Heart Biomarker Evaluation in Apnea Treatment

4.2.6 Troubleshooting

1. HANDLING PARTICIPANTS WHO ARE EXTREMELY APPREHENSIVE ABOUT HAVING BLOOD DRAWN. Do not under any circumstances force the participant to have blood drawn. It may help to explain to the participant that the blood drawing is designed to be as nearly painless as possible. It may be helpful to have the participant relax in the bed just so the phlebotomist can check the veins in the participant's arms, without actually drawing blood. If the participant has "good veins" the phlebotomist can reassuringly say, "Oh, you have good veins; there should be no problem."
2. Bandaging the Arm. If the patient continues to bleed apply pressure to the site with a gauze pad. Keep the arm elevated and straight until the bleeding stops. A gauze bandage can be tightly wrapped around the arm over the pad, and left on for at least 15 minutes.

3. Procedures for Difficult Draw. If a blood sample is not forthcoming, the following manipulations may be helpful.

   • If there is a sucking sound, turn needle slightly or lift the holder in an effort to move the bevel edge away from the wall of the vein.
   • If no blood appears, move needle slightly in hope of entering vein. Do not probe. If not successful, release tourniquet and remove needle. A second attempt can be made on the other arm.
   • Loosen the tourniquet. It may have been applied too tightly, thereby stopping the blood flow. Reapply the tourniquet loosely. If the tourniquet is a velcro type, quickly release and press back together. Be sure, however, that the tourniquet remains on for no longer than two minutes at a time.
   • In general, the phlebotomist should not attempt a venipuncture more than twice. However, at the discretion of the phlebotomist and with the approval of the patient, the phlebotomist may make additional attempts to obtain a blood sample.
   • Reassure the participant that the inability to obtain a clean venipuncture is not any sign of a medical problem on their part.
   • If venipuncture is unsuccessful or requires multiple sticks, this should be noted on the Phlebotomy Form.

4. WHEN A PARTICIPANT FEELS FAINT OR LOOKS FAINT FOLLOWING THE BLOOD COLLECTION.

   • If the person is seated, he/she can sit with the head between the knees if necessary, or allow him to lay down.
   • Provide the person with a basin if he/she feels nauseous.
   • Have the person remain supine or seated until the color returns and he/she feels better.
   • Place a cold wash cloth on the back of the person's neck.
   • If the person faints, use smelling salts to revive by crushing the ampoule and waving it under the person's nose for a few seconds.
   • If the person continues to feel sick, contact a medical staff member who will advise you on further action.

Other Possible Problems:

5. **Not all tubes are collected** (blood flow ceases, difficult venipuncture, etc.). Always fill collection tubes in the order specified. Make notations of difficulties on the Phlebotomy form. If the participant is willing, another attempt should be made to complete the draw collecting only those tubes that were not filled in the first venipuncture.
6. **Collection tube does not fill.** First, try another tube of the same type. Partially filled plasma EDTA, citrate or SCAT-1 tubes are not acceptable if less than 1/2 full. Partial tubes for serum are okay, but will result in a reduced number of aliquots. If a tube is not completely filled, clearly note on the Processing Form as this can affect future assays.