Phleb-Finders’ Emergency Protocols

SOP Purpose #

The purpose of this protocol is to standardize how Phleb-Finders independent contractors should handle emergencies during the venipuncture process.

SOP Scope #

This protocol pertains to all venipunctures performed by Phleb-Finders contractors in which there is injury or risk of injury to either the patient or the phlebotomist.

Roles and Responsibilities #

• The CEO provides approval for all phlebotomy procedures.
• The COO, Phlebotomy staffing lead(s), and Phlebotomy Supervisor(s) are responsible to ensure these procedures are followed.
• The Phleb-Finders Independent Contractor is responsible for understanding and following these procedures.

Protocol and Procedures #

The following procedures ensure the safety of the Patient(s) and Phlebotomist(s) at the point of service. This may be at a workplace, residence, or other area selected to perform the blood draw.

Number of Venipunctures Allowed #

• The Phlebotomist is limited to two (2) sticks. If first attempt to draw is unsuccessful, and the Patient is willing, the Phlebotomist may attempt one (1) more time. MAXIMUM of 2 attempts !
• If the second attempt is unsuccessful, the Patient is willing, a supervisor or lead Phlebotomist can make one (1) additional attempt.

Adverse Complications #

Blood collection, whether by venipuncture or finger-stick, can result in adverse complications.

Definitions: #

• Nausea/ Vomiting: Normally caused by vasovagal reaction. This is a physical response from your nervous system that can be triggered by seeing the needle, seeing your own blood, or just feeling anxious about the process.
• Bruising: injury to soft tissue resulting in the leakage of red blood cells from damaged capillary veins. Common reason for Bruising after a venipuncture is not enough pressure applied after the draw or too deep of penetration.
• Excessive Bleeding: the release of blood at the point of penetration. This may be due either to injury during the process or an underlying medical condition. Monitor venipuncture site closely for at least 10 seconds to assure bleeding has stopped.
• Nerve injury: Tingling sensation or sharp pain. STOP and withdraw the needle immediately.
• Fainting: temporary loss of consciousness due to stress or decrease in blood flow to the brain.
• Seizure: Uncontrollable shaking or involuntary movements of part or all of the body.

Nausea/ Vomiting #

The most likely reason a patient may feel sick to their stomach when having blood drawn is that their body is having a vasovagal reaction. This is a physical response from your nervous system that can be triggered by seeing the needle, seeing your own blood, or just feeling anxious about the process.

1. Make the patient as comfortable as possible.
2. Instruct the patient to take deep slow breaths.
3. Apply cold compress to the patient forehead.
4. If vomiting, offer the patient a container to vomit in and offer tissues.
5. Offer small amount of water to rinse out mouth.
6. Stay with the patient until feeling of nausea/ vomiting subsides.

Bruising #

• To prevent bruising the Patient should keep their arm straight while applying firm pressure at the point of puncture for 2 to 5 minutes after completion of the procedure.
• You may ask the patient to apply mild pressure to the site while you label the tubes but you must continue to observe the site.
• Guide the patients hand to the puncture site and press to show the amount of pressure needed.
• Advise the Patient not to lift any heavy objects or otherwise put stress on the site of the venipuncture for at least 2 hours after the blood draw.

A small amount of bruising at the immediate location of the venipuncture is not unusual. If more
extensive or rapid bruising occurs, take the following steps:

1. Elevate the bruised area and apply a cold pack to the site for 10 minutes
2. If the Patient is concerned, have them contact their personal physician for advice
3. If the bruising remains or progressively becomes worse, the Phlebotomist Should Call
   Phleb-Finders to report the incident.
4. Complete an Incident Report Form
5. E-mail the completed Incident Report form to [email protected]

Excessive Bleeding #

In most cases, applying pressure to the puncture site for 3-5 minutes will stop bleeding. Observe the patient closely and watch for hematoma. If hematoma or bleeding persists, apply a gauze pad and wrap until the bleeding has stopped. Instruct the patient to leave on for at least 15 minutes. If it does not:

1. Continue to apply pressure and call 911 emergency services
2. Instruct the Patient to contact his personal physician
3. Call Phleb-Finders to report the incident.
4. Complete an Incident Report Form
5. E-mail the completed Incident Report form to [email protected]

Nerve Damage #

Feeling a sharp pain or tingling could be an indication of nerve injury.

1. Listen to and watch the patient.
2. If you hit a nerve, the patient may jerk his arm or describe a shocking pain.
3. If your patient reports this, immediately stop the procedure and remove the needle.
4. Instruct the patient to elevate his arm and use ice and light pressure on the site.
5. Report to Phleb-Finders to report the incident.
6. Complete an Incident Report Form
7. E-mail the completed Incident Report form to [email protected]

Fainting #

While the amount of blood taken in a single phlebotomy stick is insignificant for a healthy Patient, loss of consciousness can still be caused by the psychological trauma of a (minimal) medical procedure. Phlebotomists should be alert to the warning signs:

•  Dizziness, heart palpitations, sweating, nausea
•  Blurred vision or muffled hearing
•  Shallow or rapid breathing
•  Change in skin color, becoming pale or greyish
•  Changes in posture, particularly slouching or sliding in the chair
•  Changes in behavior- becoming very quiet, nervous, irritable or restless

If any of the above warning signs occur:

1. Remove the tourniquet and needle immediately
2. Allow the Patient to sit still and relax as long as needed and encourage them to take slow, deep breaths.
3. Do not use an ammonia inhaler. It may make matters worth. If symptoms continue:
   a. Have the Patient place their head near their knees
   b. Ask if the Patient needs to lie down, find a comfortable place in a secluded area where the Patient can have their feet elevated and their head cushioned. Carefully assist the patient to the floor.
   c. Apply an ice pack to the back of the head if available.
4. Encourage the Patient to sip juice or water. If the Patient recovers quickly, without fainting
5. Check the Patients pulse. If you have a blood pressure cuff, take their blood pressure. Document all results for the Incident Report Form.
6. Inform the Patient that it is their decision to continue or stop. If they want to continue, carefully monitor the Patient as he/she completes the specimen collection. If they want to stop, end the appointment and document the outcome on the lab consent form.
7. Call Phleb-Finders to report the incident.
8. Complete an Incident Report Form
9. E-mail the completed Incident Report form to [email protected]

If the Patient faints and regains consciousness

1. Remain calm and professional
2. Call 911 immediately
3. Do NOT leave the Patient alone. Stay with them until emergency help arrives.
4. As rapidly and gently as possible, move the Patient to the floor. Use your legs to assist and prevent injury to yourself. If another person is present, ask for help. You cannot administer potentially lifesaving procedures if they remain seated. Place them in the Recovery Position: on their side, facing away from you with their head tilted back to ensure their airways are open. Support their head with your hand. Bend the Patient’s uppermost leg to prop the body up. Provide additional support by kneeling behind the Patient and resting their back against your legs.
5. If respiration is not apparent and/or no pulse is found begin CPR. Follow CPR protocol until emergency medical help arrives.
6. Call Phleb-Finders to report the incident.
7. Complete an Incident Report Form
8. E-mail the completed Incident Report form to [email protected]

For all medical emergencies, if you are uncertain what to do #

1. Do not hesitate to call 911 immediately
2. Call Phleb-Finders to report the incident.
3. Complete an Incident Report Form
4. E-mail the completed Incident Report form to [email protected]

For more information, visit www.cdc.com

Potential Risks: #

Failure to follow these procedures could result in illness, injury, or death of either the patient or the phlebotomist.

The Universal Precaution Rule #

Treat all human blood, bodily fluids, and other potentially infectious materials as if they are infectious. #

Always take precautions to prevent exposure. Blood, bodily fluids, and any devices or materials that come in contact with them can transmit
disease. #

If you are stuck by a needle containing blood or exposed to Blood Bourne pathogens the CDC (Center for Disease Control) recommends the following: #

1. Wash needlesticks and cuts with soap and water
2. Flush splashes to the nose, mouth, or skin with water
3. Irrigate eyes with clean water, saline, or sterile irritants
4. Immediately seek medical treatment
5. Call Phleb-Finders to report the incident.
6. Complete an Incident Report Form
7. E-mail the completed Incident Report form to [email protected]