Drawing blood/phlebotomy tips and tricks

[CrunchRN]

Ok, so I took my class last february, got some tips here, and now have done at least 70 draws. I am decent, but now I want to be better than that.

My problems are those women (they are all post menopausal women in my study) with those skinny itsy bitsy torturous veins that you really cannot hardly feel, but can see a little. And then the other problem are those women you just cannot palpate or see anything.

Advanced tricks and tips please! Actually, basic ones are great too.

I am using butterflies.

[sankofah]

have u people lost your little bit of minds! see thats why i want to become an instructor. u know goodness and well you r not supposed to go in the wrist. y would u advise a new phlebotomist or nurse to that site. u ought to be ashamed of urselves! everyone develops their own little tricks of the trade but patient care should always, always come first! smh i am sooo dissappointed in all of u who support or perform shoddy practices.

[sankofah]

i also wanted to post but i had lost my train of thought that try not to rely on sight it will set u up for failure as palpating the vein is the best and stay away from shallow ones as well. study the craft as much as possible and use proper gage needles for size of vein as well as age appropiate and location. as using wrong size can damage veins and cells and when u get arterial blood as opposed to veinous blood it can alter some test results. try to understand what goes on in the core lab as well u will be better for it and u will try to avoid cross contamination of solvents in tubes and perform proper order of draw.

[staceyk1974]

Let me give you a patient's perspective. I'm not a phlebotomist or a nurse. In fact, I don't work in the medical field at all. I am someone with notoriously hard veins to find. I had to have blood drawn today. I warned her about my veins. She tried feeling around for about a minute on each arm and then saw the huge vein in my wrist and decided to go there. I've had blood drawn many times, and never had someone use my wrist. My veins are difficult, but not impossible for someone with some patience. She stuck me, then wiggled the needle around, moved it in deeper and finally filled the required vials. It's been 8 hours, and the pain in my wrist and hand have gotten progressively worse. My hand is almost unusable at the moment.

Take the time to find difficult veins.

[CrunchRN, ADN, RN]

Ouch. I don't do wrists. So sorry for your bad experience.

[iluvivt, BSN, RN]

Can't say I have never used the wrist but it is usually in my last resort category...get this...... almost half the lawsuits related to IV therapy are related to IV starts and drug administration into the wrist..and that includes both surfaces ...so only use this area as a last resort...stay shallow...pt complains of a shooting pain..TAKE THE NEEDLE OUT IMMEDIATELY. I would tell you to take the take to find a good vein before you start poking.. a not so great vein.....apply warm heat..it works great and is fast

[Cmunley86]

CrunchRN said:

Ok, so I took my class last february, got some tips here, and now have done at least 70 draws. I am decent, but now I want to be better than that.

My problems are those women (they are all post menopausal women in my study) with those skinny itsy bitsy torturous veins that you really cannot hardly feel, but can see a little. And then the other problem are those women you just cannot palpate or see anything.

Advanced tricks and tips please! Actually, basic ones are great too.

I am using butterflies.

Well, I only have a little more of a year's experience. But, where I have gone to school, interned, and worked the wrists aren't even considered unless you are specialized in respiratory therapy (they are used for arterial blood gasses or ABGs)(or a RN that's extremely experienced). On a critical nursing home patient, I have drawn from the vein that goes along the thumb side-but it was a last resort, and I had someone verify it was a good spot to go. And also, the veins you see aren't always the best veins. Hot packs, heel warmers, warm paper towels work well too. One other thing (I don't recommend this for every patient, and don't inspectors see this!) but ripping a part of the index finger of the glove can help too.

[Been there,done that, ASN, RN]

Apply three bandaids "I tried".. call lab.

[OKNurse2be]

This is from "having been a pt perspective" but I have not too visible/palpable veins on the surface of my hands (supine) and when you are in L&D they don't put IV in the antecubital region because they want you to have some mobility of your arms.. so all three of my kids I had my IV in the wrist. I have never had any long term effects from having the IV placed there, but I will tell you that it hurt to have it in. I don't know why they wouldn't try my hand each time, but they didn't.

[psu_213, BSN, RN]

sankofah said:

have u people lost your little bit of minds! see thats why i want to become an instructor. u know goodness and well you r not supposed to go in the wrist. y would u advise a new phlebotomist or nurse to that site. u ought to be ashamed of urselves! everyone develops their own little tricks of the trade but patient care should always, always come first! smh i am sooo dissappointed in all of u who support or perform shoddy practices.

Well, sometimes you need blood stat and if the wrist veins are all you have, you go there--new nurse or not! If there is a good vein somewhere else, I would avoid the wrist, but sometimes it has to be done. (Try to get of the soapbox and avoid telling nurses they should be 'ashamed' of themselves). Also, avoid the textspeak and annoying acronyms--they make your post more difficult to understand. Thanks!

To the OP, try lowering the side rail and allowing the arm to lay down over the edge of the bed. Also, when you clean the site, move the alcohol wipe from distal to proximal over the site where you think you want to stick. This can move blood above the valves in the vein and help to plump it up.

[psu_213, BSN, RN]

Cmunley86 said:

Well, I only have a little more of a year's experience. But, where I have gone to school, interned, and worked the wrists aren't even considered unless you are specialized in respiratory therapy (they are used for arterial blood gasses or ABGs)(or a RN that's extremely experienced).

When I was in school, the basically told us that respiratory therapists draw almost all ABGs and RNs almost never do. Well, in the 3 jobs I have had as an RN, the RNs drew all ABGs...and it was only after the RN could not get it that respiratory was called. As a brand new nurse still on orientation I had to stick someone in the wrist for an ABG. I didn't like the pain I was causing, but I realized it had to be done and I had to learn.

As for venipuncture in the wrists...don't do it unless you have to, but it occasionally has to be done.

[Firstklass7]

I feel for you! How have you been so far?

[Firstklass7]

You should never rip off the tip of the glove! Once you clean the site, you end up contaminating it again once you feel it again with your finger! Why clean the site then???!! Bad move...