Secondly, they lay most of the time. Get a good night's sleep the night before your donation, eat healthy foods and drink extra liquids. 1 Article; Patients health is your priority. Finding difficult veins isnt impossible, but it can require a few different methods to be put into place. Continue with Recommended Cookies. 0000018898 00000 n 5. 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. When drawing blood, you will need several tubes for different samples in your equipment. It can help veins to pop up, making them probably visible and easier to find. As a result, it can be difficult at times to find a vein to draw blood from. The first area for venipuncture is in the antecubital fossa. But sometimes, it can find a vein you didnt see or feel. That is usually the last resort. This instructional video, from the Blood Collection series produced by Medcom, Inc., is about special precautions for drawing blood from obese patients. This can help individuals with deep veins, who are obese, or with some edema. 0000006606 00000 n This helps you build trust with a patient even further. Only major veins should be used here. What may be warm to you could burn the elderly. The heat will help dilate the veins and gravity will assist in filling those veins. WebPatients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. Before and after the insertion, the tube should be left in the holder. Create an account and get 24 hours access for free. Using your thumb, pull back on the skin and hold the vein down. All e-mails from the system will be sent to this address. If you cant find one, consider the third option, the forearm. You can do that by gently massaging the arm, from the wrist to the elbow. Then, push down with the flat of the finger over the area. 2. Get the patient to lower his or her arm. It allows the phlebotomist to control the vacuum, which is good because it is much less traumatic on a patient's vein. 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. It will stop the bleeding and prevent the creation of hematoma. 0000015433 00000 n Apply a tourniquet approximately 3-4 inches above the selected site. To avoid bruising, place the tourniquet over the patients shirt sleeve if drawing blood from an arm vein. The number of samples or volume of blood needed will tell you which size syringe to use. This can pose a real problem as their veins collapse quicker. Follow us and never miss out on the best in nursing news. WebObesity isn't just a cosmetic concern. qG@OWdeDHj5b$Ze+QPbk8oo9uDP+GJXU'X96B@;"p4-BBR'@;Z6U`[VTk^9@(} f4qa l8pE2xr/4A-\1~},HZU!6)QH` T@C 6y@ Eh7| c"qnN n Qf3NQA(d2=d9 yN|1*XYa28YSIkefHIly `zhMs\\U@>fU^s,'/ksc>M# /jD/[7=6e*6c\u1_UL3Rll5nd;m,&!w{,`YNk 3 ]^]u>mrA- k`JM4>!Aoa0z't@l"4vl~"Frq}}]#)V1Z/8BnMs^|^x}^%0)&f3FY8I'wU\`Osd{z_b|{Q30Sck-BT[@'hJV2y )lw[;w]p39=%=N|=}|60m2}Edt/#2x!Ta}$n8x4py}` lt endstream endobj 202 0 obj <>stream Pumping fists can lead to pseudohyperkalemia or increased level of potassium in the blood. If at the hospital, get nursing staff to assist you. of water (or other nonalcoholic drink) before your appointment. The veins of one patient may be different in size and quality from another. If properly inserted blood should flash into the catheter. Although this is not a necessity, it is pretty much recommended. }; Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. If a person is overweight, it might be harder for a professional to find the vein. Then, massage from the wrist to the elbow. WebIf you are drawing blood from an arm, make sure to sit near the patient, as close as possible. So, the choice of equipment will change from patient to patient. They need to be labeled in advance. Sometimes, it can still be hard to find the vein after applying the tourniquet. They can be riskier, especially if you need to draw a lot of blood. You need full access to the arm so you will have to sit in front of the patient, a bit to his side. Place it at the chin and lightly draw a straight line. This is the name displayed to others on any playlists or clips you share, Copyright 2023 by Alexander Street, part of Clarivate, Logo of Alexander Street, part of Clarivate. 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. element: document.getElementById("fbct7c991c3d"), Manage Settings Superficial veins often times can't handle an IV bolus or radiology contrast. Orange light highlights veins as deep as 3 mm. Ask the person to lower their arm for a few minutes before applying the tourniquet. As a phlebotomist, venipuncture is one of the main parts of your job. Don't take aspirin for 2 days before your appointment. The rightvein should feel somewhat bouncy as you press on it. Sometimes, you may see a tendon thinking that it is a vein. 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. A doctor can access the femoral vein and others to draw blood. In situations like these, you have to be patient and apply various techniques depending on the reason for the difficulty. Drink an extra four (8 oz.) Talk about pressure! Veins will appear as a dark line. Enjoy :). In the case of elderly patients, make sure to use smaller needles and to be extra gentle. Use left/right arrows to navigate the slideshow or swipe left/right if using a mobile device. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. We use cookies to ensure that we give you the best experience on our website. 0000011603 00000 n Do not massage down as doing so will defeat the purpose. Dismiss. If you do otherwise, you are going to injure the patient. 0000001689 00000 n Take a look at these tips for drawing blood successfully: Feel & Touch When you receive your initial instruction on how to conduct basic blood draws, your After identifying the site for the blood draw, gather the appropriate supplies needed. Nursing schools do not teach this skill due to legality issues. As a result, this will lead to the release of histamine increasing the vein. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. They are not as healthy and strong as they once were. To expedite your donation, start your RapidPass on the day of your appointment. Commercial heat-packs are best for this technique as you can choose the temperature you want. Next step is explaining the procedure. Sometimes I get lucky, sometimes I get nothing. 196 0 obj <> endobj xref Nitroglycerine is yet another substance that can help you out during phlebotomy. In that case, you would use the order of Draw (venipuncture). Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. Gravity will often reveal hand veins you didnt see earlier. When done drawing blood, ask the patient if all is well. At outpatient areas, ask the patient to hold their arm at their side for a few minutes. 0000005419 00000 n There are numerous situations where you should refrain from using a tourniquet as a part of your equipment. If I can't feel it then I let SWAT come in with the ultrasound. H\@E|E/g#0tW Y3y(N> CA}G)H6GUab/Jqk;gy>>n5%sLWorayo|zEnmn;4d~{;m/E. ), 2023 Center for Phlebotomy Education All Rights Reserved, Phlebotomy Continuing Education Exercise (ATM): Phlebotomy and the Obese Patient. Apply the tourniquet one to two inches above the wrist if drawing a hand vein. With the foot- some places require a specific order r/t other dx that can increase DVT risk :) 0000009535 00000 n Identify the patient using two patient identifiers as mandated by JCAHO. 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. Using a tourniquet is something most people are used to seeing during difficult blood draws. Choosing a specialty can be a daunting task and we made it easier. 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. Place them one by one in the holder and take samples. What Does VEAL CHOP Stand For in Nursing? 2. I hope you find my posts helpful. It worries me to see so many people in this thread and others talk about seeing veins and palpating them only if you can't see one. Venous access s 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. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. One thing that I find that helps is using two tourniquets - take them together and tie it. The Highest Paying Jobs For Nurses With a BSN, Types of Masters in Nursing Degrees & Specialties, Pros & Cons of Getting a Master's Degree in Nursing, Nurse Practitioner vs Physician Assistant, Highest Paid Nurse Practitioner Specialties, How to Conduct a Nursing Head-to-Toe Assessment, How to Read an Electrocardiogram (EKG/ECG), Understanding and Interpreting the Glasgow Coma Scale, Complete List of Common Nursing Certifications. WebOnce veins have been located, return the patients arm to the horizontal position for the blood draw. If they come in for their appointment well-prepared, it should be easier to find a vein almost immediately. There are various reasons to perform a phlebotomy. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. Average delivery time is 5-10 business days. To make a basic grid for your female body proportions, turn your ruler so its perpendicular to the vertical line you drew. 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. Excess fat around the waist can put you at an even higher risk for obesity-related health problems, including heart disease and type 2 If all else fails, you can always use drugs. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Besides that, there are some additional considerations. 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. Perform hand hygiene and don proper PPE. Subscribe for the latest nursing news, offers, education resources and so much more! 0000008998 00000 n My trick is to press on their hand or arm with both of my thumbs. Create well-written care plans that meets your patient's health goals. Has 7 years experience. This is a common misconception - pumping the hand does not increase venous circulation. At nurse.org, we believe that no one knows nurses better than, well, nurses. In the end, they can only lead to injuries. It is crucial to use needle and cannula that is smaller than the patients vein. Be careful, though. There are numerous considerations when performing venipuncture or phlebotomy. Throw everything in proper containers. 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. No matter how a patient looks like, it is necessary for a medical professional to protect himself. Follow the cephalic and basilic veins down the forearm. You can support each other and do twice as much good! A tourniquet should also never be left on for more than one minute. In this guide, well cover how to find a standard vein and what you can do if that vein isnt proving to be a good option. Please wait while we send your information. That's why we rely on registered nurses and other experienced healthcare The WHO has best practices that are key to preventing infection and being successful during blood draws. 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. 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. If you donate frequently, be sure to take multivitamins with iron to ensure you continue to. 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 Weight gain. With this in mind, you should be sure that youre getting any requisite or helpful information from your patient before beginning to draw blood. I will say a fair amount of A second option for finding veins and drawing blood are hand veins. The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. WebWhen the patient has never had blood drawn The most important factor in controlling the spread of infection is Hand washing before and after the patient Latex sensitivity is a type of Allergic reaction The recommended vein to perform the venipuncture b/c sometimes is more superficial than other veins is called Median cubical vein In order to reduce the risk of thrombosis, lines need to be flushed with a solution of heap in. Check out our Facebook page and give it a like: http://www.redcrossblood.org/donating-blood/tips-successful-donation. Firstly, they are sick. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. The needle has passed through the vein. Fasting glucose and hemoglobin A1c (HbA1c) Other tests are performed as indicated by clinical findings. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with blood draws. 0000031735 00000 n Dont go deep. (function() { Massage the arm. An example of data being processed may be a unique identifier stored in a cookie. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. 0000019017 00000 n 0000029232 00000 n Dont be discouraged if at first, you dont access the vein. 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. Select a donation type and find a convenient time that works best for you. To find out the advantages of the syringe method go here. Medical professional also has to be a salesman of the sort. This forces blood up and fills the vein. Gloves are a must. Use a transilluminator to find or confirm vein A transilluminator is a cool way of finding or confirming veins. If youre still experiencing difficulties, placing a warm washcloth over the puncture site can also increase blood flow and make a vein more prominent than was previously the case. In fact, based on this, the entire procedure can be harder or easier. Apply a heat compress to the area for 3-5 minutes. This They should be spread distally from proximal joint to the insertion site. For multiple samples use the luer adapter or a 10 ml syringe. Take a look at these tips for drawing blood successfully: When you receive your initial instruction on how to conduct basic blood draws, your instructor will most likely tell you to locate the vein you are targeting by sight. Insert along the vein. Rotate the wrist while maintaining the position of the arm. Blood tests are no longer Hi! Use these tips to reduce the level of difficulty and make your chances more successful. The information provided should not be used for diagnosing or treating a health problem or disease. This is the first and crucial rule of venipuncture. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. 0000036112 00000 n You may have to apply heat more than once. Congratulations, you just took the first step towards a new future by furthering your education. If you are having difficulty finding a vein or is unsuccessful at drawing blood, ask for assistance from another experienced phlebotomist or you can get help from a doctor. Wetting the area, followed by deep massaging or palpating will oftentimes reveal or confirm vein location. As a phlebotomist, I have been faced with situations where drawing blood from a person was quite difficult. Additionally, these steps only apply to the adult and pediatric population and not neonates. If the median cubital, cephalic, or basilic veins cant be found, then go to other sites on the arm. Someone else may be able to find something that you cannot. Lastly, you will have to mix tubes with an anticoagulant. The nurse can take the persons blood pressure. Venipuncture or drawing blood is one of the most common procedures performed in any medical center. The elderly need special care and attention when doing a blood test. Relax for a few minutes in our refreshment & recovery area have some cookies or other snacks youve earned it! Also, avoid cotton as fibers may stay in the wound and reopen it later on. More than one-third of U.S. adults and 16% of U.S. children are obese. To use a tourniquet to draw blood correctly, you should tie it three or four inches directly above the puncture site. Some patients are easier than others because of the prominence of their veins. However, this article will take you through the basics of drawing blood so you can understand the steps and guidelines. During phlebotomy, the doctor is the one that needs to ensure everything goes well. Make sure not to press too hard! 0000260220 00000 n If none of the above options enable you to find a strong vein, you may need to find another puncture site. After all, you want the experience to be as pleasant for them as possible. You may need the approval of a physician or someone else. Otherwise, it may indicate that you have missed which is when you should immediately back up. Make sure that tourniquet is removed before the needle. You should draw blood in the following locations: Often, you wont know your patient personally before drawing their blood, unless you work at a smaller practice and have done it for them before. Next, identify the vein that you will be using. 0000010671 00000 n Web Place the tourniquet over the patients sleeve of the patient shirt sleeve if drawing an arm vein. Like most medical procedures, phlebotomy can be really easy or really hard. They can help you to find a usable vein quickly, so you can get the blood draw you need, and your patient can remain comfortable throughout the experience. This is due largely to the fact that patient factors will vary greatly when it comes to drawing blood. WebSome obese people are no prob, but some have deep veins, rolly pollies, etc. Specializes in RN-BC, CCRN, TCRN, CEN. WebUsing consistent, proficient personnel to per-form blood draws. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. 0000180491 00000 n Once veins have been located, return the patients arm to the horizontal position for the blood draw. If a vein is not prominent enough to see easily, you can feel around for it. Spend a decent amount of time looking for good veins. Enjoy :). Continuous interaction can help distract a person during this time. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Always start by thinking that a patient is infectious and that he can spread a disease. Finally, an ER tech came up and he used a venoscope, which is basically a fancy flashlight - basically the same thing that bruali described in their post. This can cause an overall loss of plasma in the blood, and the sample could be unusable. Before you start injecting needles into people, make sure to get a proper training and get used to the entire process. WebInflate cuff to 30mm Hg above systolic reading and maintain pressure for about 1 to 2 minutes. It is the best thing for patients with low blood pressure. Click to visit Blood Collection: Special Considerations, Obese Patients Scar tissue can especially be problematic as it is hard to penetrate. Often, even a loose bind can help a vein to pop. You need to overcome those fears by exuberating confidence and persuading a person that everything will be alright. This allowed him to see the vein and was able to get the IV in. When performing venipuncture, make sure to sit whenever you can. The elderly lose fat tissue as well as muscle mass, making their skin saggy. Afterward, make sure to store them properly. Adjust it slightly. The dorsal venous network is I understand that consent is not required to purchase any goods or services from this school and that my consent can be revoked at any time. Follow your institutions policy when using heat. If the person is dehydrated or hasnt been drinking a lot of fluids, get them to drink some and see if that helps. Increased body mass can also lead to issues during venipuncture. If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. Syringe, vacutainer, and needle size should 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. 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. Maybe the number one thing that a person can do is to make sure they are well hydrated. window.ClickTable.mount(options); 0000008110 00000 n Remove the tourniquet as the last amount of blood is drawn. 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. What are some tips and techniques for drawing blood from an elderly person? They are springy and bouncy. Follow your institutional policy when using blood pressure cuffs. 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. 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. In order to prevent it, professional will have to avoid phlebotomy from a hematoma and to avoid drawing plunger forcefully. If you experience dizziness or lightheadedness, stop what youre doing and sit down or lie down until you feel better; avoid performing any activity where fainting may lead to injury for at least 24 hours. The needle may also not be in a vein. 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 people have normal looking serum. Explain the procedure and reason for the blood draw to the patient. Going there is risky as you can hit a nerve or tendon. Being able to find a usable vein quickly is crucial, and something you learn throughout your training. Then, apply heat to the lowered arm. Use a 23 gauge needle for small, thin, and weak veins. Without proper specimens, unhelpful or even harmful medical treatment could happen. Massaging may help you in finding a vein if you have not already found one. Although this is a benign, temporary effect, it can be quite misleading and can lead to the bad diagnosis. WebTips for Drawing Blood Always feel the vein rather than see it! Sometimes the veins are deeper so therefore you will have to go deeper. These three together can help you find a vein. 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. Quiz and answer key included. You dont have to drink tons of water the night before but the recommended daily water intake should suffice. All information provided to Carrington College shall be subject to our Privacy Policy. There is a nice way to fill the tubes faster. Ask the individual to flex his or her arm a bit. 0000016460 00000 n The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Afterward, you can easily go upwards. If you can see the vein clearly, then this will only help you ensure that you place the needle correctly the first time. This makes sense, as many individuals, particularly those with very low body fat in their arms, will have extremely visible veins. You could get help from them. When the blood draw is complete, gently release the tourniquet. It used to be that all 50 states required blood tests before getting a marriage license but that is no longer the case. If using wet or damp washcloths, do so with caution. Still, if you prepare yourself for any possible variable, you should be able to make drawing blood second nature. Fourthly, they are not very active, possibly causing lower blood pressure, hence slower blood flow. It worries me to see so many people in this thread and others talk about seeing veins and palpating them only if you can't see one. You should never tie it too tightly at first. On average, it is much harder to find veins in people with darker skin tone. Wear a shirt with sleeves that you can roll up above your elbows. It is the first area to look for veins. Try light exercise beforehand. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. Whether youre becoming a nurse, a doctor or a certified medical assistant, youll probably have to draw blood countless times over the course of your career. Do not snap your fingers over the vein as doing so can be painful and can initiate clotting activity, resulting in erroneous test results. If the needle site starts to bleed, apply pressure and raise your arm straight up for 5-10 minutes or until bleeding stops. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Has 9 years experience. Anchor the vein from below with your non-dominant hand by gently pulling on the skin distal to the insertion site. Many times, you will have to resort there to draw blood. Label appropriate tubes at the bedside and place them into transport bags. Feel out all your possible options before you decide to go for it. Extend the arm. He got her first stick, and i will definately try this in the future if i have trouble. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Many times combining techniques can mean the difference between finding a vein or not. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. Massage the arm from the wrist to the elbow if using arm veins. Check between the knuckles. Obese patients, particularly those considered to be extremely obese, have reported being treated with disrespect by physicians and other medical staff. This will move their fluid and/or tissue out of the way so you can see a good vein. In the event that you cant locate the appropriate vein strictly by vision, this can be a great alternative method. While it is important to know the best veins to access its also important to know which areas to avoid. Rolling up gown sleeves (rather than pushing sleeves up) to enhance tourniquet visibility. 0000001196 00000 n Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. }()); Drawing blood from a patient can be a daunting task, but it also is a necessity for nurses. just like everyone else. Do not snap it against the patients skin as doing so could cause bruising in the area.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-banner-1','ezslot_5',168,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-banner-1-0'); The 3 main areas to find veins include the antecubital fossa, the forearm, and hand veins.
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