WHO guidelines on drawing blood : best practices in phlebotomy

Abstract

Phlebotomy – the drawing of blood – has been practised for centuries and is still one of the most \rcommon invasive procedures in health care. Each step in the process of phlebotomy affects the \rquality of the specimen and is thus important for preventing laboratory error, patient injury and \reven death. For example, the touch of a finger to verify the location of a vein before insertion of \rthe needle increases the chance that a specimen will be contaminated. This can cause false blood \rculture results, prolong hospitalization, delay diagnosis and cause unnecessary use of antibiotics. \rJostling and jarring of test tubes in transit can lyse or break open red blood cells, causing false \rlaboratory results. Clerical errors in completing forms and identifying patients are common, \rcostly and preventable. Other adverse effects for patients are common; they include bruising \rat the site of puncture, fainting, nerve damage and haematomas. These guidelines outline the \rsimple but important steps that can make phlebotomy safer for patients.\rPhlebotomy also poses risks for health workers. It is still common to see a phlebotomist carry \rout dangerous practices known to increase the risk of needle-stick injury and transmission of \rdisease. Dangerous practices include:\r• \rrecapping used needles using two hands; \r• \rrecapping and disassembling vacuum-containing tubes and holders; \r• \rreusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and \rsometimes blood; \r• \rworking alone with confused or disoriented patients who may move unexpectedly, \rcontributing to needle-sticks. \rPhlebotomy involves the use of large, hollow needles that have been in a blood vessel. The \rneedles can carry a large volume of blood that, in the event of an accidental puncture, may \rbe more likely to transmit disease than other sharps. Bloodborne organisms that have been \rtransmitted after needle-sticks include viruses such as hepatitis B and human immunodeficiency \rvirus (HIV), bacteria such as syphilis and parasites such as malaria.