Dear Center for Phlebotomy Education:

We have a regular patient who is an IV drug addict. Naturally, his veins are extremely hard to find. Those we can find are so scarred they can hardly be used. He keeps asking if he can insert the needle since he knows exactly where his best access sites are. We're at our wit's end with finding veins on him, and wonder what problems there might be in honoring his request. What should we do?

My Response:

Under no circumstances should the needle be placed in the hands of any patient. Not only can it be used as a weapon if the patient has an ulterior motive, but there's another huge legal liability here. Here's how it could play out. The addict is allowed to stick himself. He injures a nerve or nicks an artery and sues for damages. Remember, your patient is an addict and is always looking for ways to finance his addiction. The addict’s attorney successfully argues that he should not have been allowed to draw his own blood because he has not been trained in the risks of the procedure. The attorney is absolutely right.

To us, it seems permitting this practice is setting your facility up for big problems. We suggest bringing this to the attention of your risk manager and establish a written policy.