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Drawing blood

Posted

I transferred from a telemetry floor to an adolescent psych floor. On the telemetry floor, we frequently had to start IVs and draw blood. I sucked at both. Even though I would go through all the steps correctly...tourniquet tight enough, arm held low, etc. etc. I would always either never see the blood return or I would see it and then it's gone or the vein blows. I've always felt so horrible about it because most of the other nurses never had a problem with drawing blood or starting IVs, even when they did, it wasn't often. Now on the psych floor, I don't have to deal with IVs anymore (thank God!!) But, I still have to draw blood. I thought it would be super easy on kids because most of them have excellent veins. Then, I had to draw blood from one strong teenager with very good veins that popped out so good that you could see them from across the room, and when I went to draw his blood, I didn't see any blood return at all in the needle. I told a senior nurse that I tried, but, it seemed as if his veins kept rolling. She stuck that needle in his arm and drew the blood in like 2 seconds it seemed like. I felt terrible. I was wondering if they were talking about me behind my back saying, "She came from a medical floor and she can't even draw blood." Can any of you senior nurses give me some good advice or tips on drawing blood? Thank you.

blondy2061h, MSN, RN

Specializes in Oncology. Has 15 years experience.

I'm sure they're not talking about you behind your back. Drawing blood isn't everything ;) I'm horrible at it to, so no advice, sorry!

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

if you have a staff Educator talk to them. They may have models for you to practice on with someone guiding you along the way. Another choice is to tell your supervisor you need assistance in this area because you want to excel. Perhaps time with the lab phlebotomist will help. Do not be ashamed to ask. I have learned all kinds of stuff from other disciplines. Also, do you have trouble seeing at that distance? Some people wear glasses to correct near or far vision, but the distance between your eyes and the patient may be in between.

Feel more than look. The vein should be plump and bouncy. If you have trouble with them rolling, stabilize the vein above and below the insertion site.

Perpetual Student

Specializes in PACU. Has 4+ years experience.

The first time I tried drawing blood there was some horrible confusion. For some reason everyone started screaming and running around when I fired up the chainsaw and headed into the patient's room. Apparently I was supposed to get just venous blood using a small needle. Why bother when you can get plenty of aortic blood by making a nice transverse cut through the abdomen?

Er sorry, night shifter night off delirium has set in.

Try to find some folks you work with who're good sticks and get one to watch you and give you pointers (after you're done, no sense in making the patient uneasy) the next time you do it. It's not the end of the world and I doubt anyone's going to look down on you.

We don't draw blood, but we start IVs.

I need 3 hands to start an IV. If I have someone in there to assist me I can get an IV 99% of the time. If I'm doing it by myself, that goes down quite a bit. I don't know what it is, but since I'm a new nurse, I figure the 2 handed technique will come with time. For now, I just grab someone to come with me. Even an aide can help with taping it down while I hold pressure on the vein so the person doesn't bleed all over.

Super_RN, BSN, RN

Has 12 years experience.

My advice is to practice on co-workers with good veins who are willing! I'm serious about this--Not only do you have to NOT worry about freaking out a patient, they can give you pointers while you're doing it!

Orca, ASN, RN

Specializes in Corrections, psychiatry, rehab, LTC. Has 25 years experience.

My advice is to practice on co-workers with good veins who are willing!

I have offered my arm many times to colleagues who want to practice.

cookienay

Specializes in ER, education, mgmt. Has 18 years experience.

have a more proficient nurse go with you the next time to see what you are doing wrong. they can give you guidance on how to be more successful.

sunnycalifRN

Has 6 years experience.

Feel more than look. The vein should be plump and bouncy. If you have trouble with them rolling, stabilize the vein above and below the insertion site.

Excellent advice. Many nurses try to "look" for veins, rather than feel for them. Even veins that are visible, may have no bounce, or if the vein is hard (often due to chemo), there may be little to no blood running in it. So, don't stick it.

For those patients with loose skin and veins that can move back and forth 1/2 inch, I stabilize the vein with one finger below the intended insertion site and gently stretch the skin downward.

Regarding the "flash", for hypovolemic or cold patients, you may not see any flash but, if you're confident that you're "in", just apply suction by vacutainer or syringe (whichever you're using) and you'll often be surprised to see excellent blood return even though there was no flash.

The poster who advised "practicing" on willing co-workers is also right on the money. Since you've had troubles with blood draws/IV starts, you've got yourself psych'ed out, and you probably think, "I'm going to fail" and Lo and Behold, you do. After you do a half dozen successful sticks on willing arms (probably belonging to 6 different people!!), your confidence will be high and I'll bet that you'll start hitting 'em on patients!!

And, one last thing . . . patients usually know their own bodies, so just ask the patient (if possible), where the phlebotomists usually have success. Relax and practice . . . you'll be a "pro" in no time!!

One thing that hurts a lot of people is the old advice to "go in at a 20-30 degree angle, and once you get flash to lower the angle". Forget the angle. Go in at as flat as an angle as you can. As a previous person noted, go for a vein that you can really "feel", as opposed to one that just looks good. And if you can feel it but can't really see it, find a land mark, a freckle, a scar, a mole, anything to x marks the spot. Then go for it. Pull the skin back to stabilize the vein, and approach a little from behind the vein. The most painful part is the skin puncture so thats when most people jump. So, go through the skin, then stop for a second and let the patient calm down, then advance. You'll get it.

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

I have learned recently that no matter what you see the only thing that counts is what you feel. Tap that and you are golden.

I practically close my eyes having learned this lesson and accepted it!