Phlebotomy on very large bulging veins

[Charslight]

Has anyone had trouble drawing blood from patients with very large veins? As a former ICU RN - placing IV's in large veins was occasionally misleading as you would think you could get in without any problem but the tunica appears to be thicker and sometimes they roll.

Today I had to do phlebotomy on a young man with absolutely massive veins. I got in, but there was minimal flow and when I applied the test tube to the vacutainer there was no suction.

I stopped and went in the other arm and chose a smaller vein, but as soon as I got in, the vein bulged up. I got my specimen, and I don't think I caused a hematoma, but I have never seen veins respond like this. I gave him some ice and applied pressure. The blood also clotted immediately - does anon think this has to do with anything.

These veins were so large, they almost looked like shunts.

Any advice?

[OCNRN63, RN]

I learned the hard way to avoid veins like that like the plague since they rarely wound up being usable. Occasionally I could get them if I applied plenty of traction, but most of the time I looked for a smaller vein.

[missnurse89]

Try to apply the tourniquet not quite as tight (or none at all if they are bulging already.- you can also have them hang their arm down if you need just a little bit of venous congestion). I find that those "monster veins" as I call them, will easily be compromised with all the pressure being applied. Then add injury by needle stick and those veins have had enough. You could also try using a blood pressure cuff instead of a tourniquet (just pump the cuff up just a tad) and that helps too. Plus this is more comfortable to the patient. Another thing is just doing some more looking. Those kind of veins are deceiving. I do try to find another vein, usually those patients have really good veins just off to the lateral AC. Do you feel comfortable with your technique? It can be hard to change to phlebotomy when you are used to doing IVs all day long. Really with phlebotomy you just barely have to insert the needle just enough to enter the vein and no more.

[Charslight]

Thank you everyone. I did go for the smaller vein after the second try and didn’t tie the tourniquet tight at all. Very deceiving. Thank you.