Blood Draws

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Newer RN needing some advice...

I work the night shift at a rehabilitation and short stay facility. As part of my nightly duties, I am supposed to draw and send in any labs that may be ordered by the primary. I absolutely dread coming to work seeing the lab book packed full of blood draws that I need to do. After having absolutely no experience (aside from one draw in clinicals on a school dummy) I need some helpful advice and hints from you pros out there! There's nothing worse than missing all of your draws. It is so frustrating and has taken quite the toll on my confidence. I feel like I'll never get the hang of it :(

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Specializes in Critical Care, Education.

Suggest you discuss this with your manager & whoever is responsible for clinical training. Be very honest. Nursing school does not prepare anyone to become a phlebotomist so there shouldn't be any shame in your game. A short term solution would be to ask someone (more expert) to come in early or get someone to float to your unit to help you. Longer term should involve training & practice for you. They need to provide whatever help is needed to ensure that patient needs are met.

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You can read advice on All-nurses and watch You-tube videos. However after getting a "mental" idea you really need to go to the boss, charge nurse, whomever, and say you need a refresher on blood draws. It may not need to be more than someone coming in one hour early to do the morning draws with you. It does not need to be a several hour, or several week, long course.

All the reading and watching videos cannot compare to actually standing by a co-worker as they do it and they can help you as you do a few.

It isn't horribly hard (this is from a nurse who was (is) not a naturally born blood draw, IV, nurse), but with practice and exposure almost anybody can become quite good. I did.

I know from my own early experience....the more I messed up the worse I got. If I was successful it was more luck than skill. I avoided working where those skills were needed. I don't want you to get yourself in the same situation.

Eventually though if I wanted a decent job I had to learn and now am very confident.

However if you don't feel comfortable asking the boss for help try You-tube videos and put "blood draws" into the allnurses search box, you will find a lot of hints.

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I've talked to my managers before and they help when they have the time. Was just looking for technique advise! Thanks for the response

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Specializes in Hospital Education Coordinator.

you mean no one has observed your competency? Scary. Why can't the day staff do some of them? About the only way I know to do this myself would be to ensure I was VERY organized before I started, had all my equipment there, have a cart to push around (leave out in hall for infection control purposes and MAKE SURE you label at the bedside). Label at the bedside anyway. If you are interrupted with patient requests, hit the call button and let someone else take care of it. I woiuld have a sit-down with my DON

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Okay, I hope you can check out the you-tube videos and my quick search on All-nurses brought up several posts about tips and techniques for phlebotomy. I think successful phlebotomy and IV sticks are 80 % psychological. Best of luck, you can do it!

(Am I spelling phlebotomy correctly? My spell check doesn't like it, wants to change it to lobotomy, ha ha.)

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\ said:
you mean no one has observed your competency? Scary. Why can't the day staff do some of them? About the only way I know to do this myself would be to ensure I was VERY organized before I started had all my equipment there, have a cart to push around (leave out in hall for infection control purposes and MAKE SURE you label at the bedside). Label at the bedside anyway. If you are interrupted with patient requests, hit the call button and let someone else take care of it. I woiuld have a sit-down with my DON

They have watched me do it so I know I'm doing everything correctly as far as the skill goes and the tubing and what not afterwards. I don't have a problem with that. I just would like some advice regarding actually getting blood and enough of it. Day staff doesn't have time to do it and if I can't, the mangers try if they have time. If neither of us can, then we call a lab tech but that costs us money. I would just like to be proficient and not have to rely on my managers and techs all of the time. It would build confidence tremendously. I'm not saying I NEVER get the draw, I just haven't had much experience so it takes time to get a good technique down.

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Specializes in L&D.

Make sure you get a good vein for your draw. I'm by no means an expert(I am a new nurse as well who grad in May 13), but I get most of mine. Are you getting in the vein at all? I used to be really bad at missing veins and coming up along the side. If you are getting in the vein and the problem is getting enough blood, try tilting the needle up/down a little.

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My job now requires me to draw blood frequently. Here are some suggestions;

Go by what you feel over what you see. Lots of good veins are not visible. I always try the AC first. Most pts find drawing from the hand more painful.

A good vein will feel springy. If it isn't springy it's likely a tendon.

I always use a butterfly because I treat renal patients. As soon as I see flash I insert my tube into the vacutainer. This was the hard part for me because coming from the hospital I was used to inserting IVs and my instinct was to advance upon seeing blood return.

Sometimes you may have to manipulate the needle around to get blood to flow. Sometimes you may have to pull back on the needle. Or raise the angle.

With my elderly pts I use my finger to anchor the vein to keep it from rolling.

Lastly, if you have trouble finding anything to stick try using a a BP cuff instead of a tourniquet. Pump it up to about 70 and you should get a vein.

Good luck!

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\ said:
My job now requires me to draw blood frequently. Here are some suggestions; Go by what you feel over what you see. Lots of good veins are not visible. I always try the AC first. Most pts find drawing from the hand more painful. A good vein will feel springy. If it isn't springy it's likely a tendon. I always use a butterfly because I treat renal patients. As soon as I see flash I insert my tube into the vacutainer. This was the hard part for me because coming from the hospital I was used to inserting IVs and my instinct was to advance upon seeing blood return. Sometimes you may have to manipulate the needle around to get blood to flow. Sometimes you may have to pull back on the needle. Or raise the angle. With my elderly pts I use my finger to anchor the vein to keep it from rolling. Lastly if you have trouble finding anything to stick try using a a BP cuff instead of a tourniquet. Pump it up to about 70 and you should get a vein. Good luck!

Thanks so much!! I'm kind of excited to try these tricks out now haha

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Last time I had routine phlebotomy done for my yearly check up the phlebotomist had me gently squeeze a few test tubes in my hand (assuring me they would not break) and to turn my hand slightly towards my body. I forget exactly what he said, why it helps. Maybe something about tightening the muscles anchoring the vein?

It can't hurt and may help? I only work part time now and only had one chance to try it for an antecubital IV stick which went fine, but it may have gone fine without the "trick." I had the patient squeeze a handful of 4 X 4's, use whatever is handy.

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Just an update: I'm 4 for 5 on my draws since I posted this! Thanks for all of the helpful advice!

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