Pumping the Fist Before Drawing Blood: Why You Shouldn't.

When drawing blood samples from patients, one of the most commonly committed venipuncture errors is asking the patient to pump his/her fist when finding veins. While it may make hard-to-find veins easier to locate, repetitive clenching and releasing the fist makes the potassium level in the blood below the tourniquet skyrocket. When drawn and tested, the potassium level the lab reports cannot be trusted to be accurate. The term that describes this error is pseudohyperkalemia, or falsely elevated potassium levels in the blood.

In this video, Your Personal Phlebotomy Guru explains why every phlebotomist must find alternative ways to locate veins and makes several suggestions that won't alter the blood before it's even tested.

Time code:
0:20---Introduction
0:47---Consequences to the patient when fist-pumping is permitted
1:32---What the studies say about how fist-pumping changes lab results
2:31---clip from "Potassium Results Your Physicians Can Trust"
4:46---Summary

[fineartlifestyling]

Very useful! They should instruct this to every patient because I do this all the time! And on at least two occasions the labs showed elevated potassium and creatinine

[sunnyaripeka]

This is Great!!! Love this video! I am a Phlebotomy Instructor and this will be added to my list of required videos for my students!

[Skipper.]

It not only increases k levels, it also increases other levels in the blood as well. As for clenching your fist, I don’t allow patients to do this either as it can clamp down on the vein. It’s important to make sure patients understand the importance of hydration prior to having a blood test. Unfortunately most people these days are not well hydrated leading to vasoconstriction.

[nativetexan]

Gosh, this was great! I knew pumping the fist was a no no, but didn't know about the Potassium issues involved with it!!

[porpolo]

This has happened to me multiple times. I've always had issues with nurses having issues getting blood out of me. They blame my veins. They have me pump my fists vigorously and low and behold Potassium levels off the scale. Of course I was lucky enough to just find this video. Getting retested tomorrow.

[universaldonor]

I have had scores of blood tests over the decades and NEVER had so much as a bruise much less a hematoma...until I went to Quest Labs yesterday morning for a blood test...and the tech put the rubber band on my upper arm and asked to me to start pumping my I removed the bandaid an hour later there was a rather large bump under my skin that was deep purple....36 hours later it is still there

[stevendoerflinger]

Good info Dennis. Do you recommend that a patient makes a fist at all or should they avoid that all together? Previously, I would instruct my patients to make a fist but don’t squeeze. The fist aspect of it seemed to help stabilize the vein. I’m now second guessing that instruction. Any thoughts? Thanks

[queenjtaylor]

Can I have some advantages and disadvantages to the four different phlebotomy techniques please and thank you

[brandonfiedler]

Im Taking a phlebotomy class and we are watching the video to have showed what is the title of the video that you use.

[AmandaBuhs]

Would this affect HCG levels? I clenched my fist as they put the needle in and then straightened my hand out. I didn’t relax my fist, I straightened it out. I don’t want that to give me a false result.

[certifiedquality]

Hi im getting rapid small pumps on my right arm sometimes on forearm or biceps .what can cause that?

[sharris]

I was in the hospital last night and the lab tec came in to draw my blood. Well she had me pump because there was no vein. I'm almost sure she hit a nerve. She stuck me and and sharp electric excruciating pain went down the opposite side of the injection site from my forearm to my thumb. I screamed out and yelled a cuss word because it hurt so bad. It was like a shock, like electricity. She said she didn't know what happened and the pain should subside. I hurted about 30 minutes and forgot about it so I never reported it to the nurse. Now I'm home and wakes up to to stinging sharp pain in the same area when I move this arm, turn a know, bend and unbending etc. I just called the hospital floor I was on and left message for the supervisor. Has this girl caused permanent nerve damage in my arm or will this go away?

If you reply, please hit the like on my comment, that is the only way I'll get a notification sent to my phone knowing you replied. Thanks

[irene]

Will a too tight tournaquet cause a falsely increased potassium?

Will using a butterfly needle crush the blood cells and cause a falsey elevated potassium?

Will holding a fist for too long do so as well?

[gen-X-trader]

Does pumping have any effect on red blood cell count or blood pooling?

[thecyclist]

My potassium level was 5.53 but it should be between 3.50-5.10, Can it happen because of pumping the first while blood was being drawn? because I did too much pumping

[derodse]

Whenever I have a patient who is a hard stick and they want to pump their fist, I tell them this little story while I’m warming their venipuncture site of what happened to me years ago.

Years ago, me and a coworker were sent to a patient’s room to see if we could get her blood. The patient was a hard stick and others had tried but couldn’t get anything. I took the lead and asked the patient to pump her hand (because this was how we were trained 30 years ago). We got the sample and were proud of ourselves. We were patting ourselves on the back thinking we ruled the floor with our mad phlebotomy stills… until we received a call from the tech running the test.

Lab tech: I need you to recollect that patient’s potassium sample again.
Me: But why? She was a difficult stick and I’d hate to put her through that again.
Lab tech: Sorry, but I can’t used that sample.
Me: what do you mean you can’t use it?
Lab tech: I can’t use it because I would be too embarrassed to result this.
Me: You’d be embarrassed?
Lab tech: Yes. Her potassium level is incapable with life. There’s no one she could have a potassium level that high and still be alive. She was alive when you stuck her, right?
Me: Yes. She was alive when I last saw her.
Lab tech: Ok. Redraw her, but don’t have her pump her fist.

This was the first time I had ever been told not to pump the fist.

I went back. This time I warmed the venipuncture site. Used a syringe and got the sample. Her potassium was normal.

Shortly after this happened our pathologist sent out a memo telling everyone to discontinue the fist pumping.

Even though this was over twenty years ago, people are still asking patients to pump.
When I explain that this is a pre-analytical error and that this could potentially be dangerous for the patient because if their potassium is low, now it looks “normal”. Which you definitely don’t want for a pre-op patient. If it’s reported as “critical high” their doctor is going to make them report to the E.R for a recheck (and now they’re paying for an E.R. visit they didn’t need). Something so simple could mean the difference between being under treated or over treated.
As a phlebotomist, I feel it’s important to educate my patients. I tell them you can make a fist, just don’t pump it. I’ve had a few come back and tell me they’ve mentioned this to the next phlebotomist and we’re surprised they didn’t know it. I’ve even had patients tell their doctors have notice a change in their results.

[ramarao-byip]

Recently I got checked my potassium 3 times from different labs in a span of a week after seeing this video. The first test was with turniquet for more than a minute and doing fist pumping. The result was 5.6 mEq/L. Second time with turniquet less than 1 minute without fist pumping but it seems proper syringe was not used . The result was 5.3 mEq/L. The first and second readings were taken from the same spot within a span of 1 day. Third reading was taken after a span of 3 days without tourniquet and fist pumping . To my surprise the result was 4.0. I still did not understand what caused such a drastic drop. Howrver, I would like to mention that I was taking fenugreek supplement till the day before first reading and I stopped it from that day till I got the third report. I am a mild hypertension patient aged 47 taking metprolol 25 mg daily. Any idea why such drastic drop happened in a span of two days?

[suganyapalanisamy]

Will fist pumping during blood donation increases potassium level in collected blood ??

[johnsarab]

My phlebotomist had me unclench for 3rd vial. We now I'm bruised and have pain in half my arm!

[Gypsymumma]

My thing is why do nurses ask to make a fist while drawing blood