[How to prevent phlebotomy-related nerve injury]

Phlebotomy-related nerve injury is relatively rare but could be a serious complication of venipuncture; however, widely recognized and effective methods to prevent nerve injury at venipuncture have not been established. By considering the anatomical features of peripheral nerves and veins of the arm, several techniques may be feasible. To prevent median nerve injury, which is the most serious among the nerve injuries in the arm, the following order of vein selection is recommended: (1) radial vein (2) median cubital vein (3) basilic vein (4) forearm veins (5) veins of the back of the hands. However, this order should be changed according to the status of the actual veins of the patient. To avoid the needle from being inserted too deeply, short needles such as butterfly needles may be preferred. Although probing is a very dangerous procedure which must be avoided, re-direction of the needle is an acceptable procedure if it is performed once per venipuncture. In addition to these technical efforts, it is critical to ask each patient before venipuncture whether he or she has experienced nerve injury during previous phlebotomy in order to avoid unnecessary repetitive nerve injuries in the same patient. In order to avoid such situations, we have established a computer-based system to alert phlebotomists to the complications which patients have experienced during venipuncture. These and other methods should be tested in many institutes and data should be systematically collected to investigate whether phlebotomy-related nerve injury can be effectively prevented.