Complications of venepuncture

doi:10.4236/abb.2013.41A018

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Advances in Bioscience and Biotechnology, 2013, 4, 126-128 ABB

http://dx.doi.org/10.4236/abb.2013.41A018 Published Online January 2013 (http://www.scirp.org/journal/abb/)

Complications of venepuncture

Omiepirisa Yvonne Buowari

Medical Women Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria

Email: [email protected]

Received 20 November 2012; revised 27 December 2012; accepted 15 January 2013

ABSTRACT

Venepuncture is the commonest procedure performed

in health care settings. A review of literature and

search on complications of venepuncture and blood

collection. This procedure is without complications,

which sometime can be fatal. Complications that can

arise from venepuncture include haematoma forma-

tion, nerve damage, pain, haemaconcentration, extra-

vasation, iatrogenic anaemia, arterial puncture, pete-

chiae, allergies, fear and phobia, infection, syncope and

fainting, excessive bleeding, edema and thrombus.

Keywords: Venupucture; Haematoma; Complications;

Syncope

1. INTRODUCTION

Venepuncture is the most common invasive medical

procedure performed by health care providers [1,2].

Early detection and good communication between the

patient and health care provider is important whenever

venepucture is performed to prevent serious compli-

cations. Venepuncture is the act of puncturing the vein

for giving a drug or removal of blood [2,3]. Venepunc-

ture has been practiced for centuries and is still one of

the most common invasive procedures in health care [2].

However, practices vary considerably between countries

and between institutions and individuals within th e same

country. These differences include variations in blood

sampling technique, use of safety devices, disposal me-

thods, disposal methods, reuse of devices and availa-

bility of hepatitis b vaccine [2].

Venepuncture should be performed with care. Uni-

versal precautions should be observed at all times to

protect the patient and health care provider. Gloves

should always be worn when obtaining blood specimens.

Before beginning any procedure, identify the patient

accurately [3]. The veins of a patient are the main source

of specimens for testing the entry point of medications

and the site for intravenous infusion and blood transfu-

sions because there are only a limited number of easily

accessible veins in a patient, it is important that everyth-

ing be done to preserve their good condition and availa-

bility [3].

Blood can be collected from a patient for laboratory

investigations, blood donation or therapeutically to re-

duce the amount of blood as in patients with polycy-

themia Vera. Blood investigation and analysis is one of

the commonest diagnostic tool u s ed by doctors.

A variety of adverse complications may be encoun-

tered during blood collection process [4]. Laboratory

investigations request by doctors is an important com-

ponent in the diagnosis and treatment of patients. A

superficial vein most commonly used for venepuncture.

The best sites for venepuncture of superficial veins of the

upper limbs are the median cubital vein. It lies over the

cubital fossa and serves as an anastomosis between the

cephalic and basilic veins [5]. The cephalic vein in both

the forearm and arm can be followed proximally where it

empties into the axillary vein, the basilic veins joins the

brachial vein [5]. Inappropriate sites for venepuncture

are arm on side of mastectomy, edematous areas, haema-

tomas, arms in which blood is being transfused, scarred

areas, arms with fistulas or vascular grafts and sites

above an intravenous cannular [5]. Serious complications

can occur because of venepuncture even when only a

small volume of blood is withdrawn; therefore, medical

personnel should be prepar ed to provide appropriate care

1. Areas that have been burnt or scarred should be

avoided during phlebotomy [4,6]. Burned areas are very

sensitive and susceptible to infection whereas veins

under scarred areas are difficult to palpate [4,6] and

difficult to insert need le [4].

In a study by Kagel and Rayan, the most common sites

for developing complications in order of frequency are

forearms, hand, wrist and antecubital fossa [7]. Patients

whose veins have been repeatedly punctured often be-

come scarred and feel hard when palpated [4].

2. HEMATOMA FORMATION

2.1. Hematoma Formation Is the Most Common

Complication of Venupuncture

This type of complication is caused by blood leaking into

the tissues during or after venepuncture. A common sign

of this complication occurring is swelling at or near the

OPEN ACCESS

O. Y. Buowari / Advances in Bioscience and Biotechnology 4 (2013) 126-128 127

venepuncture site.

Haematoma complication can occur as a minor com-

plication of venepuncture 1. The haematoma forms under

the skin adjacen t to the puncture site [6]. When it occurs

release the tourniquet immediately, withd raws the needle,

and apply firm pressure [6]. Haematoma occurs when the

area around the puncture sites begins to swell indicating

that blood is leaking into the tissues, wh ich will result in

a bruise [2,4] due to partial insertion into the vein 4. If

this happens, immediately remove the needles apply

pressure for two minutes and recheck to ensure bleeding

has stopped [4]. To avoid haematoma formation from

venepuncture, puncture only the uppermost wall of the

vein just under the skin, remove the tourniquets before

removing the needle, use the major superficial veins,

make sure the need le fully penetrates the uppermost wall

of the veins because partial puncture may allow blood to

leak into the tissue just und er the skin and ap ply pressure

to the puncture site. Haematoma is formed when blood

leaks into the tissue surrounding the insertion site after

failure to penetrate the vein properly during insertion [8 ].

Haematoma is a collection of blood under the skin [9]. If

a haematoma begins to form while blood is being with-

drawn, the needle should be removed immediately and

pressure maintained over the site [9]. Some of the causes

of haematoma formation after venepuncture are small

fragile veins, needle too large, excessive probing to find

vein, removing the needle prior to releasing the tourni-

quest, needle going all the way through the vein, needle

only partially entering the vein allowing leakage, apply-

ing pressure to gauze before the needle is removed [9].

2.2. Infection

This may be localized giving rise to thrombophlebitis or

systemic leading to septicemia. The infection may be

localized or systemic. However, peripheral intravenous

cannula infections are more commonly associated with

localized than systemic infection [10]. Inadequate clean-

sing or poor technique can lead to infection [9]. Infection

can cause phlebitis and thrombus formation [8]. It is

prevented by good aseptic technique and keeping any

dressing over the venepuncture site clean [8,11]. Phlebi-

tis is an acute inflammation of the intima of the veins [8].

It is caused by mechanical and chemical irritation or by

microscopic particles that may contaminate infusion flu-

ids’.

2.3. Nerve Damage

Hematoma formation following venepucture can be pain-

ful and can potentially cause nerve damage [2,9]. Among

complications associated with phlebotomy, nerve injury

is relatively rare, but is potentially serious and often re-

sults in malpractice lawsuits [12]. Patient may feel sharp

electric tingling if a nerve is hit. Immediate discontinue

that venepuncture and the patient may need physical

therapy [4]. Inap propriate sites or excessive probing may

lead to nerve damage [9]. Patient may complain of se-

vere pain and the procedure should be stopped immedi-

ately [9].

2.4. Haemoconcentration

This can result from prolonged tourniquet application. It

can be caused by prolonged tourniquet application, mas-

sageing, squeezing or probing a site, long-term intrave-

nous fluid therapy, scleroses or occluded veins, dehydra-

tion and certain diseases [4]. Haemoconcentration may

cause false increase in potassium ion, phosphorus, am-

monia and total protein [4]. Intravenous line complica-

tions can result in morbidity and increased health care

costs from prolonged hospitalization, extended use of

intravenous antibiotics therapy and surgical intervention

[7].

2.5. Extravasations

Extravasations occurs when a cannula pulls out of the

vein or becomes partly occluded by venous construction

causing backflow of the infusate through the puncture

site into the surrounding tissues [8]. The patient may

complain if tightness, burning and discomfort around the

intravenous site and th ere may be swelling and b lanch ing

of the tissues [8]. In extravagation, the cannu la enters the

tissues rather than the vein [11]. In this condition, flush-

ing will be difficult and swelling/pain may be noted the

cannula should be removed immediately.

2.6. Syncope and Fainting

Patients may become dizzy and faint at the thought or

sight of blood [6]. It is caused because of rapid fall in the

blood pressure and it is an autonomic nervous system

reaction (psychomatic trigger) usually based on fear [6].

Syncope and fainting can procure during venepuncture

[1,4].

2.7. Petechiae

Petechiae may occur following venepuncture. This may

be due to coagulation problems or abnormalities [4,6].

The patient may bleed excessively after blood collection;

make sure bleeding stops prior to leaving the patient.

2.8. Excessive Bleeding

Excessive bleeding after venepucture can occur. In-pa-

tient on anticoagulants, on drugs such as aspirin medica-

tion or drugs that decrease the number of platelets [4].

The patient should not be left alone until bleeding has

stopped.

O. Y. Buowari / Advances in Bioscience and Biotechnology 4 (2013) 126-128

128

2.9. Edema

This is abnormal accumulation of fluids in the intercel-

lular spaces of the body and it can be localized or dif-

fused [4]. Collection of blood should be avoided from

these sites, which will contaminate specimen with tissue

fluid [4].

OPEN ACCESS

2.10. Fear and Phobia

Fear and phobia may occur in some patients on seeing

the needle. This may cause the patient to move puncturing

the artery rather than the vein [11]. The needle should be

withdrawn and pr essure applied.

2.11. Thrombosis

Thrombus is a solid mass derived from blood clot con-

stituents in the vessels that is a clot. Thrombus may par-

tially or fully occlude a vein or artery making venepunc-

ture difficult [4].

2.12. Arterial Puncture

The artery can be punctured instead of the vein. When

this occurs, the needle should be removed immediately

and pressure app lied over the site.

2.13. Pain

While some discomfort is to be expected, the needle

should be removed immediately if the patient complains

of excessive or severe pain [ 9 ] .

2.14. Allergies

The patient may be allergic to th e cleaning agen t or other

solutions used to disinfect the site therefore ask for any

allergy. Some patients have latex allergy.

2.15. Iatrogenic Anemia

Anemia may occur when large volumes of blood are

collected for investigation s and is common in infants.

REFERENCES

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582-584.

[2] World Health Organization (2010) WHO guidelines on

drawing blood: Best practices in phlebotomy.

http://www.who.int/en/

[3] West Tennessee Health Care Integrated Laboratory. Ve-

nepuncture. Physicians’ laboratory handbook.

www.gomcl.com

[4] Complications in blood collection. Professional and Lin-

guistic Assessments Board 1223/1023, 66-71.

[5] The BD Vascuta iner Blood Collection Syste m. He lpin g a ll

people live healthy lives. http://www.bd.com/vascutainer

[6] Edtexx Medical Cooperation (2007) Funda mental s of p h le-

botomy. 2nd Edition, Texas Tech University, Lubbock,

43-53. www.depts.ttu.edu

[7] Kagel, E.M. and Rayan, G.M. (2004) Intravenous cathe-

ter complication in the hand and forearm. Journal of Trau-

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doi:10.1097/01.TA.0000058126.72962.74

[8] University Section of Anesthesia, Pain and Critical Care

Medicine. Venepuncture and intravenous cannulation. Cli-

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[9] Phlebotomists Association of Ireland Ltd. (2010) Phle-

botomy guidelines. 25-26.

www.pairl.ie/doc/pal_guidelines_pdf

[10] Morris, W. and Tay, M.H. (2008) Strategies for prevent-

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[11] Ohrishi, H., Watanabe, M. and Watanabe, T. (2012) But-

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[12] Cole, E. Cannulation and venepuncture.

http://www.cefl.org.uk/