Phlebotomy 101: Complications

Phlebotomy, while generally a safe procedure, can have potential complications. Common complications that occur during collection include hematoma formation, nerve damage, phlebitis, a collapsed vein, and changes in patient status. By adhering to strict aseptic techniques and following proper procedures, phlebotomists can minimize the risk of these complications and ensure patient safety. 

Hematomas

A hematoma is a localized collection of blood that has escaped from blood vessels and accumulated in the tissue surrounding the puncture site. Essentially, it is a bad bruise.

While most hematomas are small and resolve on their own within a few days, they may cause discomfort.

How Do They happen?

• If the needle punctures through the vein wall, blood can leak into the surrounding tissues.

• Repeated attempts to find a vein can cause minor trauma and increase the risk of bleeding.

• Insufficient pressure applied after the needle is withdrawn can allow blood to continue leaking into the tissues.

• If a patient is taking blood thinner medication (anticoagulants) that increases bleeding time.

• Failure to remove the tourniquet before removing the needle.

Patients with small or fragile veins are more prone to hematoma formation.

How Can Phlebotomists Prevent Hematomas?

Phlebotomists can prevent accidentally forming hematomas by:

• Choosing an appropriate vein and avid areas with visible bruising or scarring.

• Minimizing the number of needle insertions.

• Applying firm and consistent pressure to the puncture site after needle withdrawal until the bleeding stops completely.

• Selecting an appropriate needle size for the size of the vein.

• Being aware of patient conditions that may increase the risk of a hematoma forming. 

Nerve Damage

Nerve damage, in the context of phlebotomy, refers to injury to a nerve caused by direct contact or pressure from the needle during a blood draw. While rare, it can result in pain, numbness, tingling, or weakness in the affected area.

In most cases, nerve damage from phlebotomy is temporary and symptoms resolve within weeks or months.

How Does it Happen?

• The needle may directly puncture or come into close contact with a nerve.

• If the needle is inserted too deeply or if excessive force is used, it can compress or irritate a nerve.

• A large hematoma can sometimes put pressure on nearby nerves.

How Can Phlebotomists Prevent Nerve Damage?

• Avoid veins in areas where nerves are close to the surface.

• Use a gentle and controlled technique when inserting the needle.

• Choose an appropriate needle to minimize trauma.

How Do Phlebotomists Know They Hit a Nerve?

While phlebotomists are highly trained to locate and access veins, nerves can sometimes lie close to the surface or in unexpected locations. We use our knowledge of anatomy and careful palpation to select the best site and minimize the risk of nerve contact. However, even with the best technique, it is sometimes impossible to know definitively if a nerve is being touched. That is why open communication with the patient is absolutely vital. 

• If the phlebotomist encounters unexpected resistance while inserting the needle, it may suggest that the needle is contacting something other than the vein, such as a nerve.

Disclaimer: If you experience sharp, shooting pain, tingling, or numbness during a blood draw, please tell your phlebotomist immediately. Your feedback is crucial for ensuring your safety and comfort.  

Phlebitis

Phlebitis is the inflammation of a vein. 

Most cases of phlebitis are mild and resolve on their own within a few days, however may be tender to touch or very painful.

How Does Phlebitis Happen?

• The needle itself can cause minor irritation to the vein wall during insertion or withdrawal.

• Certain medications, disinfectants, or IV solutions can irritate the vein lining.

• Infection at the puncture site can lead to phlebitis.

What are the Signs of Phlebitis?

• The area around the vein may appear red and feel warm to the touch.

• The vein may be tender or painful.

• Some swelling may occur around the affected vein.

• The inflamed vein may feel hard and cord-like under the skin.

Can Phlebotomists Prevent Phlebitis?

Phlebotomists take several precautions to minimize the risk of phlebitis including:

• Maintaining a sterile environment during the entire procedure.

• Using the correct antiseptic solution and allowing it to dry completely before the procedure.

• Avoiding excessive force or multiple needle attempts.

Collapsed Vein

A collapsed vein occurs when the walls of a vein temporarily or permanently close, obstructing blood flow. This can happen during or after a blood draw. 

How Does a Vein Collapse?

• Repeated needle punctures or improper needle insertion can damage the vein wall, leading to collapse.

• If the bevel of the needle is stuck to the vein of the wall, the suction of the vacutainer tube may cause the vein to collapse.

• If the phlebotomist is using a syringe, a collapsed vein may occur if the plunger is pulled too quickly.

• Prolonged or excessively tight tourniquet application can also contribute to vein collapse.

Preventing Vein Collapse:

• Choosing a suitable vein with good visibility and resilience.

• Avoid excessive force or multiple needle attempts.

• Applying the tourniquet correctly and only for the minimum necessary time (no longer than 1 minute).

• Identifying and avoiding veins that are already fragile or have a history of complications.

If your vein collapses during a blood draw, don't worry! Your phlebotomist may adjust the needle position slightly, try a different vein, or even switch to a different needle, such as a butterfly needle, to access a more suitable vein with your content. Your comfort is our top priority.

Changes in Patient Status

Phlebotomy procedures can occasionally present unexpected challenges. Phlebotomists must be prepared to handle situations like fainting or nausea effectively. 

Fainting (Vasovagal Syncope)

Fainting, also known as vasovagal syncope, can occur in some individuals during or after a blood draw. It is a reflex response that causes a sudden drop in blood pressure and heart rate.

• The signs of blood, needles, or anticipation of pain can trigger a fear response, leading to the release of stress hormones. This can cause blood vessels to dilate, leading to a sudden drop in blood pressure.

• Pain, even mild discomfort during a blood draw, can trigger the vasovagal response. 

If a patient begins to feel faint or show symptoms, the phlebotomist will stop the procedure immediately. 

• Common signs that a patient may faint include pale skin, dizziness, sweating, nausea, blurred vision and a feeling of lightheadedness.

• Patient communication is vital if they feel faint or experience any symptoms they should immediately inform the phlebotomist.  

• Openly discussing any anxieties or concerns the patient may have can help alleviate stress and reduce the risk of fainting.

Nausea and Vomiting

While uncommon, some patients may experience nausea or even vomiting during or after a blood draw.

• Anxiety or fear related to the procedure can trigger nausea.

• Some patients may experience discomfort during the blood collection, which can trigger nausea.

If a patient exhibits signs of nausea or vomiting, the phlebotomist will stop the procedure immediately. They may offer an emesis bin, a tissue, or assist the patient to a safe position. 

• Common signs that a patient may vomit include pale skin, sweating, nausea, feeling faint or lightheaded, abdominal discomfort, and gagging.

Engaging the patient in conversation or offering them something to distract them, such as listening to music can help to reduce the risk of nausea.