Phlebotomy

[zacarias, ASN, RN]

hey all!

i'm a very new nurse on a medicine floor in the seattle area. my question is about phlebotomy. we do our own peripheral draws sometimes and this is something i want to get good at, along with ivs.

the butterflies we use that are very small seem like they should be easy to get into veins. i know i'm very inexperienced but i hit and miss a lot. i anchor the vein distal to where i plan to insert the needle but the vein seems to roll quite easily. i sometimes get a flashback but then the blood won't flow into the tube. i've done it successfully before mind you but i have like no confidence and feel i need some good advice from seasoned "venipuncturists."

a lot of the patients on our floor have bad veins too but i don't want to let that stop me. is it easier to try antecubital veins or hand veins first for lab draws?

thank you so much and i hope everyone is doing well!!

[Keysnurse2008]

hi!

Well lets start with the basics.

#1 if you are dealing with a post op surgical pt .....then they've had a blood loss right?

so ...do not attempt to draw fromdown low.....go for the nice plump ac.

#2.I always tell people to feel the vein with the tourniquet on....apply the tourniquet....feel the vein is it plump?can you take your index finger and almost bounce off the spongy vein?if you can its a good vein to draw from......slip your bfly needle in at a 45 degree angle and designate one hand as THE hand thats only job is to hold that needle exactly/firmly/dont move it ...in place while you pop your vacutainer on.

#3 remember.......when you aredealing with smokers...elderly....postop pts...vascular impaired pts .....these patients may have enlarged valves .....so thats another good reason to go higher ...like to the ac.

[Paige Turner RN]

some days you hit and some days you miss................that's all there is to it.............(besides what is posted above)

[NICU_Nurse, BSN, RN]

Zac, have you tried using a transilluminator? Venoscope makes this spectacular transilluminator for only $150 with a one-year warranty. It can be strapped upside down on the patient's arm to leave both of your hands free to start the IV. We use these on the babies and they work like a charm, but they're actually meant for adult use! Peds just got lucky! :) Check out this link:

http://www.venoscope.com

This shows the transilluminator strapped on upside down. I cannot TELL you how much this has helped me improve my accuracy. We had them, but not this particular brand, and they didn't work worth a crap. I figured, hey, for $150 if I can improve my IV sticks, it's worth it. This thing has paid for itself again and again and I'd be lost without it. If you can't afford the money, check with your unit supervisor and see if this is something they will consider trialing on the unit (heck, let them buy one, test it out, and then decide if you want to spend the money on your own).

Good luck!!