NCCT Collection Complications and Corrections 2 — Questions and Answers
Question 1: A patient develops a large, painful swelling at the venipuncture site during blood draw. What is the most likely complication?
- Thrombosis
- Hematoma (Correct answer)
- Phlebitis
- Petechiae
Correct answer: Hematoma
A hematoma forms when blood leaks from the vein into the surrounding tissue, causing visible swelling and pain at the puncture site.
A hematoma occurs when the needle goes through or partially exits the vein, allowing blood to leak into the subcutaneous tissue. Signs include rapid swelling, discoloration, and pain. The phlebotomist should immediately remove the tourniquet, withdraw the needle, and apply firm pressure for at least 5 minutes. Hematomas are more common in elderly patients, those on anticoagulants, or when the needle is inserted at too steep an angle.
Question 2: What should a phlebotomist do if a patient begins to faint during venipuncture?
- Continue the draw quickly to finish before they fully faint
- Remove the needle, apply pressure, and lower the patient's head (Correct answer)
- Slap the patient's face to keep them alert
- Ask the patient to hold their breath
Correct answer: Remove the needle, apply pressure, and lower the patient's head
The draw must be discontinued immediately. The needle is removed, pressure applied, and the patient's head lowered to restore blood flow to the brain.
Syncope (fainting) during venipuncture is a vasovagal response where blood pressure drops and blood flow to the brain decreases. The phlebotomist must stop the procedure immediately, remove the tourniquet and needle, apply pressure to the site, and lower the patient's head between their knees or recline the chair. Ammonia inhalants may be used if available. Continuing the draw risks injury if the patient falls or convulses. The event must be documented in the patient's record.
Question 3: Which of the following conditions makes a patient more susceptible to hematoma formation?
- Dehydration
- Anticoagulant therapy (Correct answer)
- Diabetes mellitus
- Hypertension
Correct answer: Anticoagulant therapy
Patients on anticoagulant therapy have impaired clotting ability, making them more prone to bleeding and hematoma formation at the puncture site.
Anticoagulant medications (warfarin, heparin, direct oral anticoagulants) inhibit the coagulation cascade, prolonging the time it takes for blood to clot. When a vein is punctured, the anticoagulant prevents rapid sealing of the puncture site, allowing blood to leak into surrounding tissue. These patients require extended pressure application (minimum 5 minutes, often longer) after venipuncture. The phlebotomist should ask about anticoagulant use before the procedure.
Question 4: A blood specimen appears hemolyzed (pink/red serum). Which of the following most likely caused this?
- Using a 21-gauge needle
- Drawing blood through an IV line (Correct answer)
- Mixing the tube by gentle inversion
- Applying the tourniquet for 30 seconds
Correct answer: Drawing blood through an IV line
Drawing blood through an IV line can cause hemolysis because the fluid pressure and catheter bore size can damage red blood cells.
Hemolysis occurs when red blood cells rupture, releasing hemoglobin into the serum or plasma and giving it a pink to red appearance. Drawing through IV catheters causes hemolysis because blood is forced through narrow catheter lumens under pressure, creating turbulence and shear forces that destroy cells. Other causes include using too small a needle, pulling the syringe plunger too forcefully, vigorous mixing, or forcing blood through a needle into a tube. Hemolyzed specimens affect potassium, LDH, magnesium, and other analyte results.
Question 5: What is the most common cause of specimen rejection by the laboratory?
- Incorrect tube type
- Hemolyzed specimen
- Mislabeled or unlabeled specimen (Correct answer)
- Insufficient volume
Correct answer: Mislabeled or unlabeled specimen
Mislabeled or unlabeled specimens are the most common reason for rejection because they pose the highest risk to patient safety from potential misidentification.
Specimen labeling errors are the number one cause of laboratory specimen rejection and are considered the most serious preanalytical error. An unlabeled or mislabeled specimen cannot be reliably linked to the correct patient, and reporting results from a misidentified specimen could lead to wrong diagnosis or treatment. Laboratories have strict policies requiring complete labeling (patient name, ID number, date, time, collector initials) at the bedside immediately after collection. A new specimen must be drawn if labeling is incorrect.
Question 6: A phlebotomist notices the blood flow stops during venipuncture. What should be tried first?
- Insert the needle deeper immediately
- Slightly reposition the needle by rotating or pulling back slightly (Correct answer)
- Remove the needle and try the other arm
- Apply a second tourniquet above the first
Correct answer: Slightly reposition the needle by rotating or pulling back slightly
A slight repositioning of the needle (gentle rotation or pulling back) may restore blood flow if the bevel has lodged against the vein wall or passed through the vein.
When blood flow ceases during venipuncture, common causes include the bevel pressing against the vein wall, the needle passing through the vein, or vein collapse. The first corrective action is gentle repositioning: slightly rotating the needle to free the bevel from the wall, or pulling back slightly if the needle has gone through. Pushing deeper increases the risk of nerve injury or hematoma. If repositioning fails, the phlebotomist should release and reapply the tourniquet or try a new site.
NCCT Collection Complications and Corrections 2
A patient develops a large, painful swelling at the venipuncture site during blood draw.
What is the most likely complication?