I feel so bad- anyone else ever done this?

[LoriAlabamaRN]

Hi everyone,

We're shortstaffed tonight so I decided to help one of my LPNs out and do her lab draw (blood) for her... the resident is a 78yo lol, skinny and no fat but has large veins protruding on the backs of her hands... usually I draw blood in the AC but both sides had bad bruising so I drew from one of the veins on the back of her hand... all went well, I drew the blood and immediately put pressure on the site. After about 90 seconds I lifted the gauze expecting to see no more bleeding- and before my eyes the skin on the back of her hand filled with blood underneath! I immediately clapped pressure back on, and held it for five minutes before daring to release it, but the back of her hand looks awful. I feel so bad... I've never had that happen before, not after holding pressure for as long as I did. The puncture did not bleed externally when I let go, but it was horrifying how quickly she bled into the skin around the vein. You could literally see it rolling around under her skin. I'm kicking myself now, I should have held pressure longer, she is on blood thinners after all... has anyone else had this happen?

[burn out]

Yes I have had this happen to me and seen it happen to others quite frequently and almost always the patient has been on coumadin. I hope one of the tubes you collected was blue for a pt/inr.

[LoriAlabamaRN]

Yup, it was a pt/inr... I just feel crummy about it.

[Binkey, BSN]

Lori,

The important thing to remember with elderly patients is that those ropes that are on the back of their hands, aren't the best veins to cannulate.

Though they appear large, they have lost much of the superficial fascia (Sub-Q) tissue which supported them, so in fact they are very fragile veins and when cannulated, they frequently result in a hematoma. Also remember that the clotting cascade is 2-6 minutes. It varies, because of disease processes and medications that they are on. So perhaps pressure should have been held longer, but it sounds like you did the best you could.:balloons:

[ahsitters]

Done that befor and it scared the hell out of me too. Senior staff assured me that it happens with pts on coumadin and that It looks worse that what it actually is because of the lack of fatty tissues in the hands and because the skin is so translucent. You did good. And you'll know what to expect next time.