A Draw That Did Not Go to Plan

In practice

A young man who said he had never fainted is having blood drawn from his right arm. The first tube begins to fill, and then a swelling starts to rise under the skin near the needle. The medical assistant recognizes a forming hematoma. She releases the tourniquet, withdraws the needle, activates the safety device, and presses gauze firmly over the site with his arm straight and raised. A moment later, he sighs, goes pale and begins to sweat. She lowers the exam table, helps him lie back, calls for a colleague, and stays beside him. The colleague alerts the provider. She keeps pressure on the site while he lies still. After several minutes, his color returns and he says he feels better. The provider checks on him. When he feels well enough, she uses his left arm, with him lying down this time. She completes the draw without difficulty and labels the tubes in front of him. Before he leaves, she checks both arms. She documents the hematoma, the fainting reaction, the second site, and the time of each event.