Phlebotomy Puncture Juncture: Preventing Phlebotomy Errors - Potential For Harming Your Patients

Helen Ogden-Grable, MT(ASCP)PBT; Gary W. Gill, CT(ASCP), CFIAC

Disclosures

Lab Med. 2005;36(7):430-433. 

In This Article

Abstract and Introduction

  • Phlebotomy errors may cause serious harm to patients -- up to and including death, either directly or indirectly.

  • It is essential, therefore, to establish, implement, and practice quality control in phlebotomy.

  • Quality control consists of those materials and methods practiced in real time in every venipuncture to promote intended outcomes.

The number of patients that may be harmed while undergoing phlebotomy[1] procedures is enormous based on a consideration of sheer numbers alone. In this country, we estimate more than 1 billion venipunctures are performed annually. The Fall 2004 BOR Newsletter lists the fact that 26,773 phlebotomy technicians have been certified since the PBT registry examination was introduced in 1989. Prior to the introduction of safety devices,[2] phlebotomists suffered an estimated 600,000 needlestick injuries or more annually. One can imagine, therefore, the potential for harm to patients who, after all, are on the receiving end of every venipuncture.

Phlebotomists enjoy the privilege of patient trust, as they are being permitted to perform an invasive procedure that no healthy individual would ordinarily volunteer to undergo. The dictum "first, do no harm"[3] applies to phlebotomists as well as to physicians. Indeed, the etymology of "safety" is salvus, meaning "freedom from harm."

Phlebotomy errors may cause serious harm to patients -- up to and including death, either directly or indirectly. This statement might sound radical until we investigate the many possible errors that might occur while performing a blood collection procedure. It is essential, therefore, to establish, implement, and practice quality control in phlebotomy. Phlebotomists who normally work independently and without direct supervision in the hospital setting or in the outpatient facility must take the responsibility for performing quality control on their own work. Quality control consists of those materials and methods practiced in real time in every venipuncture to promote intended outcomes.

First let's take a look at the errors that could occur in a typical phlebotomy setting[4]:

  • Identifying the patient

  • Communicating with the patient

  • Selecting the venipuncture site

  • Sites for capillary skin puncture

  • Choosing the "right stuff"

  • Special considerations related to patients

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