A relatively common problem in phlebotomy is failure of the first venipuncture. Whether this becomes a problem depends on a number of factors.
Worst case scenario: inexperienced and flustered phlebotomist making multiple failed attempts to collect blood despite complaints from the patient or family member
High risk patient:
(1) limited number of veins suitable for venipuncture
(2) poor veins (small, rolling, invisible)
(3) intravascular infusion line(s) in other accessible veins
(4) irritable
(5) coagulopathy
(6) history of requiring multiple sticks
(7) squirming or unable to hold still
A variety of devices are available for localizing veins that are difficult to locate, but these tend to be expensive.
High risk phlebotomist:
(1) inexperienced
(2) poorly trained
(3) high complication rate
(4) no backup with an experienced phlebotomist
(5) continues despite protests from the patient or family
High risk situation:
(1) emergency
(2) inability to contact clinician
(3) no protocol for when to go to PICC line or port
(4) no policy for handling the difficult venipuncture, with limit on attempts (usually 2)
