Best tips for blood draw on elderly

[Kitty Hawk, ADN, RN]

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!

[Always_Learning, BSN, RN]

I prefer to use a butterfly for all of my draws...your mileage may vary. My best tip for drawing blood from an elderly patient is to maintain traction on the skin. Typically, an older individual will have less subcutaneous fat, so it takes a little more work to stabilize the vein you are aiming at. As I am right-handed, I form a "V" with the thumb and index finger of my left hand and stretch/stabilize the skin above the vein. Then I do the stick with my right hand. I don't move my left hand until I see blood return.

Also, take a look at your patient's veins before you do anything. I have found some thin, elderly patients with HUGE, distended veins. For these patients, I do not even use a tourniquet at all, because I have found that the veins typically blow if I do.

I might take more time than most when I am "shopping" for veins, but I prefer to "measure twice, stick once." A little investigation often reveals a good vein "no one else saw." After all, there's no sense aiming for that dodgy vein in the wrist when, for example, you could have looked a little higher or lower (or on the back of the arm) and found a nice plump one. Also, warm blankets, warm washcloths, or a glove filled with hot water and tied off (like a mini hot water bottle) are helpful for making veins dilate and stand up.

But most of all, practice makes perfect. :)

[iluvivt, BSN, RN]

I will send you a link I have that has great pictures but it is on my work computer so I will do it the next day I work. It is the best I found thus far in explaining the anatomy. That little "knot" you saw was most likely a valve so best to puncture above or below it to avoid damaging it.

[pfeliks]

I've been a RN case Manager for 2 years now. I started out in heme/onc and then did Bone Marrow transplants. I've never had blood drawn on a home patient. What tests are you drawing for? We would only ask for bloods on whose results we would intervene. Our patient's usually have their Coumdin dc'd. I guess we don't think of venipuncture as part of comfort care for someone with a 6 month or less prognosis.

[IVRUS, BSN, RN]

Your "preceptor" who is instructing you is WRONG to show you how to draw labs, and yet He/She won't, or doesn't wear protective gloves. That is a violation of every policy I've seen since PPE (Personal Protective Equipment) became mandatory. What if you were secretly a surveyor? Ouch... that organization is surely dinged.

Also remember that elderly patient has lost much of the SQ tissue that used to support that blood vessel, so now, that vessel is very fragile and will blow easily, hence the looser, or absence of the tourniquet.

I always draw my PT/INR, or PTT's with a butterfly needle.. I think your preceptor needs MUCH education and also needs to have his/her competency assessed. I bet they would NOT measure up. And that, my friend, puts the patient at risk, first and foremost.

That is such a shame.

[CrunchRN, ADN, RN]

Don't shoot me for this confession! I cut the tip off my gloves. I

[IVRUS, BSN, RN]

Why would you cut of the tip of the glove? Are you doing it to repalpate the site.. If so, you are setting the patient up for infection. Once the area has been cleansed, you DO NOT go back and feel that vein. Please get in a habit of wearing the gloves and not ripping off the tips. Once you've established which vein to access, clean the area well, and perform the puncture.

Why do you want to risk hurting the patient, much less putting yourself at risk... Hmmmm.

[CrunchRN, ADN, RN]

I always cleanse my finger tip too. Sometimes I just need to check again. I have no back-up available and they are timed draws so the pressure is on. I would never endanger a patient. I wish I always felt 100% confident to just go for it, but not there yet.

[IVRUS, BSN, RN]

But you have resident bacteria, and skin cells which are constantly shedding, so just because you cleanse your finger, that does not give you the ability to retouch the site. Think about it.. you are retouching where the needle will enter their vascular system. Then you perform your VP and now you've just caused whatever was on your fingers, to be transferred into the PATIENT's blood stream.. Ewwww.

Please stop this practice.

[CrunchRN, ADN, RN]

Yes mother.

[IVRUS, BSN, RN]

You're welcome daughter!

[CrunchRN, ADN, RN]

You're welcome daughter!

I do know you are right. LOL. I just need to "man up".