A California colleague wonders about the appropriateness of palpating a blood donor's vein with a sterile gloved finger, immediately prior to phlebotomy, but after the venipuncture site has been disinfected by an arm prep scrub. According to his reading of the AABB Technical Manual's Method 6.2, after the skin has been prepared, it must not be touched again. One should not re-palpate the vein at the intended venipuncture site. However, according to Method 6.3, once the bevel has penetrated the skin, palpation of the skin above the needle stem may be performed with a gloved finger, provided the needle is not touched. He asks if blood center collections staff use sterile gloves to palpate the 'prepped site' even before the needle's bevel has penetrated the skin, in order to assure the location of the vein, and if so, what has been their experience?

The following responses have been received.

ADDENDA July 14, 2003

1. A Technical Director of a Blood Bank in Northern California reports that his center does NOT allow palpation of the vein after preparation (swabbing) of the venipuncture site. However, in order to assure the location of the vein to be punctured, the phlebotomist will usually mark the preferred draw site by pressing a metal grommet into the site just prior to preparation. The mark is visible even after the site preparation and provides a good guide for the phlebotomist.

2. A colleague who used to be a California blood banker reports that at her current position in the Pacific Northwest, they do not allow palpation of the vein after prep under any conditions. Their SOP allows for the placing of a dot with a black felt marker just above the spot selected for venipuncture. This is visible following venipuncture site preparation. This practice has been in place through several FDA and AABB inspections/assessments and has not been mentioned even in observations.

3. A retired pediatric hematologist in Palo Alto comments that when he was performing venipunctures in the old days, he used his fingernail to draw an X at the spot before applying the prep - a bit crude, but always handy.

ADDENDA July 17, 2003

4. A colleague from Spain strongly discourages the practice of palpating the vein after the site has been prepared to learning phlebotomists. The main reason is to avoid bacterial contamination of blood components. In fact, they have reported work on this issue which has been published recently in Haematologica 2003;88:839-40 (no abstract). Their phlebotomists were surprised when they saw that bacteria were present on the blood donors' arm after phlebotomy site preparation. It was a good lesson for all of them.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator