Blood Draw Procedures

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The warden at our maximum security prison does not want to allow the nurses to bring inmates out for routine blood draws. Instead, inmates are to stick their arms through the pie flap on the cell door so that nurses can obtain the venous sample. Medical staff are concerned for the safety of the inmate and our exposure to possible needlesticks. Can you give any guidance about the safety and exposure risks with this procedure?

The NCCHC standards for health services in prisons require that health care interventions are done within community practice protocols. The warden’s proposed procedures for drawing blood are not in keeping with community standards, pose infection control and safety concerns for inmate and health provider alike, and interfere with the principle of medical autonomy in the sense that security is trying to dictate how medical procedures are to be carried out.

Many variables go into a blood draw, which can be difficult even under the most ideal clinical settings. Doing it through a slot in the door complicates it much further. The procedure involves use of a pressure device to temporarily stop blood flow. Finding a vein may require examination of the whole arm and hand, and often the limb must be positioned in a particular way to enhance success of the draw. Infection control procedures are required to keep the field and needles sterile. We do not know how standard precautions can be maintained given the scenario you describe. And patient cooperation and communication are needed to prevent injury to either party.

If the warden is concerned about bringing the inmate to the clinic for a routine draw, an area on the tier can be set up appropriately for such basic health interventions. A clean, private room adapted to this purpose would allow the necessary security presence if required. Not all maximum security inmates are a safety threat to the same extent. Treating inmates as the warden proposes would only serve to dehumanize them, making them more likely to act out in such circumstances.

As to resources, we suggest you consult the CDC’s process for venipuncture, available online at www.cdc.gov/std/program/medlab/ApF-PGmedlab.htm. Also, an outline for proper phlebotomy techniques is available from the National Credentialing Agency for Laboratory Personnel: www.nca-info.org/pdfs/examoutlines/cl-lab-phlebotomy.pdf.

Although the facility might not have a credentialed laboratory phlebotomist, it would be hard to defend its door-slot procedure in court when the community overall does not recognize the procedure.
— From CorrectCare Volume 20, Issue 2, Spring 2006