The newly revised venipuncture standard released by the Clinical and Laboratory Standards Institute in April, 2017 is the most comprehensive revision in the document's history. With over 140 new mandates, facilities have a lot of changes to implement. This series discusses one or more substantive changes each month.

Sometimes, a tourniquet isn't the right tool for the job. Obesity, for example, often requires a blood pressure cuff so that the patient's circulation in the arm is restricted sufficiently to palpate the available veins of the antecubital area. In prior versions of the industry's venipuncture standard, Blood pressure cuffs, when used in place of a tourniquet in phlebotomy, were recommended to be inflated to 40 mm Hg. When the new standard was revised, the limit was changed. Now, cuffs should be inflated just below the patient's diastolic blood pressure.

"My committee's research found 40 mm may not be sufficient for all patients," says committee chairholder Dennis J. Ernst MT(ASCP) NCPT(NCCT). "Applying one limit for all patients isn't practical and not always effective. For patients with high blood pressure, 40 mm may not be enough; for pediatric, and geriatric patients and patients with low pressure, it may be too much."

To comply with the standard, Ernst says collectors will need to find out patient's diastolic pressure by asking a caregiver or by taking the pressure themselves.

Editor's note: Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions as soon as possible. The document, Collection of Diagnostic Venous Blood Specimens (GP41-A7), is the standard to which all facilities will be held if a patient is injured during the procedure or suffers from the consequences of an improperly performed venipuncture.

Read an interview by CLP Magazine with Dennis J. Ernst MT(ASCP), NCPT(NCCT) about the revised standard.