Arterial puncture phlebotomy

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Estimated frequency: 
Rare at 0.0029% (1/34,000 needle insertions); 12 cases out of 410,000 donations.
Time to detection: 
Immediate for large majority of cases; rare cases may be discovered post-donation.
Alerting signals, symptoms, evidence of occurrence: 
Bright red blood in bag, fast blood-flow rate (<4 minutes), pulsating tubing. One case diagnosed post-donation after donor developed a brachial artery pseudoaneurysm.
Demonstration of imputability or root cause: 
Bright red blood, pulsing and/or rapid filling of bag immediately after needle insertion into the artery.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest new keywords: 
arterial puncture, blood donation, AV fistula, compartment syndrome, bright red blood, pseudoaneurysm
Suggest references: 
Newman BH. Arterial puncture phlebotomy in whole-blood donors. Transfusion. 2001 Nov;41(11):1390-2 Newman BH. Arm complications after manual whole blood donation and their impact. Transfusion Med Rev. 2013 Jan; 27(1):44-9. Epub 2012 Jun 6. Parsons J. Incidental arterial phlebotomy of a whole blood donor. Transfusion. 2014 May;54(5):1220.
Expert comments for publication: 
Arterial punctures are 5 times more common in newly trained phlebotomist than in experienced phlebotomists. The outcome is usually good but serious sequelae can occur including pseudoaneurysm (1.5% of arterial punctures), AV fistulas and compartment syndrome. Donors with known arterial punctures should be alerted to seek immediate medical attention for symptoms such as rapid swelling and/or numbness of arm, thrill, dilated veins or a pulsating mass.