Drawing blood/phlebotomy tips and tricks

[CrunchRN, ADN, RN]

Ok, so I took my class last february, got some tips here, and now have done at least 70 draws. I am decent, but now I want to be better than that.

My problems are those women (they are all post menopausal women in my study) with those skinny itsy bitsy torturous veins that you really cannot hardly feel, but can see a little. And then the other problem are those women you just cannot palpate or see anything.

Advanced tricks and tips please! Actually, basic ones are great too.

I am using butterflies.

[Hystericka RN]

Try using double tourniquits, one up near the axilla, one mid forearm.

When anchoring, pull down hard with your thumb, just one finger so you don't flatten vein.

Try to avoid going by veins you see, not saying if you see a big night crawler, avoid if, just FEEL those veins!!!

Veins bounce (as you probably know) so bounce em up as far as you can till you feel a "fat" entry point.

Flabby skin can be pulled back for the illusion of tautness.....

Practice, practice, practice. Each poke is a learning experience!

[sunflower918]

Hi,

I've been a phleb for 20 years now; just graduated from nursing school!!

Almost everyone has a decent vein in their wrist-turn their hand so the thumb is on top and the pinkie finger is on the bottom (their hand will be "sideways"), and use a hot pack or wrap hand/wrist in a hot towel. These veins must be anchored properly or they will move away from the needle. Also, I don't know what your facility's policy is (some do not allow this), but in extreme cases I will draw from the inside wrist-palm side- after warming up the area with a hot pack. I use the smallest gauge needle I can get away with as this is a tender spot for the pt. Don't be afrain to check for surface veins on the upper arm or on the back of the upper arm; most elders have veins in some strange places you can access. Take your time whenever you can-better to take your time looking for decent access than to stick people numerous times.

Good luck and remember-no one gets everyone-at times we all have a difficult day trying to get blood from these patients no matter how much experience we have!

Hang in there

[CrunchRN, ADN, RN]

Thanks so much Hystericka and Sunflower!

I am way too much of a weeny to go for those wrist veins:eek:

Keep them coming all!

[JPRloverNurse]

The inside wrist veins almost always work for me! They terrified me at first but I have never had any problems using them. I have seen people stick patients between the fingers! I feel so bad for the pt because that really seems to hurt them.

[CrunchRN, ADN, RN]

buckdropper said:

The inside wrist veins almost always work for me! They terrified me at first but I have never had any problems using them. I have seen people stick patients between the fingers! I feel so bad for the pt because that really seems to hurt them.

Come teach me!

[amydayre]

Find out which wrist the pt wears her watch on, usually the "snuff cuff" the radial aspect just below the thumb has a nice fat vein. The arm the pt wears her watch on will have more engorged hand and wrist veins. Don't know the mechanism, just 15 years of experience stickin' em! :)

[PadawanLearner]

There are some people on whom I get better results with a Blood pressure cuff instead of a tourniquet. Inflate the Bp cuff as though you were taking a Bp and leave it pumped up until you draw blood.

[CrunchRN, ADN, RN]

Thanks for the tips!

[HmarieD]

BP cuff inflated to about 100 works great.

I always liked those plump wrist veins too but you must be very careful to avoid the many nerves in this area. I had a tech hit a nerve once and it was very painful, and gave me problems for weeks.

[JomoNurse]

i'm horrible at starting IVs. I even miss the ones that are painfully obvious and very feelable. My poor patient will be riddled with IV stick marks by the time I get something. I'm not new, either!

[Indy, LPN, LVN]

I do not like inside wrist veins; when I was brand new I hit a nerve on someone in that area, and I've done ONE blood draw in that area in the 20 years since. I trust feel over sight any day. With the onion thin skin, I put the sleeve of the gown between the tourniquet and the skin to avoid skin tears. Practice, practice, practice. I learned phlebotomy when I was 19 and so, you'd think my fingers would remember what to do. Well they do, but my fingers learned on needle and syringe, and we didn't use butterflies on everybody like they do nowadays. When I get ahold of a butterfly with the little button to retract the needle, it reminds me of an IV so I blow veins trying to thread the darn thing. I really only have great luck with a needle, syringe and an AC vein.