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