Phlebotomy advice???

Curious1alwys, BSN, RN · Sep 29, 2005

:rotfl:

I have garden hose veins!! We are doing Phlebotomy too right now..that and IV insert. I watched some others practice with the butterfly on the fake arm but we have not really tried to take each others blood. I can't find anyone willing!! Do you have people to practice with?? I guess once you know how to do it, that is all you can do. I think Phleb is very much trial and error...:stone Maybe someone with a phleb history can help??? :coollook:

Curious1alwys, BSN, RN · Sep 29, 2005

Did you guys learn that to select veins you should start distal and work up?? That would mean that if the veins on the hand were good that you should use them before the anticub. Now, everytime anyone has either taken my blood or IV'd me it has been in the anticub space. What is up with that?? I know I have good veins on my hands, very plump and big....:uhoh21:

Fun2, BSN, RN · Sep 29, 2005

Sometimes you can maneuver the needle slightly to the left or right & get the stick. Slightly moving outward gets the stick at other times, if you go past the vein.

If the vein is a "rolling" vein, pulling the skin distally towards you sometimes helps keep the vein still.

Do you have a venipuncture arm to practice on? Either way, human arm or fake arm, the more practice you get, the better you will get.

Good luck. :)

truern · Sep 30, 2005

I would volunteer for practice, but I'm a *very* hard stick so it just ain't hap'nin :rotfl:

Sorry

HeartsOpenWide, RN · Sep 30, 2005

Did you guys learn that to select veins you should start distal and work up?? That would mean that if the veins on the hand were good that you should use them before the anticub. Now, everytime anyone has either taken my blood or IV'd me it has been in the anticub space. What is up with that?? I know I have good veins on my hands, very plump and big....:uhoh21:

We were trained the other way around. Start with an anticub space with a vacutaner and 22 G if you can not get on either arm use a butterfly and go for the back of the hand.

PhoenixGirl, when going for a vein you can not see feel for a "spongy feeling" under the skin. (Tie to tourniquet, have them pump their hand three times and make a fist) Some times if you do not get blood at first, just slowly bring the needle out and sometimes you will get the "juices flowing". Some people were trained to move (dig) the needle around to find the vein. OUCH! I have never done this but have had patients that complained of other people doing it to them. Try your best to get it on your first try, but do not beat yourself up if you don't every time. Don't use the same vein, go to anther one.

B/D use to make me soooooo nervous, especially when I did it on the MD I worked for :uhoh3: . But now it is a piece of cake. Many people warn me that they are a hard stick or that no one can get them, but I rarely miss. I worked with a clinic that took a motor home to all the indigent areas in the city and surrounding towns. Many of the patients were IV drug users. I was very nervous about drawing from "ruined" veins, but never missed once the whole summer I was there. Practice, makes perfect so, breath and try to keep a steady hand. Get your routine down for what is comfortable for you. I put the patients arm on a pillow, then I get my tiger top (always first) in the vacutainer and have the remaining tubes lined up in order against the patients arm. I then set the filled vile behind their arm. And remember, if you are using a vacutainer method, always remove the last tube before removing the needle or you will have a mess! Also, if the patient is on Coumadin or Warafin you may need to hold a cotton ball on their arm for them. (but always have them apply pressure when you are done, but don't have them bend the arm!)

You can try running a patients hand under warm water to get veins on the hand to plump up. If you are having a patient come in later for a fasting B/D tell them to make sure to drink lots of water, dehydration makes it harder to get the veins, good ol' water plumps them up! If you you can fortell a "roller" simply ancer it down with your thumb and pointer finger!

Fun2, BSN, RN · Sep 30, 2005

(Tie to tourniquet, have them pump their hand three times and make a fist) Some times if you do not get blood at first, just slowly bring the needle out and sometimes you will get the "juices flowing". Some people were trained to move (dig) the needle around to find the vein. OUCH! I have never done this but have had patients that complained of other people doing it to them.

Definitely don't "DIG"! Ouch is right!!! So, OP, please don't think my comments meant that. lol I've had a few phlebotomist "digging" for my veins...it's not fun at all.

As for hand pumping, at first I was taught this, then taught not to. I was told it can make to much potassium in the test results?????? I'm not sure what is being taught now, you may want to ask your instructors the best method. I'll definitely make sure to ask when I get to that point for my own benefit. (We were taught to have patients clench their fist, and when you get your stick, have them to release their fist.)

Like HeartsWideOpen stated, make sure you take the tube out before you remove the needle :chuckle, and don't bend the arm up to stop the bleeding. If you just bend the arm up, when the patient puts the arm back down, the site could start bleeding again.

Don't get depressed about not getting every stick. You'll get better.

cardiacRN2006, ADN, RN · Sep 30, 2005

Phlebotomy has a lot to do with confidence. You have to believe that you will be successful, and then be firm with the needle. Soon, you will be drawing blood from thumbs and between knuckles like the rest of us. Then when you get to IVs, they will be a breeze!

BTW, I learned to start at the AC, and then move downward. First off, the veins are better anchored in the AC, and second, it hurts to have your blood drawn from the hand!

Fun2, BSN, RN · Sep 30, 2005

Very true! I have to admit though, I've never had to do a blood draw from thumbs or knuckles. lol

I know when I was a baby & in the hospital, my veins were terrible (other than having baby veins...lol). My mom told me I ended up having an IV on my head!

Does anyone remember the acronym for the order of tubes? I've been trying to remember, but it's been too long.

Phlebotomy has a lot to do with confidence. You have to believe that you will be successful, and then be firm with the needle. Soon, you will be drawing blood from thumbs and between knuckles like the rest of us. Then when you get to IVs, they will be a breeze!
BTW, I learned to start at the AC, and then move downward. First off, the veins are better anchored in the AC, and second, it hurts to have your blood drawn from the hand!

ICRN2008, BSN, RN · Sep 30, 2005

The order of draw is: SPS (blood cultures), red top (no additive), blue top (sodium citrate), green top (heparin), lavender (EDTA) and finally gray (oxalate). I think you draw the gold top (SST) after the red, but I can't remember.

Here is the acronym: "Stop, red light, green light, go" for sterile, red, light blue, green, lavender, and gray.

Always go anticubital first, then to the hand because the blood vessels are less likely to collapse if you go proximal. Doing by phlebotomy by feel is the only way to learn it well. Try feeling your friends or family members' veins (with tourniquet in place) if they'll let you. You don't have to stick them or anything :)

If I remember correctly, pumping the hand is not recommended because it can cause tissue fluid contamination of the specimen. Leaving the tourniquet in place for too long can do the same thing. You can, however, have the patient make a fist while you are feeling for a vein.

My med tech program used a book called Phlebotomy Essentials by McCall and Tankersley. I highly recommend it to anyone who is learning.

Good luck!

3KittiesRN · Sep 30, 2005

I did the phlebotomy program at my school last semester and loved it...however when it was time to do the skills lab I was soooooooo nervous...I was the first to do a venipuncture on someone and as soon as I got the needle in I backed out...I didnt even get to put the tube in!:chuckle when it was time for my externship I did MUCH better...It is very true what the above poster said about confidence...if you have confidence going in the vein...you will most likely be sucessful...by the time I was done with my 3 week externship I had done over 300 draws and 10 capillary sticks...I live in California so I can't work as a phlebotomist until I get my license...I sent in my paperwork but it takes 4-6 months to process...so i'm just waiting:o

some good tips

- pull the skin very taut before going in the vein...the better you anchor it the less chance of rolling

- if you put the touriquet on and you don't feel a vein...just wait a little bit and a vein just might "pop" out...if not try the other arm

- if you still can't find a vein then look at the hand...

- you can draw blood in so many places on a person's arm or hand! be sure someone teaches you all the different areas and techniques

The best advice is to be confident the rest will come with practice!

good luck!

p.s tourniquet off, needle out, cotton ball, snap!! hehe one of my phlebotomy instructors got this phrase in my head