Phlebotomist: Troubleshooting a Failed Venipuncture

There are several procedural errors that can cause a failed venipuncture. If an error occurs a phlebotomist should know how to correct the error. It the error is not corrected it may be difficult to obtain blood on the first try. The following error could cause a venipuncture to fail.

Tube Position

How the collection tube is positioned is an important part of the collection process. The tube should be properly seated with the needle in the tube holder penetrating the tube stopper. The tube can be reseated to ensure that the needle sleeve is not pushing the tube off the needle.

Tube Vacuum

If the needle bevel is not completely under the collection tube could loose its vacuum. This could also happen if the bevel backs out of the skin slightly. Whenever there is a loss of vacuum a short hissing sound is often heard. There may also be a spurt of blood in the collection tube before the flow stops. The shipping and handling of tubes can cause them to loose their vacuum. This can easily occur if tubes are bumped together during transport, if they are dropped or if they are pushed to far into the needle before venipuncture. If a tube looses its vacuum, do not use it. Try a new tube instead.

Needle Position

Improper needle position can cause a failed blood draw. There are visual cues that can help to determine if the needle is correctly positioned in the vein. A correct insertion technique is evident by the free flow of blood into the needle. There are several improper needle positions that could impede blood flow. If the bevel is on the upper or lower vein it will not allow for blood flow. If the needle is inserted too far or if the needle is partially inserted, blood could leak into surrounding tissue. A collapsed vein could also cause impede blood flow.

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