7 Questions Every Phlebotomist Must Answer Correctly

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Your laboratory’s ability to manage risk and the well-being of your patients is at stake

Anyone who has seen the Hitchhiker’s Guide to the Galaxy can tell you the answer to every question in the universe is 42. However, if you manage phlebotomists or other laboratorians drawing blood samples from patients, 42 is the wrong answer for these seven questions. The future of the galaxy may not be at stake, but your laboratory’s ability to manage risk sure is, and so is the well-being of your patients.

Question 1: To what extent can you relocate the needle if you miss the vein?

We can put a man on the moon, so why we can’t put a needle into someone’s vein precisely every time? We’re not guiding a lunar lander through space, that’s why. We’re navigating surgical steel in the dark, relying only on our mind’s eye to sense the exact location of the vein, stop it precisely in the center, and extract blood for testing. and we’re doing it hundreds of thousands of times each year. We only put twelve men on the moon.

What does your staff do when they miss? If their answer is 42 they need to stop watching sci-fi movies. It’s all about preventing nerve injuries.  Of all the veins that traverse the antecubital vein, the nerves most often injured during needle relocation lie perilously close to the basilic vein, which is on the inside (medial) aspect of the antecubital area. When the basilic is missed, the standards specifically forbid side-to-side needle relocation. For veins not close to vulnerable nerves a calculated relocation may be acceptable, but probing is beneath the standard of care on any planet.

Question 2: At what angle should the needle be inserted into the arm?

If it can be shown in a legal case involving an alleged injury during a venipuncture that the angle of insertion was in excess of 30 degrees, the facility may be liable for the injury. Does your staff know what 30 degrees looks like? Don’t be sure. Show them an illustration (one exists in the CLSI venipuncture standard), demonstrate, and approximate.  At the very least, instruct your staff or students to enter the skin at the lowest angle possible, and your patients will be hitchhiking to a less litigious outcome for your facility.

Question 3: How much time passes between when you release pressure and apply the bandage?

Seconds matter in space travel, intergalactic warfare, and phlebotomy. If your staff lets patients bend their arms up as a substitute for direct pressure, then bandages at the speed of light after the tubes are mixed and labeled, they need to abort their take-off. The standards say not to let patients bend the arm up, and that we must be sure bleeding has stopped. When those who draw blood lift the gauze, blink, and bandage, there’s no way they can be sure. It takes at least 10 seconds of observation. The next exit on the Intergalactic highway is to remedial training. Make sure they take it.

Question 4: Can you puncture the first good vein you find?

Today is a great day to break away from the gravitational pull that keeps specimen collection personnel from conducting a thorough survey of all accessible venipuncture sites. As mentioned in Question #1, accessing the basilic vein carries a higher risk of arterial and nerve injury than other antecubital veins. That’s why the standards mandate we select a median or cephalic vein before drawing from the basilic. Draw from the basilic vein only when no other antecubital vein is accessible and hitchhikers who come to your universe for healthcare will be glad you’re commanding the starship.

Question 5: What constitutes proper patient identification?

Up to 16% of identification bracelets contain erroneous information. Don’t trust them; they could be on alien imposters. Identify patients by asking them to state, not affirm, their name, address, unique identification number and/or birth date. Have them spell their last name whenever possible. Compare the information given with the information on the order, requisition, and identification band if available. If patients can’t participate, have a caregiver or family member provide the identifiers for them, then document the name of the verifier. May the force of positive patient identification be with you.

Question 6: How can you protect fainting patients from injury?

Make sure every patient your staff draws is either lying down or seated in a chair with armrests-not sitting upright in their hospital bed, not on exam tables, and not in any chair without side supports. Never leave the patient’s side throughout the procedure in case they pass out and fall forward.

Ask patients if they’ve ever fainted during a blood draw and if they feel all right before sending them back to their mother ship.

Question 7: What do you do when the patient expresses shooting pain?

Should the patient express excruciating pain during a venipuncture attempt, even tingling or numbness in the hand or fingers, the draw must be discontinued immediately. Make a second attempt, preferably in a different location. Because these are symptoms of impending nerve injury, any other reaction can bring liability. especially if the patient is an inhabitant of Earth where they’ll sue for coffee being too hot.

If your staff can answer these seven questions correctly, congratulations. The potential for your facility  to injure patients just hitched a ride to a more hospitable solar system, and your potential to manage the risk of phlebotomy will live long and prosper.

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About Author

Dennis J. Ernst, MT(ASCP)
Dennis J. Ernst, MT(ASCP)

Dennis J. Ernst is director of the Center for Phlebotomy Education and also teaches phlebotomy at the University of Louisville School of Allied Health Sciences.

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