Seeking your expertise with blood draws

  1. I really enjoyed the IV starts and IV stories threads. Would any of you care to share some clinical pearls regarding drawing blood? I don't usually have a problem with it, but I'm always looking for better ways to do things, especially if it benefits my patients. My facility does not have phlebotomy staff. The nurses do the blood draws and we send them to an outside lab.

    Thanks in advance
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  2. 10 Comments

  3. by   P_RN
    I first learned how using a glass syringe and needle, so I am much more comfortable with that combination. I use a3-5 cc syringe with a 23-21 butterfly if I can. I really HATE the "vacuatainer holders" because they feel funny, but I use them if absolutely necessary.

    If your facility has a policy manual look to see if that is OK to use this combo. Incidentally I think the technique is easier to learn and translates into ease in learning how to use the safety sets for IV starts, in particular the Jelco brand ones.
    Then the needleless connector system to transfer the blood to the vacuum tube makes it safe. I'd never use a needle to transfer nowdays.

    Remember to keep yourself safe by always using gloves and goggles. I have had blood actually spray from a venipuncture before.

    P
  4. by   BrandyBSN
    I just did my first "weird" blood draw. Using a vacuutainer.

    I pulled the needle back out once the tube was full, put a 2x2 on it, and she held it for a few minutes. I left the room to take care of the sample, and when I came back in, she had lifted the pad to see her arm, and it shot out of the vein and sprayed her in the face! She had a big streak of blood on her shirt, and a little on her face. She looked so shocked! I was too. I didnt know it would do that. Did I mention this was my lab partner? We were demonstrating blood draws for the underclassmen.

    It was wierd! Never thought I would need to Z-track on blood draw
  5. by   kennedyj
    Brandy- sounds like you got the brachial artery...lol. if not just picking on ya'!


    One thing that I was never taught in school was that after you are ready to pull the needle out don't push down with the gauze before. It only helps the needle scrape the vein. Instead pull the needle out then quickly press down on the gauze.

    If drawing 10ccs/2 tubes or less I like the 23g butterflies.

    Jared
  6. by   kewlnurse
    I can get blood out of just about anybody, 2 words: cephalic vein.
    Brandy, you were probably in an artery.
  7. by   nilepoc
    Preferred site of blood draw, radial artery. using a 10 or 20cc syringe and a 20g needle. If the radial arteries are shot from repeated sicks or arterial line placements, the dorsal pedal arteries work very well also. Never ever consider the brachial artery, as it is the only source of blood for the hand and can be devistating to thrombus.

    To get the stick, I place my left index finger on the pulse feel it for about 10 seconds, visualize thw spot I think the pulse is in remove my finger and insert the needle, bevel up. Works like a charm. Need I mention that I only do this on patients requiring blood gases that do not already have an art. line.

    For really edemitis, overly fluid resucitated patients, I like to take a tongue depressor and lay it flat in the ac, then apply pressure to squeeze out the extra fluid. Then, the veins become visible again and will be palpabel when a tourniquet is applied. This is for patients with 3+ edema. It also works well when I go to place a PICC.
  8. by   EMaas
    Hmm..I always use the brachial on pt.s who aren't dehydrated or have flat veins. I go for the radial if I can't find an otherwise good vein. I always be sure my tourniquet is good and tight and I like to hold the vein flat when sticking. I always use a butterfly on elderly folks and peds and a vaccutainer on just about anyone else. I never, ever "dig" and I only stick twice. If no success, someone else gives it a shot. Hmm...rolling veins are always fun. I like to stabilize them with a finger on one side of it or downward pressure on the vein. Heating pads work well on flat veins...and that's about all of my advise. We do our own sticks, too, so we have lots of tricks up our sleeves!
    :-)

    Good Luck!
    EM
  9. by   nrsbaby2be
    As I am still in the pre-nursing phase, the only contact I've come is as the patient. For the most part, the phlebotomist always used the vacutainers, but I remember once a nurse took my blood using the butterfly. It was definitely less painful. What are the circumstances you can use the butterfly vs. the vacutainer?
  10. by   PPL
    Holy Smokes! This site has changed! I've been gone too long! Is it just my imagination, or are fair skinned, freckled redheads the worse/hardest to draw? What about the very obese, what tricks to use?
  11. by   UVaRN2Be
    I use a butterfly 23 G with vacutainer. I sometimes use a blood pressure cuff inflated to 60 instead of a tourniquet. Have had to wrap arms in hot towels, towel wet in a chuck, heated in microwave. Also, used NS bags heated in micro for pt to hold. I usually dont use these all the time as opposed to some I work with. For obese pts, if I cant palpate vein I will ask where someone has gotten them before and look for scar or "landmark."
  12. by   Chuckie
    We
    Last edit by Chuckie on Jan 17, '03

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