What could have caused the extensive bleeding this patient experienced after the venipuncture?

Complications during blood collection and Treatment

• There may be various types of complications of blood collection.
• Following are some of the possibilities:

Complications during blood collection:

Fainting during the collection of the blood:

1. The patients feel dizziness, and this may happen during or after the collection of blood.
2. There is a sudden decrease in blood pressure, and sometimes the patient may have a temporary loss of consciousness.
3. The reason is:
   1. This is due to vasovagal syncope.
   2. Please don’t leave the patient alone and don’t allow them to drive for another 30 minutes.
   3. Immediately lie down on the patient’s flat and raise the legs.

Syncopy during Blood collection

Hematoma:

1. There is a leak of blood from the site of the venipuncture site.
2. There may be a bruise formation.
3. Hematoma forms when:
4. The needle goes into the small vein.
5. It may pass through the vein.
6. The needle is partially in the vein.
7. The needle was removed when the tourniquet is still there.
8. Not adequate pressure was applied after the venipuncture.
9. Blindly searching the vein.
10. Apply the pressure bandage to the area.

Complications during blood collection: Blood collection site and complications

1. The patients on anticoagulant therapy:
2. These patients have more chances of bleeding.
3. These patients keep the pressure on the venipuncture site and don’t leave them until there is a complete stop of the bleeding.
4. Allergies:
5. There may be reactions to the antiseptic or band-aids or bandages or latex.
6. If it happens, give some antiallergic medication.

Hypersensitivity Reaction:

1. Some patients may develop Type I hypersensitivity reaction just seeing their own blood.
2. The patient will have a typical picture of hypersensitivity reaction type 1.
3. All symptoms are due to histamine or histamine-like substances produced in this hypersensitivity reaction.

Type 1 Hypersensitivity mechanism

1. The patient may have an anaphylactic reaction, and this may be:
   1. Localized.
   2. Or a systemic reaction.

Infections:

1. The infection is more common in immunocompromised patients.
2. Advise the patient to look after redness, pain, swelling, or tenderness.
3. Pain due to nerve involvement:
4. The patient may feel a sharp pain and tingle due to the involvement of the nerve.
   1. It is best to take out the needle.
   2. Sometimes permanent damage may take place to the nerve.
5. Phlebitis:
6.  This is a rare complication after the blood collection.
7. Sepsis:
8. This is another rare complication of blood collection.

Skin puncture:

1. The skin puncture is done in the pediatric group and the diabetics.
2. The common sites are fingertips, heels, and ear lobes. Heels are common sites in children.
3. Fingertips are used in adults (diabetics) and small children.
4. Earlobes are used for arterial blood as a possible substitute for arterial blood to assess pH, pCO2, and pO2.

Presentation (sign/symptom) of the patient:

1. Nervousness.
2. Itching of the skin.
3. Feeling of confusion.
4. Nausea, vomiting, and diarrhea.
5. Abdominal or back pain.
6. There will be flushing, pallor, or cyanosis.
7. Urticaria.
8. Laryngeal edema leads to stridor.
9. Tachycardia.
10. There is low blood pressure.
11. Convulsions.
12. Respiratory depression.
13. Bronchospasm leads to an asthmatic attack.
14. Treat the patient for a type1 of hypersensitivity reaction.

Treatment

1. Treatment of blood collection complications:
2. If the patient becomes faint, stop the blood-taking procedure and lie down the patient with raised foot end.
   1. Remove the needle and give assurance to the patient.
   2. Talk to patients.
   3. Please don’t allow him to drive another 30 minutes.
   4. Offer juice or water to the patient.
   5. Ask the patient to breathe slowly (deep breathing).
3. If hematoma appears, take out the needle and apply pressure for two minutes.
   1. Remove the tourniquet.
4. In patients with petechiae, make sure that there is no bleeding before the patient leaves the lab.
   1. In such patients, there are coagulation problems.
5. There may be excessive bleeding in patients on aspirin or anticoagulation therapy.
   1. Don’t leave the patients until there is a complete stoppage of the blood from the venipuncture site.
6. In case the patient may feel sharp electric pain, immediately take out the needle.
7. In case of an arterial puncture:
   1. Immediately remove the tourniquet.
   2. Hold pressure at the site for at least 5 minutes or till bleeding stops.
   3. Check the pulse and blood pressure.
8. In case of hypersensitivity reaction, give antihistamines.
9. Can give steroids.

Question 1: If patient becomes faint, what you should do immediately.

Question 2: If a patient gets sharp pain what you should do.