Complications

• Herbs, Vitamins, and Dietary Supplements Having Effects on Coagulation and Blood Clotting

  • Garlic
  • Ginkgo biloba
  • Ginseng
  • Anise
  • Dong Quai
  • Omega-3 fatty acids in fish oil
  • Ginger
  • Vitamin E
  • Fucus
  • Danshen
  • St. John’s wort
  • Alfalfa
  • Coenzyme Q10
  • Bilberry
  • Bladder wach
  • Bromelain
  • Cat’s claw
  • Celery
  • Coleus
  • Cordyceps
  • Evening primrose
  • Fenugreek
  • Feverfew
  • Grape seed
  • Green tea
  • Guarana
  • Guggu
  • Horse chestnut seed
  • Horseradish
  • Horsetail rush
  • Licorice
  • Prickly ash
  • Red clover
  • Reishi
  • Sweet clover
  • Turmeric
  • White willow
• Patients taking herbs often do not realize the side effect of bleeding that can occur
• Excessive post venipuncture bleeding may occur with herbal medications
• Apprehensive Patients may require assistance from nurses during venipuncture
• Fainting (syncope) is caused by insufficient blood flow to the brain
• Vasovagal reaction causes fainting (syncope)
• Triggers for fainting (syncope) include the sight of blood, having blood drawn, fear of bodily injury, standing for long periods of time, heat exposure, and exertion
• Conditions that can cause fainting include postural hypotension, dehydration, low blood pressure, heart disease, anemia, hypoglycemia, and neurological disorders
• Symptoms before fainting include paleness of the skin, hyperventilation, lightheadedness, dizziness, nausea, a feeling of warmth or cold, clammy skin
• Phlebotomists must be aware of symptoms and monitor patients throughout the venipuncture procedure
• Apprehensive patients and fasting patients may be prone to fainting
• Herbs, vitamins, and dietary supplements can interfere with blood tests and should be discontinued before tests
• Patients with a history of fainting may faint again during collection
• Ammonia inhalants are not recommended according to CLSI standards
• In a syncope or seizure situation, notify designated first-aid–trained personnel immediately
• Seizures during venipuncture are rare. Remove tourniquet and needle, apply pressure, and summon help
• Restrain the patient only to prevent injury in a seizure situation. Do not place anything in the patient’s mouth
• Report any very deep puncture caused by sudden movement by the patient to the physician
• Document the time a seizure starts and stops according to institutional policy
• Patients presenting with petechiae may have prolonged bleeding following venipuncture, indicating a coagulation disorder
• Venipuncture Complications


  • Petechiae
  • Allergies
  • Vomiting
  • Additional Patient Observations
  • Patient Refusal
  • Fainting
• Petechiae


  Small, nonraised red hemorrhagic spots that may indicate a coagulation disorder such as a low platelet count or abnormal platelet function
• Petechiae


  Additional pressure should be applied to the puncture site following needle removal
• Allergies


  Patients may be allergic to alcohol, iodine, latex, or adhesive bandage glue. Precautions include using alternate antiseptics, paper tape, self-adhering wrap (Coban), and nonlatex products
• Vomiting


  If a patient experiences nausea or vomiting before, during, or after blood collection, instructions include deep breathing, cold compresses, providing an emesis basin or waste-basket, rinsing the mouth with water, and notifying the nurse or designated personnel
• Additional Patient Observations


  Phlebotomists must be alert for changes in a patient's condition and notify the nursing station
• Patient Refusal


  Some patients may refuse to have their blood drawn. The phlebotomist can discuss the issue with the nurse to convince the patient to agree to the test
• Fainting


  Patients may faint during blood collection. Instructions include removing the tourniquet and needle, applying pressure, notifying the nursing station, supporting the patient, laying the patient flat, loosening tight clothing, and providing sweet drinks for outpatients who have been fasting
• Phlebotomists should carefully listen to the patient and observe body language. Patients have the right to refuse to have their blood drawn
• Equipment Assembly


  Positioning equipment within easy reach, including extra evacuated collection tubes to account for potential issues with vacuum levels or tube detachment during blood collection
• Tourniquet application


  1. Always screw the needle onto the holder tightly

  2. Release the tourniquet immediately if the needle becomes unscrewed from the holder

  3. Activate the safety device when removing the needle
• Only the necessary amount of equipment is brought into isolation rooms
• For patients on the psychiatric unit, leave the phlebotomy tray at the nursing station and take only the necessary equipment into the room
• Do not leave any type of equipment in the patients’ room
• Using a blood pressure cuff to locate veins

  Inflate the cuff to a pressure of 40 mm Hg
• Too much pressure affects the flow of arterial blood
• Consider routinely using latex-free, single-use tourniquets
• Application of the tourniquet for more than 1 minute interferes with some test results
• The Clinical and Laboratory Standards Institute (CLSI) sets the limit on tourniquet application time to be 1 minute
• The tourniquet should be released as soon as the vein is accessed