Was this blood test unhygienic/dangerous?

[Cakeeater100]

Any medical professionals that can help much appreciated!

Today I had a blood test at a hospital. It's one of those departments where they see dozens of people every hour, 6 or so phlebotomists working. I have had lots of blood tests over the years so was not expecting anything untoward but today bothered me.

Anyway I had a blood sample with a tourniquet (strap to tighten the arm) attached at the top of the arm. The blood was taken and a tiny pad placed on the bleed. Then the lady lowered the tourniquet and placed it right OVER the bleed with just the loose tiny pad underneath. This was the tourniquet used on all the previous patients. She then filled in the paperwork, removed the tourniquet and finally attached a plaster on the pad.

I was a bit taken aback, a loose pad could have rolled off and the tourniquet bled on. It could have been bled on by other patients too. I have never had this done before and was slightly bewildered.

I don't know whether I should complain or whether this is normal practise. I know on AIBU I risk being slaughtered as an mental Myrtle but settle my mind, was this risky?

PALS are not just about complaining, it's advice too. But don't know whether it's worth it.

Yes I admit I said nothing and sat there like a lump of lard.

My concerns are about blood borne infection really.

Was the tourniquet blood stained and in direct contact with your puncture wound? If so then yes absolutely seek advice urgently! Otherwise the issue here is you have serious anxiety not the phlebotomist

Think about it logically for a minute. If this was an inherently dangerous practice and it has been done regularly by a big phlebotomy department then enough people would have got ill by now to trigger a review.

Also on a practical note, the blood tends to dry on the cotton wool pad quite quickly so it’s difficult to see how anything could be transmitted. Most places are happy for you to hold the pad in place with your unwashed hands that have been in contact with hospital surfaces.

Do you have health anxiety?

Not an issue OP.
Stop worrying.
Blood wouldn't soak through pad as pressure from tourniquet would help stop the bleeding - that's why phlebotomist put it there.
You have more to fear from hospital door handles than this.
Get well soon.

What @Wingedharpy says

Relax

Do you mean that the tourniquet was used momentarily keep pressure on the pad?

Yeah op, if be freaked out too. It's very unhygienic, not sure why you are getting so many sarcastic comments

OP what blood borne infections do you think you might have been exposed to? From what you wrote there was a pad between your skin and the tourniquet.

Yes this is bad practice. I wouldn't have issue with a reusable tourniquet in outpatients personally (although the Infection Control team would....) but putting pressure on the wound with a reusable tourniquet I wouldn't accept.

You wouldn't put pressure on a puncture wound with a dressing or tape that had been used on the previous patient with just a thin dressing separating. I would definitely raise this via PALS so this person can receive retraining.

Not sure why previous posters are criticising the op, maybe they didn't understand that the tourniquet was being misused for putting pressure on the wound.

And in future op do speak up if you are unsure about something.

I take blood at least 5 times a day- I still use a fabric tourniquet- the latex style ones are useless- you just can’t get them tight enough to get a good vein.
I’m wondering if this is more about more generalised anxiety around your health & the care given by HCP’s.Blood born viruses are exactly that- carried between donor & host if that makes sense ie: carried on fresh blood into an open area. BBV’s can’t live outside the body for very long, we’re talking 10’s of minutes no more, and certainly not on a surface life the fabric of a tourniquet.(I do wipe it down regularly with alcohol wipes though before people start shouting “grim!” ) Talking to your GP might be helpful in terms of reassurance & if you still feel you’d like to write to PALS that route is always open to you.

They always do it this way when I have blood taken at the Gp’s and psychiatrist hospital (lithium). I don’t see the problem, blood doesn’t deep through, so what’s the issue? No different to using the same stethoscope, or blood pressure cuff (IMHO)

Next time just have your finger ready to press the cotton wool & tell them you would rather they not use the tourniquet to apply pressure.

We still use fabric tourniquets at our surgery but we don’t use the tourniquet to press the cotton wool on.

However, in over a decade I have never had someone bleed through a pad. Even if they are on blood thinners.

Asking if it’s the correct bottle is better than not taking the correct sample, you not getting the results & needing another blood test.

I've never known the tourniquet to be used to apply pressure after.

What is the point when that can be done by the patient?

In my area the single use tourniquets have only recently come in. Before that it was normal for the reusable tourniquet to be used to apply pressure after the test was taken.

We only use the fabric ones, they’re far better and you need all the help you can get when you’re trying to get access in a neonate so that wouldn’t concern me. I’ve never see pressure applied to the puncture site using the tourniquet and I agree it’s not ideal however your risk of contracting a blood borne infection in this manner would be minimal. I think it would be best for you OP to stop worrying about this and I really don’t think a complaint it warranted here. As was previously stated, the phlebotomist having to clarify what blood bottles to use is no biggie, there are many different bottles, different sizes etc and some blood tests are less common than others, isn’t it better that she clarified rather than using the wrong bottle resulting in you having to come back to repeat the test?

Thanks for the replies especially those who work in clinical settings.

The phlebotomist getting clarity on bottles was probably a good thing, so that I can understand is a non issue.

But seems that using a fabric tourniquet to apply pressure to a wound is not best practice. Though the risk of infection appears minimal. It hasn't been helped though by a former nurse friend of mine telling me I should wait a few weeks then get a test for hep B and C "just in case".

That would be a huge waste of NHS resources.

@jerrysbellyhangslikejelly you have fabric touniquets for neonates? I just use the hand holding theirs to hold and touniquet at the same time. If I'm going somewhere other than the hand I tie a piece of gauze around. I've never seen a neonatal sized tourniquet!

I give blood every two months (and am regularly tested for a separate condition). They've never put the tourniquet on after drawing blood. They usually put on a little foam tube thingy over the plaster and tape that down to keep the pressure on.

Side issue, but wow, are people really using tourniquets on neonates? Never seen that in 20 years of paeds.

Right, sorry, back on topic. Absolutely agree it is sensible to check bottles if unsure. There are so many possible tests out there, very hard to remember them all. And when you add in different colour bottles for the same tests in a child vs an adult it really helps confuse things.

If, and only if, this were a reusable tourniquet, I'd consider the described practice as suboptimal in terms of infection control, but would not be running around looking for blood borne virus testing. The gauze didn't slip.

Fuck me love.......Dont get I'll and have a requirement to spend time in hospitals!

Your nurse friend should not be giving advice if she is that ignorant. You are not at risk of any blood borne virus. It's entirely up to you if you go to PALS, but if you choose to, bear in mind that it may be viewed as a complaint against the phlebotomist.

A large part of my work involves taking bloods ( work in GP practice ) . It’s good practice to loosen the tourniquet before completing the procedure so I’m not sure why the phlebotomist would have left a tourniquet in place to hold the injection swab .
I usually apply a swab and ask the patient to press on it ( provided they can follow instructions ) .
Hospitals usually use disposable tourniquets now but it would not be good to leave a tight tourniquet in place after the procedure was complete due to risk of extensive bruising / haematoma etc .

Emilizz34 I have a blood clotting disorder with a fairly high INR (not unusual for it to be 3.5 or above). Simply releasing the pressure on the tourniquet wont cut the mustard to stop me bleeding after a blood test. I would have thought that a lot of people on warfarin are similar.

Probably doesnt help that I have 'good' veins - I'm a phlebotomist's dream - you only need to look at my veins and they pop out!