46.0 Difficult Venipuncture


Title of Manual: Specimen Collection

Version No: 1.0

Title: Difficult Venipunctures

Effective Date: 12/20/10
Revised Date: 06/23/14

Document #: GPA.SPC.46.0


I. PURPOSE

The purpose of this policy is to provide guidelines for blood collections when the patient is difficult
to collect due to inaccessible veins or uncooperative behavior.
This is to be performed by all personnel who have been trained on venipuncture operation and
reporting protocol.

II. MATERIALS

Reagents

Supplies

Equipment

● See Previous Pages


III. PROCEDURE

1. For all phlebotomy performed
    a. If the first collection attempt is unsuccessful, only one additional attempt can be made to collect
        via venipuncture.
    b. When second phlebotomists is available or after a total of three attempts, contact the ordering
        physician and request the advice for the next steps. Advise patient of the physician’s instructions.

2. Sites NOT Acceptable for Venipuncture

    • Feet and Leg Veins
    • Areas with extensive scarring
    • Burn areas
    • Hematomas or extensively bruised area
    • Veins on the underside of the wrist (palm side)
    • Thrombosed Veins
    • Arteries

3. If the vein is difficult to find, there are several steps that can be taken:

    a. Massage the arm from the forearm to the elbow. This technique forces blood into the veins.
    b. Tap the antecubital space sharply with the index and second finger 2-3 times. This will cause the vein
        to dilate.
    c. The patient may lie down with the arm to be used for venipuncture hanging over the side for a
        few minutes.
    d. A warm, wet washcloth may be applied to the area for five to ten minutes. The heat will cause the
        veins to dilate. Be careful that the washcloth is not so hot that it burns the patient.

    e. Consider using the other arm for venipuncture. The patient may tell you where a vein can be found as
        they are usually correct in their suggestion.
    f. When your patients are chilled veins are more difficult to locate.

4. Uncooperative Patient
    a. At times the behavior of the patient makes it difficult or dangerous to attempt collection
    b. In the event that a phlebotomist feels that the collection of a blood sample poses a risk to the patient,
        other caregivers, or to the phlebotomist, no attempt should be made until the behavior is addressed.
    c. Laboratory staff should not attempt collections that may put anyone at risk.
    d. The ordering physician should be contacted if the collection cannot be completed.

IV. QUALITY CONTROL

N/A

V. CALCULATIONS/CALIBRATION

N/A

VI. INTERPRETATIONS

N/A

VII. METHOD PERFORMANCE SPECIFICATIONS

N/A

VIII. REFERENCES

Procedures for the collection of Diagnostic Blood Specimens by Venipuncture;
Approved Standard – 5th Edition NCCLS, Wayne, PA, 2003 Vol. 23, H3-A5.

IX. RELATED DOCUMENTS

N/A

X. DOCUMENT HISTORY

X - MINOR REVISION
(Laboratory Director’s Signature on Original Subsequent Document Attached)

MAJOR REVISION
(Requires Laboratory Director & Department Director Signature - where applicable)

Reason for Change

02/10/14 New Document Control Format

06/23/14 Moved procedure to
Specimen Collection Manual



Laboratory Director

(Signature)

Date

Natalie Depcik-Smith, MD
(Print)



Department Director

(Signature)

Date

Robert M. Gay, M.D.
(Print)



Designee

Date

(Print)

(Signature)

(Print)

(Signature)

(Print)

(Signature)

(Print)

(Signature)

(Print)

(Signature)



Download PDF version