What to do if no blood is obtained after fully advancing the needle during a blood draw?

From the Guidelines

If no blood is obtained after fully advancing the needle during a blood draw, the next best step is to slowly withdraw the needle and observe for a flash of blood. This approach is based on the principle that a flashback of blood indicates the needle is in the access, as suggested by the clinical practice guidelines for vascular access 1. When the needle is fully advanced and no blood is obtained, it may be necessary to adjust the position of the needle to ensure proper placement within the vessel. The guidelines recommend lowering the angle of insertion and continuing to advance the needle into the fistula until it is appropriately positioned within the vessel, but before doing so, slowly withdrawing the needle to check for a flash of blood is a prudent step. Key considerations in this process include:

• Ensuring the needle is properly positioned to avoid complications
• Adjusting the angle of insertion as needed to facilitate blood flow
• Securing the needle once proper placement is confirmed to proceed with the procedure. In the context of real-life clinical medicine, prioritizing patient comfort and safety while efficiently obtaining a blood sample is crucial, and slowly withdrawing the needle to observe for a flash of blood is a straightforward and effective next step when initial attempts are unsuccessful.

From the Research

Next Steps After Failing to Obtain Blood

If you are unable to obtain blood after the needle is fully advanced, the next best step is to:

• Slowly withdraw the needle and observe for a flash of blood 2, 3. This approach allows for the assessment of whether the needle is correctly positioned in a vein, without causing unnecessary trauma to the surrounding tissue.

Rationale for the Approach

The chosen option is based on the principles of venipuncture and the potential complications associated with the procedure 2.

• Withdrawal and re-insertion at the same site or a different site may increase the risk of complications such as bruising, hematoma, or infection 4, 5.
• Changing the angle of insertion without withdrawing the needle may also increase the risk of complications and is not a recommended practice.

Considerations for Venipuncture

When performing venipuncture, it is essential to consider the potential risks and complications, including:

• Hemolysis, which can damage the blood sample 3
• Infection, which can lead to serious complications 4
• Venous thromboembolism, which can be associated with inflammation and infection 5