No matter what, always take your time to find just the right vein. As the body ages, the skin becomes thinner and blood vessels become weaker. 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. Survey the hand and choose a vein that you can draw blood from. If a vein is not prominent enough to see easily, you can feel around for it. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with blood draws. 0000022045 00000 n A better vein might be available in the forearm or at the back of the hand. To use a tourniquet to draw blood correctly, you should tie it three or four inches directly above the puncture site. Drink an extra four (8 oz.) WebA measurement around your waist. 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. We and our partners share information on your use of this website to help improve your experience. On average, it is much harder to find veins in people with darker skin tone. Secondly, they lay most of the time. But lots of people swear by it, so there might be something to it! This can pose a real problem as their veins collapse quicker. Top Cheap and Fast Online RN to BSN Programs, Affordable Online Nurse Practitioner Programs, Top Direct-Entry Nurse Practitioner Programs, Top Psychiatric Nurse Practitioner Programs, Top Pediatric Nurse Practitioner Programs, Top Acute Care Nurse Practitioner Programs, Top Online Family Nurse Practitioner Programs, Top RN to Psychiatric Nurse Practitioner Programs, Top Womens Health Nurse Practitioner Programs, How to Get an Associate Degree in Nursing. By submitting this form, I authorize and agree that a representative of Carrington College can contact me about educational services and future offers by email, phone and/or text messaging at the email and telephone number provided above using an automated telephone dialing system, and/or an artificial or pre-recorded voice or text message. The gratification of giving blood is a feeling you'll want to share. Blood tests are one of the most important diagnostic techniques available to physicians. Has 7 years experience. 3. Alternate arms if youve given blood In the end, if other medical experts managed to draw blood from a particular vein, you can do the exact same thing. Fluid retention. Go to Alexander Street homepage, Blood Collection: Special Considerations, Obese Patients. Just my opinion. just like everyone else. Some guidelines suggest 40mm Hg. Without proper specimens, unhelpful or even harmful medical treatment could happen. Quiz and answer key included. What Does VEAL CHOP Stand For in Nursing? If at the hospital, get nursing staff to assist you. (function() { Additionally, these steps only apply to the adult and pediatric population and not neonates. 3,377 Posts. 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 Using your thumb, pull back on the skin and hold the vein down. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. equally, but do you know which nurses are making the most money in 2023? With vein locators, you can see where all the veins are. Gravity will often reveal hand veins you didnt see earlier. These can include: Learning about your During phlebotomy, the doctor is the one that needs to ensure everything goes well. 0000276013 00000 n It uses high intensity light that is directed down through the skin. If you are drawing from a leg, the extremity needs to be placed over the bed so Spend a decent amount of time looking for good veins. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with bl 0000015433 00000 n 0000012097 00000 n Massage the vein. For multiple samples use the luer adapter or a 10 ml syringe. If I can't feel it then I let SWAT come in with the ultrasound. The site should not be warmed to a temperature higher than 42 EC. When drawing blood, you will need several tubes for different samples in your equipment. Some will come on wheelchairs, using a cane, needing help to walk, move, sit and stand. Follow us and never miss out on the best in nursing news. Some veins can be deep in the antecubital fossa area, especially, if there is a lot of fat tissue. Also, by palpation, you can sometimes feel valves in people and learn to avoid them. Massage the arm from the wrist to the elbow if using arm veins. Next step is explaining the procedure. The needle is in place but there is no blood flow? Next, locate the vein you will be using for the blood draw. Next, identify the vein that you will be using. It will easily increase the smaller veins. The needle has passed through the vein. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. Hemolysis is one of the most common things that interfere with the tests. Identify the patient using two patient identifiers as mandated by JCAHO. Wetting the area, followed by deep massaging or palpating will oftentimes reveal or confirm vein location. window.ClickTable.mount(options); The device may be limited in that instance. Only major veins should be used here. The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. Its important to do everything in your power to ensure the comfort of the patient when drawing blood. Prepare by drinking enough fluids before the blood test. 0000007172 00000 n Big ppl are not bad to stick at all, especially the ones with edema. My trick is to press on their hand or arm with both of my thumbs. Put ur finge Remove the needle from the patients arm and press down on the vessel with gauze. Excess fat around the waist can put you at an even higher risk for obesity-related health problems, including heart disease and type 2 As a result, it can be difficult at times to find a vein to draw blood from. 0000031034 00000 n There are numerous considerations when performing venipuncture or phlebotomy. window.ClickTable.mount(options); In the event that you cant locate the appropriate vein strictly by vision, this can be a great alternative method. The WHO has best practices that are key to preventing infection and being successful during blood draws. The practice of phlebotomy is not something that can strictly be learned from watching videos or reading a how-to guide but something that must be practiced repeatedly in a controlled environment with other trained professionals. Specializes in Wound Care. They dont harm the patient in any way and can be used regularly to make your job easier and safer. WebDrink an extra 16 oz. Same goes with veins. Even with all these guidelines, perhaps the best approach is if you ask the patient from which vein they usually draw his blood. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. Word of caution: make sure to remove the substance before rubbing the vein with alcohol. WebTips for Drawing Blood Always feel the vein rather than see it! When you encounter such a case, make sure to use blood pressure cuff or try one of the other tricks we shared in our guidelines. Please enter a valid e-mail address. Do not be afraid to touch your patient. 0000012539 00000 n 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. What constitutes a difficult vein? Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. The elderly need special care and attention when doing a blood test. 2023 Carrington College. Ask the individual to flex his or her arm a bit. So, the choice of equipment will change from patient to patient. While it is important to know the best veins to access its also important to know which areas to avoid. 0000005419 00000 n If the median cubital, cephalic, or basilic veins cant be found, then go to other sites on the arm. However, this article will take you through the basics of drawing blood so you can understand the steps and guidelines. Do not apply the tourniquet too tightly over the arm or wrist as it could cause injury or collapse the vein. Blood Test Vs Blood Donation (Comparisons). Commercial heat packs are best. Be careful, though. This will give you more stability and it will relax you. After that, pressure needs to be applied on insertion point. The region from which you are drawing blood has to have a healthy tissue. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. The information provided should not be used for diagnosing or treating a health problem or disease. All e-mails from the system will be sent to this address. However, there are numerous things that can go wrong while you draw blood. WebOnce veins have been located, return the patients arm to the horizontal position for the blood draw. Ask the person to lower their arm for a few minutes before applying the tourniquet. Make sure that no one gets directly exposed to blood. Nitroglycerine is yet another substance that can help you out during phlebotomy. Password must have at least 8 character(s). When performing venipuncture, he needs to convince a person that he is capable of drawing blood safely. What may be warm to you could be hot or even burn someone else. A trick I use sometimes is putting a second tourniquet 2 inches above the first tourniquet. It can really make the veins pop. The other day I saw a Once you have located a vein, you can cause increase distention through massaging or exaggerated palpation (pressing repeatedly over the top of the vein). Position the patient and hyperextend the patients arm. This, in turn, can cause increases in your blood pressure. 0000260220 00000 n Choosing a specialty can be a daunting task and we made it easier. Sometimes theyre very small, or hard to see. Another thing a person can do is to try to be relaxed as much as possible. Do it by performing a quick backward motion. As a phlebotomist, I have been faced with situations where drawing blood from a person was quite difficult. The rightvein should feel somewhat bouncy as you press on it. More than one-third of U.S. adults and 16% of U.S. children are obese. What about other resources that may be available? Scar tissue can especially be problematic as it is hard to penetrate. 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. 196 45 The other day I saw another nurse do a different variation of this, and she put one tourniquet above the AC (like usual), and another 2 inches below the AC. Make sure bleeding at the puncture site has stopped and the site is cared for. Should RaDonda Vaught Have Her Nursing License Reinstated? In certain cases, the patient may move a bit which may result in you sticking the needle in your own finger. We've looked at programs nationwide and determined these are our top schools. It will stop the bleeding and prevent the creation of hematoma. It uses high intensity light that is directed down through the skin. 0000001689 00000 n The veins of one patient may be different in size and quality from another. Always start by thinking that a patient is infectious and that he can spread a disease. I am a full time phlebotomist and I enjoy my job. 0000016846 00000 n Webwhy might it be difficult to draw blood from an elderly patient The skin becomes thin and blood vessels become weaker how much whole blood is needed to yield 5 mL of serum 0000010671 00000 n Hopefully, these 50 tips will help you establish what is ok and what is not. This helps you build trust with a patient even further. I will say a fair amount of There is a nice way to fill the tubes faster. You need to overcome those fears by exuberating confidence and persuading a person that everything will be alright. Weight gain. WebIf the finger or heel is cold to the touch, pre-warming the site for a few minutes with a warm compress or commercial heel warmer will increase the flow of blood through the capillary beds. Make sure they are feeling well before leaving. Rotate the wrist while maintaining the position of the arm. Enjoy :). Specializes in RN-BC, CCRN, TCRN, CEN. Sometimes the veins are deeper so therefore you will have to go deeper. You want to lessen the number of sticks you give to the elderly. Congratulations, you just took the first step towards a new future by furthering your education. While doing all of this, make sure to penetrate the skin with one quick move. Before and after the insertion, the tube should be left in the holder. This illuminated the veins that he could not palpate. 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. Many times combining techniques can mean the difference between finding a vein or not. Avoid snapping or tapping veins. Remove the needle, take care of the site and repeat the procedure. Sometimes, doing so can reveal a vein. 0000018898 00000 n Put ur fingers on the bottom of their arm and press the tops with your thumbs. Dont go deep. Don't take aspirin for 2 days before your appointment. It is a medical problem that increases the risk of heart disease, diabetes and certain cancers. Frail veins can pose a great problem when drawing blood. 0000017785 00000 n Invert a BP cuff so that the blood can go to the lower regions of the limb. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. 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. 0000025579 00000 n There are tips for making veins pop out when taking blood. I have to say, I started off doing venipuncture for lab draws prior to IVs and found that a good way to learn. Venipuncture is a skill that takes time and practice to master. Follow your institutional policy when using blood pressure cuffs. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. Sometimes, you will need another person or two to help you with difficult patients. Another way that prednisone can increase blood pressure is weight gain. 1. You have to palpate first and decide from there. Be sure that youre doing everything in your power to keep a level mindset before and during the blood drawing process. If you can find a vein with that desirable characteristic, youll know that youve discovered a usable vein, even if its not prominent. Get the patient to lower his or her arm. Check between the knuckles. If you have an issue finding the vein, do not hesitate and call for a senior, more proficient colleague. Continuous interaction can help distract a person during this time. There are two main ways to find a vein to draw blood. The order of venipuncture sites is vital to follow. Try light exercise beforehand. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. When you are retaining water, it increases the total volume of fluid that is being pushed through your blood vessels by your heart. This is painful and can bruise the patient. A doctor can access the femoral vein and others to draw blood. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. Then, apply heat to the lowered arm. Insert the needle into the vein. This is mainly due to the fact that different people have different biological systems which can make it harder to find and puncture the vein. Sign up to receive the latest nursing news and exclusive offers. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. First, gather all of your supplies and discuss with your patient what you are going to be performing. Drawing blood from the elderly, young children, and infants can also be a challenge. Think of an anecdote or a story you would like to share. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. He got her first stick, and i will definately try this in the future if i have trouble. If necessary, apply the tourniquet and examine the median cubital, cephalic, and basilic veins. Provide a password for the new account in both fields. What are some tips and techniques for drawing blood from an elderly person? Otherwise, it may indicate that you have missed which is when you should immediately back up. For the elderly, using a syringe or the butterfly system is recommended. Thank you. Medicine is a very serious profession. Veins will appear as a dark line. However, thats not always a luxury most phlebotomists are afforded. 0000279572 00000 n We'll need to know about all prescription and over-the-counter medications you're taking. 0000019017 00000 n Blood pressure cuff is a great method of extracting blood in case that the veins are not visible enough. The WHO has set forth the following standards of patient care for hospitals to adhere by: They also identify dangerous and unsafe practices for blood draws including, >> Related: Arterial Blood Gases (ABGs) Explained. Ask the individual to elevate his or her arm at the elbow. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. Using a tourniquet is something most people are used to seeing during difficult blood draws. window.addEventListener('click-table-loaded', function(){ The first area for venipuncture is in the antecubital fossa. Liver function studies. It is also possible to apply multiple tourniquets. Medical professional also has to be a salesman of the sort. Then, deflate blood pressure cuff and apply tourniquet. It includes preparation of the patient, finding the right vein, insertion of the needle, disposal of waste and handling of potential hazards. Click here for a previous article I wrote about rolling veins. 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. They will be much easier to spot and throbbing. If the veins are deep and not visibly popping out, use a tourniquet and have the patient lower their arm. This makes sense, as many individuals, particularly those with very low body fat in their arms, will have extremely visible veins. One of our Enrollment Services Representatives will be contacting you shortly. The loss of support makes it easy for veins to roll causing difficulty in drawing blood. The needle may have pulled out of the vein. Genetically, we dont get to choose our veins. Usually, it happens due to squeezing or massaging around the site or due to prolonged application of the tourniquet. Putting some rolled towels underneath or a pillow helps, too (just make sure to put some chux on top of them in case you make a mess!). Label appropriate tubes at the bedside and place them into transport bags. Sometimes, the patient may experience hemoconcentration. Continue with Recommended Cookies. 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. Can You Get an Associate Degree in Nursing Online? Looking for a change beyond the bedside? Blankets or towels from a warmer can also be used. Afterward, you can easily go upwards. Properly label the tubes and send them to the laboratory for analysis. 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. There are various reasons to perform a phlebotomy. 1) Phlebotomy Pages, Words of Wisdom From and to Phlebotomists, 2014,http://www.phlebotomypages.com/expert_tips.htm, 2) The American Red Cross, Tips For A Successful Donation, 2015,http://www.redcrossblood.org/donating-blood/tips-successful-donation. Place them one by one in the holder and take samples. Massaging may help you in finding a vein if you have not already found one. 4. Then, push down with the flat of the finger over the area. Other times, they dont want to pop out or raise for the phlebotomist to be able to draw successfully. Additional equipment such as goggles and splash shields should also be worn in extreme situations. possible. As a result, this will lead to the release of histamine increasing the vein. You could get help from them. For example, the veins of a middle-aged man will likely be easier to find than that of a woman, unless shes extremely active. Although this is not a necessity, it is pretty much recommended. Make sure to find a vein that is properly hydrated. Find a convenient blood drive near you and schedule an appointment to donate today. When done drawing blood, ask the patient if all is well. If the antecub has already been accessed there are great options for venipuncture. Sometimes you can find a good one there, though be careful as you insert the needle. Get help from a Doctor. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. Perform good hand hygiene and don appropriate PPE. After all, you want the experience to be as pleasant for them as possible. WebInflate cuff to 30mm Hg above systolic reading and maintain pressure for about 1 to 2 minutes. This is especially important for babies and small children that have the natural aversion to needles. Use these tips to reduce the level of difficulty and make your chances more successful. Syringe, vacutainer, and needle size should venipuncture is one of the main parts of your job. Press the space key then arrow keys to make a selection. If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. 0000029592 00000 n The elderly are prone to bruising when applying the tourniquet. Use your index finger to palpate and trace the standard path of the vein on the arm. Manage Settings A tourniquet should also never be left on for more than one minute. 0000028908 00000 n Patients health is your priority. With the foot- some places require a specific order r/t other dx that can increase DVT risk :). An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. Applied Muscle Tension (AMT) is a series of simple exercises that help your blood pressure stay up and improve blood flow, so your chance of experiencing any side effects, like fainting, stays low. Apply a heat compress to the area for 3-5 minutes. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. Like most medical procedures, phlebotomy can be really easy or really hard. Re: the 2 tourniquet trick (above and below). Use either a syringe or the luer adapter with the butterfly system. To make a basic grid for your female body proportions, turn your ruler so its perpendicular to the vertical line you drew. While holding patients arm, make sure that your finger is well above the insertion point. H\@E|E/g#0tW Y3y(N> CA}G)H6GUab/Jqk;gy>>n5%sLWorayo|zEnmn;4d~{;m/E. You know all nursing jobs arent created (or paid!) A trick I use sometimes is putting a second tourniquet 2 inches above the first tourniquet. All rights reserved. Carrington College does not recruit or enroll residents of the European Union. 0000016460 00000 n That's why we rely on registered nurses and other experienced healthcare Insert the beveled needle at a 30-degree angle into the vessel. While this process is one of the more basic tasks that you will be assigned when working in a hospital, clinic, or medical practice, it can be daunting for many professionals. WebTo clarify: The serum on the left is what normal serum looks like, but actually comes from an obese patient middle aged or older with metabolic issues (the patients I normally work with). Follow institutional guidelines and policies wherever applicable. You are able to confuse the nerves before the insertion. Check out our Facebook page and give it a like: http://www.redcrossblood.org/donating-blood/tips-successful-donation. How Does Donating Blood Affect Your Body? glasses of liquids and avoid alcohol over the next 24 hours. Wear a shirt with sleeves that you can roll up above your elbows. If you really can't see a vein they usually will have one on their hand just between the 4th and 5th finger on the top of the hand. Phlebotomy Pages advises that individuals use touch as their primary indicatorwhen looking for the vein from which to draw blood.1 Veins will often feel as though they are slightly risen beneath the skin. Top Student Loan Forgiveness Programs for Nurses, Top Nursing Interview Questions & Answers, How to Create a New Graduate Nurse Resume, Best White Shoes for Nurses and Nursing Students, Best Stethoscopes for Nurses and Nursing Students, How to Work in the US as a Foreign-Educated Nurse, Why Nursing is a Great Career Choice for Men. Venous access should always be based on feel, not looks. Blood tests are no longer Hi! They are springy and bouncy. However, for the elderly, it may be difficult. Many times, you will have to resort there to draw blood. Also, avoid cotton as fibers may stay in the wound and reopen it later on. You dont have to drink tons of water the night before but the recommended daily water intake should suffice. The hand and lower arm are the best places for transilluminators. Most people have normal looking serum. What if I cant find a vein? 2. You need to have a firm, strong grip on patients hand. If using wet or damp washcloths, do so with caution. It is the first area to look for veins. Click to visit Blood Collection: Special Considerations, Obese Patients Average delivery time is 5-10 business days.
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