Problem: Not anchoring the vein
Why is it a problem? Vein may roll, leading to failed attempts and bruising.
Solutions: Anchor the skin below the site to stabilise the vein before insertion.

Problem: Poor vein choice
Why is it a problem? Increases chance of multiple attempts, pain, nerve and tendon damage, and poor-quality samples.
Solutions: Select a straight, well-palpable vein; avoid small, fragile or previously damaged sites.

Problem: Patient dehydrated
Why is it a problem? Dehydration reduces venous filling, making veins harder to access.
Solutions: Encourage hydration beforehand (if appropriate); warming can also help.

Problem: Patient anxiety not addressed
Why is it a problem? Anxiety heightens distress, may affect cooperation, and in some cases contributes to fainting.
Solutions: Acknowledge concerns, give clear explanations, and use distraction or applied tension techniques.

Problem: Patient cold
Why is it a problem? Peripheral vasoconstriction makes veins less visible and harder to palpate.
Solutions: Warm the patient’s arm or room to encourage dilation.

Problem: Poor needle choice
Why is it a problem? Can cause vein trauma, haemolysis, or sampling failure.
Solutions: Match needle gauge to vein size, patient needs, and test requirements.

Problem: Valve occlusion
Why is it a problem? If the needle rests against a valve, blood flow is obstructed.
Solutions: Withdraw slightly or adjust angle to restore flow.

Problem: Rushed palpation/procedure
Why is it a problem? Poor vein assessment increases the risk of failed or traumatic attempts.
Solutions: Take time to palpate carefully and plan your approach.

Problem: Poor positioning
Why is it a problem? Unstable or uncomfortable positioning increases movement and risk of complications.
Solutions: Position the patient comfortably, with the arm extended and supported.

Problem: Poor use of tourniquet
Why is it a problem? Too tight or prolonged use causes haemoconcentration, discomfort, or inaccurate results.
Solutions: Apply just firmly enough, and release promptly as soon as not needed anymore.

Problem: Lack of anatomy knowledge
Why is it a problem? Increases the likelihood of missing veins or injuring nearby structures.
Solutions: Revise upper limb anatomy and practise palpation regularly.

Problem: Unconfident with/wrong equipment – poor infection control
Why is it a problem? Delays, errors, or breaches of asepsis compromise patient safety.
Solutions: Check equipment in advance and maintain aseptic technique. Practice with equipment first.

Problem: Abusing veins
Why is it a problem? Repeated puncture in the same site leads to scarring, thrombosis, or vein loss.
Solutions: Rotate sites and use alternative veins where possible.

Problem: Inadequate care of puncture site
Why is it a problem? Increases risk of bleeding, haematoma, or infection.
Solutions: Apply firm pressure until bleeding stops and dress appropriately.