NMED 1117 - Case Study: Managing Failed Venipuncture During Obesity

This case study explores the challenges of performing venipuncture on obese patients, specifically addressing a scenario where the initial attempt to draw blood is unsuccessful. The essay outlines various reasons for venipuncture failure, including incorrect needle positioning and loss of vacuum in the collection tube. It then proposes alternative techniques, such as finger sticks, the use of blood pressure cuffs instead of tourniquets, and warm compression methods to improve vein visibility. The importance of proper patient positioning and communication is also emphasized. The case study concludes by highlighting the need for phlebotomists to exercise gentleness and care when repositioning needles to minimize patient discomfort and potential harm during venipuncture attempts on obese individuals. This document is available on Desklib, a platform offering a variety of study resources for students.

Running head: MANAGEMENT OF FAILED VENIPUNCTURE DURING OBESITY
MANAGEMENT OF FAILED VENIPUNCTURE DURING OBESITY
Name of the Student:
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1MANAGEMENT OF FAILED VENIPUNCTURE DURING OBESITY
One of the key functions pertaining to the functions of a phlebotomist, is the act requiring
the retrieval of blood from the concerned patient (Lima-Oliveira et al., 2014). As opined by the
Center for Disease Control and Prevention, almost one out of a group of three individuals is
considered to be obese, with the likelihood that these statistics will increase to double the
numbers in the future (Skinner & Skelton, 2014). The prevalence of obesity, often results in
difficulty in the performance of drawing blood from the concerned patient, as outlined in the
above study (Al-harosh & Shchukin, 2017). The following paragraphs of the essay, highlight the
key steps which can be taken, in the management of a failed venipuncture pertaining to an obese
client.
One of the key reasons pertaining to a failure in the process of drawing of blood, may be
wrong positioning of the concerned needle, due to misconducts in needle insertion or an
incidence of the absence of vacuum in the required tube. In such situations, the act is required to
be repeated, by gentle removal of the needle following by its repositioning. The concerned
phlebotomist, must not dig for the veins or harm the obese patient in the process. In the situation
of suspected loss of vacuum in the concerned tube, additional or novel tubes may be utilized for
careful repetition of the act (de Freitas Floriano et al., 2018).
In the situation of the concerned obese patient highlighted in the case study, the patient
seems to possess veins which are deeply in the body, resulting in difficulty of the phlebotomist to
locate and palpitate. In such situations, alternative techniques may be implemented, since further
repositioning may lead to the destruction of red blood cells and the resultant release of factors
concerning blood coagulation. Alternative methods like a finger stick may be used for the obese
patient. This would involve sterilization of the concerned site topically, using disinfectants,

2MANAGEMENT OF FAILED VENIPUNCTURE DURING OBESITY
followed by piercing with a sterile lancet. The blood so produced in the form of a large droplet,
may then be collected with the aid of a capillary tube (Grebely et al., 2017).
In the likely event of a failed venipuncture as observed in the case of an obese patient, a
tourniquet may be used, which is bandage based device, using principles of compression and
constriction, in order to control, regulate and direct the flow of blood to the concerned area for
the purpose of withdrawal. However, tourniquets have a reputation for causing considerable loss
of comfort in the concerned patient and may not work if the patient is excessively obese. In such
situations, alternative methods such as a blood pressure cuffs may be utilized, which have been
reported to cause led discomfort in the patient (Balakrishnan et al., 2016).
However, in the light of failure pertaining to the withdrawal of blood despite utilization
of the above methods, alternative methods may be used for the purpose of the same in the obese
patient of the case study. This would involve usage of warm compression techniques. The
concerned phlebotomist may use heat which can further aid in withdrawing of the blood, and
lead to greater visibility of the required vein. If the blood withdrawal process of the concerned
obese patient is rescheduled for another day, the phlebotomist may request him to wear warm
clothes pertaining the purpose of the same (Drew, Bennett & Littlejohn, 2015).
Often the key reasons pertaining to the failure to withdraw blood during venipuncture of
an obese patient, is wrong positioning. In such situations, the concerned patient in the case study,
may be instructed to completely extend the arms, which aids in repositioning of the veins to
arrive in close proximity to the skin. Further methods would involve requesting the patient to
relax and clarifying which positions have been used, if the patient has engaged in blood
withdrawal in the recent past (Jung et al., 2018).

3MANAGEMENT OF FAILED VENIPUNCTURE DURING OBESITY
Hence, to conclude, the occurrences of failed venipuncture is not uncommon during the
act of withdrawal of blood in an obese patient. With respect to the obese patient highlighted in
the case study, a number of alternative methods may be used by the concerned phlebotomist,
based upon the level of comfort experienced by the patient. However, irrespective of the type of
method used in the event of a failed venipuncture, it of utmost importance for the phlebotomist
to utilize gentleness in repositioning of the needles, in order to avoid potential bleeding and harm
to the concerned patient.

4MANAGEMENT OF FAILED VENIPUNCTURE DURING OBESITY
References
Al-harosh, M. B., & Shchukin, S. I. (2017). Peripheral vein detection using electrical impedance
method. Journal of Electrical Bioimpedance, 8(1), 79-83.
Balakrishnan, V., Wilson, J., Taggart, B., Cipolla, J., & Jeanmonod, R. (2016). Impact of
phlebotomy tourniquet use on blood lactate levels in acutely ill patients. Canadian
Journal of Emergency Medicine, 18(5), 358-362.
de Freitas Floriano, C. M., Avelar, A. F. M., & Peterlini, M. A. S. (2018). Difficulties Related to
Peripheral Intravenous Access in Children in an Emergency Room. Journal of Infusion
Nursing, 41(1), 66-72.
Drew, B., Bennett, B. L., & Littlejohn, L. (2015). Application of current hemorrhage control
techniques for backcountry care: part one, tourniquets and hemorrhage control
adjuncts. Wilderness & environmental medicine, 26(2), 236-245.
Grebely, J., Lamoury, F. M., Hajarizadeh, B., Mowat, Y., Marshall, A. D., Bajis, S., ... & Gorton,
C. (2017). Evaluation of the Xpert HCV Viral Load point-of-care assay from
venepuncture-collected and finger-stick capillary whole-blood samples: a cohort
study. The lancet Gastroenterology & hepatology, 2(7), 514-520.
Jung, D. E., Lee, H. C., Yoon, H. K., & Park, H. P. (2018). The effects of ipsilateral tilt position
on right subclavian venous catheterization: study protocol for a prospective randomized
trial. Trials, 19(1), 292.

5MANAGEMENT OF FAILED VENIPUNCTURE DURING OBESITY
Lima-Oliveira, G., Lippi, G., Salvagno, G. L., Picheth, G., & Guidi, G. C. (2014). Phlebotomist
labelling primary blood tubes for clinical laboratory tests: an important step to medical
diagnostics. Journal of Medical Diagnostic Methods, 3, e111.
Skinner, A. C., & Skelton, J. A. (2014). Prevalence and trends in obesity and severe obesity
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