During a draw, swelling begins to form around the needle. What should the phlebotomist do?
- Release the tourniquet, remove the needle and apply firm pressure
- Finish filling the tubes quickly and then apply a firm pressure bandage
- Push the needle slightly deeper to get back into the vein
- Tighten the tourniquet to slow the bleeding into the tissue
Show the answer
A. Release the tourniquet, remove the needle and apply firm pressure
Swelling means blood is leaking into the tissue, so the draw is stopped at once: tourniquet off, needle out, pressure on. Carrying on enlarges the hematoma, can compress nerves and gives a specimen of doubtful quality.
Reference: CLSI GP41: complications, hematoma
Which action is most likely to cause a hematoma?
- Removing the needle while the tourniquet is still on
- Releasing the tourniquet once blood flow has started
- Holding pressure on the site with the arm kept straight
- Using a 21-gauge needle on a large median cubital vein
Show the answer
A. Removing the needle while the tourniquet is still on
With the tourniquet still tight, pressure in the vein forces blood out through the puncture when the needle is withdrawn. The other choices are correct technique that helps prevent bruising.
Reference: Venipuncture complications: hematoma prevention
A seated outpatient says "I feel dizzy" and turns pale during the draw. What should the phlebotomist do first?
- Finish the last tube as quickly as possible
- Go to the front desk and call for a nurse
- Offer the patient some water or fruit juice
- Release the tourniquet and remove the needle
Show the answer
D. Release the tourniquet and remove the needle
The draw is stopped and the needle removed at once so the patient is not injured if they faint; pressure is applied and the patient is supported and has the head lowered or is laid flat. The patient is never left alone, and nothing is given by mouth to someone who may lose consciousness.
Reference: CLSI GP41: complications, syncope