Advances in Bioscience and Biotechnology, 2013, 4, 126-128 ABB Published Online January 2013 (
Complications of venepuncture
Omiepirisa Yvonne Buowari
Medical Women Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria
Received 20 November 2012; revised 27 December 2012; accepted 15 January 2013
Venepuncture is the commonest procedure performed
in health care settings. A review of literature and
search on complications of venepuncture and blood
collection. This procedure is without complications,
which sometime can be fatal. Complications that can
arise from venepuncture include haematoma forma-
tion, nerve damage, pain, haemaconcentration, extra-
vasation, iatrogenic anaemia, arterial puncture, pete-
chiae, allergies, fear and phobia, infection, syncope and
fainting, excessive bleeding, edema and thrombus.
Keywords: Venupucture; Haematoma; Complications;
Venepuncture is the most common invasive medical
procedure performed by health care providers [1,2].
Early detection and good communication between the
patient and health care provider is important whenever
venepucture is performed to prevent serious compli-
cations. Venepuncture is the act of puncturing the vein
for giving a drug or removal of blood [2,3]. Venepunc-
ture has been practiced for centuries and is still one of
the most common invasive procedures in health care [2].
However, practices vary considerably between countries
and between institutions and individuals within th e same
country. These differences include variations in blood
sampling technique, use of safety devices, disposal me-
thods, disposal methods, reuse of devices and availa-
bility of hepatitis b vaccine [2].
Venepuncture should be performed with care. Uni-
versal precautions should be observed at all times to
protect the patient and health care provider. Gloves
should always be worn when obtaining blood specimens.
Before beginning any procedure, identify the patient
accurately [3]. The veins of a patient are the main source
of specimens for testing the entry point of medications
and the site for intravenous infusion and blood transfu-
sions because there are only a limited number of easily
accessible veins in a patient, it is important that everyth-
ing be done to preserve their good condition and availa-
bility [3].
Blood can be collected from a patient for laboratory
investigations, blood donation or therapeutically to re-
duce the amount of blood as in patients with polycy-
themia Vera. Blood investigation and analysis is one of
the commonest diagnostic tool u s ed by doctors.
A variety of adverse complications may be encoun-
tered during blood collection process [4]. Laboratory
investigations request by doctors is an important com-
ponent in the diagnosis and treatment of patients. A
superficial vein most commonly used for venepuncture.
The best sites for venepuncture of superficial veins of the
upper limbs are the median cubital vein. It lies over the
cubital fossa and serves as an anastomosis between the
cephalic and basilic veins [5]. The cephalic vein in both
the forearm and arm can be followed proximally where it
empties into the axillary vein, the basilic veins joins the
brachial vein [5]. Inappropriate sites for venepuncture
are arm on side of mastectomy, edematous areas, haema-
tomas, arms in which blood is being transfused, scarred
areas, arms with fistulas or vascular grafts and sites
above an intravenous cannular [5]. Serious complications
can occur because of venepuncture even when only a
small volume of blood is withdrawn; therefore, medical
personnel should be prepar ed to provide appropriate care
1. Areas that have been burnt or scarred should be
avoided during phlebotomy [4,6]. Burned areas are very
sensitive and susceptible to infection whereas veins
under scarred areas are difficult to palpate [4,6] and
difficult to insert need le [4].
In a study by Kagel and Rayan, the most common sites
for developing complications in order of frequency are
forearms, hand, wrist and antecubital fossa [7]. Patients
whose veins have been repeatedly punctured often be-
come scarred and feel hard when palpated [4].
2.1. Hematoma Formation Is the Most Common
Complication of Venupuncture
This type of complication is caused by blood leaking into
the tissues during or after venepuncture. A common sign
of this complication occurring is swelling at or near the
O. Y. Buowari / Advances in Bioscience and Biotechnology 4 (2013) 126-128 127
venepuncture site.
Haematoma complication can occur as a minor com-
plication of venepuncture 1. The haematoma forms under
the skin adjacen t to the puncture site [6]. When it occurs
release the tourniquet immediately, withd raws the needle,
and apply firm pressure [6]. Haematoma occurs when the
area around the puncture sites begins to swell indicating
that blood is leaking into the tissues, wh ich will result in
a bruise [2,4] due to partial insertion into the vein 4. If
this happens, immediately remove the needles apply
pressure for two minutes and recheck to ensure bleeding
has stopped [4]. To avoid haematoma formation from
venepuncture, puncture only the uppermost wall of the
vein just under the skin, remove the tourniquets before
removing the needle, use the major superficial veins,
make sure the need le fully penetrates the uppermost wall
of the veins because partial puncture may allow blood to
leak into the tissue just und er the skin and ap ply pressure
to the puncture site. Haematoma is formed when blood
leaks into the tissue surrounding the insertion site after
failure to penetrate the vein properly during insertion [8 ].
Haematoma is a collection of blood under the skin [9]. If
a haematoma begins to form while blood is being with-
drawn, the needle should be removed immediately and
pressure maintained over the site [9]. Some of the causes
of haematoma formation after venepuncture are small
fragile veins, needle too large, excessive probing to find
vein, removing the needle prior to releasing the tourni-
quest, needle going all the way through the vein, needle
only partially entering the vein allowing leakage, apply-
ing pressure to gauze before the needle is removed [9].
2.2. Infection
This may be localized giving rise to thrombophlebitis or
systemic leading to septicemia. The infection may be
localized or systemic. However, peripheral intravenous
cannula infections are more commonly associated with
localized than systemic infection [10]. Inadequate clean-
sing or poor technique can lead to infection [9]. Infection
can cause phlebitis and thrombus formation [8]. It is
prevented by good aseptic technique and keeping any
dressing over the venepuncture site clean [8,11]. Phlebi-
tis is an acute inflammation of the intima of the veins [8].
It is caused by mechanical and chemical irritation or by
microscopic particles that may contaminate infusion flu-
2.3. Nerve Damage
Hematoma formation following venepucture can be pain-
ful and can potentially cause nerve damage [2,9]. Among
complications associated with phlebotomy, nerve injury
is relatively rare, but is potentially serious and often re-
sults in malpractice lawsuits [12]. Patient may feel sharp
electric tingling if a nerve is hit. Immediate discontinue
that venepuncture and the patient may need physical
therapy [4]. Inap propriate sites or excessive probing may
lead to nerve damage [9]. Patient may complain of se-
vere pain and the procedure should be stopped immedi-
ately [9].
2.4. Haemoconcentration
This can result from prolonged tourniquet application. It
can be caused by prolonged tourniquet application, mas-
sageing, squeezing or probing a site, long-term intrave-
nous fluid therapy, scleroses or occluded veins, dehydra-
tion and certain diseases [4]. Haemoconcentration may
cause false increase in potassium ion, phosphorus, am-
monia and total protein [4]. Intravenous line complica-
tions can result in morbidity and increased health care
costs from prolonged hospitalization, extended use of
intravenous antibiotics therapy and surgical intervention
2.5. Extravasations
Extravasations occurs when a cannula pulls out of the
vein or becomes partly occluded by venous construction
causing backflow of the infusate through the puncture
site into the surrounding tissues [8]. The patient may
complain if tightness, burning and discomfort around the
intravenous site and th ere may be swelling and b lanch ing
of the tissues [8]. In extravagation, the cannu la enters the
tissues rather than the vein [11]. In this condition, flush-
ing will be difficult and swelling/pain may be noted the
cannula should be removed immediately.
2.6. Syncope and Fainting
Patients may become dizzy and faint at the thought or
sight of blood [6]. It is caused because of rapid fall in the
blood pressure and it is an autonomic nervous system
reaction (psychomatic trigger) usually based on fear [6].
Syncope and fainting can procure during venepuncture
2.7. Petechiae
Petechiae may occur following venepuncture. This may
be due to coagulation problems or abnormalities [4,6].
The patient may bleed excessively after blood collection;
make sure bleeding stops prior to leaving the patient.
2.8. Excessive Bleeding
Excessive bleeding after venepucture can occur. In-pa-
tient on anticoagulants, on drugs such as aspirin medica-
tion or drugs that decrease the number of platelets [4].
The patient should not be left alone until bleeding has
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2.9. Edema
This is abnormal accumulation of fluids in the intercel-
lular spaces of the body and it can be localized or dif-
fused [4]. Collection of blood should be avoided from
these sites, which will contaminate specimen with tissue
fluid [4].
2.10. Fear and Phobia
Fear and phobia may occur in some patients on seeing
the needle. This may cause the patient to move puncturing
the artery rather than the vein [11]. The needle should be
withdrawn and pr essure applied.
2.11. Thrombosis
Thrombus is a solid mass derived from blood clot con-
stituents in the vessels that is a clot. Thrombus may par-
tially or fully occlude a vein or artery making venepunc-
ture difficult [4].
2.12. Arterial Puncture
The artery can be punctured instead of the vein. When
this occurs, the needle should be removed immediately
and pressure app lied over the site.
2.13. Pain
While some discomfort is to be expected, the needle
should be removed immediately if the patient complains
of excessive or severe pain [ 9 ] .
2.14. Allergies
The patient may be allergic to th e cleaning agen t or other
solutions used to disinfect the site therefore ask for any
allergy. Some patients have latex allergy.
2.15. Iatrogenic Anemia
Anemia may occur when large volumes of blood are
collected for investigation s and is common in infants.
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