How is CRPS and a Routine Blood Draw Related?
Routine blood tests are common practice within the healthcare system. Blood tests detect a number of illnesses, infections, pregnancy, and keep track of patient health. While mildly unpleasant (no one wants to be pricked with a needle!), a properly performed blood draw should be no risk to the patient. Millions of Americans visit their doctor’s office every year to have their blood drawn. It could be to seek diagnosis for symptoms of illness or part of a yearly physical exam. A simple blood draw shouldn’t be a procedure a patient worries about being performed properly. Aside from the slight discomfort of the needle prick, a blood test shouldn’t pose any inherent health risk to the patient.
When it’s not a routine blood draw
There are many instances where the outcome of a blood draw results in CRPS. However, very few discussions are being had in any forum about what went wrong. The Shaked Law Resource is known for our truthful, fact-based legal articles that provide unbiased information readers in search of information post-accident won’t find anywhere else. Within this writeup, we’ll provide readers with the information they need to be aware of, in the event a routine blood draw results in serious injury such as Complex Regional Pain Syndrome.
Within this article, we’ll answer the following important questions related to the link between CRPS cases and previous blood draws:
- What are the steps to a safe blood draw?
- Why is CRPS known as “The Suicide Disease”?
- What is being done for CRPS patients?
Whether it’s due to the carelessness of the phlebotomist (a medical professional with the special licensing needed to draw blood) or a registered nurse (a licensed medical professional who works alongside the doctor and cares for patients on a daily basis) who fails to use proper technique to perform the blood draw, any mistake made during a blood test can cause severe and permanent harm to the patient. In cases where nerve damage results as the outcome of improper lab drawing procedure, CRPS (Complex Regional Pain Syndrome; formerly known as RSD) occurs.
In the medical profession, any act that occurs as a result of the intentional recklessness of the healthcare professional is known as malpractice. If the phlebotomist, nurse, or other licensed professional employed to perform lab draws on patients is aware that their actions could cause harm, but they act regardless, they are committing medical negligence. In the event that a jury would find the act of the healthcare professional “unreasonable” under the circumstances under which it was committed, they could find that person liable for medical malpractice. Healthcare professionals, under their license, are liable for the safety of each and every patient they come into contact with.
What are the steps to a safe blood draw?
In order to properly perform a blood draw in both office and hospital settings alike, there are several steps that must be followed in order for the procedure’s outcome to be safe, quick, and as painless as possible. If these steps are not performed in order, or a step is ignored, missed, or treated without the proper attention paid to it, a patient can sustain irreparable injury to the arm and/or hand. The nerves in the arms and hands are extremely delicate and must be treated with care. Improper handling of a needle or an improperly sized needle used on a patient (the elderly and minors are at risk for improperly sized needles if the healthcare professional is not careful) can result in CRPS, leaving the patient in agony for a lifetime.
When a nurse performs a blood draw, he or she must begin with the following steps:
- Proper hand washing technique as per OSHA: Every medical professional that comes into contact with patients or hazardous materials (blood, bodily fluid, excrement) must be certified by OSHA before they can touch a patient. Hand washing must be performed to the letter, to avoid the risk of infection to the nurse and to the patient.
- Apply a tourniquet to the patient’s upper arm in order to locate a vein: This should be done in a timely manner. Locating a vein can be difficult on the elderly, heavier patients, or darker skinned patients, but this is not a reason to neglect the duty of care or become lazy. Each patient must be treated with care and given the full attention of the healthcare provider despite the difficulty in their treatment. When the vein in either the arm or hand is located, the nurse must remove the tourniquet and then proceed to step three in a timely manner. If the provider is unsure of whether the vein can be used, they MUST call for assistance from a superior. A device called an AccuVein may be brought in to properly locate an accessible vein. In the event they use an artery instead of a vein, or knick one of the delicate nerves in the arm, severe injury such as CRPS can result.
The healthcare professional must remember to double check everything prior to performing the test:
- Ensure everything necessary is present and within reach: All supplies necessary to perform the blood draw should be in reach prior to performing the procedure. This includes the appropriately sized needle. For children and the elderly, a “butterfly” needle must be used to avoid injury. AccuVein should be considered if the first attempt to draw blood fails. Supplies usually necessary for a blood draw include: alcohol wipes, Vaccutainers (vials) for collecting blood samples, gauze pads, and latex free bandaids. When everything is prepared and within reach of the nurse, she or he should double check the area to ensure nothing was missed.
During the blood draw:
- Apply the tourniquet to the patient’s upper arm in preparation for the blood draw: Clean the area to be used for the blood draw with an alcohol wipe from the inside to the outside of the arm, ensuring no bacteria comes in contact with the area to be drawn. Gently hold the patient’s elbow with one hand while using care to perform the procedure. When the needle is secure, perform the blood draw in the correct order (each vial has a different colored top; for medical professionals this is of utmost importance–misdiagnosis can occur if the vials are not drawn in the correct order).
After the blood draw, the following steps must be followed to ensure proper minor wound healing:
- Remove the tourniquet from the patient before the last vial is drawn: There is an inherent risk of nerve damage, CRPS, and/or hematoma (a large, painful bubble of blood under the skin that risks a blood clot) if the tourniquet is not removed in a timely manner. It should always be removed before the last vial of blood is drawn to allow the pressure in the arm to gradually return to normal. The fingers should never be allowed to turn blue during a blood draw, and the healthcare provider should keep their eye out for this. If this occurs, the procedure must be stopped, the tourniquet and the needle removed in that order, and a doctor must be called immediately to assess the situation.
- Apply pressure, bandaid, raise the patient’s arm: It’s a common misconception that the arm must be held in the downward position after a lab draw. In reality, nursing students are taught to put the patient in a “Statue of Liberty” position (that is, arm raised above the head, if tolerated) for 60 seconds to allow the blood not to pool in the crook of the arm, where most blood tests are performed. It’s also important to inquire whether the patient has a latex allergy, and apply a latex free bandaid if necessary.
Why is CRPS known as the “Suicide Disease”?
Patients who sustain CRPS after medical malpractice such as an improperly performed blood draw have one of the highest rates of suicide in the world. The pain caused by Complex Regional Pain Syndrome has been the subject of multiple documentary films, due to its moniker as the “Suicide Disease”. Even celebrities, such as pop superstar Paula Abdul suffer from CRPS and choose to share their anguish with the world in a series of posts.
The epidemic of patients who are diagnosed with CRPS and subsequently commit suicide months or years after, is not a coincidence. The link between CRPS and suicide has been scientifically proven to be factual. The pain and suffering caused by this disease is absolutely unbearable, and most patients will find they have no quality of life after being forced to survive with little to know known pain control for it. Opioids are addictive and physical therapy when the body has already been through pain and suffering is difficult or impossible for many patients.
What is being done for CRPS patients?
There are clinical trials on the horizon for CRPS. Research is being done every day to further the treatment and pain control for victims of this “suicide disease”. However, Complex Regional Pain Syndrome has now been classified as a rare disease in recent years, leaving little in the way of treatment outside of clinical trials that “may” or “may not” work for patients inflicted. The Food and Drug Administration explains that a disease is classified as rare if:
“[…]A disease is considered rare if fewer then 200,000 people in the United States have it.”
There are only several other known diseases in medicine with pain that can be considered on par with what Complex Regional Pain Syndrome patients suffer. These other extremely rare diseases–Marfan Syndrome, Ehlers-Danlos Syndrome, Amplified Musculoskeletal Pain Syndrome (AMPS), and Scleroderma–are some of the only other diseases in modern medicine to be considered even closely linked to the level of severe pain inflicted upon those with CRPS. It should be noted that when not directly linked to medical negligence, CRPS can be found as a co-morbidity (secondary illness) in the aforementioned rare diseases.