During a blood collection, bacteria that are present on the skin surface may adhere to the outside of the needle as it enters into the vein. This can allow bacteria to infect the puncture site. A serious infection of the blood (septicemia) or of the tissue (cellulitis) may result. To avoid an infection, it is imperative that the phlebotomist uses a technique that thoroughly cleanses the skin at the site prior to venipuncture.
Once the phlebotomist locates a suitable vein for venipuncture, the site of the vein that will be punctured is cleansed.
The Clinical and Laboratory Standards Institute (CLSI) no longer recommends using a circular target motion method for cleansing the arm. Their studies suggest that the back and forth friction is superior to the circular concentric cleansing. The CLSI standards recommend cleansing the site with friction using a clean gauze pad with 70% isopropyl alcohol solution or a commercially prepared alcohol pad. The alcohol must be allowed to air dry for approximately one minute prior to venipuncture to properly disinfect the site, prevent hemolysis of the specimen, and avoid discomfort for the patient.
During the remainder of the procedure, the site must NOT be touched by anything.
- The phlebotomist should avoid retouching the site after cleaning it. If it is absolutely necessary to re-palpate, the phlebotomist MUST change gloves and re-clean the puncture site. Cleaning the tip of the glove to palpate the collection site deviates from the CLSI standard.
- Make certain that no other piece of equipment touches the site. This includes the ends of the tourniquet and gauze. If you suspect that your needle has touched the site before entry, dispose of the needle, re-clean the site and repeat the procedure using a new needle.
If a patient complains that there is redness or pain at the puncture site, even hours or days after the procedure, immediately refer the patient to his/her physician for evaluation.
