HAZARD: Nerve or arterial injury

Many anatomical variations of the veins are possible. Generally, the

median cubital vein is easily identified and accessed. The basilic vein
crosses the median nerve and brachial artery, increasing the risk of
injuring these structures during venipuncture.

HAZARD: Hematoma formation

The point where two veins converge should be avoided, since at these
points, pressure is less likely to be effective in controlling the bleeding
and will lead to hematoma formation.
TIP: Locating the vein

A good light source will help to visualize the vein, but it is best
identified by its 'spongy firmness' on palpation. Extending the arm
brings the veins to the surface for easier identification.

TIP: Differentiating between veins and arteries

Arteries pulsate and are elastic, whereas veins are cord-like, and roll
easily.
Occlude the vein by applying the tourniquet 7 to 10 cm proximal to the
venipuncture site.

HAZARD: Skin pinching

Care should be taken that the skin does not get caught in the
tourniquet when it is tightened. This can be avoided by keeping a
finger between the catch of the tourniquet and the skin.

HAZARD: prolonged occlusion

Care should be taken to keep the time between occlusion with the
tourniquet and the venipuncture short, since prolonged occlusion will
lead to hemolysis.
TIP: fist clenching

The patient may be asked to briefly clench the fist, to increase blood
flow and make the veins more visible. Care should be taken not to let
the patient clench the fist too tightly or too often, since this may
increase hemolysis.
HAZARD: Povidone iodine use

It is advised not to use povidone iodine to disinfect the puncture site.

Contamination with iodine may cause erroneous results such as raised
potassium levels.
HAZARD: Contamination of the puncture site

Care should be taken not to touch the puncture site after disinfecting
it. If the site has been touched or contaminated, repeat the
disinfecting process.
TIP: Blood spillage prevention

Once the blood sample has been collected, first release the tourniquet
before removing the needle from the vein. The increased pressure in
the vein due to the occlusion may cause bleeding from the puncture
site.
HAZARD: shaking the sample

The blood sample should never be shaken, since this will cause
hemolysis and distort the test results.

TIP: letting the patient apply pressure

The patient may be asked to keep the gauze or cotton swab in place
on the extended arm, to achieve hemostasis. This allows the health
care provider to safely discard any sharp materials.