ASCP ASCP Venipuncture Complications and Special Procedures 1 — Questions and Answers
Question 1: A hematoma begins forming during venipuncture. The phlebotomist should FIRST:
- Continue the draw as quickly as possible
- Remove the needle and apply firm pressure immediately (Correct answer)
- Apply a tourniquet above the hematoma
- Massage the area to disperse the blood
Correct answer: Remove the needle and apply firm pressure immediately
When a hematoma forms, the needle must be removed immediately and firm pressure applied to stop blood from leaking into surrounding tissue.
Question 2: Which finding during venipuncture indicates an accidental arterial puncture?
- Dark red blood with very slow flow
- Bright red blood that pulses into the tube (Correct answer)
- Blood that clots immediately in the tube
- No initial blood return
Correct answer: Bright red blood that pulses into the tube
Arterial blood is oxygenated, appearing bright red, and pulses into the tube due to the higher pressure in arteries.
Question 3: Small pinpoint hemorrhages (petechiae) appearing on the forearm after tourniquet application may indicate:
- A normal response to tourniquet pressure
- A coagulation or platelet disorder (Correct answer)
- Local infection at the venipuncture site
- Superficial phlebitis
Correct answer: A coagulation or platelet disorder
Petechiae suggest abnormal platelet function or a coagulopathy and should be reported to the ordering clinician.
Question 4: A patient reports a sharp, shooting pain radiating down the arm during needle insertion. The phlebotomist should:
- Redirect the needle slightly to improve position
- Remove the needle immediately and document the incident (Correct answer)
- Reassure the patient that this sensation is normal
- Apply more downward pressure on the needle
Correct answer: Remove the needle immediately and document the incident
Radiating pain indicates possible nerve contact or injury; the needle must be removed at once and the incident fully documented.
Question 5: Which antecubital vein carries the HIGHEST risk for nerve and arterial injury during venipuncture?
- Cephalic vein
- Median cubital vein
- Basilic vein (Correct answer)
- Accessory cephalic vein
Correct answer: Basilic vein
The basilic vein is located near the median cutaneous nerve and brachial artery, making it the highest-risk antecubital site.
Question 6: The BEST preventive measure against vasovagal syncope (fainting) during phlebotomy is:
- Collecting the specimen as quickly as possible
- Having the patient lie down or recline before and during collection (Correct answer)
- Applying a cold compress to the forehead before collection
- Drawing from the hand vein rather than the antecubital fossa
Correct answer: Having the patient lie down or recline before and during collection
Placing the patient in a reclined or supine position maintains cerebral blood flow and is the most effective prevention for vasovagal syncope.
ASCP ASCP Venipuncture Complications and Special Procedures 1
A hematoma begins forming during venipuncture.
The phlebotomist should FIRST: