Blood Draw Help Needed


I'm an older RN in Home Health. I initially worked in a hospital for 7 months, then in a SNF for 6 yrs before landing in my current job, which I love. The problem is that my infrequent blood draws (maybe one every 6 months) are only partially successful. I didn't do a lot of IV starts in any of my jobs, but at least I COULD start them without infiltration.

I seem to be hitting the vein in the AC using either a butterfly or regular collection needle of either 21 or 22 gauge on the 1st attempt at least 75% of the time. But when I switch out the collection tube for a new one, the flow stops after only an inch or so. I have tried raising and lowering the angle of the needle. After that, I can't seem to start a new draw anywhere unless it is on a man with good veins.

Information that would be helpful:

1) Should I remove the tourniquet before switching out the tubes or leave it on even if it takes more than one minute?

2) Any reference materials you can suggest?

Thanks for any other suggestions.


474 Posts

Has 1 years experience.

Once you get a flash back push needle a Lil more don't stop once you get that flash


3,413 Posts

Has 38 years experience.

Watch you tube videos, they help a lot.

I learned this from a IVDA, sometimes it works....unfortunately there is no magic fix. Softly, gently (this is assuming you have a "free" hand to work with, I know that can be hard), tap the skin several times right on top of, right over, where the needle is. This little movement sometimes helps, I imagine, by "nudging" the needle into a better position so you get blood flow again.

Also it is not unusual or uncommon for a patient to have better veins in their hands than their AC. It doesn't have to be the AC for blood draws.

Slipping CMA

75 Posts

1st thing that came to my mind is which hand are you using to hold the needle. I'm naturally more right handed so I hold the needle steady with my left hand and change with my right. You shouldn't have to adjust, the needle shouldn't move at all when changing.

You don't always have to use the AC just the best vien for the job. A nice juicy bouncy straight vien.

nursej22, MSN, RN

3,126 Posts

Specializes in Public Health, TB. Has 38 years experience.

Sometimes fragile veins just can't tolerate the amount of suction from the vacutainers. Is drawing with a syringe and then transferring an option?

Specializes in Burn, ICU. Has 10 years experience.

I only use butterflies (it's all I was taught), so no tips about the vacutainer needle. With the butterfly, I hold the needle in my dominant hand and swap tubes with my other hand. I try to have them laid out & ready so there's not too much fumbling. I do find that sometimes after I've swapped, the next tube won't flow...usually means I need to reposition the needle a bit. I'm not always sure whether I moved it a bit or whether the suction of the new tube was too much. But with the butterfly can usually slide the needle in/out and watch for a new flash in the chamber. (I don't take the tube out of the holder, so if I land a good spot it will just flow anyway, but if it's a touchy spot if helps me to know that I definitely have the flash & need to hold still now!) I don't remove the torniquet until I'm done filling tubes (unless it's a tube that needs to be drawn without one...probably more common in the hospital than home care?)

I also use 25 or 23 gauge butterflies....I only go with the bigger ones for certain draws that require them. Are the veins you're picking too small or fragile for a 21? (I know you said you're using the AC, but I actually find those harder to find and hit sometimes, especially in older people who've had a lot of blood draws/IVs in their history.)

I'm definitely not the strongest blood-drawer, so I'll watch this with interest!