Are you a nurse? Do you draw blood? Can you take our Quick Survey?

NO50FRANNY · Feb 9, 2012

Hi Everyone! I'm a nursing student and we are trying to do a project on drawing blood for a presentation for our fellow nursing students. As part of the project we are looking to get some information from experienced nurses on ticks, ticks, and techniques that may be helpful to new nurse. If you have experience in this area...we would love to hear from you!! Please take a moment to reply to our quick survey. We appreciate your help!!
What is your educational background?
Years of experience?
Years drawing blood?
What kind of education did you get for doing blood draws?
What was the most challenging part about drawing blood?
Are there any tip or tricks you have learned throughout the years that you have found useful?
How often do you have to draw blood on your clients?
Which labs do you most frequently draw?
Are there any particular labs that are difficult to draw?

Hi there, happy to oblige- answers in order...

1) Bachelor of nursing degree and critical care certificate

2) Coming up to 15 years nursing experience

3) Taking blood and inserting cannulae for 5 years

4) "You've seen it done haven't you?"

5) I don't like hurting people, so the challenging thing for me was how terrified I was

that I would miss and have to do it again. Patients on the receiving end need you

to be confident

6) Tips and tricks- I actually have a little session I do with people that are learning and

have been told that it was really helpful so I will sum up-

The last thing a patient wants to hear from you is "Oh, you have terrible veins" or "I'm going to try", just act confident and like you know what youré doing, a relaxed patient is half the battle. No-one has terrible veins nor deserves to be told so, some are just more difficult to access than others. You should attempt on veins you can feel rather than veins you can see. Have a feel of your own bouncy big veins, look for the same on your patient, and most importantly take your time. One arm is usually better than the other. Smacking a pts arm around is not pleasant for them, just rub their arm if you want to agitate your vein. Use gravity, hang their arm over the bed, and make sure you are in the correct position yourself. Bevelled needles are designed to find veins so using a smaller one will not necessarily make you more successful- it's counterintuitive but I rarely use anything smaller than 18g. Take a deep breath just before you aim.

7) Probably put in lines / take blood between 5 and 30 times a shift.

8) Basic bloods, Full blood count and liver/renal function.

9) Haematological profiles can be huge and you need lots but other than that not really.

Hope this helps.

DroogieRN · Feb 10, 2012

what is your educational background? ba in another field, aas in nursing.

years of experience? 20 months.

years drawing blood? 20 months.

what kind of education did you get for doing blood draws? trial by fire.

what was the most challenging part about drawing blood? figuring out veins that are likely to "blow."

are there any tip or tricks you have learned throughout the years that you have found useful? in elderly and renal patients, and patients on anti-coagulants, the veins are often quite fragile. a tight rubber touniquet can engorge the vein so it blows out as soon as you pierce it with a needle. often no tourniquet is even needed, but a bp cuff inflated to about 20 mmhg over systolic is perfect much of the time.

how often do you have to draw blood on your clients? daily. lab isn't available after 1315 for some ridiculous and unknown reason.

which labs do you most frequently draw? cardiac enzymes.

are there any particular labs that are difficult to draw? blood cultures, if the patient is a difficult stick and their ivs don't draw well.

TrailBlazerRN · Feb 10, 2012

What is your educational background?

RN BSN

Years of experience?

Years drawing blood?

A little over a year, I worked at the hospital that I currently work in as a tech before, and we were trained in phlebotomy and able to draw blood.

What kind of education did you get for doing blood draws?

Mostly on the job training. Where I work, the other nurses were really good about letting me practice on them. I also had complete a competency in an admission clinic in which I had to draw 12 successfully.

What was the most challenging part about drawing blood?

Knowing that finding a good vein isn't about sight, it's about the feel! I had a very hard time getting over being able to stick a vein that I could feel but I couldn't see.

Are there any tip or tricks you have learned throughout the years that you have found useful?

How often do you have to draw blood on your clients?

Patience. Get all of your supplies together, go in with confidence. Know that you have more options than just the AC. For some people, the AC has their best veins, but other people have great veins on their hands and wrist. Also, some vessels will roll, so be sure to anchor them down with a finger... just don't stick yourself! I usually draw blood at least once per shift, especially nights for AM labs. But if we're busy its great that we can delegate to the techs.

Which labs do you most frequently draw?

CBC, blood bank samples, lytes, PT/INR

Are there any particular labs that are difficult to draw?

Well, blood cultures can be difficult. At my institution, two sets of blood cultures always have to be drawn and they have to be drawn from two different sites. Sometimes this can be difficult to get two sticks on a patient that is a hard stick!!

beckster_01, BSN, RN · Feb 10, 2012

what is your educational background? bsn

years of experience? 1.5 as an rn

years drawing blood? around 3. i drew blood as a tech, but didn't work for about 6 months at the end of my program/before i started my job

what kind of education did you get for doing blood draws? when i was a tech they had me do 50 supervised blood draws at an outpatient clinic. as a nurse i spent one afternoon drawing blood, and was supposed to be supervised for 3 successful iv insertions on my unit. that didn't really happen though...

what was the most challenging part about drawing blood? i have always had a difficult time drawing from patients with severe pitting edema. hot packs are your best friends...

are there any tip or tricks you have learned throughout the years that you have found useful? i found it easier when i figured out that once i make the initial poke i need to stop, double-check my angle/direction, then enter the vein in one smooth motion. everyone has their own techniques, that is just what works best for me.

how often do you have to draw blood on your clients? 5-10 times per shift. more often on the night shift.

which labs do you most frequently draw? cbc, bmp, and pt/inr are the standards.

are there any particular labs that are difficult to draw? on my floor perhaps blood cultures. the technique is no different, besides the prep of course, it is just a larger volume of blood.

KaroSnowQueen, RN · Feb 10, 2012

What is your educational background?

LPN

Years of experience?

almost 28 years

Years drawing blood?

1990 - 2007 (17 years)

What kind of education did you get for doing blood draws?

one day intensive class at work, and one day seminar

What was the most challenging part about drawing blood?

Finding the right vein on teeny little dehydrated patients vs finding any vein on very large folks

Are there any tip or tricks you have learned throughout the years that you have found useful?

FEEL for the vein, the bouncier the better.

How often do you have to draw blood on your clients?

Now, never. Then, daily, sometimes several times a day.

Which labs do you most frequently draw?

CBC, CMP, PT/INR, CARDIAC ENZYMES.

Are there any particular labs that are difficult to draw?

None more than others.

GitanoRN, BSN, MSN, RN · Feb 10, 2012

Hi Everyone! I'm a nursing student and we are trying to do a project on drawing blood for a presentation for our fellow nursing students. As part of the project we are looking to get some information from experienced nurses on ticks, ticks, and techniques that may be helpful to new nurse. If you have experience in this area...we would love to hear from you!! Please take a moment to reply to our quick survey. We appreciate your help!!
What is your educational background?
Years of experience?
Years drawing blood?
What kind of education did you get for doing blood draws?
What was the most challenging part about drawing blood?
Are there any tip or tricks you have learned throughout the years that you have found useful?
How often do you have to draw blood on your clients?
Which labs do you most frequently draw?
Are there any particular labs that are difficult to draw?

What is your educational background?

RN BSN

Years of experience?

15+ yrs.

Years drawing blood?

15yrs. +

What kind of education did you get for doing blood draws?

Right out of nursing school, I got certified & began working with the IV team dept.

What was the most challenging part about drawing blood?

it would be Morbid Obese patients and dehydrated pt's.

Are there any tip or tricks you have learned throughout the years that you have found useful?

when I have any of the above mentioned I use double tourniquet, it works for me.

How often do you have to draw blood on your clients?

every day and at times every shift depending on the situation & the unit I'm working.

Which labs do you most frequently draw?

what we refer to as the "Rainbow"

Are there any particular labs that are difficult to draw?

I wouldn't call them difficult, but the most tedious labs. which are referred as "Culture labs" because of the amount of preparation involved.

I hope we have answered all of your concerns, good luck.... Aloha~

KelRN215, BSN, RN · Feb 10, 2012

what is your educational background? bsn

years of experience? 4 1/2

years drawing blood? 4-ish

what kind of education did you get for doing blood draws? took an iv class and was supervised with 3 sticks. it is assumed that if you can place an iv, you can draw blood.

what was the most challenging part about drawing blood? for me, it is squirming children. i'm not good at drawing blood on the really little ones who can't sit still.

are there any tip or tricks you have learned throughout the years that you have found useful? what you feel is better than what you see.

how often do you have to draw blood on your clients? depends on the day. we have phlebotomy from 7-3, if any labs need to be drawn after that time it is up to nursing to draw them. i draw blood off of central lines far more often than via peripheral stick though.

which labs do you most frequently draw? cbc, chem, drug levels, coags, type & cross.

are there any particular labs that are difficult to draw? ammonia levels are challenging because they need to be "free-flowing" and you cannot use a tourniquet.

Guest 360983 · Feb 11, 2012

What is your educational background? BSN so fresh the ink isn't dry yet

Years of experience? WELL under 1 year--I'm still in my first month of work.

Years drawing blood? Two (I drew blood in the Army)

What kind of education did you get for doing blood draws? Watch me stick someone, then pair up with your buddy and stick each other until you figure it out. In nursing school, there was probably a video (we had a lot of videos) and we practiced on old fake arms. They were good for working on technique but all of the obvious scars made them useless for learning find a vein.

What was the most challenging part about drawing blood? Finding a good vein. My patient population is heavy on IV drug users with scarred veins and dehydrated people.

Are there any tip or tricks you have learned throughout the years that you have found useful?

-I ALWAYS ask my patient where their good veins are or where they want me to draw blood. Some of them with terrible veins will point to that one good spot and most will be able to guide you at least a little. Plus, giving patients input makes them happier.

-Go for the veins you feel. The ones you see are lying to you.

-If you can, do your first sticks on an unconscious patient. They won't see how nervous you are.

-Faking confidence is never more important than when you're wielding a needle.

-Until you're awesome at finding veins, carry around a tourniquet and check everyone's arms for veins. Check all the nurses on the floor who will let you. Check family members. Check friends. Don't give your number to the guy at the bar until he lets you feel for veins.

-I like to ask patients if they want me to go "1, 2, 3" or just stick them. It gives them a semblance of control.

-Fold your tourniquet in half so it's shorter, then use it.

-Use gravity to your advantage. Have your patient hang their arm off the bed. Use this idea when you get to OB and are doing heel sticks--prop the baby's crib up at an angle if you don't do skin-to-skin.

-If you have an order for whatever labs but you're expecting orders for additional labs, draw them. All of my patients get a rainbow, even if I only need one vial. No one likes being poked more than necessary and it will save you time. Draw for the labs you need first in case the patient clots up or the vein blows.

-Learn from anyone who is good at what they do, even if they are "only" a tech. Techs in my unit are allowed to do most blood draws, and some of them are downright magical in finding veins.

How often do you have to draw blood on your clients? I work in the ER and it's a good day if everyone only needs one set of labs. I put IVs in about half of my patients. I generally see about 10 faces a day.

Which labs do you most frequently draw? HIV (everyone gets it because our population is high risk), CBC, BMP, cardiac enzymes

Are there any particular labs that are difficult to draw? Blood cultures can be a bit of a pain because it's done at two sites, I can't use a pre hospital IV site (ie something EMS put in) and I can't delegate it.

turnforthenurse, MSN, NP · Feb 11, 2012

sure thing.

what is your educational background? bsn
years of experience? about 8 months of rn experience + a year and a half of tech experience (i say this because as a tech i was allowed to draw blood)
years drawing blood? total? 1 year, 10 months.
what kind of education did you get for doing blood draws? just what i learned in nursing school. i didn't have to get a phlebotomy certification or anything.
what was the most challenging part about drawing blood? patients who do not like to be poked or trying to find veins in severely dehydrated patients.
are there any tip or tricks you have learned throughout the years that you have found useful?
- adequate lighting.
- place a pillow above the elbow but underneath the arm and let the arm hang down in a dependent position to facilitate filling of the veins.
- wrapping the extremity in a warm towel for a few moments can also help veins perk up.
- sometimes using 2 tourniquets helps or if the patient has very fragile veins, sometimes i won't even use a tourniquet at all.
- draw an extra tube or two. typically patients have a cbc and bmp or cmp ordered (and a mag or phos level, but that can be taken from the same tube as the bmp or cmp) but if i am expecting maybe a pt/inr, i will draw a blue top, too.
how often do you have to draw blood on your clients? it depends. on my floor we have lab techs come and draw unless the patient has a central line, then we draw the labs ourselves. i once had a patient who would not let lab poke him, only me, so i always drew his labs. if i need something in a timely manner, i will go ahead and draw it myself instead of waiting for lab to come. in the icu, everyone draws their own labs unless the patient is a very difficult stick, then we call lab.
which labs do you most frequently draw? cbc, bmp/cmp, k/mg/phos level, pt/inr, cardiac enzymes, liver panel.
are there any particular labs that are difficult to draw? blood cultures, especially if the patient is a very hard stick because they need to be poked at 2 different sites.

psu_213, BSN, RN · Feb 11, 2012

what is your educational background? asn, bsn

years of experience? almost 4

years drawing blood? almost 4

what kind of education did you get for doing blood draws? pull the cover off the needle, stick the needle in, when you get a flash, push the tube down (as in my only education on drawing blood came right before my first attempt...on the job).

what was the most challenging part about drawing blood? jumpy patients.

are there any tip or tricks you have learned throughout the years that you have found useful? i have not read everything everyone else has written, but it seems like a lot of good stuff so far. especially want to second the idea that it is best to go for the vein you can feel rather ran just the superficial one that is easy to see. also, in the er i like to grab extra tubes. often times doctors will add a test (say a dig level) and they will not have the correct tube of blood in the lab, so that means sticking them again if you did not grab some extra tubes.

how often do you have to draw blood on your clients? being in the er, it is often just once on each pt (occationally more often). but, given the number a pts. i see in a day, that can mean i stick many people through the day. often times we get blood work when we insert their iv.

which labs do you most frequently draw? cbc, bmp/cmp, coags are the most frequent...in that order. somewhat regular ones, in no particular order, include 'abdominal' labs (lfts, amylase, lipase, etc), cardiac enzymes, drug leves (dig, dilantin, depakote, narcotics, asa, apap), lactate.

are there any particular labs that are difficult to draw? for the most part, any venous stick is bascially the same on any given pt. abgs can be difficult (although this is different from most labs) and i don't do them all than often, so it is difficult to become proficient.

tnt1985 · Feb 20, 2012

what is your educational background? bsn

years of experience? 2+

years drawing blood? 3 years

what kind of education did you get for doing blood draws? learned from trial and error on the job or by watching others.

what was the most challenging part about drawing blood? trying to find veins in fluid overloaded patients.

are there any tip or tricks you have learned throughout the years that you have found useful? yes, we have an ultrasound machine that helps us find veins. the machine is called a sonosite and nurses now must be certified to utilize it. if i use the sonosite machine i can successfully draw blood or obtain an iv in 90% of my patients. we have called phlebotomy in the past but find the sonosite machine to be much more helpful.

how often do you have to draw blood on your clients? at least once per day. if the patient is extremely sick, at least every 6

if not more frequent. as nurses we have prn orders for the below listed labs.

which labs do you most frequently draw? bmp; mag; phos; ionized calcium; abg's; vbg's; ptt/pt inr; cbc; lactate; hfp

are there any particular labs that are difficult to draw? blood cultures or abg's (if the patient doesn't have an arterial line). with blood cultures you need two peripheral sticks and this can be difficult to obtain in fluid overloaded patients or patients who are a difficult stick.