HELP! - Phlebotomy tips needed!!

[kat620]

I recently started working in healthcare as an MA and have not had the best luck with phlebotomy. I know 50% of my missed sticks are due to the stress and nerves that I build up over drawing blood but I'm curious as to whether people believe that being a good phlebotomist is like being able to draw, sing or even juggle!

I know the technique and the procedure of venipuncture I was just hoping for some tips to perfect my skills besides practice, practice. Honestly right now the only veins I feel confident with are the ones that are completely visible or the ones just below the skin that you can't see but that aren't too deep.

Any tips for catching those deep veins on heavier patients or even thin patients sometimes have really deep veins?

I'm hoping I'll improve with more practice I just wanted to see if anyone had any tips or advice

Thanks!!!

[thinkertdm]

Practice will help fine tune your sense of touch. Seeing a vein is nice, but getting an idea of where a vein is by touch will help.

[sunnycalifRN]

I worked 5 years as a phlebotomist. My "go to" vein was always the median cubital vein. It is the largest and is generally very easy to palpate. I never, use "seeing" the vein when going for the vein . . . always, palpate for the vein . . . once I find it and it's almost always in the same spot in the AC fossa . . then I mentally fix that location or use something to mark the skin, if necessary. Then, advance until you get a flash and you're good to go.

Yes, sometimes the median cubital vein can be "deep", as you say, but, with good palpation, you can exactly locate the vein, and go for it. BTW, you seldom will "see" the median cubital, that's why palpation is key, but that is also why I could draw blood on almost anyone.

[kelsey.kristine, CNA]

I agree with the above poster, NEVER go with a vein you "see"!!!

I took a class as part of my CNA training(and EKG, yadda yadda), and LOVED it. I was always SO nervous about finding a vein(we practiced on each other in class), so as weird as it was at first, I practiced finding veins on anyone I knew. They may have found me a little crazy, but they put up with it, and when I found one and let them feel, they found it kinda cool!

Ultimately though, practice makes perfect, I think. :) Also, my teacher would have us "mark" the spot sometimes, mostly in the beginning stages.....I'd use the alcohol wipe that I use to clean the skin. I palpate, and don't move my eyes from the spot, then wipe and put the wipe in a diamond shape(if that makes sense? So a corner is pointing right where the vein is) and that helped me a lot

[FlyingScot, RN]

If you are still nervous sticking easy veins maybe it's not the right time to start sticking the hard ones. Perhaps you would be better off becoming more comfortable/proficient with the process when you are not stressed out. If you are nervous believe me your patient is 100 times more nervous (you know they can sense fear) which only makes them a harder stick. Maybe leaving the harder sticks to a more experienced person while watching them do it, having them explain what they are doing at each step and asking questions might be a good start. When you can smoothly complete a venipuncture on an easy stick then it's time to start challenging yourself. Ultimately it does take practice, practice, practice but if you're terrified you won't be learning anything and both you and the patient suffer.

[Cthulhu]

I am having a very difficult time with phlebotomy also. I am going to register for a phlebotomy course this upcoming semester. I can get my family just fine, but when it comes to my patients, I do not do well. I am very discouraged.

[KateRN1]

I never learned phlebotomy in nursing school but was not so good at starting IVs, so I was terrified when I took a job on an acute floor where the RNs did their own blood draws. After a couple of tries (and practicing on my husband), much to my surprise, phlebotomy has turned out to be one of my better skills.

Some tips:

Don't tie the tourniquet too tight. This can create too much pressure in the vein and make it easier to "blow." Sometimes using a blood pressure cuff is better than the tourniquet.

Don't go for veins you can see, go for the ones you can feel. Ask friends and family members to let you "feel them up." Tie on a tourniquet and practice feeling for veins.

Don't go in at too high of an angle or too deep. You may be going right through the vein, especially if you're leaving a lot of bruises.

Use a butterfly until you're comfortable with the skill set. The flash lets you see the "pop" you should feel as you enter the vein. Once you see the flash, don't go any deeper.

Practice, practice, practice. Admit to the people in your office that you are not feeling very confident and ask if you can practice on them.

Good luck!

[NaKcl, BSN, RN]

:nurse:As everyone said, practice is the answer. Sometime I volunteer to start an IV or blood draw on other nurses' patients. Some nurses think they are getting away with their jobs, but I see them as additional opportunities for me to gain more experiences.

[gymnut]

This is great that this thread came along because I have to learn phlebotomy as well for my PCA job.

I only got to do one stick and it didn't go well. It was on a patients hand because his IV was started at the wrist (other arm didn't have good veins, or so my preceptor said) and the patients wife was complaining that she didn't want me doing the blood draw because I was new. So I had the patient, my preceptor and the wife all watching me like a hawk. Needless to say I flubbed and we couldn't get any blood

They are trying to get me into the lab soon so I can practice, but I'm really nervous. I have a tourniquet at home so I'm going to practice my tying and feeling.

[Ashleyb2442]

Hey

Well first you need to relax and think, but don't over think.

Just follow the basics of drawing blood

-Make sure you tie the tourniquet correctly, dont leave it on,

-Take your time deciding what vein to chose and feel around

-It you cant see a vein redo the tourniquet, apply something warm to make those vein pop,

Switch sites if needed, also make sure you hold down the vein once you find it, you don't want it to move away from you.

All I can really suggest is take your time and go slow, you do better and don't be afraid to touch the patient, cuz you make them more nervous

[GM2RN]

I was phlebotomist before becoming a nurse. I would modify the advice about veins you can see. It's ok to use veins you can see but you should also be able to palpate them. So just don't rely only on the veins you can see, but develop the skill to also palpate the ones you can't see and you will be much more successful.

As far as feeling a "pop" when you enter a vein, sometimes I do, but more often I don't, so don't rely on that one either.

[HmarieD]

I agree with the others as to feeling the vein - it should be plump and bouncy. One trick I learned from a phlebotomist was after palpating the vein, use your inkpen with the tip retracted to press at the site making a little round "o". Then clean the site with alcohol. "o" marks the spot! This is really useful when you can't visualize the vein, keeping you from contaminating the site by touching it again after cleansing.