Phlebotomy/tourniquet help

[dizzymisslizzy]

I'm taking a phlebotomy class while I wait to see if I get into my schools nursing program and its only the beginning of the class, but I am already stressed. I am not good at tying tourniquets. I try on people outside of class that say it is tight enough and I can find veins no problem. However in class when I try my classmates say it is not tight enough and I have to try until I get it right in front of the whole class. I have watched the teacher do it, other students do it, and I've looked up videos on YouTube. I am just starting to feel discouraged. Is it performance anxiety or is there a trick to getting it tighter?

[mrsboots87]

This the easiest part if the whole process. It sounds like nerves are getting the best of you. Remember, the point of a tourniquet is to cut off or severely reduce blood flow temporarily so the veins "puff up". That's why it can only be applied for a very short period of time. Just pull that sucker tight and then be quick about your poke and you'll be fine. Shop for your vein by having client clench their fist and use an alcohol swab on the spot you think the better vein is at. Once visualized, then get everything ready so when you tie off the tourniquet, you get get the poke done quick and the tourniquet removed.

[IVRUS, BSN, RN]

Do not stress about this! Taking a tourniquet and applying it correctly will become second nature to you once you've done it several times. However, a few key points:

1. Remember that the arm color below the tourniquet application should appear somewhat darker as you are trapping blood.

2. If you think your tourniquet is too tight, check to make sure you haven't obliterated the pulse. (you do not want to stop arterial flow!)

3. Try to not let the tourniquet be on that patient's arm for longer than two minutes at a time.

4. Remember when working with the elderly, your tourniquet should be placed lightly, or not as tight. If you apply the same tension to an elderly patient's arm that you place on your 30 y/o, you will cause too much pressure on that vein, and it's likely to blow.

[CrunchRN, ADN, RN]

Practice, practice, practice. Performance anxiety sucks, but you just have to push through it.

[dizzymisslizzy]

Thanks all. I'm sure once I start doing well in front of the class I will be fine. I usually can do anything once I get the right attitude.

Side note though: we were given the stretchy disposable tourniquets to practice with at the beginning of class a few weeks ago. Could my problem be that it's been stretched out too many times?

[SopranoKris, MSN, RN, NP]

When you put the tourniquet under the arm, grasp each side very close to the arm, not the ends. Cross the left in front of the right and tuck it under with your right thumb. This will ensure your end always lay up, out of the way, and that you simply need to pull the end to get it to pop off quickly.

Take your time to find the right vein! Palpating is painless, multiple pokes aren't. Don't be afraid to use gravity (arm dangle) or warm towels to help the veins pop up on patients who have hard-to-find veins. Taking your time to find the best vein gives you a better success rate. Don't go for a vein just because it's visible. Sometimes good, juicy ones are the ones you feel. You'll get the hang of it quickly the further you progress.

Phlebotomy was excellent training prior to nursing school. I did a phlebotomy Externship before I started. Now I have no trouble doing my IV starts. Everyone in my class freaked out over it. I knew I could confidently hit the vein. It's just a different angle and then threading the cath off the needle.

Enjoy your class! :)

[missnurse89]

A great tip that I leaned as a home health nurse: use a BP cuff instead of a tourniquet for elderly and obese patients. It makes a wonderful difference for those situations. It helps to reduce skin tears and seemed to be more effective for locating a vein in obese patients. Plus it seemed that it was less discomfort to the patients. They actually began to request the bp cuff to be used instead. I personally would rather be poked 5 times than have to have a typical tourniquet applied on myself, but that's just me. The tourniquet is the worst part when I have to get my blood drawn! Hate it!

As far as applying the tourniquet, keep practicing and it will become easier as you become more comfortable and confident and you will get your own routine down. Practice is important. I always hated tourniquets! It gets easier though the more you do it.

You can't be worse then me when I first started using tourniquets. I actually popped a patient in the face taking one off (no injuries though, might I add.) Thankfully the patient had a great sense of humor but I was mortified! Trust me! It gets easier. You can do it!