Venipuncture help

This is just something that gets better over time. There is no substitute for experience. Even with a lot of experience, most of us have days when we couldn't hit our rear end with both hands..... It's important to recognize these times and acknowledge your limitations - and ask a co-worker to do the start if you're having an 'off' day.

There are a variety of different devices that help you find veins. I'm sure that other AN'ers can chime in with their recommendations.

It's hard to say without knowing more about your work environment or specialty. Or whether these are draws that occur when the patient was previously resting (midnight/4am). I'll take a shot in the dark nonetheless...

I'm guessing you are dealing with inpatient draws and not walk-in's, appointments, and such. My own preference is to go distal on the off hand. In my neck of the woods there's been a strong preference to go right for the Median Antecubital Vein. This can complicate things however when either you or the next nurse has to do a PIV change. Hands, wrist, or Basilic forearm vein have always been fast and easy. Faster still to get your samples though from a line restart if it's scheduled to happen that day. The person following you will be pleased as well with one less procedure to make time for.

I tend to warm areas first and use gravity. I've been addicted to heel warmers or warm compresses since my first year on the job. The short amount of time that's needed for that to work can be filled with conversation with the patient. Then again, I've found that engaging in conversation proves to be an excellent distraction. Typically, though not always, I'm finishing up while the patient is asking me when I'm going to stick them.

Beware of areas where the skin appears to be very thin. Although it's workable, the likelyhood of infiltration is pretty high. And I prefer securing the vein I intend to work with until I have flash (at least). I've seen some of my cohorts lose what would have been a good stick with elderly or frail patients for example due to not gently securing the intended vein. Or choosing a highly visible vein that turned out to be thin walled.

There's a lot more to be said on the subject, but hopefully that helps a bit.

If you miss a patient and someone else gets it go with them and see where they get it from and what technique they used. I was a phlebotomist for 3 years and when I had little experience this helped me gain little pointers and I was able to use the ones that worked well for me. :)

I've used warm (BE CAREFUL! NOT HOT!!!) moist compresses for a few minutes prior to my sticks. Helps to dilate the veins. Keep the arm low and as straight as poss. Simple stuff.. They also do make a vein illumination scanner if your place has one; if not, maybe that could be something they could consider purchasing.

• Ask the patient. If they are hard sticks, they know and will tell you where most people get blood.
  

• When in doubt, use a butterfly. They are easy to use, visible blood return and if worse comes to worst, much smaller needle to fish around with
  

Also, veins tend to be in the same general area on most people. Study where yours and your friends and family are, for example, the one between 4th and 5th fingers on back of hand, 4 in the AC, etc.