What if you can't hit a vein to draw blood?

Nurses General Nursing

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At my HH job I was sent out to draw a lab on this woman who has a portacath. I told the boss I've never drawn blood from a portacath and she gives me this instruction sheet and tells me it's easier than drawing from a PICC line.

So today I go out to this lady's house. She is really heavy and when I feel for her portacath it feels like it is about two inches below the skin. She says it is sore and I back off from this option because I am not comfortable with it.

So I drive to the hospital lab and come back with some butterfly needles and a tourniquet. She has no veins to speak of, but I make a sad attempt to hit what I hoped was a vein (the only place on her arm that felt elastic at all).

She winces in pain even though I am as gentle as I can be (she has metastatic bone cancer so no doubt she is in tremendous pain), so after one stick I tell her I won't subject her to any more and I will get a more experienced nurse to come out and see what they can do (there was an LPN staying with her but I couldn't get her off the couch to help me).

I call one of the nurses who told me he would help with anything I needed. He made some kind of excuse but said he would get it done in the morning and that was the last time I could get ahold of him (I know he won't do it, he can't do it because I never go the chance to tell him this woman's name :uhoh3: ) So, I talked to the boss, basically she said to have her drink plenty of fluids and use warm compresses to get the veins to come to the surface and I had better get the blood tomorrow, or else.:gandalf:

Now I have been stressed out and worried because I am not the best at drawing blood and it is lucky for me to get it with good veins. I feel like I want to go sit in the corner and count my own fingers or suck my thumb. The stress with this job lately has been about to run me around the bend.

Does anyone have any other advice they can offer about how to get this done? I know I should have more experience/better orientation and it would be noble for me to refuse to take the case and find another job but this is not what is going to happen. For one thing, I had a hard enough time finding a job and I have too many bills to just up and quit.

Specializes in ER.

And so many years later you probably have more appreciation for what a difficult spot your boss put you in. That was crap- did you stay with that agency?

Specializes in oncology, med/surg (all kinds).

i am concerned, too, enough that even though i have 10000 things to get done in the next hour i feel compelled to write. there are 2 separate problems here. #1 you don't send someone off with instructions on how to access a port. no, it isn't very hard to do. but there is a way to do it and you must be competent. in order to be competent, you must be trained. the others are correct you are putting your license on the line by agreeing to do something you are not properly trained for. check the nurse practice act in your state. not as boring as you might think (close, but not totally). is this your first job as a new grad? possibly not the best choice, but maybe this is as bad as it will get, so don't take my word for that!

your second problem is missing your stick. i see lots of fabulous and useful responses for tricks and what-not. i have used most of them at ne time or another. i will give you *my* trick, then i will give you some bad news.

the trick is this: hot and wet. where i work, all the nurses use hot towels for the hard sticks. but i make a very hot, wet bunch of washclothes (heated in the micro maybe) then wrap it around dry towels --we certainly don't want to burn the vein out of them! then i let them cook for a couple minutes while i assemble my gear. (i also like to use sterile rather than clean gloves if i can--better feeling with them) then, the skin being a little tiny pink is okay, we are not trying to actually cook the patient. hot and wet helps me every single time.

now the bad news. you need to just do lots and lots and lots and lots of sticks. hundreds? thousands? i don't know. you will miss a lot. and when you are really really good--you will still miss. there is skill involved, but also a lot of luck. i have gotten an iv in a person who didn't have a vein in their body. i have missed a stick in a guy with ropes for veins. if you have any opportunity at all to spend some time doing nothing but sticks, it will really help. every trick in the book won't help unless you just do it over and over and over. it took me a few years to have the confidence to say i was pretty good! i was pretty good before then maybe but couldn't admit it. as long as someone else could get a stick i couldn't then i must be horrible! you get some. you miss some. sorry. that's the way it is. even the nurses on out vascular access team miss sometimes!

you will be okay.

Specializes in ICU, Telemetry.

Don't do this unless you've at least seen it once, and preferably had an experienced nurse with you the first time you access a port. Someone handing you a piece of paper is completely unsatisfactory. I had a good on the floor teacher, but if I hadn't and had just been given a piece of paper, I could see myself jamming a needle into someone's pacemaker by accident....

Specializes in Emergency Nursing.

I think that before any kind of procedure you need to have at least seen it done once before they can just throw you into it and expect you to do it competently by yourself. As a phlebotomist here are a few of my recommendations for blood draws:

  • Elevate the arm or hand your going to draw from with a pillow. This will help to stabilize the arm or the hand and put it in a better position for blood flow.
  • For tricky veins (especially in the hand) take a few extra alcohol pads and scrub the surface. A little bit of vigorous scrubbing can help to bring up veins but remember the last swipe of alcohol should be using a clean pad and the swipe needs to be in a clockwise spiral so that you are pulling away as much of the bacteria on the surface of the skin from the venipuncture site as possible.
  • For the really tricky veins use warm compresses to help bring tough to find veins to the surface. Get some really hot, wet facecloths, wrap them in a dry facecloth or a chux pad and then place them on the hand or forearm for about 5 - 10 minutes.
  • A few tips for overweight patients... If your drawing from the arm, try using a second tourniquet and have the patient rotate their closed fist (like they're going to give you a thumbs up) which tends to help palpate the Cephalic vein on bigger people. If your drawing from the hand, ask the patient to bend their fingers (to make their hand look almost like a paw) instead of making a closed fist because sometimes with larger patients if they make a closed fist this pulls the skin too tightly to properly palpate a vein.
  • And of course PRACTICE, PRACTICE, PRACTICE! :)

After the issue with getting the blood is resolved, please consider getting her port evaluated. You sort of alluded to thinking there may be something wrong with the port (at least that is how I read it and I might be wrong there). People who have ports expect to use them for blood draws. If something is wrong with it, it needs to be corrected. You may want to check to see how long she has had the port. If it is relatively new, there are problems associated with new ports. The soreness may be one, if it was just recently inserted. If it is an old port, there may be a problem and it may need to be adjusted or replaced.

The trick I use when drawing from a port that I never accessed before is to look for where others have accessed it. You can usually see the marks from the previous needles. Also, think of the port as being shaped like a 2 liter bottle cap, with the top being covered with a rubber covering. You have to penetrate the rubber covering, then continue iunserting the needle until you hit the other side. Holding the port steady while accessing it so it doesn't move and cause discomfort is a good idea.

Specializes in Derm/Wound Care/OP Surgery/LTC.

After I became a nurse, I took a phlebotomy class at the local community college. $90 and six two hour sessions. Best money I ever spent! :yeah:

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