How to Identify the Most Common Venipuncture Complications like a Pro
Venipuncture is an art as much as it is a science. Though tools are coming out that make the procedure a lot easier, you should be well informed of the potential complications. In this post, we’ll cover many of these and go over suggested best practices. If you're a newly minted nurse, the prospect of performing daily venipuncture may keep you up at night, but fear not. Soon enough it will be second nature. Until then, keep this guide
Fainting, or syncope, occurs equally in all ages and in both sexes. Fainting may occur more often in some families than in others. In general, Syncope can be caused by pain, trauma, anxiety, blood loss and standing still for too long. For some people, giving blood is a strong fainting trigger. Here is how these individuals respond to giving blood:
- Dilation of peripheral blood vessels
- Sudden drop in blood pressure
- Slowed heart rate
Before a patient faints, they may become dizzy. Often, the precise trigger is the sight of blood and not the prick of the needle itself.
Signs That a Patient Is about to Faint
Signs that a patient is about to faint include:
- Shallow breathing
- Blood draining from the face
What to Do?
Even if you know the patient has a history of fainting, verbally ask them if they do. If they say yes, ask them to lie down. If they say no, find a way to ask them to lay down anyway. During the procedure, if the patient says they feel faint or dizzy, remove the needle immediately. Ask the standing patient to lower their head and breathe slowly.
Apply a wet towel to the back of the patient’s head and offer juice or water to drink. If the patient faints, break the fall and ask for help to move them.
Never allow the patient to leave until they have fully recovered. Finally, fill out a detailed incident report.
Needle Inserted Incorrectly or Vacuum Failure
If you think you’ve inserted the needle incorrectly, gently reposition. Never dig for veins. Use a vein illuminator if you can’t identify an appropriate vein. If you think the problem is vacuum within the tube, replace it. Always keep spare tubes within arm’s reach.
This condition is characterized by a small red or purple dot. It is caused by bleeding into the skin. Before you draw blood, you should always check the target area for these spots because they can indicate ruptured veins. If you detect these spots, reposition.
Petechiae can also be caused by blood coagulation and can indicate issues that are more serious.
If you must draw blood from an affected area, know that the patient may bleed more than usual. Always ensure bleeding has stopped before the patient leaves.
Hematoma is characterized by swelling around an injection site. As blood seeps into surrounding tissues, a bruise forms. Hematoma is often the result of partial needle insertion into a vein. If you detect hematoma, remove the needle immediately and apply pressure for a few minutes. Then make sure that the bleeding has stopped and don’t forget to fill out your incident report!
Always check to see if a patient is taking anti-coagulants or aspirin before venipuncture as these drugs can cause excessive bleeding. Unfortunately, your patient may not always disclose the use of herbal preparations, so you must be on guard for excessive bleeding at all times. Be on guard when a patient presents with low platelet counts.
If the patient bleeds excessively after venipuncture, don’t leave their side until bleeding has stopped. Similarly, discourage the patient from leaving until they've stopped bleeding.
If you hit a nerve, the patient may feel a sharp, electric tingling. Immediately remove the needle and fill out an incident report.
If your patient exhibits symptoms of seizure, immediately stop venipuncture. This is a rare complication, but a serious one. Never place anything in the mouth of a patient who is exhibiting seizure symptoms. Always fill out an incident report.
Obese patients tend to present with deep veins. They’re harder to reach, although the use of a quality vein illuminator can help. Otherwise, you may have to depend on your knowledge of anatomy to find a vein. Blind sticks can tax both nurse and patient. If you can’t find a vein, ask for help from more experienced personnel. Never dig for veins. If all else fails, consider a finger stick.
When fluids build up where they shouldn’t, finding a vein can be downright impossible. Edema may be local, or it may be present in large areas of the body. Generally, you should avoid drawing blood from affected areas. The most common areas affected by edema are the hands and feet, though you may find fluids in the arms and legs.
Veins can become hard due to inflammation or by disease processes. Additionally, patients who undergo frequent venipuncture may have scarred veins. These veins feel exceptionally hard to the touch. You are better off avoiding them.
Hemoconcentration is a build-up of large molecules in the blood. A few things that can cause hemoconcentration include:
- Repeated and prolonged tourniquet use
- Long-term IV therapy
- Squeezing or massaging a site for too long
- Occluded veins
Hemoconcentration may cause localized increases in phosphorous, ammonia, certain proteins and potassium.
Collapsed veins are most often caused by pulling the plunger back too quickly or with too much force. You should always use gentle pressure when drawing blood. It can also be caused by vacutainer use on veins that are too small.
Burned Areas of the Skin
You should always avoid burned or scarred areas of the skin. Burned areas are extremely sensitive. Perhaps more importantly, they are very susceptible to infection. Veins beneath scar tissue are difficult to palpate.
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