How to Draw Blood and What to Do if You Accidentally Poke Yourself

Introduction

• We may enter residency programs where we will have to draw our own blood

• I decided to improve my skills by spending an afternoon in my clinic’s lab

• I was given instruction on how to properly draw blood from the phlebotomist and practiced on several patients until I felt comfortable drawing blood

• Attached are the steps to drawing blood

Needle Stick Injuries

Background

• The rate of needle sticks is 18.7 per 100 occupied beds per year for non-teaching hospitals and 26.8 injuries per 100 occupied beds per year for teaching hospitals

• The risk of HIV transmission is 0.33%

• The risk of HCV transmission ranges from 0-7%

What Should You Do Immediately after a Needle Stick?

• Immediately cleanse the wound site: soap and water, can also use an antiseptic

• Document the exposure

• Obtain patient information

  • Obtain a detailed history about risk factors for HIV and HCV and any previous/current treatments

  • Obtain HIV and HCV serology labs

• Obtain your baseline labs

  • LFTs

  • HCV serology labs

  • HIV serology labs

Risk Factors for HIV Seroconversion

• Deep injury (odds ratio 15)

• A device visibly contaminated with the patient's blood (odds ratio 6.2)

• Needle placement in a vein or artery (odds ratio 4.3)

• Terminal illness in the source patient (odds ratio 5.6)

Post Exposure Prophylaxis and Testing

HCV

• Follow up serology and LFTS at 6 weeks, 4 months, and 6 months

• No Post exposure prophylaxis for HCV

HIV

• Follow up serology at 6 weeks, 12 weeks, and 6 months

• Medications

  • None needed if Patient is HIV negative or the source is unknown

  • If patient’s HIV status is unknown, but there are several risk factors consider treatment with two reverse transcriptase inhibitors

  • If patient is HIV + and is either asymptomatic or has a known low viral load start treatment with two reverse transcriptase inhibitors

  • If patient is HIV + and is symptomatic or has a known high viral load and there was a large volume of exposure start treatment with two reverse transcriptase inhibitors and a protease inhibitor

  • Medications should ideally be begun within two hours after exposure

  • Treatment should last four weeks

How to Draw Blood

1. Assemble your supplies.

2. Wear gloves.

3. Decide which arm you will be drawing from and tie the tourniquet a few centimeters from the ante cubital fossa.

4. If no veins are palpable immediately, have the patient make a fist and clench and release a couple of times.

5. Once a suitable vein is found, disinfect the area with the alcohol wipe.

6. Allow the alcohol on the skin to dry completely.

7. If you need to touch the venipuncture site again, disinfect the fingers you will need to palpate with using an alcohol wipe.

8. With the needle attached to the Vacutainer holder and a tube loosely in the holder, ensure that the bevel of the needle (the end with a hole) is pointing up.

9. Anchor the vein using the thumb and finger of the opposite hand, and insert the needle.

10. Push the tube onto the needle and check for blood flow.

11. If there is no blood flowing into the tube, rearrange the position of the needle by inserting it further into the patient, bringing the needle slightly back out, or changing the angle of the needle.

12. Allow the tube to fill. Remove the tube and mix the contents.

13. Fill remaining tubes and repeat previous step.

14. Remove the tourniquet.

15. Have a piece of gauze ready in the opposite (anchoring) hand, remove needle, and place gauze on top of the venipuncture site. Apply pressure.

16. Discard the needle in a sharps container.

17. Label the tubes.

18. Ensure that the patient has stopped bleeding, and apply tape and gauze, or a bandage to the venipuncture site.

19. Discard waste and put materials away.

http://www.wikihow.com/Draw-Blood

References:

Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. Morbidity and Mortality Weekly Report. Recommendations and Reports. 2001 Jun 29;50(RR-11):1-52.

Panlilio AL; Cardo DM; Grohskopf LA; Heneine W; Ross CS. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. Morbidity and Mortality Weekly Report. Recommendations and Reports. 2005 Sep 30;54(RR-9):1-17.

Parker, G, Perry, J, Jagger, J. 2003 percutaneous injury rates. Advances in Exposure Prevention 2005; 7:42.

Occupational exposure to bloodborne pathogens; needlestick and other sharps injuries; final rule. Occupational Safety and Health Administration (OSHA), Department of Labor. Final rule; request for comment on the Information Collection (Paperwork) Requirements. Federal Register 2001 Jan 18;66(12):5318-25.

Cardo DM; Culver DH, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for Disease Control and Prevention Needlestick Surveillance Group. NEJM 1997 Nov 20;337(21):1485-90.

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