused by incorrect vein selection or improper venipuncture technique and may result in loss of movement to the arm or hand and the possibility of a lawsuit.
Temporary or permanent nerve damage
Permanent injury in the venipuncture procedure is damage to the
median antebrachial cutaneous nerve.
Phlebotomy Errors in technique:
Blind probing, electing high-risk venipuncture sites, Employing an excessive angle of needle, Lateral redirection of the needle, Excessive manipulation
Technical Complication may be detected by the presence of pink or red plasma or serum. - Rupture of the red blood cell membrane releases cellular contents into the serum or plasma and produces interference with many test results so that the sample may need to be redrawn.
HEMOLYZED SAMPLES - Hemolysis
Causes of Hemolysis
• Using a needle with too small a diameter (above 23 gauge) • Using a small needle with a large evacuated tube • Using an improperly attached needle on a syringe so that frothing occurs as the blood enters the syringe • Pulling the plunger of a syringe back too fast • Drawing blood from a site containing a hematoma • Vigorously mixing tubes • Forcing blood from a syringe into an evacuated tube • Collecting samples from IV lines when not recommended by the manufacturer • Applying the tourniquet too close to the puncture site or for too long 10. Using fragile hand veins • Performing venipuncture before the alcohol is allowed to dry • Collecting blood through different internal diameters of catheter and connectors • Partially filling sodium fluoride tubes • Readjusting the needle in the vein (probing) or using occluded veins
Technical Complication • This is caused by transient rise in chylomicrons following a meal containing fat • It causes interference with large number of chemical analyses because of turbidity. It disturbs the following investigations particularly strongly: –Amylase –Bilirubin –Protein –SGOT –SGPT
LIPEMIA OR LACTANESE
Technical Complication • Blue or black skin discoloration commonly due to repeated trauma or puncture of the veins
Hematoma Formation
Causes of Hematoma
• Vein is too fragile • Needle penetrates all the way to vein • Needle is partly inserted to vein • Needle is removed while torniquet is on • Excessive probing 6.Pressure not adequately applied after venipuncture
Phlebotomy Major reasons for sample rejection are the following:
• Unlabeled or mislabeled samples 2. Inadequate volume • Collection in the wrong tube • Hemolysis • Lipemia • Clotted blood in an anticoagulant tube • Improper handling during transport, such as not chilling the sample • Samples without a requisition form • Contaminated sample containers 10. Delays in processing the sample 11. Use of outdated blood collection tubes