Vent: "I should warn you, I'm a tough stick..."

Specialties Emergency

Published

Seriously? If I had a dollar for every time I heard this and got it on the first stick, I'd be retired.:smokin:

Specializes in Peds ED, Peds Stem Cell Transplant, Peds.

As an ER nurse myself, and also a tough stick, usually takes 4-5 tries each time. I warn everyone.

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I'm impressed JBudd. Anyone that's good enough to taunt the IV Gods by saying they'll get it in one stick before they stick, and still get it? :yelclap:

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Specializes in Emergency, Haematology/Oncology.

I was with a haematology patient on my last night shift and simply had to write this. Sometimes I get access on people and almost want to jump up and down and scream yay! when I get their line in because they really are difficult. This man, throughout his lifetime, has had Hodgkins' disease, Myelodysplasic syndrome, 2 bone marrow transplants, and is currently being treated for Non-Hodgkins lymphoma and has GVHD. He has a port-o-cath, but needs peripheral access x 2 and bloods for cultures, ugh! So, I access the port, one down. This man rightfully, is trying to tell me as pleasantly as he can, that I have no chance. After telling me all the usual stories, I ask him specifically what people say when they miss and take this on board. Just as I am getting ready he tells me, that the "ANAESTHETIST had five attempts last time, and he would do it more often than you". Oh crap I think, but tell him that I put in about 15 per shift. I'm still pretty confident about the one I am feeling on his right arm. In it goes, as well as one on the left. Even when they were in he wasn't convinced that they were working or that it was all over, had the gall to tell me I was lucky. To which I said "EXCUSE ME?" He giggled and said "no, no all skill, all skill...." I wore the vampire hat for the rest of the shift.

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Specializes in Trauma, Teaching.
I'm impressed JBudd. Anyone that's good enough to taunt the IV Gods by saying they'll get it in one stick before they stick, and still get it? :yelclap:

Yeah I know, but.... she was really bugging me. And I'd already seen some pretty good veins :devil:

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Okay so question... I have been told by many nurses that I am a very hard stick. My veins are very tiny and using too large of a needle burns so bad that I have literally jumped off a table before. I am not a wimp. I have a double mastectomy and never even open the painkillers they gave me post surgery, not because I think I'm tough but because the pain is manageable. During the C-section of my son they had to call in the anesthesiologist. She stabbed me multiple times. Total time to find a vein 1 hour and 30 minutes. I was then told to inform people that I'm a hard stick and not to use anything over a 22 which I'm not really sure what that means but I'm sure it has something to do with needle size. I have recently been diagnosed with breast cancer. I had a double mastectomy and I told them not to use anything over a 22. A vein was located but it still took them 45 minutes. Now I need chemotherapy but I know it weakens veins, and the doctor has already stated that he doesn't do ports for those on short-term chemotherapy. Because I am Young they want to do a blood draw before every chemo session to make sure I'm not pregnant even though both my husband and I have had tubes tied. Because blood draws usually result in veins that look like they have bumps at the draw site, as well as multiple bruises, I'm very scared about trying to recover from being stabbed from a blood draw only to be stabbed for chemotherapy. How do I explain this very real fear to a doctor in a way that doesn't get me an eye roll? There are so many phony "hard stick" people out there, how do I explain that this fear is real and extremely legit for me, without getting blown off?

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Specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.
55 minutes ago, Elizabeth Adams said:

Okay so question... I have been told by many nurses that I am a very hard stick. My veins are very tiny and using too large of a needle burns so bad that I have literally jumped off a table before... Now I need chemotherapy but I know it weakens veins, and the doctor has already stated that he doesn't do ports for those on short-term chemotherapy.

Chemotherapy is notoriously bad on veins, regardless of your vein size when you start. Ask to have a port-a-cath put in.

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21 hours ago, Elizabeth Adams said:

Because I am Young they want to do a blood draw before every chemo session to make sure I'm not pregnant even though both my husband and I have had tubes tied.

I think you should talk to your team about this. IMO it is not reasonable that you should have to go through it. Tubal ligation is 99% effective on its own, not to mention your partner having had the equivalent procedure for himself.

As to the IV pokes, be kind/friendly about it and choose wording that hasn't become cliche: "I'm a little nervous because even anesthesia has had some significant problems with my veins in the past; they've been a longstanding problem. What is usually done about this sort of thing?" (Or, "what options do we have" etc. etc)

Any good nurse will heed that appropriately; they should have a good answer and/or be willing to talk about a game plan with you.

((Hugs)) to you and I wish you the very best with your upcoming treatments ~?

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Specializes in Burn, ICU.

I, also, think that your doctor needs to review their assessment of the problem! In an inpatient setting, I advocate for patients to get PICC lines all the time; they might wind up being discharged after a week but we put veins through a lot during a critical care admission. I don't give chemo, but I would suspect that some infusions need a bigger lumen than a 22 (pretty darn small; basically a pediatric IV). Some drugs also may not be appropriate for PICC lines, so developing a plan with your doctor makes sense.

About blood draws: even if you can convince them that you're 100% never gonna be pregnant, it's often necessary to do a blood count before or after chemo, so you'd still have lab work needs. In the short term, maybe ask for EMLA cream?

Best wishes for your treatment.

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A tiny percentage If you are skilled, gifted, confident, and great with IV's.

I have fabulous veins and should never need to be stuck more than once, as proven by most of my times of having to get stuck.

but one nurse was nervous because I was a nurse, I think. She tried twice and couldn't get me. Thankfully, she got another nurse.

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On 3/6/2020 at 11:18 AM, Elizabeth Adams said:

Okay so question... I have been told by many nurses that I am a very hard stick. My veins are very tiny and using too large of a needle burns so bad that I have literally jumped off a table before. I am not a wimp. I have a double mastectomy and never even open the painkillers they gave me post surgery, not because I think I'm tough but because the pain is manageable. During the C-section of my son they had to call in the anesthesiologist. She stabbed me multiple times. Total time to find a vein 1 hour and 30 minutes. I was then told to inform people that I'm a hard stick and not to use anything over a 22 which I'm not really sure what that means but I'm sure it has something to do with needle size. I have recently been diagnosed with breast cancer. I had a double mastectomy and I told them not to use anything over a 22. A vein was located but it still took them 45 minutes. Now I need chemotherapy but I know it weakens veins, and the doctor has already stated that he doesn't do ports for those on short-term chemotherapy. Because I am Young they want to do a blood draw before every chemo session to make sure I'm not pregnant even though both my husband and I have had tubes tied. Because blood draws usually result in veins that look like they have bumps at the draw site, as well as multiple bruises, I'm very scared about trying to recover from being stabbed from a blood draw only to be stabbed for chemotherapy. How do I explain this very real fear to a doctor in a way that doesn't get me an eye roll? There are so many phony "hard stick" people out there, how do I explain that this fear is real and extremely legit for me, without getting blown off?

Sit your doctor down and tell him again what your situation is with veins. Tell him that even an anesthesiologist had to stick you 15 times and they do IV's all day, every day.

Tell him you need him to show you the respect you deserve by believing you about the veins.

Let him know that you are putting your very life in his hands and that you need him to work WITH you, be a partner with you in getting you the treatment that could greatly improve your situation.

Tell him that you need him to not deny you an approach that takes you, the whole person, the individual person in to account.

Don't scold him but do stand up for yourself. Have someone with you for moral support.

His reason for not doing ports with short term chemo is what? Ask him and let him answer. GEt his reason for his "one size fits all" approach.

Find another doctor if necessary.

Or why can't they insert the IV and draw the blood right after they start the IV?

Ways to get a good vein:

dilate the veins with a heating pad for a few minutes.

Get the person doing the IV/blood draw to be in a comfortable position. I have never understood why some nurses almost stand on their heads for this procedure instead of getting comfortable.

How about using an ultrasound to visualize the veins (not just do a blind attempt)? The AccuVein AV500

Use a BP cuff for a tourniquet. I always get better results when I do this.

Don't let anyone stick you more than twice. Ask for a different person after the 2nd try - although I hope that won't be necessary.

Have them start as low as possible on the arm/hand, so as not to ruin the vein higher up its length.

Make them use a topical anesthetic if its use is not contraindicated for you (like allergy to it, possible bad interaction with other meds you take, numerous other possibilities). Look it up to see possible contraindications and side effects.

Talk to the Manager in advance so he/she can have the ultrasound and topical anesthetic available when you arrive for your treatment.

Understand that there are risks and benefits to everything, including ports. The doctor might have some valid reasons for not liking ports for short term treatment.

Avoid bruising by keeping firm pressure on the site of IV (after it's out of your vein) or site of blood draw. The dressing they put over the site never gives enough pressure in my opinion. I always put pressure with my hand even if they apply a dressing.

I wish you all the best.

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To get back on the lighter side (somewhat) of this thread, has anyone had an IV drug using pt ask to be the one to do their own blood draw, or was my father the only one?

Given he was HIV+, it was in an office vs an IV (when he got admitted it was always a femoral line), and it was the early 90s... his PCP went with the flow.

Would not recommend as standard ER practice, but he can't have been the only one to suggest it...

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