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

apocatastasis · Oct 17, 2011

I hate it when people are so in your face about it. I rarely miss on patients that say they're a tough stick.

My standard line is to put it very casually, "Well, if I can't get one in your arm, I'll have to put one in your neck." If they're REALLY a hard stick, they'll usually say, "That's where they had to put it the last time" or "Last time, I had a PICC." Either way, saves everybody 20 minutes of frustration.

On the other hand, if they're just being challenging, threatening to go after their neck with a needle makes smug smiles fade pretty quickly.

emtb2rn, BSN, RN, EMT-B · Oct 17, 2011

Yeah, when I hear "picc" and "last time" in the same sentence, I know it'll be interesting.

I also tend to look on the backside of the forearm and at other non AC or hand vein locations. Gotta get creative. But sometimes, they truly are a hard stick.

apocatastasis · Oct 17, 2011

If they've had a PICC, I'll take a quick look at non-obvious places... but if I can't find anything, usually I just call the PICC nurses to insert an IV using the ultrasound machine.

Quickbeam, BSN, RN · Oct 17, 2011

This thread fascinates me. I'd love some advice about what you should do if you know you are a hard stick. Say nothing? I've been yelled at for that: "If you knew you were a hard stick, why didn't you tell me!!!". If you say something you are a drama queen. Hard to know what to do. I've been stuck 8 times and then turned over to an anesthesiologist who got it first try.

Double-Helix, BSN, RN · Oct 17, 2011

I've never stuck anyone eight times, nor do I roll my eyes. I acknowledge their concerns and use therapeutic communication to build trust.
Just because I feel an urge to vent on this particular aspect of my job on this particular day in no way, shape, or form, indicates that I jab away maniacally while disregarding the discomfort of my patient. I certainly did not mean to make it sound that way.
It's just that I think this is something that many Emergency nurses can relate to. How many times a day, day in and day out, do we hear this, and how often is it really the case?
And, this is *my* vent, I'd thank you very much not to hijack! You're welcome to start your own thread about what it's like to have difficult veins to access.

If you don't want any posts that are contrary to your opinion, I suggest you don't post in in an open forum.

Some people are a hard stick. They don't tell you that to sound challenging or offend you and your superior IV skills. These people have probably been stuck several times whenever they need an IV or blood draw. They tell you they are a hard stick because they are hoping that you will acknowledge what they've gone through in the past. Maybe you'll look a little harder for a decent vein. Maybe you'll call someone with more experience, if you're not great at IVs.

The statement actually lets you off the hook if you don't get the stick on the first try. If you do get it, that's wonderful and you'll probably be that patient's favorite person for the day. So either way, you win. Why would you let one person's comment about their own body and their past experiences offend you so much?

Altra, BSN, RN · Oct 17, 2011

This thread fascinates me. I'd love some advice about what you should do if you know you are a hard stick. Say nothing? I've been yelled at for that: "If you knew you were a hard stick, why didn't you tell me!!!". If you say something you are a drama queen. Hard to know what to do. I've been stuck 8 times and then turned over to an anesthesiologist who got it first try.

I think the point is, there is no magic information revealed by the patient stating, "I'm a hard stick". If that is truly the case, I can conclude that after about 20 seconds of examining you.

Some people truly have very poor venous access options, either from medical conditions, lifestyle choices, habitus, or simply quirky venous anatomy.

But as this is a vent -- we ER nurses hear that repeatedly throughout any given day, and many times from patients whose veins I can see from the doorway, and who seem almost put out when I pop one in with no effort at all. I don't understand what the psychological secondary gain is from being "a hard stick", but I've seen this phenomenon too many times to discount that it is a factor in a suprising number of patients.

Altra, BSN, RN · Oct 17, 2011

And this is my closely related contribution to this vent:

"You're gonna have to use a baby needle"

or

"Y'all got a butterfly needle?"

Deb123j · Oct 17, 2011

I love it when they are tatooed (is that a word???) all over and state that they are afraid of needles. REALLY???

enchantmentdis, BSN, RN · Oct 17, 2011

I just don't think it's necessary to tell the nurse you are a tough stick. It's almost like the patient is challenging you to botch the procedure. As nurses we can tell right away if they're going to be difficult. I've even seen patients smile and say, "see, i told you." Sigh. I guess sick people have strange ways of entertaining themselves. I've told patients before, "Why don't i let you think about it a bit and i will try in a little while. I also remind them to please focus on something other then being a hard stick."

enchantmentdis, BSN, RN · Oct 17, 2011

lol....
I try two times and hit them with an I/O before they get too fussy.
By the time they've seen the Black n Decker cordless drill it's in...
(3 words though: lidocaine, lidocaine, lidocaine)

Conrad Murray sure likes that lidocaine for his sticks. But he asked for the lidocaine gel, ointment, whatever to be put in a more attractive tube for the gloved one. Rich folks--different than the rest of us. Lol.

enchantmentdis, BSN, RN · Oct 17, 2011

I love it when they are tatooed (is that a word???) all over and state that they are afraid of needles. REALLY???

Yes, it is a word, and looks like you spelled it correctly. Kudos to you. :yeah:

Medic2RN, BSN, RN, EMT-P · Oct 17, 2011

If the patient tells me that they are a hard stick, I always ask them, "Well, where do they usually get you?"

I'll look in that area first.

Some people say that and I end up finding a vein worthy of an 18 ga. A couple of patients we see frequently, I know that a 24 in the thumb will be the best I can do. There's one patient we don't even attempt. Not going to happen.