SUBJECT: Unsuccessful Venipuncture Attempts - Laboratory Personnel Only Purpose:

There are a variety of situations in which the ordered blood test will not be able to be collected at the specified time. These include:

1. A difficult venipuncture 2. Patient refusal

3. Patient unavailable 4. Patient has not undergone proper patient preparation; ie. not fasting, medications, fluids or

dyes have not been administered. Principle:

The report of an unsuccessful attempt to draw blood is designed to facilitate communication between the laboratory and patient caregiver. When a problem arises, the status of requested laboratory tests are documented as to why the blood could not be obtained.

Responsibility:

All associates who collect blood in the Health Alliance Hospitals.

Materials: Health Alliance “Report of Unsuccessful Attempt to Draw Blood” form. (2 part)

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Procedure: A. Missed Vein

1. Number of attempts per associate

a. Only one attempt may be made until 100 successful venipunctures have been performed. This includes those done with a preceptor.

b. After the original 100 venipunctures and from then on, a second attempt made be made No more than two sticks made be made by any one associate.

2. Venipunctures performed by laboratory associates

a. When a laboratory associate fails to obtain blood from a patient, a second attempt may be made.

b. After failure on the second attempt, another laboratory phlebotomist is to attempt. c. After the second phlebotomist has attempted up to two (2) times and failed, the physician

is to be contacted to obtain the blood.

3. Venipunctures performed by non-laboratory associates

a. During the associate’s first successful 100 venipunctures, that associate is not to stick a second time.

b. After this initial period, all associates may make up to two attempts. c. After the first associate has failed, a validator may attempt up to a total of three (3)

combined attempts by the non-laboratory personnel. i. If Associate #1 tries once, the validator may make up to two attempts ii. If Associate #1 has made two attempts, the validator may only try once.

d. After initial associate and validator have failed, it is the responsibility of the unit to determine next step.

4. If the second person is unsuccessful at the sample collection, signature of the second

unsuccessful attempt is documented on the same form. The white copy remains on the unit and the yellow copy is sent to the appropriate department. E.g. lab, i.v. therapy

B. Patient is Unavailable

1. If a person attempts to perform a venipuncture on a patient but is unsuccessful because the patient is unavailable, complete an “Unsuccessful Attempt Form”. The white copy remains on the unit and the yellow copy is sent to the lab along with the labels. Nursing personnel must sign the form showing knowledge of the attempt(s).

2. Return to the floor for the venipuncture when notified by the nursing staff that the patient is available.

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C. Patient Refusal If the patient refuses the blood collection procedure, complete an “Unsuccessful Attempt Form” and indicate the reason for unsuccessful attempt (patient refused).

Also check the indicated action to be taken, and sign the form. Notify the appropriate nursing personnel and retain white copy on patient’s unit. Yellow copy is to be sent to the laboratory or appropriate department.

D. Completing the Form 1. Check the appropriate box for facility.

2. Complete patient’s name, room number, date, time, and test(s) ordered 3. Check the appropriate box, (reason why blood was not obtained): a. Missed vein b. Could not find vein to attempt c. Patient off the unit d. Patient refused e. Other reason____________ 4. Check the appropriate box for “indicated action”: a. Another blood collector is being summoned to try to obtain the blood sample. b. Please call the laboratory when the patient returns to his/her room. c. Please ask the physician, resident, intern or extern to obtain the blood specimen. d. Test(s) were cancelled because____________________________. 5. Sign the form. a. Original collector must sign first. b. Signature of second unsuccessful attempt (if necessary). c. Indicate number of attempts. d. Collector who obtained the blood and number of attempts.

6. Submit the completed form to an RN, or Unit Manager on the nursing unit for their signature. 7. Give the original copy to the person from nursing services who signed the form and keep the yellow copy to take to the laboratory to be given to the person in charge.

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E. Laboratory Associate performs venipuncture / skin puncture to obtain blood sample 1. Finds a suitable site? Yes No •Completes a “can’t get” form

•Has nursing personnel sign form and retain top copy •Return yellow copy and labels to lab for a second phlebotomist to attempt

2. Obtains blood from puncture? No Yes • Transport blood with labels to the laboratory 3. Finds a second suitable site? Yes No •Completes a “can’t get” form

•Has nursing personnel sign form and retain top copy •Return yellow copy and labels to lab for a second phlebotomist to attempt

4. Obtains blood from second puncture? No Yes • Transport blood with labels to the laboratory

•Completes a “can’t get” form •Has nursing personnel sign form and retain top copy •Return yellow copy and labels to lab for a second phlebotomist to attempt

5. Second phlebotomist able to obtain blood within 2 attempts? No Yes • Transport blood with labels to the laboratory

•Completes a “can’t get” form •Has nursing personnel sign form to have physician •Return yellow copy to lab

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F. Non-Laboratory Associate performs venipuncture to obtain blood sample 1. Finds a suitable site? Yes No •Completes a “can’t get” form

•Retain on unit •Enlists help from a validator

2. Obtains blood from puncture? No Yes • Transport blood with labels to the laboratory 3. Finds a second suitable site? Yes No •Completes a “can’t get” form

• Retain on unit •Enlists help from a validator

4. Obtains blood from second puncture? No Yes • Transport blood with labels to the laboratory

•Completes a “can’t get” form •Retain on unit •Enlists help from a validator

5.Validator able to get blood within two attempts? No Yes • Transport blood with labels to the (Attempt only once if first associate has already tried twice) laboratory

•Completes a “can’t get” form •Retain top copy on unit •Send yellow copy to lab with labels

References: 1. The Christ Hospital “Unsuccessful Attempt to Draw Blood” procedure. 11/13/97 2. The Jewish Hospital of Cincinnati, Inc. “Unable to Obtain Blood” procedure. 8/1/95 3. The Health Alliance of Greater Cincinnati Laboratory Services “Report of Unsuccessful Attempt to Draw Blood” Form. 1998

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G. Form

Report of Unsuccessful Attempt to Draw Blood TCH TJH SLE SLW TUH TFH ALS

Blood collection personnel have been unsuccessful in their attempt to obtain blood from the patient named below. Patient Name: Room: Date: Time: Tests Ordered: Timed For: Blood was not obtained because:

Missed vein Could not find vein to attempt Patient off unit Other reason Indicated action for lab phlebotomist: The tests ordered are being sent to the lab:

Another blood collector is being summoned to obtain Call Lab when patient returns to room RN to draw Physician, resident, intern or extern to obtain Tests to be cancelled because

Signature: # Attempts: Signature of second unsuccessful attempt: # Attempts: Collector who obtained blood: # Attempts: Signature of nursing personnel: Title:

White copy remains on unit Yellow copy and labels send to lab