Ideally, try to work with your patient ahead of time, or give them information about what they can do to make their blood draw experience easier. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Any time that you need blood drawn for lab work,, I'm Lou, and welcome to Phlebotomy Examiner! Has 10 years experience. Sign up to receive the latest nursing news and exclusive offers. The elderly need special care and attention when doing a blood test. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. Syringe, vacutainer, and needle size should Talk about pressure! The needle may also not be in a vein. This, in turn, can cause increases in your blood pressure. H\@E|E/g#0tW Y3y(N> CA}G)H6GUab/Jqk;gy>>n5%sLWorayo|zEnmn;4d~{;m/E. The veins we have are the veins we will have for life. Check out our Facebook page and give it a like: http://www.redcrossblood.org/donating-blood/tips-successful-donation. Make sure they are feeling well before leaving. If youre a phlebotomist who has encountered this problem before, you know how frustrating it can be. There is no easy way to draw blood. All e-mails from the system will be sent to this address. Liver function studies. Extend the arm. Next step is explaining the procedure. Call us at 1-866-236-3276 to report any additional health information that you forgot to tell us, if you have any problems or if you needed medical care after giving blood. If you are drawing blood from an arm, make sure to sit near the patient, as close as possible. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. One thing that I find that helps is using two tourniquets - take them together and tie it. Apply a tourniquet approximately 3-4 inches above the selected site. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. You can try several approaches mentioned earlier in our venipuncture guidelines that will increase the vein. This study guide will help you focus your time on what's most important. 0000180491 00000 n Alternate arms if youve given blood recently. We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. When you are retaining water, it increases the total volume of fluid that is being pushed through your blood vessels by your heart. If the person is dehydrated or hasnt been drinking a lot of fluids, get them to drink some and see if that helps. Specializes in RN-BC, CCRN, TCRN, CEN. Agree with other posters - ask them where they usually get stuck, heat packs, gravity, tie that tourniquet tight and give them a stress ball to squeeze. Get the latest on all things nursing by joining our email newsletter. 0000005419 00000 n However, in addition to our natural vein anatomy, here are several reasons why your veins may pose some difficulty when doing a blood test. If you allow the visible stress or discomfort of your patient to permeate your own mentality, then youre far more likely to make a mistake or miss the vein. Another way that prednisone can increase blood pressure is weight gain. Thank you. Sometimes, you will need another person or two to help you with difficult patients. After identifying the site for the blood draw, gather the appropriate supplies needed. The rightvein should feel somewhat bouncy as you press on it. Would hate for the patient to have to come back and drink that Glucola again. If necessary, apply the tourniquet and examine the median cubital, cephalic, and basilic veins. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! Dont be discouraged if at first, you dont access the vein. Also, avoid cotton as fibers may stay in the wound and reopen it later on. Is there an IV team, anesthesiologist, or other trained personnel that could be of assistance? If you donate your blood to organizations like the American Red Cross, then you can rest easy knowing, A phlebotomist is a medical professional whose main job is drawing blood. Most of the time, the visibility of the vein depends on the patient. 0000279572 00000 n You should never tie it too tightly at first. Wetting the area, followed by deep massaging or palpating will oftentimes reveal or confirm vein location. More than one-third of U.S. adults and 16% of U.S. children are obese. All rights reserved. If you are going to start an IV in the hand always have the patient pump their fist. Besides proper knowledge, you will also have to have a good head on your shoulders and to make sure you follow these venipuncture guidelines closely. Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. Some patient-friendly advice for getting blood drawn include the following: As a phlebotomist, though, you cant expect patients always to follow perfect procedures to make drawing blood easier, and you may even find that some patients are rude. Its your job to make sure the patient is as comfortable as possible as you take blood, and that can be difficult to do when you cant find a usable vein. In the event that you cant locate the appropriate vein strictly by vision, this can be a great alternative method. You know all nursing jobs arent created (or paid!) The WHO has best practices that are key to preventing infection and being successful during blood draws. If you encounter such a person, make sure to draw blood from larger veins instead of the smaller ones. The elderly lose fat tissue as well as muscle mass, making their skin saggy. 8, 9 Even If you can see the vein clearly, then this will only help you ensure that you place the needle correctly the first time. At nurse.org, we believe that no one knows nurses better than, well, nurses. For example, Red Cross Blood has pointed out that many individuals will have had blood drawn before and may be able to point out the vein that was used in that procedure.2 If this is the case, you can streamline the process of locating the proper vein to draw from. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. Red light reaches a depth up to 6 mm. If possible, look at areas that tend to have less subcutaneous fat, such as the back of the hand, the thumb, the wrist, and even the top of the foot. Put ur fingers on the bottom of their arm and press the tops with your thumbs. The loss of support makes it easy for veins to roll causing difficulty in drawing blood. This will lead to a better compression that will properly regulate the pressure. In fact, the majority of intensive care units require their nurses to possess these skills. Once you remove the needle, gauze should be applied for a bit. Can You Get an Associate Degree in Nursing Online? What constitutes a difficult vein? The device may be limited in that instance. trailer <<1A62135BA6734AC3B0AC4ED47D445652>]/Prev 812906/XRefStm 1512>> startxref 0 %%EOF 240 0 obj <>stream Venipuncture or drawing blood is one of the most common procedures performed in any medical center. I'm having a hard time finding veins then starting IV or drawing blood on obese patients. of water (or other nonalcoholic drink) before your appointment. Lab gives us an 8 minute window (+/- 4 minutes from exactly one hour from when they finish their glucose) to get the draw. In that case, you would use the order of Draw (venipuncture). In certain cases, the patient may move a bit which may result in you sticking the needle in your own finger. Hopefully, these 50 tips will help you establish what is ok and what is not. It can help veins to pop up, making them probably visible and easier to find. 196 45 It is crucial to use needle and cannula that is smaller than the patients vein. Very often, drinking water will get veins to show up that were not visible or palpable before. Be careful, though. It can be easy, especially when youre conducting multiple blood drawing procedures on a daily basis, to become somewhat detached from the patient that youre drawing blood from. This can be a real time saver and it is also the best way of finding the right insertion point. Some individuals will have far more noticeable veins than others, some will be calm about the procedure and others will require a great deal of calming down, etc. Wear a shirt with sleeves that you can roll up above your elbows. (Immediate download. All information provided to Carrington College shall be subject to our Privacy Policy. The hand and lower arm are the best places for transilluminators. This will move their fluid and/or tissue out of the way so you can see a good vein. Obese patients, particularly those considered to be extremely obese, have reported being treated with disrespect by physicians and other medical staff. Water may also be used to perform this technique but not warm water. It can be done by palpating the vessel or via transillumination with a special light. The patients vein may have collapsed. venipuncture is one of the main parts of your job. 0000029592 00000 n In most cases, simply following best practices and knowing how to find a difficult vein is the best way to carry out a successful draw. Perform hand hygiene and don proper PPE. I once had a patient who was a VERY difficult stick - I brought in the best of the best IV starters that were working that night, but no luck. Follow us and never miss out on the best in nursing news. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. It needs to remain loose. Feel out all your possible options before you decide to go for it. Remove the tourniquet as the last amount of blood is drawn. I have had patients tell me nurses are more successful in one arm than the other, etc. It allows the phlebotomist to control the vacuum, which is good because it is much less traumatic on a patient's vein. The worst thing you can do is to continue stabbing the patient. Below are several tips and tricks that you can use when you are faced with a difficult blood draw. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Before you can start, you need to ask the patient if he has any allergies to drugs. This can help individuals with deep veins, who are obese, or with some edema. This can help individuals with deep veins, who are obese, or with some edema. HlV7WF#J$% r!h {7@)RRXZ4J9(e??@!o]h&Do?Y[L *fIXH^ My trick is to press on their hand or arm with both of my thumbs. You need to make sure there is no resistance whatsoever. If other sites are resulting in no signs of veins then go back and re-examine the sites. But sometimes, it can find a vein you didnt see or feel. Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks, Proper safety standards to avoid a needle stick, standards for quality care for patients and health workers, including, availability of appropriate supplies and protective equipment, availability of post-exposure prophylaxis (PEP), avoidance of contaminated phlebotomy equipment. If the needle site starts to bleed, apply pressure and raise your arm straight up for 5-10 minutes or until bleeding stops. Blood tests are one of the most important diagnostic techniques available to physicians. But lots of people swear by it, so there might be something to it! 0000031735 00000 n Web Place the tourniquet over the patients sleeve of the patient shirt sleeve if drawing an arm vein. Continue with Recommended Cookies. Next, identify the vein that you will be using. Try light exercise beforehand. As a result, it can be difficult at times to find a vein to draw blood from. This makes sense, as many individuals, particularly those with very low body fat in their arms, will have extremely visible veins. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail. Premarital blood tests have been done away with. We've looked at programs nationwide and determined these are our top schools. Find a convenient blood drive near you and schedule an appointment to donate today. Fat, or obese patients, have more fat around their veins which can make it difficult to find the vein for drawing blood or starting an IV. Weight gain. Frail veins can pose a great problem when drawing blood. It uses high intensity light that is directed down through the skin. With thumb, spread the skin. 1. Veins become more visible when blood is forced into them. Always avoid drawing blood from areas where the skin is damaged, inflamed, infected or burned. 0000007667 00000 n Rotate the wrist while maintaining the position of the arm. Unfortunately, some veins are significantly easier to see than others. They will be much easier to spot and throbbing. Usually, the antecubital area has the best veins for drawing blood. Get someone to assist if you are not trained or dont have experience. On average, it is much harder to find veins in people with darker skin tone. Have iron-rich foods, such as red meat, fish, poultry, beans, spinach, iron-fortified cereals or raisins. This is also called the practice of venipuncture. Phlebotomy teams generally only make rounds at specific times in hospital settings, therefore, if a lab test is ordered immediately it could be the responsibility of the nursing staff to draw the specimen. These other sites should always only be considered when there are no other viable options available to you. Sure, its easier said than done when a needle is about to enter a persons vein, but tension can constrict veins. Sometimes, you may see a tendon thinking that it is a vein. Massage the arm. Every so often I'll go in an area where I'm not sure whether I feel anything or not, but know there's usually a vein there. I was in a patients home a few days ago and had to call EMS, the patient was obese and her spouse said she had terrible veins. The paramedic immedi Carrington College does not recruit or enroll residents of the European Union. If all else fails, you can always use drugs. In order to prevent it, professional will have to avoid phlebotomy from a hematoma and to avoid drawing plunger forcefully. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. The number of samples or volume of blood needed will tell you which size syringe to use. Word of caution: make sure to remove the substance before rubbing the vein with alcohol. Get help from a Doctor. Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. WebBy using a syringe and needle to draw the patient's blood, you can control the pressure and speed at which the blood is removed by varying the rate that you pull back on the For routine antisepsis, you can use a standard alcohol prep pad or alcohol-impregnated swabs. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. (function() { Wear a shirt with sleeves that you can roll up above your elbows. With the foot- some places require a specific order r/t other dx that can increase DVT risk :). Follow your institutional guidelines or polices or get advice from qualified personnel. WebPatients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. This will give you more stability and it will relax you. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses need to learn. A transilluminator is a cool way of finding or confirming veins. Relax for a few minutes in our refreshment & recovery area have some cookies or other snacks youve earned it! Apply the tourniquet one to two inches above the wrist if drawing a hand vein. Persons must be trained to use the blood pressure cuff. There are tips for making veins pop out when taking blood. This technique is especially helpful with hand veins. Blankets or towels from a warmer can also be used. Commercial heat-packs are best for this technique as you can choose the temperature you want. To expedite your donation, start your RapidPass on the day of your appointment. If properly inserted blood should flash into the catheter. Use either a syringe or the luer adapter with the butterfly system. Do not snap your fingers over the vein as doing so can be painful and can initiate clotting activity, resulting in erroneous test results. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Slapping can lead to contraction which can further decrease the veins, producing an adverse result. Subscribe for the latest nursing news, offers, education resources and so much more! Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. By placing a warm towel over the veins, you are increasing the blood vessels which will make them more visible. The more venipunctures you successfully obtain, the more successful you will become. 0000185079 00000 n Make sure that no one gets directly exposed to blood. What Does VEAL CHOP Stand For in Nursing? But when dealing with a particularly disruptive or difficult individual, its imperative to balance both sympathy and professionalism in this matter. Otherwise, it may indicate that you have missed which is when you should immediately back up. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Lower the patients arm for a few minutes before applying the tourniquet. Secondly, they lay most of the time. This will cause a lot of mess. 0000012539 00000 n 0000018898 00000 n For an experienced professional, this is typically a relatively easy job. Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. That means that you can trust us to have reliable, up-to-date information If using wet or damp washcloths, do so with caution. Also, by palpation, you can sometimes feel valves in people and learn to avoid them. Create well-written care plans that meets your patient's health goals. This allowed him to see the vein and was able to get the IV in. Usually, if you cant find a vein in the antecubital fossa or at the back of the hand, you will find one in the forearm. 0000027834 00000 n Remove the needle, take care of the site and repeat the procedure.