Table 8.1Summary of risks and risk-reduction strategies

RiskType of riskRisk reduction strategy
Patient/blood donorsExposure to bloodborne viruses through reuse of needles, syringes and lancets, contaminated work surfaces
  • Hepatitis B vaccine for workers
  • Sterile single-use devices only
  • Safety-engineered devices
  • Clean work surfaces with disinfectant
Infection at blood sampling site
  • Perform hand hygiene
  • Clean patient's skin with 70% isopropyl alcohol and allow to dry
  • Use sterile needle and syringe removed from the packaging just before use
Pain at blood sampling site
  • Well-trained person should take the blood sample
  • Venepuncture is less painful than heel-pricks in neonates
  • Use needle of smaller gauge than the selected vein
Haematoma or thrombus
  • Enter vessel at an angle of 30 degrees or less
  • Use gauge of needle smaller than the vein
  • Apply pressure to a straight arm for 3–5 minutes after drawing blood
Extensive bleeding
  • Take a history to identify patients on anticoagulants and with a history of bleeding
  • Use a gauge of needle smaller than the vein
Nerve damage (8, 10)
  • Avoid finger-pricks for children
  • Use antecubital vessels when possible
  • Avoid probing
Vasovagal reaction
Syncope, fainting (8, 10)
  • Hydrate patient, take postural blood pressure if dehydrated
  • Reduce anxiety
  • Have patient lie down if the person expresses concern
  • Provide audio-visusal distraction
Allergies
  • Ask about allergies to latex, iodine and alcohol before starting the procedure
Health workerNeedle or sharps injury during or after the procedure
Breakage of blood containers Splashes (rare)
  • Use safety devices such as needle covers, tube holders that release needles with one hand and safety lancets
  • Avoid two-handed recapping and disassembly
  • Place sharps container in sight and within arm's reach
  • Dispose of used sharps immediately
Exposure to blood
  • Hepatitis B vaccination
  • Wear gloves
  • Use evacuated tubes and transfer devices when drawing multiple tubes
  • Follow protocol for exposure to body fluids and report incident, even if post-exposure prophylaxis is not desired
  • Cover broken skin area with a waterproof dressing

From: 8, Implementing best phlebotomy practices

Cover of WHO Guidelines on Drawing Blood
WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy.
Copyright © 2010, World Health Organization.

All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: tni.ohw@snoissimrep).

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.