Hemolsys
The term hemolysis means breakdown of red blood cells, which is a component of blood. Hemolyzed specimen alters the test results and/or the specimen not viable for the tests.
Measures to prevent hemolysis:
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- Invert the collection tubes with additives by gently inverting the tube. DO NOT mix vigorously.
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- Avoid drawing blood from a hematoma
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- Ensure the skin prep is completely dry
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- Avoid prolonged tourniquet application or fist clenching
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- When using blood with a syringe, avoid drawing the plunger back too forcefully
Anticoagulant reflux:
Blood may reflux (flow back) into the vein during venipuncture, causing a reaction to the tube additive. Hold the collection tube below the venipuncture site to fill from the bottom up
Hematoma:
Hematoma is pooling of blood in the tissues around the venipuncture site. Discoloration of the skin from a hematoma may last for several days.
<insert picture of hemotoma>
Measures to prevent hematoma:
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- Select larger veins and use small gauge needles on small and fragile veins
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- Ensure the needle bevel is entirely in the vein. Otherwise, blood may leak into surrounding tissues resulting in hematoma.
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- Do not apply tourniquet above previous venipuncture site or attempted venipuncture sites
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- Be aware of the patient’s condition (bleeding disorders, thrombocytopenia) and medications such as aspiration and anticoagulants
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- Upon removal of the needle, apply digital pressure until bleeding stops and then apply pressure dressings
Arterial Puncture:
- Signs and symptoms include but, not limited to bright red blood color, pulsating blood flaw and excessive bleeding from the insertion site
Prevention and Management:
Be aware of vascular anatomy during the venipuncture. The Brachial artery is present in the cubital fossa close to basilic vein. The Radial artery is in the hand extending to the wrist where it is close to the cephalic vein of the forearm. Prior to the venipuncture, palpate. Avoid the area, if you feel pulse.
In case of an accidental arterial puncture, immediately remove the tourniquet and needle, fold gauze pad, apply digital pressure at the insertion site until bleeding stops (10-15 minutes). Then apply pressure dressings and ask the patient to keep the dressings for 24 hours.
Nerve damage:
Accidently puncturing a nerve during venipuncture may lead to irreversible permanent disability such as complex regional pain syndrome
Prevention: The median nerve runs inside the antecubital fossa and passes through the forearm into the palm of the hand. During venipuncture as the needle is being inserted, if the patient complains of an electric shock-type pain radiating down into his or her hand, immediately remove the needle and select another site.
Fainting:
Fainting may be due to fear of needles (needle phobia), pain, site of blood or extreme emotional distress. Reassure the pediatric and anxious patients he/she will experience very minimal pain only for few seconds during the needle being inserted, there is no pain during the specimen collection and as the needle removed.
Ensure the patient is sitting or lying down comfortably, may turn the head away to the opposite side.
