COMPLICATIONS ENCOUNTERED IN BLOOD COLLECTION 2023

PATIENT REACTIONS PAIN

 The phlebotomist must anticipate different patient  The most common patient reaction to
reactions during phlebotomy. venipuncture.
 A phlebotomist should also pay attention to the  Venipuncture from basilic vein is one of the main
non-verbal of the patient; their posture, gestures, causes of pain and nerve damage.
eye-contact, and facial expression accompanied  Action/s to be done:
by verbal communication. a) Try repositioning the needle slightly.
 A phlebotomist must respond quickly and b) Release the tourniquet.
appropriately to avoid inconveniences that may c) Avoid deep and probing venipuncture.
lead to serious problems. d) Immediately discontinue the
venipuncture if patient indicates sharps
COMPLICATIONS ENCOUNTERED IN BLOOD piercing pain.
COLLECTION
1. Pain NERVE DAMAGE
2. Hemolysis  Are the results of deep, probing venipuncture
3. Burned, damage, scarred, and occluded veins  Severe pain, a burning or electric shock
4. Petechiae sensation, numbness, or pain radiating up or
5. Edema down the arm during venipuncture.
6. Ecchymosis  If the nerve is damaged, numbness could be
7. Syncope permanent.
8. Obesity  Action/s to be done:
9. Nausea a) The needle must be removed at once. If
10. IV therapy pain persists apply an ice pack and notify
11. Diabetic shock appropriate personnel.
12. Hemoconcentration b) Avoid probing venipuncture and attempt
13. Seizures and tremors to puncture only veins that can be felt.
14. Mastectomy patients c) NOTE: Deep punctures can not only
15. Cardiac arrest nerve damage but can result in puncture
16. Failure to draw flood of an artery.
17. Continued bleeding
18. Hematoma ECCHYMOSIS (BRUISE)
19. Allergies  Is the most common complication encountered in
20. Anemia obtaining a blood specimen.
 It is caused by leakage of a small amount of fluid
around the tissue.

“Even the hardest subject can be understood when you put in the effort.”
 COMPLICATIONS ENCOUNTERED IN BLOOD COLLECTION 2023
 Action/s to be done:
a) This can be avoided by applying
pressure to the puncture site, instead of
having the patient bend the arm at the
elbow.
SYNCOPE (FAINTING)
 Is the second most complication encountered
during venipuncture.
 Is preceded by the patient turning place pale,
perspiring, and starting to breath shallowly.
Followed by dropping of eyelid; weak, rapid
pulse; and finally unconsciousness.
 Action/s to be done
a) Fetal position; supine position
b) Remove the needle immediately, lower
the patient's head, wipe the forehead and
the back of the neck with cold compress,
and loosen any constrictive clothing. If
the patient still does not respond, the
physician must be notified.
c) Its the best to ask the patient prior
drawing of blood if he/she has fainted in
the past, if yes, have the patient lie down
before drawing blood. The patient should
take some deep breaths and be offered
some orange juice or cold water to drink.
d) The incident should always be
documented.
NAUSEA (VOMITING)
 The patient may indicate that he/she feels sick.
 Terminate procedure and notify the first aid
personnel.
 Action/s to be done:
“Even the hardest subject can be understood when you put in the effort.”
a) The patient to breath deeply and slowly, and
apply a cold compress to the forehead.
b) Give menthol scent
c) Never leave your patient
d) Give the patient an emesis basin, waste basket,
or container to hold in case of vomiting.
DIABETIC SHOCK (HYPOGLYCEMIA)
 A severe hypoglycemia associated with diabetes,
the patient may experience fatigue, light-
headedness or fainting.
 This is the result of diabetes patients having their
fasting, too much insulin in their blood stream.
 Cold sweat and a pale face are the first sign
 The patient becomes weak and shaky, followed
by sudden mental confusion that appears as an
instant personality change.
 The patient may become unconscious if not
attended immediately.
 Action/s to be done:
a) Properly regulated diet and eating at
specific times of the day should be done.
b) A glass of cola or orange juice will help
temporarily.
SEIZURES AND TREMORS
 Patients occasionally experience
seizures/convulsion because of pre-existing
condition or as a response to the needle stick
 Action/s to be done
a) Remove the needle immediately and
hold pressure over the site.
b) Do not try to restrain the patient, but
move away any objects near the patient
to prevent injury.
 COMPLICATIONS ENCOUNTERED IN BLOOD COLLECTION 2023

CARDIAC ARREST compression and permanent damage to the

 Manifests itself as chest pain, shortness of patients arm.
breath, arm or shoulder pain, nausea and  A hematoma most commonly occurs when the
sweating. A person with heart problems could go needle is only partially in the vein, and when the
into cardiac arrest. phlebotomist fails to apply enough pressure after
 The patient may become unconscious and has no venipuncture.
pulse or respiration, dilated eyes, and a blue or  Action/s to be done:
gray skin tone. a) Never draw blood through a hematoma
 Action/s to be done: because it is painful and leads to
a) Immediately call a code and begin to inaccurate test results.
perform CPR to avoid death. b) If no other site is suitable, draw the
b) Only persons certified to do CPR can specimen distal to the hematoma so that
perform this procedure. free flowing blood is collected.
c) Discontinue venipuncture and apply
CONTINUED BLEEDING pressure onto the site.
 Some patients take longer than normal to stop
bleeding (ex: patients on anticoagulant therapy). ALLERGIES
 Normally the bleeding will stop approximately 2  Some patients may be allergic to skin antiseptic
mins. substances other than alcohol. Adhesive
 Action/s to be done: bandages and tape also may cause an allergic
a) Apply pressure to the site until bleeding reaction, Latex in items such as gloves and
stops. tourniquet can cause a life-threatening reaction in
b) If it continues beyond 5 mins notify those who are severely allergic.
appropriate personnel, keep on applying  Action/s to be done:
pressure onto the site. a) Use an alternate antiseptic if required.
Paper tape places over folded gauze or
HEMATOMA self-adhesive bandage material can used
 A hematoma results when leakage of a large in placed of adhesive bandages.
amount of fluid around the fluid around the Hypoallergenic tape should be used or
puncture site causes the area to swell, May result pressure applied manually until the
in bruising of the patients skin around the bleeding has stopped completely.
puncture site it adequate pressure is not Sensitively to latex should be determined
maintained. Blood that leaks out of the vein under before any phlebotomy procedure .In
the patient skin may clot and result in nerve cases of blood culture request ask the
patient if he/she has a allergies.

“Even the hardest subject can be understood when you put in the effort.”
 COMPLICATIONS ENCOUNTERED IN BLOOD COLLECTION 2023

ANEMIA b) If the phlebotomist pulls back too quickly

 Iatrogenic anemia is also known as nosocomial on the plunger of a syringe, forces blood
anemia, physician-induces anemia, or anemia into a tube from syringe
resulting from blood loss for testing. c) Shakes a tube too hard.
 Pediatric patients and adults in intensive care d) If contamination by alcohol or water
units and transplant patients are the most likely occurs at the venipuncture site or in the
candidates to develop this iron-deficiency tubes.
anemia. The consequences of iatrogenic anemia
are fatigue, shortness of breath, and impaired PETECHIAE
performance of physical work. In severe cases,  Petechiae indicates a possible coagulation
the treatment is blood transfusion. problem and should alert the phlebotomist to be
 This is usually of most concern with premature aware of possible prolonged bleeding.
infants.  When a tourniquet is applied to certain
 Action/s to be done: individuals, tiny red spots called petechiae on the
a) Only minimum amounts of blood should arm below it. The spots are actually minute
be drawn from infants. amounts of blood that escape from the capillaries
b) Infants have a small blood volume; and come to the surface of the skin as a result of
removing quantities of blood typical of platelet abnormalities of a defect in the capillary
venipuncture or arterial puncture can walls. They do not indicates that the phlebotomist
lead to anemia or threaten life if over 10% has done anything wrong.
of blood volume is removed.
c) Capillary puncture is required in EDEMA
collecting sample for patients younger  Swelling caused by the abnormal accumulation of
than age 1. fluid in the tissues, makes veins harder to locate.
Specimens collected from edematous areas may
HEMOLYSIS yield erroneous test results because the swelling
 Results when there is rupture of red blood cells alters blood composition.
(RBCs) with the consequent escape of  Choose another site if possible.
hemoglobin.  If there is no easily palpable vein in the
 Can cause the plasma or serum to appear pink or antecubital area, ask the patient what sites have
red. been successful for past blood draws.
 Can occur if:
a) Too small a needle was used during a
difficult draw.

“Even the hardest subject can be understood when you put in the effort.”
 COMPLICATIONS ENCOUNTERED IN BLOOD COLLECTION 2023
OBESITY
 One area to focus on is the cephalic vein, which
is more easily located by rotating the patients arm
IV THERAPY PATIENTS
 A limb with an IV running should not be used for
venipuncture because of contamination to the
specimen. The patients other arm or an alternate
site should be selected. If no alternate site can be
found, the IV should be turned off by the physician
and blood can be drawn from below the infusion
site after a few minutes.
 Discard 5mL of blood to clear any backed-up IV
fluid.
 Requisition forms should be noted that blood is
drawn in an IV line.
HEMOCONCENTRATION
 The increased concentration of larger molecules
and analytes in the blood as a result of a shift in
water balance. Can be caused by leaving the
tourniquet on the patients remain on for longer
than 1 minute before venipuncture.
 If it is left on for a longer time because of difficulty
in finding a vein it should remove for 2 minutes
and reapplied before the venipuncture is
performed.
MASTECTOMY PATIENT
 A patient’s physician should be consulted before
drawing blood from an arm on the same side as
a mastectomy.
 Lymph node removal, typically part of the
procedure, can cause lymphostasis (stoppage of
“Even the hardest subject can be understood when you put in the effort.”
lymph flow), which makes the arm susceptible to
swelling and infection.
FAILURE TO DRAW BLOOD
 Each institution should have a policy covering
proper procedure when a blood specimen cannot
be collected. If two unsuccessful attempts at
collection have been made, the CLS1
recommends can make two attempts to obtain a
specimen. If the second person is unsuccessful,
the physician should be notified.
 Refusal by the patient to have blood drawn. The
response to this problem is to politely excuse
yourself from the patient’s room, note the refusal
on the requisition and notify the nurse and the
physician.
 Difficulty in obtaining a specimen because the
bore of the needle is against the wall of the vein.
Slightly pulling back on the needle may solve this
problem.
MOVEMENT OF THE VEIN.
 To guard against this problem, always have firm
pressure on the arm below the intended
venipuncture site. The needle can be moved to
reach the vein, but excessive probing in the
tissues must be avoided. Care must be exercised
in moving the needle because a hematoma can
form if both sides of the vessel wall are pierced.
AN INADEQUATE AMOUNT OF BLOOD IN AN
EVACUATED TUBE.
 A "short draw" or lack complete filling of an
anticoagulated tube, can produce errors in test
results. An excessive amount EDTA will produce
 COMPLICATIONS ENCOUNTERED IN BLOOD COLLECTION 2023

shrinkage of erythrocytes, and an insufficient Note:

amount of blood in a sodium citrate tube will
introduce a dilutional problem if the specimen is
tested for coagulation studies.
IMPROPER ANTICOAGULANT
 In most cases, anticoagulants cannot be
substituted in a test. For example, blood smears
cannot be prepared from a heparinized blood
sample because with Wright stain the
erythrocytes will stain too blue.
COLLAPSED VEIN
 If tube vacuum is too great for the vein, a syringe
plunger la pulled too quickly, or the tourniquet is
too tight or too close to the site, blood cannot be
replaced as quickly as it is withdrawn and the vein
collapses. A vein may also collapse when the
tourniquet is removed during the draw, especially
if the patient is elderly and has fragile veins
(Blood stoppage on tourniquet removal is not
always the result of vein collapse. Needle position
may have changed and readjustment is needed.)
Use a smaller tube or pull the syringe plunger
more slowly.
 If blood flow does not return, discontinue the draw
and try again at another site.
Do not feel too near to the needle, as it is painful. Locate
and anchor the vein, and redirect the needle into it. If the
vein cannot be located, discontinue the draw. Never
probe; it is painful and can damage nerves or puncture
arteries.
VASCULAR ACCESS DEVICES (VAD)
 With the exception of intravenous (IV) lines in
some instances, the phlebotomist must never
apply a tourniquet or perform venipuncture on an
arm that has a VAD.
 5 mL discard tube should be collected first if
drawing blood this is done to avoid contamination
of anticoagulants that is being administered prior
drawing of blood through this VADS,
 Drawing coagulation specimens from CVADS is
not recommended.

UNDETERMINED NEEDLE POSITION:

 It needle location in respect to the vein cannot be
determined, one may have to relocate the vein,
Remove the tube and withdraw the needle until
the bevel is just under the skin. Palpate the arm
above the needle entry site.

“Even the hardest subject can be understood when you put in the effort.”