Which patient should be asked to lie down during a blood draw a patient with a

Question: How do you anticipate fainting?

You should. Studies show that up to five percent of patients will pass out during or immediately following a blood collection procedure. The problem is they don't come with a warning label on their forehead. It's no wonder the CLSI standards state precautions against patients losing consciousness on no fewer than six occasions in its venipuncture standard. How do you show that you're anticipating a loss of consciousness in every patient?

1) You're making sure every patient you draw is either lying down or seated in a chair with armrests to prevent sideways falls. Because the standards require it, you're never drawing patients who sit upright in their hospital bed or on an exam table. If you do home draws, you don't let your patient sit in a kitchen chair, or any other seat, without arm support. You're either moving them into a safer chair or you're having them lie down.

2) You're never more than an arm's reach away from patients while they are in your care. In case they pass out and fall forward, you're always there ready to secure them and you always keep the patient at least in the corner of your eye. That's because you know that a loss of consciousness can come without warning.

3) You ask patients if they've ever "had problems" getting their blood drawn. A person's history is one of the best indicators of their future behavior. If the answer is "yes," you convince them to lie down for the procedure. But never use the words "faint" or "pass out." Studies show if you use such suggestive words it nearly doubles the chance it will happen.

4) Before releasing them from your care, you ask patients if they feel all right. Their answer can reveal that they're feeling dizzy or on the verge of a vasovagal reaction that can lead to a loss of consciousness. Not every patient is willing to admit they feel a little lightheaded; those who don't may welcome the invitation to tell you. If the patient indicates that he doesn't feel so well, provide a cold compress to the back of the neck or forehead, lower the head below the plane of the heart or, if assistance is available, lay the patient on the floor or nearby cot. Do not allow the patient to walk. If the patient doesn't look so well but says he feels fine, don't buy it. He's probably too ashamed or embarrassed to admit it.

5) You look for signs. Symptoms include pallor, perspiration, anxiety, lightheadedness, hyperventilation and nausea. Talkative patients suddenly become quiet. All these signs can preempt a loss of consciousness. Ask patients if they feel all right, but don’t rely on verbal responses completely. Often, patients who pass out are as surprised as you are.

Despite your vigilance, sometimes patients pass out anyway. If this happens during a collection, release the tourniquet and remove the needle at once. Keep the presence of mind to activate the sharp's safety feature to avoid an accidental needlestick. Prevent the patient from falling to the floor and summon assistance. If possible, lower the patient's head below the level of the heart to facilitate blood flow to the brain. Avoid the use of ammonia inhalants since patients who may be asthmatic could develop respiratory distress.

Failure to anticipate fainting in every patient lessens the chances of protecting a patient from injury. Because it is a known risk of the procedure, patients have a right to expect that you are prepared to protect them from a fall that could ensue. Therefore, every healthcare worker who draws blood should expect every patient to pass out.

Correct answer: Yes, I anticipate fainting by positioning patients in either a reclining position or in chairs with arm rests that provide support, by keeping within arm's reach, by remaining vigilant to the signs of an imminent loss of consciousness, by asking patients if they've ever had "problems" with prior blood draws, and by making sure they feel all right before releasing them from my care.

Anxious for the rest of the questions? I've compiled all eight into one of our most popular downloads, "Eight Questions Every Phlebotomist Must Answer Correctly."

Fainting does sometimes occur as a result of venipuncture. A patient may experience a feeling of weakness or light-headedness or in severe cases, the loss of consciousness at any time during the venipuncture procedure.

Before the procedure

If a patient is aware that he/she gets light-headed or has in the past fainted while having blood collected, the patient may alert the phlebotomist. The phlebotomist must then take appropriate measures to safeguard the patient during the procedure. For example, the phlebotomist may instruct the patient to lie down instead of sitting upright during the procedure. This practice may lessen the risk of patient fainting and eliminate the possibility of patient injury due to falling or sliding out of a draw chair.

During the procedure

If a patient faints during the venipuncture, immediately abort the procedure by gently removing the tourniquet and needle from the patient's arm, applying gauze and pressure to the skin puncture site, and calling for assistance. If the patient is seated, place the patient's head between his/her knees. A cold compress applied to the back of the neck may help to revive the patient more quickly. The use of an ammonia inhalant (smelling salts) to rouse the patient is considered an unsafe practice. The inhalant may cause irritation and/or anaphylactic shock in some patients. A typical fainting spell is self-limited and usually, the patient comes around fairly quickly. However, the phlebotomist should stay with the patient for at least 15-30 minutes to ensure the patient has fully recovered from the fainting episode.

After the procedure

If the patient states that he/she feels dizzy after the blood collection is completed, again, as stated above, place the patient's head between his/her knees and apply a cold compress to the back of the neck. The phlebotomist should never direct the patient to an alternate location while the patient is experiencing dizziness. There is a great likelihood that the patient will faint while walking and be injured. It is never advisable for the phlebotomist to allow the patient to leave after the procedure until the patient is safely able to do so. A patient who faints should not operate a vehicle for at least 30 minutes after regaining consciousness.

It is important to review your facility's specific procedures and know how to react appropriately if a patient experiences dizziness or faints during a blood collection.

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