Allied Health Blog

There are several complications that can occur following a venipuncture procedure.  Some complications are extremely rare and others can occur very easily if care is not taken to ensure proper collection techniques.

Infections can occur at the site following a venipuncture.  Although this type of complication rarely occurs, the risk for infection increases if the following aseptic techniques are not used.

-  Do not open adhesive tape of bandages ahead of time or stick them to anything      that could be contaminated.

-  Do not preload needles onto tube holders.

-  Do not touch the site with any nonsterile object after it has been cleaned, before or during needle insertion.

-Inform the patient to keep the bandage on for at least 15 minutes after specimen collection.

Nerve injuries can result from several reasons.  Most commonly a nerve injury is associated with poor site or improper vein selection, inserting the needle to quickly or deeply, patient movement when the needle is inserted, excessive lateral redirection of the needle, or blind probing.  Any of these potential causes can lead to permanent nerve damage.  National guidelines have been created to help reduce the risk of nerve injuries to patients.  A phlebotomist is trained to choose an alternate site if an initial venipuncture is unsuccessful.

Another type of complication can occur if blood refluxes into the patient’s vein from the collection tube during venipuncture.  This type of complication is rare but can occur when the contents of the collection tube are in contact with the needle while the blood is being drawn.  A phlebotomist should always make sure that the patient’s arm is kept in a downward position and that the collection tube is below the venipunture site and filling from the bottom up.

Vein damage can occur if a venipunture is improperly performed or if several venipunctures are performed in the same area over an extended period of time.  This recurrent use of the same site can cause a buildup of scar tissue that makes subsequent venipunctures difficult.

An initial attempt to draw blood does not always succeed.  There are a number of different procedural errors that can cause venipuncture failure.  An effective phlebotomist should be aware of these types of errors and know how to correct any that may occur.  This knowledge is extremely helpful in determining if blood can be obtained the first time or if a procedure must be repeated.  Whenever a procedure fails the first time, an experienced an effective phlebotomist should calmly evaluate the situation for the following potential problems:

Tube Position

The way the tube is positioned can affect blood collection.  Check that the tube is properly seated and that the needle in the tube holder has penetrated the tube stopper.  Ensure that the needle sleeve is properly placed and not pushing the tube off the needle.

Tube Vacuum

The tube may loose vacuum if the needle bevel is not completely inserted under the skin or if the bevel backs out of the skin.  This problem can often be identified by a short hissing sound that can be heard.  Also, blood may spurt into the tube before the blood flow stops.  There are several other causes for a tube to loose its vacuum that include, damage to the tube during shipping and handling, if the tube is dropped, or if the tube is pushed too far onto the needle prior to venipuncture.

Needle Position

A common cause of failure to collect blood has to do with improper needle position.  There are visual cues that an experienced phlebotomist can easily identify to determine if a needle is incorrectly positioned in a vein.  If it is difficult to determine the needle position visually, it may be necessary to use your finger to relocate the vein.

Collapsed Vein

The vacuum draw of a tube can sometimes create too much pressure for a vein.  The pressure can cause the vein to collapse temporarily.  When this happens blood will cease to flow through that vein.  A collapsed vein can also occur if a tourniquet is tied too tightly or too close to the venipuncture site.  The rapid removal of blood from a vein can cause it to collapse if the blood is not replaced fast enough.

There are several common complications that can result from venipuncture.  The severity of each complication can vary from swelling and discomfort to vein damage or nerve injury.  A phlebotomist should be aware the different ways these complications can arise and the signs associated with venipuncture complications.

Hematoma formation is the most common venipuncture complication.  This type of complication is caused by blood leaking into the tissues during or after venipuncture.  A common sign of this complication occurring is swelling at or near the venipuncture site.  This swelling is called a hematoma and is painful and usually causes bruising or possibly compression injuries to nerves.  Many lawsuits have occurred because of this type of complication.  A phlebotomist should discontinue collecting blood as soon as a hematoma is discovered.  A patient could become injured and the blood specimen could become contaminated if the blood draw is permitted to continue during a hematoma formation.  Inaccurate test results usually occur when using blood collected when a hematoma is forming.

Iatrogenic anemia can occur as a result of blood continually being removed on a regular basis or in large quantities for testing.  This type of complication often occurs in infants.  The most common reason for blood transfusion in neonatal intensive care unit (ICU) patients is due to the need to replace blood due to regular blood removal.  To prevent this complication from occurring unnecessarily a phlebotomist should coordinate with physicians to minimize the number of times a patient has his blood drawn.  It is also important to minimize redraws by following quality assurance protocols, and only collecting the minimum required specimen volumes.

Inadvertent arterial puncture rarely occurs when proper venipuncture procedures are followed.  The common cause of this type of complication is deep or blind probing that can result in an inadvertent arterial puncture.  The vasilic vein is especially sensitive to this type of complication and is usually the last area that is considered for venipuncture.  The danger of a complication from an inadvertent arterial puncture is that a leak could go undetected and cause an accumulation of blood in an area that can cause a compression injury to a nearby nerve.  This type of injury could permanently damage the nerve and lead to a lawsuit.