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Help With Blood Draws

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EyesForward EyesForward (Member)

I thought this would be a good place to get some suggestions. When I have a patient with small veins I can usually always find the vein in a hand with a syringe and a 25 g. needle. I get a flash, and can easily draw about 1 cc., but after that it seems like I lose the blood flow, and cannot get any more. I've tried drawing slower, with less pressure, but nothing comes. If I pull harder I get so much resistance from the aspirator I'm afraid I'm blowing the vein. Often I have to collect enough for coagulation, which has to fill up the tube, along with cbc's and chemistry, so 1 or 2 cc's just doesn't do it. How come I know I'm in the vein but the blood doesn't keep flowing after the initial 1 or 2 cc's? Thank you!

A 25 gauge is pretty small to be drawing blood with, that could actually be part of the problem even with small veins the antecubital is usually old faithful...Do you have access to a vacutainer. If so, try it with people who have big ones and get the hang of it..eventually you will be able to do it blind with ones that have small veins. Can't some tests actually be effected by using such a small needle??? Couldn't a 25 cause lysis of some of the components? Anyone???

Erin

LilgirlRN, ADN, RN

Specializes in ED staff.

Erin you're right, it causes hemolysis. What I've done in the past is this, use a BP cuff as a torniquet, get a 25 gauge butterfly needle, pop the top off of whatever color tube you need and let it just drip in. The lab is usually cooperative and let's me use pediatric tubes. Choice of a vein is very important. I try to look in places that other's haven't. If your state will let you, use a little lidocaine with a diabetic syringe just under the skin in tender places. We have a high sickle cell population here, their veins get used up quickly. I've used lidocaine in the palm of their hand in order to get a cbc and retic count. with butterflies you can stick just about anywhere, I like the veins of the upper arm. Most of them have never been stuck. You can't use the BP cuff there, but usually can find decent veins there. In very rare cases where I couldn't get blood any other way, I'd do an arterial stick :)

nursemary9, BSN, RN

Specializes in Psych, Med/Surg, Home Health, Oncology.

Hi

Just read your post. Even for hard sticks, I find 25g needle just too small to get good blood return.

Try a little larger butterfly--21g even a 23 is better. If you have access to a vacutainer it helps, too.

Also there are the pediatric tubes, where you don't need quite so much blood.

Practice, Practice, Practice---that's the only way to get really good.

We draw all of our clinic patients off of a 24g IV and have success 99% of the time. Occasionally we hemolize, but not that often. We use 24g Intima IV Catheters. Similar to butterflies, flush with hep and cap until it's chemo time. There are times that the patient needs to be warmed up to dialate their veins. This works wonderfully!!

I agree. 25g is just too darn small.

This is an old thread, but I'm looking for any assistance to help me learn to do blood draws.

I'm working in a NH part time and I'm going to have to learn to do so.

My nursing history is such that I've never been in a situation, until now, that I've had to draw blood. On my regular job the RNs do it, or we'll send them to the hospital for lab. The LPNs never do blood draws there,

but at the NH I'm going to have to be able to do it.

And the other nurses are going to get tired of always coming and doing it for me, and so far they've been great, but I hate to keep imposing on them.

I've ordered a book from Amazon that might help me out, but if anyone knows any online sites with good information, I'd like to know, so I can read there, too.

Any information/links would be appreciated.

Thanks!

catlyn

could you give me some tips about how you get your IV,s to draw thanks

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion. Has 32 years experience.

generally speaking the more distal you are to the deeper,larger vessels----the slower the flow. Hand veins are usually close to the surface and therefore easy to hit----so challenge yourself and go for the actual blood drawing veins at or close to the ACF. Contrary to the practice I often see these sites should be avoided for routine IV therapies and preserved as blood drawing veins. also change your needle size to a 21 gauge---decreases hemolysis----better to poke the patient once and get a good draw with an appopriate sized needle and with a result that you can trust. There are times you must use a small gauge needle---so distend the vein well ----hang arm down before applying the tourniquet----heat pack prn---BP cuff set at slightly below pts diastolic. Go for the gushers---if you can hit the hand veins you can get the big ones---also watch the phlebotamist---Ilearned a lot of little tricks from them

Occasionally this happens to me. I'm not completely sure the etiology. Sometimes it is that the vein is blown and I've hit a dead end. But sometimes if I pull the needle out a little it will start flowing again and also lifting the needle up a little helps. Otherwise, unfortunately I just take it out, apologize and give it another shot. Best of luck!

This is an old thread, but I'm looking for any assistance to help me learn to do blood draws.

I'm working in a NH part time and I'm going to have to learn to do so.

My nursing history is such that I've never been in a situation, until now, that I've had to draw blood. On my regular job the RNs do it, or we'll send them to the hospital for lab. The LPNs never do blood draws there,

but at the NH I'm going to have to be able to do it.

And the other nurses are going to get tired of always coming and doing it for me, and so far they've been great, but I hate to keep imposing on them.

I've ordered a book from Amazon that might help me out, but if anyone knows any online sites with good information, I'd like to know, so I can read there, too.

Any information/links would be appreciated.

Thanks!

catlyn

I'm a new nurse and certainly not a pro at drawing blood. I actually am probably more successful at starting IVs than drawing blood (I don't get it either!). A few things I've learned is that you're not always going to do great. It happens. I work with a former IV nurse that has her days where she may have trouble drawing blood. Not everyone has great veins and it can be complicated. Do not draw blood based upon looks. Sometimes you can see that a vein looks good but it may be completely superficial. Always draw by touch. I use my left hand generally because I use my right hand for so much and I feel like my left may be more sensitive. Don't go in too deep or you'll blow the vein. Go in the smallest amount possible to get blood. Butterfly needles are the easiest to start with. Straight sticks I only use if it's a really big vein and I don't have a thousand tubes to get. Sometimes If I have trouble finding a vein I'll close my eyes to feel. That way I'm sure not to go for something superficial. As far as how deep and whatnot you go it's something you just kinda learn eventually. If you do use straigt sticks watch your technique to remove tubes so you're not jiggling around in the vein too much which can be painful. Um I think that would be my tips lol. I hope this helps and good luck!

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