Best tips for blood draw on elderly

[Kitty Hawk]

I am a new hospice CM and loving it so far! Only been a little over a week. I had my first blood draw which went well but the lady had unusually great veins for her age not to mention a "knot" that kind of marked the spot to go in above.

I have been reading all I can on the subject, but would like additional tips. My preceptor is beyond awesome but she's being doing it for so many years not to mention she does the draws w/o gloves and I prefer to use gloves.

I've heard to tie the tourniquet find the vein w/o gloves, mark it w/an alcohol pad, release tourniquet, put on gloves, put tourniquet back on then proceed with the draw, does that seem reasonable?

I know you should go for veins that you can feel and not necessarily see but honestly I'm not good at palpating them. I get they should feel springy and like a rubber band but I honestly just don't feel that if they're deeper which they often are. Would it help to study the anatomy of the veins and really have that memorized? If so does anyone have a link that they really recommend for that? (I can google but I don't know which is best)

I watched the blood draw kings on youtube and it seems they did things that aren't really recommended such as pumping hand instead of making a fist (is a fist necessary? some say yes some say no!)

Another tip I read was for the patient to lie their arm down but rotate the wrist, anyone do that?

Sorry for all the questions but like many, in the hospital and other facilities we only had to draw from lines which was easy. There's no one to really fall back on in the field and I'm guessing you should only attempt to stick them twice.

Also I used a regular needle on this patient even though elderly bc it was for a PT/INR and had to be a full tube and was told the butterfly wouldn't cut it. I'm thinking for most others you would use a butterfly? Thank you!

[toomuchbaloney]

For difficult distal draws I make the extremity dependent and use a warm damp towel to encourage blood flow. Keeping the patient as relaxed and comfortable as possible helps.

Good luck.

[duskyjewel]

Dear Lord....handling needles and breaking the patient's skin without gloves on?! Do people just get complacent or are they nuts?

[Ginapixi, BSN, RN]

yes! it is done with gloves and i have done plenty of blood draws in the hospital setting as well as in the home (though MUCH less!), port access etc, always with gloves - However, i have started nursing back in the day when gloves were for the OR, may be (!) dressing changes and guess what, we used to clean and sterilize syringes as well as hypodermic needles and had less infection rate than we do now!

so don't get your panties all in a bunch if some one does it with out gloves - patients at home have their own home germs IF the nurse does excellent hand washing the infection danger is probably way less than in a hospital setting

[duskyjewel]

Sorry (not sorry), bad infection control practices will always get my panties in a bunch. And I agree with the surveyor comment....do that in front of one of them and you'll earn yourself and your organization a ration of trouble!

[IVRUS, BSN, RN]

I seriously disagree that your infection rates were less than what is seen now. Some places have reduced their infection rates with the central line bundle to zero! I doubt you can beat that.