I know this topic has been brought up many times before in various parts of the forum, but I didn't see any active topics for this general topic. I wanted to be able to discuss blood draws in general with everyone!
We all have to do it at some point. How do you feel about doing blood draws? Do you like doing them or hate doing them? What helps you guarantee a successful draw most of the time? Do you need to work on it? What other thoughts do you have on it?
Personally, I'm sort of fascinated by drawing blood! After drawing successfully on a patient, I get this awesome rush of excitement. I've hit more veins correctly than I've missed, but it totally gets me down when I miss. This is especially so when the patient has at least fairly good veins.
I don't have much issue finding veins before I puncture the skin. The problem is more of knowing when I hit the vein. My supervisor/trainer said you can feel when the needle breaks the surface of the vein. I'm not feeling this 80% of the time. Do you go by this technique, or can you tell another way? If you can feel the needle hitting the vein like my supervisor said, what tips do you have for me to better pay attention to that feeling? Maybe I just need to slow down and pay attention harder to the feeling. I haven't used a butterfly needle yet, so I can't go by the flash of blood with a regular straight needle.
I have been an RN for a little less than 2 years in LTAC and have practically no experience in blood draws, though my intention is to try and practice. My patients are so sick, with a lot of ESRD and dialysis that the veins are elusive to even our amazing phlebotomists.
I have done blood draws for around 4 years now working in ambulatory care. I myself have never felt a needle hitting a vein lol I do a lot of pre-investigating before I attempt a stick. I am not a blood draw genius, I would say I have a 90% success rate though. My first question to patients is what site has worked the best in the past? Most patients know where their good veins are and it saves me time and trouble just to ask.
If they are unsure or just a hard stick all around, I go by feeling the vein not by doing a visual. If it's that rubbery/bouncy feeling then it's usually a good place to go. If I can't find any, I will use heat packs to get veins to pop and have the patient hang their arm down to their side for a few. If all of those tricks fail, I will see how the patient feels about using a butterfly in their hand. I try to do this as a last resort though because it can be pretty sore after using the hand. I also try to not use butterflys if possible because in my experience the blood clots easier and I won't have enough for my tubes. I will do two attempts on a patient, after that I either ask for them to drink water and come back another day or have another nurse/MA try.
Some people no matter what you do, are just really hard sticks. In that case, we just recommend the patient go to the actual lab in the hospital because they have gear we don't in ambulatory care to find veins. I would rather them go there, get a one and done stick, then get poked several times.
Well, I suppose it's a good thing that as nurses, we normally won't be the ones performing the blood draws! Especially for those of us not that stellar at it.
I love discussing this with y'all and hearing about your experiences!
SaltySarcasticSally, I love all of your advice! I try to not even look at the patient's arm initially so my visual won't interfere with trying to feel for the vein. You're totally right, it's always better to feel the veins rather than just looking for them.
I love this thread and your enthusiasm! It is silly but sometimes being competent at little skills like these really makes the job easier and more enjoyable. I spent a whole day in a blood draw lab for one of my clinicals and it was really eye opening. If you ever encounter a Medical Assistant in your work setting, grill them. They have SO many tips for successful blood draws.
Lots of good advice here that I won't repeat, but another useful technique I've seen is hyper extending the arm by laying it against a pillow. It makes the experience more comfortable for the patient and gives you better vision and access. If you think you see a vein but are not quite sure, cleaning the site with rubbing alcohol can make the veins "shine" as one clinical instructor taught us. Also have to agree with the importance of "feeling" rather than going by sight. It's really hard to pierce the skin and then dig around for the vein if you are going by site alone, and you will give the patient a nasty hemotoma if you do so.
As far as feeling, I can attest that I feel a little "pop" when I've gotten into the vein. It is very subtle, but perhaps you can feel it if you really concentrate? The flashback is the most reliable evidence for a successful venipuncture though. Good luck to you OP, hope this thread has given you some good tips!
Not every nurse does blood draws. I know plenty of nurses who have never drawn blood. I do regularly in my job and it really requires lots of practice and a good teacher to help you troubleshoot the misses. I would try to start out with healthier patients before trying your skills on elderly, dehydrated patients or people with significant muscle atrophy.
Regarding the feel when you get in the vein, sometimes you feel this, sometimes you don't. Butterfly needles are good because you can see the "flash" of blood that shows you are in the vein.
So y'all, I drew blood unsupervised for the second time ever yesterday! I'm so excited.
The patient was an older man, and he had surprisingly good veins for being a thin man in his 60s. On the second tube of blood though, the blood stopped flowing! Not sure what happened there. But I still got half of a tube before it stopped. Thankfully that's all we needed!
RNrhythm, BSN, RN
258 Posts
I have been an RN for a little less than 2 years in LTAC and have practically no experience in blood draws, though my intention is to try and practice. My patients are so sick, with a lot of ESRD and dialysis that the veins are elusive to even our amazing phlebotomists.
Thank-you for the reminder about Youtube.