Venipuncture questions!

JustBeachyNurse, LPN · Jul 23, 2015

Do you have nurse clinical educator that can help you? Why do you have to draw blood soon?

You really can't learn from a message board and you tube videos. You can cause harm at worse a hematoma or nerve damage

Oceanpacific · Jul 24, 2015

I think you may be confusing 2 different procedures. To do phlebotomy (collecting blood samples), the needle doesn't get inserted very far into the vein. To insert an intravenous catheter, it looks like the needle is being pushed in, but it is actually a softer, inner cannula that is being advanced or threaded into the vein.

You deserve to have proper instruction on this (and so do your patients). Utilize your clinical instructor or facility nurse educator. You may need to practice on anatomical models. Good luck.

ScrappytheCoco · Jul 24, 2015

Honestly whether it's phlebotomy or IV start, it's something you have to do on a real person to learn. Good luck!

Lev, MSN, RN, NP · Jul 24, 2015

1) Aren't we supposed to go in at an angle of 10-15 degrees and STOP when we see flashback?

Not necessarily. There is no one way to draw blood. Depends on how superficial or deep the vein is. When I see the flash I may or may not advance the catheter slightly. It depends on how it feels. If I see a flash and the blood is not flowing well, I will increase my angle and advance very slowly til it flows. Sometimes I can feel a very deep vein in the AC and I may be going at a 45 degree or greater angle. You will pick up a feel for it as you trial and error.

2) If we're drawing multiple tubes of blood, when should we remove the tourniquet?

I generally remove the tourniquet after getting the tubes, but before removing the catheter. At times, I will add a tourniquet about 2-3 inches below to first one to aid blood flow, or if blood is flowing well, sometimes, removing the tourniquet helps (rarely).

3) what is the best size gauge/needle to use? why do people say it's not good to use the butterfly?

I generally use a 23g butterfly (light blue) to draw blood. I will use the 21g (green) if the veins are huge. Generally, the 23g works better on all veins but the 21g may be too big for the thin spidery dehydrated vein or veins that are over joints which may be all you've got. I don't know why it wouldn't be good to use a butterfly. In fact it is easier to get blood via butterfly vs straight/IV needle.

4) is there a website telling me how FULL i need to fill each of the different commonly used tubes? (lavender, light blue, SST, etc) I really dont want to over or underfill the tubes!!

The only ones that really need to be full are the light blue tubes which are generally your tubes for checking d-dimer, PT, PTT, INR. General rule is to fill til it stops filling. However, if you see your blood is slowing down, do the light blue top tubes first, then do the green top (which tend to hemolyze), then lavender, then gold. The green and lavender only have to be filled 1/2 way. Lavenders may be able to be run 1/4 filled. Depends on who's in the lab. Gold tube are big, but 1/3 way full will suffice. Of course, the under filling is only really ok if blood is just not coming.

5) AC is the first choice for drawing blood right? what are other good options if you cant find the AC? is AC still best in elderly? how about obese patients?

AC is a great choice. It is still ok in elderly and obese. The veins tends to be larger and more visible and straight. Unless there is a restricted extremity or the vein or skin next to the vein looks bad any vein can be used for blood draws.

6) some veins are so prominent i can totally feel them. i have heard it's best to feel rather than see them. how about the veins i cannot feel at all (or see) what do i do??

I go for veins that I cant necessarily feel. If you can see then and estimate how deep they are and everything else matches up, go for it. I didn't start going for veins I couldn't feel til I got very confident with large veins that I could see and feel.

As a side: When putting in IVs, I also used mostly 22g (or 24g catheters if I wasn't sure) til I mastered IVs. Then I started putting them into deeper veins that I couldn't feel well. Now, in the ER, I can put in a 20g IV or higher in most everybody. I'm considered "average" in my ER.

xiongmao · Jul 24, 2015

You are amazing. I really appreciate the time and effort you put into writing this response. It was super helpful. You give nurses a good name- people like u make me want to be a better nurse thank U again.

Lev, MSN, RN, NP · Jul 24, 2015

Happy to help!

HouTx, BSN, MSN, EdD · Jul 24, 2015

Be sure to follow your organization's policy & procedure! This is what should guide your practice. If you deviate from the P&P, you can incur personal liability. . . . not a good outcome.

Totally agree with the need for actual clinical instruction & practice for venipuncture & IV starts. This is an absolute necessity for any type of skill that required physical action.