Alicia Hayes, Case Manager at Medical Protection, looks into the causes of phlebotomy claims and complaints received by Medical Protection.

The taking of blood, phlebotomy, occurs very regularly in the healthcare setting. Despite its frequency, or perhaps because of it, Medical Protection often sees cases arising from injuries suffered by patients during this routine practice. The purpose of this article is to remind practitioners of the risks involved in phlebotomy and provide practical advice, which aims to reduce the risk of adverse incidents or injuries occurring.

Any procedure, whether it be straightforward or complex, carries potential risks. While the risks associated with phlebotomy in general practice are generally low, the risk of patients suffering an injury if they faint during the procedure should nonetheless be assessed carefully.

Fainting

A relatively low percentage (less than 5%) of patients faint (usually due to a vasovagal syncope) during or immediately after the drawing of blood. While for the most part no long-term consequences are suffered by the patient, Medical Protection recommends taking steps to reduce the risk of injury, if a patient does faint. Patients can suffer significant dental or facial injuries/lacerations or even a serious head injury if their faint is not anticipated or appropriately planned for. Being mindful of and preparing for this scenario will reduce the risk of the patient suffering an injury but also the prospect of a claim for compensation being made.

Practical advice: dos and don’ts

• DO prepare by asking appropriate questions before you begin, which will establish whether the patient is at increased risk of fainting.

• DO ask the patient whether they are nervous around needles or whether they have previously fainted when having blood taken.

• DO ask the patient whether they ate prior to their visit. Consider whether the patient has had to fast for these blood tests.

• DO consider other risk factors such as whether the patient has hypotension.

• DO, depending on the answers provided, consider having the patient lie down.

• DO ensure the patient is seated safely back into the chair and there are arm rests on each side.

• DO NOT have the patient sit on the edge of a clinic bed, which has no arm rests or other protective features.

• DO ensure that you have all the equipment needed for the procedure before you begin so that you can be by the patient’s side for the duration.

• DO NOT turn your back at any point or leave the patient’s side even for a moment to retrieve something (such as a blood tube).

• DO look out for signs of impending syncope which would include the patient’s skin going pale, hyperventilation, pupils becoming dilated, or if they become suddenly silent. In addition, a patient may mention they feel lightheaded or nauseous, or are experiencing a cold sweat.

• DO consider how you might summon help quickly in advance if the patient were to faint.

• If the patient does faint, release the tourniquet and remove the needle while also ensuring that you do not inadvertently sustain a needlestick injury. Gently lower the head of the patient below the level of the heart and summon help. 

If a patient does suffer an injury during a faint, after ensuring that the patient has received the treatment they need, ensure that you make full and thorough notes in the medical records regarding the incident, immediately after it has happened. We would also recommend you complete an Adverse Event Analysis. Both steps will assist if a subsequent claim is made. Medical Protection is on hand to provide advice and assistance if an incident like this occurs, and with any resulting complaint or claim.

In summary, while the taking of blood is a very routine procedure, do not allow complacency to creep in. Being mindful of the risks it involves will help to reduce the likelihood of an adverse incident occurring and in turn a potential claim for compensation, if injuries are suffered.