Time to implement safety devices for phlebotomy
Sharps box should be within reach of phlebotomist
Blood-drawing devices with integrated safety features designed to prevent percutaneous injuries should be rapidly implemented, including phlebotomy needle/tube holder assemblies, butterfly-type devices, and syringes used for blood drawing, the authors of a new book on the subject recommend.1
After implementation, the devices should be closely monitored for user and patient safety, the authors note, adding the following general recommendations concerning phlebotomy:
• All unnecessary needles should be eliminated from use, including needles used for drawing blood from intravenous, arterial, and central lines, which can be replaced by needleless or blunt cannula devices. In addition, the practice of changing needles for blood culture phlebotomy should be abandoned to avoid the hazard of manually removing a blood-filled needle from the syringe.
• The practice of injecting blood through a stopper into a vacuum tube using an exposed needle should be discontinued.
Methods of drawing blood directly into vacuum tubes or other specimen containers should be preferentially employed; alternatively, safety syringes with a cylindrical needle shield locked in place over the needle that allow a vacuum tube to be inserted into the shield during blood injection will reduce needlestick risk and reduce risk of blood splatter from dislodged tube stoppers.
• Automatically retracting finger/heelstick lancets should be used in place of manual lancets or non-retracting spring-loaded lancets.
• The use of micro-bore glass capillary tubes for measuring hematocrit should be immediately and completely discontinued. Plastic capillary tubes or alternative methods of measuring hematocrit that do not require capillary tubes should be used.
• Glass blood collection tubes should be replaced by plastic or otherwise breakage-resistant tubes.
• Blood-drawing personnel should be advised not to manually recap or remove needles from blood-drawing devices.
• Blood-drawing personnel should be explicitly advised not to cut the tip off the index finger (or any other part) of procedure gloves, since it increases the risk of blood exposure.
• All facilities should provide puncture- resistant disposal containers within arm’s reach of blood-drawing personnel for all phlebotomy procedures.
Reference
1. Ippolito G, Puro V, Petrosillo N, et al. Prevention, Management & Chemoprophylaxis of Occupational Exposure to HIV. Charlottesville, VA: International Health Care Worker Safety Center; 1997.
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