Drawing bloodwork

Rdahmad · May 16, 2007

Well, for phlebotomy, you will only increase in skill the more you do it. I'm in nursing school, about to graduate, and I've been a lab assistant/phlebotomist for a few years. The best advice concerning your handling of tubes and not being steady in that, would be to practice inserting needles and changing tubes on a fake arm or maybe on a hot dog. If you are using a butterfly device to draw blood, make sure you see the little flash of blood and then attempt to tape the wings of the butterfly to the patients skin... you don't have to totally tape it down, but just enough so it doesn't move so much while you use both hands to change the tubes in the vacutainer. If you are in town in Tallahassee, I'd let you practice on me! Maybe some of the nurses would help you to learn how to feel more comfortable drawing blood. I have to tell you, you get more comfortable the more you do it, so take every opportunity to draw blood.

Also, you may lose a vein once you think you have entered it only because it's a vein that rolls to the side once you insert the needle in the skin. Unfortunately, phlebotomists sometimes have to dig in the skin, withdrawing the needle not outside the skin, but just enough to feel for where the vein is, and then moving in that direction attempting to hit the vein. It really is a skill that perfects over time and practice feeling for veins and also, if you see veins in the inside of the forearm, and you think they are wide enough, even if you just see them, go for them using the butterfly if nothing else. Also, you can go for the hand, although it is often more painful, but sometimes blood values are critical for the doctor to evaluate, so the pain might have to happen unfortunately. Also, something I didn't know until just yesterday, make sure you pull the tube out the vacutainer prior to withdrawing the needle because remember the vacuum in the tube is still sucking if you haven't filled the entire tube and may hurt the patient even if it is a tiny split second pain.

If you are desperate, you can also do a finger stick for chemistries and hematology specimen using the little baby tubes and squeezing the finger to retrieve the blood. That's what some of us do if we're desperate.

REmember to have the patient pump his her hand in a fist and even ask them to squeeze their muscles too. It will force blood out faster. Remember also, or know, that some tests you only have to retrieve a certain amount of blood and you don't have to fill every tube to the top. If you have a hard stick, usually filling the lavendar tube for a CBC only requires filling up to just above the end of the label. PT/PTT's usually require at least half or above half if possible, but always try to fill that one up. Often medical tech's will get a critical value that is due to a short sample. So, blue tubes try to fill all the way. And, for the chemistries, like BMP, CMP, K, MG, glucose, hepatic/liver tests..etc. you only need so much. If you can get something in there, at least a quarter of the tube, that should be sufficient, though if you can get more, that would be great to ensure there is enough plasma or serum for the tests to be done. They spin them in the centrifuge in the lab. You know, you could call the lab and ask them how much blood they must have to perform the test.. if it's a hard stick, they can tell you how much you probably need to get. And remember the finger stick.. it may get hemolyzed, maybe, but you won't know until you send it down to the laboratory. And make sure for the CBC's and others, you mix blood in the tube because they contain solutions that keep them from clotting. The red tubes don't have anything in them so you don't have to worry about them.

If you have any questions please let me know. Just keep practicing and remember to feel for the veins, rather than just looking for them. Have the patient squeeze their hand if they can, but if not, also remember to wait a little while, sometimes the veins are more apparent or are better felt after a minute. Don't give up. You'll notice after doing it, that you know where veins are found on most patients.. on either side of the sides of the wrists,and there are a few that run around the antecubital area... also, in the hand, tap or flick veins.. it gets them to perk up.

I love phlebotomy because it can be a challenge and many nurses don't have skill doing it because they just don't do it often enough. Even phlebotomists sometimes don't get it after a few tries and multiple people have to try the patient.

GOOD LUCK and be confident. Tell yourself you'll find the vein and don't lose your cool. I'll pray for you!

God bless you.

Rashida

Creamsoda, ASN, RN · May 16, 2007

Thanks, that was a great post!

Cher

rgroyer1RNBSN, BSN, RN · May 23, 2007

All I can tell you is that this isnt my best skill either, but it does help to use the butterfly and tape it down thats how Ive always done it. hope that helps

srna2008 · Jun 27, 2007

We do all of our own labs, but if we have a difficult stick, we can call lab up to get the blood. I was watching the lab tech and she used a butterfly and as soon as she got into the vein, she put a piece of tape across teh butterfly to hold it place and free up her hand. I have not tried it yet, but it seemed to work well for her

Silkybo · Jul 5, 2007

My best advice is get comfortable. Sit down in a chair, adjust the patient's bed, kneel on the floor, whatever you have to do so you aren't in an ackward position. If your back is hurting or you are at a funny angle, its harder to get the stick. Also, take advantage of gravity. Have the patient hang their arm off the bed to fill up the veins in their lower arm and hand. Close your eyes when looking for the vein and find it by feel. Veins that are visible aren't always the best. Find your vein before you glove up. Ask for help if you need it. Sometimes if you have a tech hold the patient's arm still, or work the syringe to pull blood while you do the stick, it helps. Most of all.....practice! It took me a long time to get good at blood draws and IV's. We have a supervisor who can get blood from a stone, and I used to ask her to do a lot of my draws. Recently she said she misses when my requests were easy. "Now when you say somebody is a hard stick, they are REALLY hard!"

ICU_JOSIE, MSN, RN · Jul 5, 2007

Thats the main issue I have I think, lol...keeping the vacutainer or butterfly steady. I dont know how the lab techs do it all the time.
Cher

Practice, Practice. Practice ..... the more you do it, the more skillfull you'll be! Concentrate on the task at hand soon you'll realize that practice makes perfect! :lol2:

ripcurl1 · Jul 5, 2007

I'm not sure what type of equipment you have but to minimize changing tubes with your right hand try this. Hook your butterfly tubing up to a 10cc syringe (this is only if 10cc of blood is enough for your labs) Once you get in to the vessel slowly press the plastic butterfly wings against the skin and gently switch hands...gently pull back blood into the syringe. Do not pull back hard...this can rupture the cells and cause your speciman to hemolyze. Hope this helps.

Christie RN2006 · Jul 5, 2007

Thats the main issue I have I think, lol...keeping the vacutainer or butterfly steady. I dont know how the lab techs do it all the time.
Cher

Your answer is in your statement... they do it all the time, thats why they are so good at it! Its like anything, the more you do it, the better you will be. At my hospital, the lab techs come and draw our blood when its a peripheral stick, but when I did my clinical rotations with hospice I got several opportunities to draw blood and I used a butterfly needle whenever I did it.

Pheebz777, BSN, RN · Jul 7, 2007

I always raise the bed up high enough that I'm comfortable standing up without straining my back. Also it let's me lower the patients arm to get those veins pumping.

For some reason, my chances of getting blood drawn and doing IV sticks is less when I'm sitting down. My success rate is higher when I'm standing up.