Pumping the Fist Before Drawing Blood: Why You Shouldn't.
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- เผยแพร่เมื่อ 8 มิ.ย. 2024
- When drawing blood samples from patients, one of the most commonly committed venipuncture errors is asking the patient to pump his/her fist when finding veins. While it may make hard-to-find veins easier to locate, repetitive clenching and releasing the fist makes the potassium level in the blood below the tourniquet skyrocket. When drawn and tested, the potassium level the lab reports cannot be trusted to be accurate. The term that describes this error is pseudohyperkalemia, or falsely elevated potassium levels in the blood.
In this video, Your Personal Phlebotomy Guru explains why every phlebotomist must find alternative ways to locate veins and makes several suggestions that won't alter the blood before it's even tested.
Time code:
0:20---Introduction
0:47---Consequences to the patient when fist-pumping is permitted
1:32---What the studies say about how fist-pumping changes lab results
2:31---clip from "Potassium Results Your Physicians Can Trust"
4:46---Summary
To obtain the full-length version of "Potassium Results Your Physicians Can Trust" in DVD or streaming formats, visit www.phlebotomy.com/potassium-....
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Very useful! They should instruct this to every patient because I do this all the time! And on at least two occasions the labs showed elevated potassium and creatinine
It not only increases k levels, it also increases other levels in the blood as well. As for clenching your fist, I don’t allow patients to do this either as it can clamp down on the vein. It’s important to make sure patients understand the importance of hydration prior to having a blood test. Unfortunately most people these days are not well hydrated leading to vasoconstriction.
This is Great!!! Love this video! I am a Phlebotomy Instructor and this will be added to my list of required videos for my students!
That's fantastic, Sunny! Thanks for helping us get the word out.
Gosh, this was great! I knew pumping the fist was a no no, but didn't know about the Potassium issues involved with it!!
Thank you!
thank you !
I have had scores of blood tests over the decades and NEVER had so much as a bruise much less a hematoma...until I went to Quest Labs yesterday morning for a blood test...and the tech put the rubber band on my upper arm and asked to me to start pumping my fist......when I removed the bandaid an hour later there was a rather large bump under my skin that was deep purple....36 hours later it is still there
That's seems so easily preventable. Sounds like the phlebotomist didn't apply proper pressure after the draw or even look to see if bleeding had stopped before bandaging.
Good info Dennis. Do you recommend that a patient makes a fist at all or should they avoid that all together? Previously, I would instruct my patients to make a fist but don’t squeeze. The fist aspect of it seemed to help stabilize the vein. I’m now second guessing that instruction. Any thoughts? Thanks
Good question, Steven. Clenching and holding the fist is fine and does not alter test results. It's the repetitive pumping that causes muscles to pour out the potassium into the bloodstream.
@Adrian Flores Adrian, send me your question using our Contact Us page here: www.phlebotomy.com/contact-us.html
Would this affect HCG levels? I clenched my fist as they put the needle in and then straightened my hand out. I didn’t relax my fist, I straightened it out. I don’t want that to give me a false result.
Hi im getting rapid small pumps on my right arm sometimes on forearm or biceps .what can cause that?
My potassium level was 5.53 but it should be between 3.50-5.10, Can it happen because of pumping the first while blood was being drawn? because I did too much pumping
My potassium was 5.6 nurse told me to clench fist a few times didn’t clean area
Can I have some advantages and disadvantages to the four different phlebotomy techniques please and thank you
We'd love to help. What are the four techniques you're referring to, just to be clear? Do you mean venipuncture, skin puncture, arterial puncture and ??? What's the 4th?
@@centerforphlebotomyeducati4509 1. Cannulation and a syringe
2. Cannula with evacuated tube and adapter
3. Syringe and needle into vein
4. Evacuated tube system used conventionally
@@queenjtaylor8105 These two videos might help with your venipuncture comparisons. th-cam.com/video/INes_0nYH58/w-d-xo.html
th-cam.com/video/ERagNBUvyUc/w-d-xo.html. As for cannulation, it's much more problematic than a dedicated venipuncture unless you're using a device specifically for the purpose. (Check out "Drawing Blood From a Line Without Hemolysis" for more info on that.) But if you must draw from a line without a dedicated device, a syringe might be better because it allows you to draw slowly, rather than letting the full vacuum of a tube pull the blood out when a tube holder is employed. I hope this helps.
@@centerforphlebotomyeducati4509 Thank you very much. The videos were very useful
I was in the hospital last night and the lab tec came in to draw my blood. Well she had me pump because there was no vein. I'm almost sure she hit a nerve. She stuck me and and sharp electric excruciating pain went down the opposite side of the injection site from my forearm to my thumb. I screamed out and yelled a cuss word because it hurt so bad. It was like a shock, like electricity. She said she didn't know what happened and the pain should subside. I hurted about 30 minutes and forgot about it so I never reported it to the nurse. Now I'm home and wakes up to to stinging sharp pain in the same area when I move this arm, turn a know, bend and unbending etc. I just called the hospital floor I was on and left message for the supervisor. Has this girl caused permanent nerve damage in my arm or will this go away?
If you reply, please hit the like on my comment, that is the only way I'll get a notification sent to my phone knowing you replied. Thanks
Does pumping have any effect on red blood cell count or blood pooling?
Yes. That's because of hemoconcentration. Here's a Phlebotomy Today blog post that explains it: www.phlebotomy.com/phlebotomyblog/hemoconcentration-what-you-must-know.html.
Im Taking a phlebotomy class and we are watching the video to have showed what is the title of the video that you use.
Glad you watched it, Brandon. Is there a question in your comment somewhere?
Will a too tight tournaquet cause a falsely increased potassium?
Will using a butterfly needle crush the blood cells and cause a falsey elevated potassium?
Will holding a fist for too long do so as well?
If you see the patient pumping their fists 🤛, and you asked to stop 🛑 ✋ but the patient also tells you that they have been pumping their fists last 5 - to 10
minutes; should you cancel their the blood 🩸 draw for the day and asked them to make an other appointment?
Five minutes of fist pumping should not require a full day to correct. I would recommend ten minutes, tops. After ten minutes of fist pumping, five minutes of rest should be more than enough to negate the effects. Hope this helps.
Will fist pumping during blood donation increases potassium level in collected blood ??
Yes. But it will have no effect on the recipient of the blood since it will be so diluted when transfused.
Recently I got checked my potassium 3 times from different labs in a span of a week after seeing this video. The first test was with turniquet for more than a minute and doing fist pumping. The result was 5.6 mEq/L. Second time with turniquet less than 1 minute without fist pumping but it seems proper syringe was not used . The result was 5.3 mEq/L. The first and second readings were taken from the same spot within a span of 1 day. Third reading was taken after a span of 3 days without tourniquet and fist pumping . To my surprise the result was 4.0. I still did not understand what caused such a drastic drop. Howrver, I would like to mention that I was taking fenugreek supplement till the day before first reading and I stopped it from that day till I got the third report. I am a mild hypertension patient aged 47 taking metprolol 25 mg daily. Any idea why such drastic drop happened in a span of two days?
@@dennisernst9987 thanks for the reply. I meant when I got 4.0 as the reading, I neither used tourniquet nor fist pumping. Do you think there could some messup with the sample in the lab. During first sample collection when I got 5.6 they took almost 7 hours to test the sample due to rush. Second and third time roughly one hour as per the collection and testing times mentioned on the reports. For your info I got Covid 4 months before giving sample. May be this info could help to know the reason
@@ramarao-by6ip It's possible the 5.6 could be due to the long delay, but you also had a 5.3 after that. So it's hard to tell if the 5.6/5.3 are the accurate results or the 4.0 is. More blood collection and processing errors lead to falsely high results than falsely low, so I suspect the 4.0 is more accurate. But it's just a hunch. If a specimen sat around longer than 2 hours without being centrifuged and the serum removed from contact with the cells, that would certainly elevate the potassium to no small degree. Or if the sample was refrigerated before it was centrifuged. Either or both could have happened to the samples that gave the higher result. The good news is that whether your level was 4.0 or 5.6, it's still pretty normal. I don't think your Covid infection had much to do with it.
@@centerforphlebotomyeducati4509 thanks once again for your quick response. Your answer relieved me a lot.
@@centerforphlebotomyeducati4509 I just forgot to mention one point.When I took the second measurement the day after it was 5.6 , though the sample was tested immediately within 1 hour, the point from which it was taken was same as the first one in the previous day. Also, I had some swelling there but I still opted to inject at the same point second time as the vein was clearly visible. Will this have any impact with regards to correlation between first and second readings that were just differing by 0.3
@@ramarao-by6ip it should have no impact. Your potassium should be the same throughout your circulatory system. It sounds like the second draw from the same site was uncomplicated, so there should be no difference based on the swelling. A difference of 0.3 isn't much, and could be from differences in testing instrumentation or methodologies. I hope this helps.
Whenever I have a patient who is a hard stick and they want to pump their fist, I tell them this little story while I’m warming their venipuncture site of what happened to me years ago.
Years ago, me and a coworker were sent to a patient’s room to see if we could get her blood. The patient was a hard stick and others had tried but couldn’t get anything. I took the lead and asked the patient to pump her hand (because this was how we were trained 30 years ago). We got the sample and were proud of ourselves. We were patting ourselves on the back thinking we ruled the floor with our mad phlebotomy stills… until we received a call from the tech running the test.
Lab tech: I need you to recollect that patient’s potassium sample again.
Me: But why? She was a difficult stick and I’d hate to put her through that again.
Lab tech: Sorry, but I can’t used that sample.
Me: what do you mean you can’t use it?
Lab tech: I can’t use it because I would be too embarrassed to result this.
Me: You’d be embarrassed?
Lab tech: Yes. Her potassium level is incapable with life. There’s no one she could have a potassium level that high and still be alive. She was alive when you stuck her, right?
Me: Yes. She was alive when I last saw her.
Lab tech: Ok. Redraw her, but don’t have her pump her fist.
This was the first time I had ever been told not to pump the fist.
I went back. This time I warmed the venipuncture site. Used a syringe and got the sample. Her potassium was normal.
Shortly after this happened our pathologist sent out a memo telling everyone to discontinue the fist pumping.
Even though this was over twenty years ago, people are still asking patients to pump.
When I explain that this is a pre-analytical error and that this could potentially be dangerous for the patient because if their potassium is low, now it looks “normal”. Which you definitely don’t want for a pre-op patient. If it’s reported as “critical high” their doctor is going to make them report to the E.R for a recheck (and now they’re paying for an E.R. visit they didn’t need). Something so simple could mean the difference between being under treated or over treated.
As a phlebotomist, I feel it’s important to educate my patients. I tell them you can make a fist, just don’t pump it. I’ve had a few come back and tell me they’ve mentioned this to the next phlebotomist and we’re surprised they didn’t know it. I’ve even had patients tell their doctors have notice a change in their results.
My phlebotomist had me unclench for 3rd vial. We now I'm bruised and have pain in half my arm!
Sorry to hear that, John. It's hard to imagine the unclenching caused the bruise. Don't let the pain in your arm go without an evaluation for long.
We are asked by the phlebotomy staff to pump our fist
Hmmm. They should be told to watch this video.
My thing is why do nurses ask to make a fist while drawing blood
Making a fist fills the veins with blood so that they are easier to find. When you purposely contract your muscles, the blood flow to them increases. Because the tourniquet is constricted, the blood distends the blood vessels as they become fuller, making them easier to locate by touch. Clenching and holding the fist does not affect test results, but pumping does.
O m g….that is what happened to me.
FYI: We, the patients, pump our fists because the phlebotomist tells us to.
Get it together!
They always make me pump
That's a shame. Maybe it's a teaching moment for you. At least let your physician know not to trust your potassium results.
@@centerforphlebotomyeducati4509 thanks. Is it just potassium. I’m on biologicals and such for vasculitis so get a lot of blood work and have horrible veins. Like where they didn’t even do it for a mri that needed contrast. So many ask to pump.