7 Complications and Quality Practices

Responding to collection complications

Respond to complications promptly, protect the patient and collector, and preserve specimen quality. Follow current facility procedures and your training. Do not continue a collection when it is unsafe or outside your scope of practice.

Collection complications

• Hematoma: Blood may leak into tissue and cause swelling or bruising. Stop the draw, release the tourniquet, remove the needle safely, and apply firm pressure. Do not probe or redirect the needle under the skin. Notify the appropriate clinician if swelling is significant or does not resolve.

• Fainting or near-fainting: Stop the draw, remove the needle safely, and protect the patient from falling. Call for help and follow the facility’s response procedure. Do not leave the patient alone or resume collection until it is safe and authorized.

• Pain, tingling, or an electric-shock sensation: Stop immediately because these symptoms may indicate nerve irritation or injury. Remove the needle safely and report the event according to policy. Never continue collecting through persistent or sharp pain.

• No blood flow: Check that the tube is seated correctly and the collection equipment is functioning. Possible causes include a missed vein, the needle resting against the vein wall, or a collapsed vein. Do not probe. Make a cautious small adjustment only if permitted by training and policy; otherwise stop and seek assistance. Use another site only as permitted by policy and the patient’s condition.

• Hemolyzed or otherwise unsuitable specimen: Collection or handling problems can cause hemolysis, including forceful aspiration or transfer, vigorous tube shaking, or improper processing. Follow laboratory rejection and recollection procedures rather than altering or concealing a specimen-quality problem. A standardized collection process includes correct tube sequence and technique.

• Patient distress, nausea, or movement: Pause, secure the equipment, and respond to the patient’s immediate needs. If the patient becomes unresponsive or the situation is beyond your training, summon help and follow emergency procedures.

For example, if a patient reports sudden shooting pain during venipuncture, stop rather than repositioning the needle. Remove it safely, apply pressure, inform the appropriate clinician, and document the event according to policy.

Quality assurance and specimen integrity

Quality assurance (QA) is the planned, ongoing work of preventing errors and checking that the collection process meets established requirements. Phlebotomists contribute to QA through practices such as:

1. Confirming the order and preparation requirements: Check the requested tests and any required timing, fasting, or special handling instructions. Ask for clarification when instructions conflict or are unclear.

2. Performing positive patient identification: Use the identifiers required by facility policy and compare them with the order or wristband. Do not rely on a room number or a familiar face.

3. Collecting, labeling, and handling correctly: Use the specified container, collection sequence, and handling conditions. Label specimens in the required manner at the collection site and time; never pre-label tubes for multiple patients. Maintain patient identification and specimen integrity from collection through testing and reporting.

4. Checking specimen acceptability: Confirm that the specimen is properly identified, collected in the correct tube, and sufficient and suitable for the requested test. Follow laboratory policy for leaking, clotted, hemolyzed, improperly timed, or mislabeled specimens. Do not relabel or correct a specimen in a way that bypasses required identity safeguards.

5. Learning from errors and near misses: Report problems through the established quality or safety process. Accurate reporting helps identify recurring causes and improve procedures.

Laboratories must establish and follow procedures for specimen collection, labeling, storage, transport, processing, and acceptance or rejection.

Documentation and reporting

Record information promptly, accurately, and objectively in the approved system. Depending on facility policy, documentation may include:

• Collection date and time, collector identity, and specimen type or source when required.

• Patient-identification checks and required collection details, such as timed draws or special handling.

• Failed or incomplete collections, recollections, patient refusal, complications, and the identity of anyone notified.

• Specimen problems, corrective actions, and any required incident or exposure report.

Document what happened, not guesses or blame. Follow confidentiality rules and disclose patient information only for authorized work purposes.

Safety and professional responsibilities

Treat blood and other potentially infectious materials as potentially hazardous. Use required personal protective equipment, hand hygiene, and approved sharps-safety devices. Activate the safety feature and promptly discard used sharps into the designated sharps container. Do not recap, bend, or break contaminated needles.

If an exposure occurs, begin the facility’s immediate response process and report it promptly for evaluation and follow-up. Employer protections include exposure-control procedures, engineering and work-practice controls, training, and post-exposure processes.

Professional practice also means explaining the procedure respectfully, obtaining cooperation, maintaining privacy, and respecting a patient’s refusal. Seek help when a situation exceeds your competence or authority. Never collect from an unapproved site or improvise around a safety or identification requirement.