Routine blood tests are common practice within the healthcare system. While mildly unpleasant, when performed properly there should be no risk of harm to the patient. Millions of Americans visit their doctor’s office every year to have their blood drawn. Whether it’s to seek diagnosis for suspected illness or simply as part of a routine yearly physical exam. Aside from the slight discomfort of the needle stick, a lab draw shouldn’t pose any further pain to the patient. Hundreds of thousands of these tests are performed every day across the United States with no complications.
However, there are as many occasions where this is not the case–and very few discussions about what went wrong; until now. The Shaked Law Blog is known for our truthful, fact-based articles that present unbiased information you won’t find anywhere else. Within this article we’ll provide readers with exactly what they need to know in the event a routine blood test has an unforeseen outcome, leaving pain and complications in its wake.
Whether it’s due to the carelessness of the phlebotomist (a medical professional with the special licensing needed to draw blood) or a registered nurse (a licensed medical professional who works alongside the doctor and cares for patients on a daily basis) who fails to use proper technique to perform the blood draw, any mistake made during a blood test can cause severe and permanent harm to the patient. In cases where nerve damage results as the outcome of improper lab drawing procedure, CRPS (Complex Regional Pain Syndrome; formerly known as RSD) occurs.
In the medical profession, any act that occurs as a result of the intentional recklessness of the healthcare professional is known as malpractice. If the phlebotomist, nurse, or other licensed professional employed to perform lab draws on patients is aware that their actions could cause harm, but they act regardless, they are committing medical negligence. In the event that a jury would find the act of the healthcare professional “unreasonable” under the circumstances under which it was committed, they could find that person liable for medical malpractice. Healthcare professionals, under their license, are liable for the safety of each and every patient they come into contact with.
THE ANATOMY OF A BLOOD DRAW
In order to properly perform a routine blood draw, there are several steps that must be followed in order for a successful outcome. If these steps are not performed in order, or a step is missed or treated without the proper care, a patient can sustain severe injury to the arm. The nerves in the arm are extremely delicate and must be treated with care. Improper handling of a needle or an improperly sized needle used on a patient can result in CRPS, leaving the patient in agony for a lifetime.
The steps that must be followed in order to properly perform a blood draw:
- Proper hand washing technique as per OSHA. Every medical professional that comes into contact with patients or hazardous materials (blood, bodily fluid, excrement) must be certified by OSHA before they can touch a patient. Hand washing must be performed to the letter, to avoid the risk of infection to the nurse and to the patient.
- Apply a tourniquet to the patient’s upper arm in order to locate a vein. This should be done in a timely manner. Locating a vein can be difficult on heavier patients or darker skinned patients, but this is not a reason to neglect the duty of care. Each patient must be treated with care and given the full attention of the healthcare provider. When the vein is located, the nurse must remove the tourniquet and then proceed to step three. If the provider is unsure of whether the vein can be used, they MUST call for assistance from a superior. In the event they use an artery instead of a vein, or knick one of the delicate nerves in the arm, the patient can be caused severe harm.
- Ensure everything necessary is present and within reach. This includes the appropriately sized needle (for children and the elderly, a “butterfly” needle must be used to avoid injury) alcohol wipes, vials for collecting blood, gauze pads, and bandaids. When everything is prepared, double check the area to ensure nothing was missed.
- Apply the tourniquet to the patient’s upper arm in preparation for the blood draw. Clean the area to be used for the blood draw with an alcohol wipe from the inside to the outside of the arm, ensuring no bacteria comes in contact with the area to be drawn. Gently hold the patient’s elbow with one hand while using care to perform the procedure. When the needle is secure, perform the blood draw in the correct order (each vial has a different colored top; for medical professionals this is of utmost importance–misdiagnosis can occur if the vials are not drawn in the correct order).
- Remove the tourniquet from the patient before the last vial is drawn. There is an inherent risk of nerve damage and/or hematoma (a bubble of blood under the skin) if the tourniquet is not removed in a timely manner. It should always be removed before the last vial of blood is drawn. The fingers should never be allowed to turn blue during a blood draw. If this occurs, the procedure must be stopped, the tourniquet and the needle removed in that order, and a doctor must be called immediately.
- Apply pressure, bandaid, raise the patient’s arm. It’s a common misconception that the arm must be held in the downward position after a lab draw. In reality, nursing students are taught to put the patient in a “Statue of Liberty” position (that is, arm raised above the head, if tolerated) for 60 seconds to allow the blood not to pool in the crook of the arm, where most blood tests are performed. It’s also important to inquire whether the patient has a latex allergy, and apply a latex free bandaid if necessary.