Drawing bloodwork

  1. Ive worked in ICU for about a year. The last hospital I worked at, if we had to poke patients for bloodwork, like cultures, the lab tech would come do it for us. Im at a new job and if we need to poke the patient for any bloodwork at all, we have to do it. Ive been having alot of trouble getting the bloodwork when I have to poke them. I feel im so clumsy when im trying to get the tubes onto the vacutainer, and I often loose the vein I was in. Anyone have tips for drawing bloodwork?
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    Joined: Feb '04; Posts: 731; Likes: 858


  3. by   Hoozdo
    This is probably my worst skill also. I have found 3 things that help.
    1. Always use a butterfly
    2. Keep your tubes real, real handy
    3. Insert the butterfly in a manner that you don't have to hold it at a precarious angle to get blood. Try to have it flush against the skin.

    Any other tips are greatfully appreciated! :spin:
  4. by   oMerMero
    I always use a butterfly. If possible, after I am in the vein, I try to hold the butterfly with my left hand, and change tubes with my right hand. My other advice, as with starting IVs...take your time! I think it is better to spend a minute or few looking for a good vein and then poking the pt once, rather than being quick with looking for veins, and having multiple sticks. That is my advice.
  5. by   surromom
    visual the vein, if you have a textbook that has phlebotomy in it, review it. i am currently taking a phlebotomy class right now, and was told it will really pay off in the future, YOU CAN DO IT!!! have confidence, oh and use the side guards when you are pushing the tube in!!! and you can always rest your fingers on their arm if using a vacutainer not a butterfly. GL!!!
  6. by   cardiacRN2006
    If you are using a vacutainer, then don't move that hand. Once you insert the needle, anchor your hand with the vacutainer in it. You will place tubes into it and adjust only with the other hand. People tend to blow the veins when they try to compensate with the vacutainer hand. Just keep that hand steady and still...
  7. by   Creamsoda
    Thats the main issue I have I think, lol...keeping the vacutainer or butterfly steady. I dont know how the lab techs do it all the time.

  8. by   nurseabc123
    Quote from Cher1983
    Thats the main issue I have I think, lol...keeping the vacutainer or butterfly steady. I dont know how the lab techs do it all the time.

    It's really easy to say "stabilize the vacutainer" on here...but harder to do, honestly, I would just have an experienced nurse, tech, phlebotomist show you. Don't be embarrassed to ask, it just shows that you want to improve and you have your patients' interests at heart. In my personal opinion, I think it's easier to keep things steady when using a straight gauge.
  9. by   JakeyWakey
    I'm just a new phlebotomist so I am still refining my skills, but I have found that using the vacutainer when possible is so much faster, and easier in the long run. I used tons of butterflies in the beginning because I was intimidated by the vacutainer, but the only way you get good is practicing. For stabilizing the tube holder you need to experiment with what works best for you, but you pretty much want to make sure that your fingers end up resting comfortably on patient when you get in the vein. This means you need to figure out what angle works best for you. If you come in too high, you will risk going through the vein more easily and you won't be able to rest your fingers on the patient for stabilization. I also tend to brace my upper arm against my side for extra stabilization. I'd encourage you to only use butterfly needles when really needed, you'll be more confident with in the long run.
  10. by   jill48
    i always use a butterfly. love the butterflies.
  11. by   StacieRN
    My advice is: in an elderly person with frail veins, don't use a tourniquet it will just blow the veins.
    You can engorge their veins by placing a hot moist towel on the arm for five min. If that doesn't work, then use a manual bp cuff.
  12. by   jill48
    and don't forget to take off the tourniquet when you are done. true story. yep, i know it sounds really bad. i was a newbie, fresh out of school. thank god it wasn't on but a few minutes, and there was no damage, but i never made that mistake again. woops.
  13. by   emmycRN
    Instead of using a vacutainer you could try attaching a syringe and aspirating the blood into it and then transfer the blood from the syringe to the tubes.
  14. by   Rdahmad
    Well, for phlebotomy, you will only increase in skill the more you do it. I'm in nursing school, about to graduate, and I've been a lab assistant/phlebotomist for a few years. The best advice concerning your handling of tubes and not being steady in that, would be to practice inserting needles and changing tubes on a fake arm or maybe on a hot dog. If you are using a butterfly device to draw blood, make sure you see the little flash of blood and then attempt to tape the wings of the butterfly to the patients skin... you don't have to totally tape it down, but just enough so it doesn't move so much while you use both hands to change the tubes in the vacutainer. If you are in town in Tallahassee, I'd let you practice on me! Maybe some of the nurses would help you to learn how to feel more comfortable drawing blood. I have to tell you, you get more comfortable the more you do it, so take every opportunity to draw blood.

    Also, you may lose a vein once you think you have entered it only because it's a vein that rolls to the side once you insert the needle in the skin. Unfortunately, phlebotomists sometimes have to dig in the skin, withdrawing the needle not outside the skin, but just enough to feel for where the vein is, and then moving in that direction attempting to hit the vein. It really is a skill that perfects over time and practice feeling for veins and also, if you see veins in the inside of the forearm, and you think they are wide enough, even if you just see them, go for them using the butterfly if nothing else. Also, you can go for the hand, although it is often more painful, but sometimes blood values are critical for the doctor to evaluate, so the pain might have to happen unfortunately. Also, something I didn't know until just yesterday, make sure you pull the tube out the vacutainer prior to withdrawing the needle because remember the vacuum in the tube is still sucking if you haven't filled the entire tube and may hurt the patient even if it is a tiny split second pain.

    If you are desperate, you can also do a finger stick for chemistries and hematology specimen using the little baby tubes and squeezing the finger to retrieve the blood. That's what some of us do if we're desperate.

    REmember to have the patient pump his her hand in a fist and even ask them to squeeze their muscles too. It will force blood out faster. Remember also, or know, that some tests you only have to retrieve a certain amount of blood and you don't have to fill every tube to the top. If you have a hard stick, usually filling the lavendar tube for a CBC only requires filling up to just above the end of the label. PT/PTT's usually require at least half or above half if possible, but always try to fill that one up. Often medical tech's will get a critical value that is due to a short sample. So, blue tubes try to fill all the way. And, for the chemistries, like BMP, CMP, K, MG, glucose, hepatic/liver tests..etc. you only need so much. If you can get something in there, at least a quarter of the tube, that should be sufficient, though if you can get more, that would be great to ensure there is enough plasma or serum for the tests to be done. They spin them in the centrifuge in the lab. You know, you could call the lab and ask them how much blood they must have to perform the test.. if it's a hard stick, they can tell you how much you probably need to get. And remember the finger stick.. it may get hemolyzed, maybe, but you won't know until you send it down to the laboratory. And make sure for the CBC's and others, you mix blood in the tube because they contain solutions that keep them from clotting. The red tubes don't have anything in them so you don't have to worry about them.

    If you have any questions please let me know. Just keep practicing and remember to feel for the veins, rather than just looking for them. Have the patient squeeze their hand if they can, but if not, also remember to wait a little while, sometimes the veins are more apparent or are better felt after a minute. Don't give up. You'll notice after doing it, that you know where veins are found on most patients.. on either side of the sides of the wrists,and there are a few that run around the antecubital area... also, in the hand, tap or flick veins.. it gets them to perk up.

    I love phlebotomy because it can be a challenge and many nurses don't have skill doing it because they just don't do it often enough. Even phlebotomists sometimes don't get it after a few tries and multiple people have to try the patient.

    GOOD LUCK and be confident. Tell yourself you'll find the vein and don't lose your cool. I'll pray for you!

    God bless you.