Tips on drawing blood and putting in IV's?

dawngloves, BSN, RN · May 16, 2002

Hmmm... Let's see...

I always look at the ante cubital first for blood draws. Careful with the tournuquet on the elderly, it can bruise, take it off as soon as you get a flash/return. Hold pressure after withdrawing the needle, (don't forget to break the vacuum first!) so the folks on Heparin or Coumadin don't get a hematoma. Don't bend the arm after an AC stick! Definate hematoma.

Use warm compresses to make veins on the little old ladies pop out. Try and look distal first in case you blow a vein so you can still use it above the site.

I have found that sometimes humor helps ease tension that can increase "pain" and make veins dissapear.

Good luck!

boobaby42 · May 19, 2002

When you draw blood, don't go for what you see, go for what you can feel. I know this sounds like a karate lesson, but close your eyes and feel for one. You know where they are supposed to be and you can see them sometimes. But, if you can't feel it, don't try it unless it is the last resort. I would rather use butterflies, but they hurt much more than other types. I don't have that much experience in elderly sticks, except for my mom. I have to stick my mom and send the blood to her doctor. I use a butterfly and I draw from the veins in her hand. The other options are not good choices because I can't feel or see anything. I feel like I am in control better with the butterfly.

With the needle and tube holder, I had trouble at first because I introduced the needle as if starting an IV rather than a blood draw. Remember to go at an angle greater than the angel for IV insertion. As soon as you see the blood coming into the tube, release the tourniquet, take the tube from the holder and quickly remove needle, apply pressure, and dispose of needle. Well, dispose of the needle safely and as soon as feasible. Like the post before me, do not bend the arm if you use the site mentioned before. I have had to practice many times, and I still have bad days. If you can, make sure you're patient has had fluids. If you can, warm the sight you're going to stick. Make sure the tourniquet is tight. Have the patient make a fist or hang his arm/hand below the level of his heart.

When all else fails, look at the thumb. I've had to infuse fluids through an IV I started in a thumb. No other choices. No one to turn to for help.

Practice and time. It will be second nature to you soon.

Good Luck

kats · May 19, 2002

I am learning phlebotomy too now. I have 45 successful sticks and need to have 50 to take my test to be certified. I will be taking my test next Friday. I only work on Friday mornings since I take classes the rest of the week. I am learning at the hospital where I am volunteering. I agree with the tips from the people above. I think one of the most important things to remember is to just take your time. I tend to try to go faster when I get nervous so my teacher has had to remind me to slow down. Plus, the patient will sense if you are nervous. The more confidant you are, the more calm they will also be. Make sure that you keep your hand with the needle very steady. Keep the bevel up and at a 15-30 degree angle. Don't panic if no blood comes out at first. Sometimes it can be as simple as the bevel being at the wall of the vein in which case you just need to adjust the angle. Other times, you may have gone a bit far and can back up. Or you may just need to straighten out the vein by pulling the skin tighter distal to the needle. That works a lot. Get in a habit of doing the proper steps in the proper order. Never forget about safety and always assume every patient has either hepatitis b or AIDS. Make sure you always check the name on the orders with the patient and then again before placing the sticker on the tube. My teacher even messed that one up briefly the other day by placing my patient's sticker on her patient's tube. I was a bit worried when I couldn't find my patient's sticker at first to say the least. I totally agree with Steph that feeling is way more important than seeing. There are times when I close my eyes if I have trouble finding a vein and it really helps. It is a great feeling to get blood the first time and you can't even see a vein at all. I have had patients who have told me they were a hard stick and I closed my eyes and they were even surprised how fast I got the blood. You can also search for the veins without the gloves, then take the tourniquet off, then put your gloves on, and go from there. As for taking the tourniquet off once the blood is flowing, make sure that it is the last tube that you will be collecting first. As for butterfly needles, I am not great at those yet, but I found I need to anchor the vein and hold the needle steady with my right hand and hold the vacutainer and switch tubes with my left. If I drop the vacutainer while switching tubes, I do my best to pick it up and continue or ask the patient for a bit of help if I think they can. Make sure you know the colors of the tops of the tubes and the chemicals they contain and the tests they are for. Make sure that you also know the proper order of the draw and that the light blue top tube needs to be filled all the way. At least that is true at my hospital. They need it to be filled to perform that particular test. It has sodium citrate and is used for anticoagulation testing. When they use that, they also need a "clean catch" so it is necessary to draw a bit of blood in another tube first that can later be discarded. As for actually inserting the needle, warn the patient when you do it and just make it as smooth and quick as possible. Most of my patients now tell me that they don't even feel the needle go in or out. The book that I have used to study for this class is called "Plebotomy Workbook for the Multiskilled Healthcare Professional" by Susan King Strasinger and Marjorie A. Di Lorenzo. The hospital where I work usually just loans them out, but I bought my own copy since it has a lot of great information in it. I called B. Dalton and had them order it for me. I also figured that by learning it now while volunteering and taking my pre-requisites, it would be one less thing to worry about in nursing school. I just re-read this and I almost forgot probably the most important thing of all. Listen to your patient. You will be surprised at how many people know exactly what needle and which vein should be used. Go with what they suggest. They usually know best from past experiences. That is about all I can think of. I haven't yet done IVs since I am not yet in nursing school so I don't have any advice for that.. I tried to talk them into teaching me that too, but they said I have to wait for that one. Good luck, don't forget to breath, don't rush, and you will do fine. I hope all this has helped a bit.

-Kimberly

kats · May 19, 2002

I almost forgot, I still haven't yet done a draw with a syringe yet, but I am supposed to do that this next Friday.

-Kimberly

snick520 · May 30, 2008

I also have trouble with drawing blood at times. I have a question, What causes to blood return to stop after the first tube is drawn. This has happen alot here lately and i know it has to be something i am doing. Can anyone help me?

chenoaspirit, ASN, RN · May 30, 2008

I can honestly say that Im the queen at my hospital when it comes to IVs and blood draws. Lab even comes to me when they cant get a stick. I honestly dont know how to explain how to do it. It just takes practice to get the process down. One thing I do for fragile elderly arms is place the tourniquet over the sleeve of their gown so it doesnt cause skin damage and it hurts less, its also beneficial for hairy men because the tourniquet pulls hair. I also agree that its best to stick the veins you FEEL rather than the ones you see. Feel for that "bouncy" feeling. You will learn where veins are commonly found. I usually use a butterfly needle with a syringe. I dont like the vacutainers. Its harder to stick obese patients because veins are deeper and harder to feel and impossible to see. The AC (inner bend of the elbow) is a great stick, but bad place for an IV because the pump will beep everytime the patient bends their arm). Its best to start more distal so you can work upward when/if it infiltrates or "blows" when stuck. I LOVE to stick. I do however rip one finger of my glove off so I can feel better (we arent supposed to do that though). I just cant feel a vein through a gloved finger. You will do fine. Just remember that the angle and technique is different with blood draws than starting IVs. Good luck, you will do fine. Oh, and once you draw the blood, place pressure with a 2x2 afterward to stop bleeding and lessen the bruise.

chenoaspirit, ASN, RN · May 30, 2008

I also have trouble with drawing blood at times. I have a question, What causes to blood return to stop after the first tube is drawn. This has happen alot here lately and i know it has to be something i am doing. Can anyone help me?

Try to make sure you stabilize the needle while you are removing that first tube. Thats why I dont use the vacutainers. I use a butterfly with a syringe. Its a consistent vacuum and I dont have to try to change the tubes during the draw. Some prefer the other way. I just find it easier. The size of the syringe depends on how much blood Im drawing (how many tubes I need).

husker_rn, RN · May 30, 2008

Also with the elderly I have been known to use a blood pressure cuff, pumped up no higher than 70 mm/hg since a tourniquet can be too tight and cause veins to sink from sight and feel.

Daytonite, BSN, RN · May 30, 2008

please see the iv tips and tricks thread on the emergency nursing forum at https://allnurses.com/forums/f18/iv-tips-tricks-3793.html.