Nitroglycerine is yet another substance that can help you out during phlebotomy. If you are a bit stiffer while rubbing the alcohol, it will prepare the hand for the procedure. In the case of elderly patients, make sure to use smaller needles and to be extra gentle. I'm Kadia. Ask the patient where they usually get stuck. I have had patients tell me nurses are more successful in one arm than the other, etc. One thing that The rightvein should feel somewhat bouncy as you press on it. Sign up to receive the latest nursing news and exclusive offers. What constitutes a difficult vein? Spend a decent amount of time looking for good veins. Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. 1-917-426-3524, By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. 0000010671 00000 n Click here for a previous article I wrote about rolling veins. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. element: document.getElementById("fbct7c991c3d"), Has 9 years experience. Fluid retention. Insert the beveled needle at a 30-degree angle into the vessel. With vein locators, you can see where all the veins are. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. This can cause an overall loss of plasma in the blood, and the sample could be unusable. 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. I have to say, I started off doing venipuncture for lab draws prior to IVs and found that a good way to learn. link to Blood Test Vs Blood Donation (Comparisons), link to No More Blood Tests For Marriage License. This is painful and can bruise the patient. Hemolysis is one of the most common things that interfere with the tests. Once veins have been located, return the patients arm to the horizontal position for the blood draw. hbba`b``3~0 U endstream endobj 197 0 obj <>/Metadata 31 0 R/Pages 30 0 R/StructTreeRoot 33 0 R/Type/Catalog/ViewerPreferences<>>> endobj 198 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 193>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 199 0 obj <> endobj 200 0 obj [/Separation/Beaumont#20Blue 221 0 R<>] endobj 201 0 obj <>stream For hand veins, apply the tourniquet 1-2 inches above the wrist. Patients health is your priority. 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. 8, 9 Even Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. This study guide will help you focus your time on what's most important. Additional equipment such as goggles and splash shields should also be worn in extreme situations. Extend the arm. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. The needle should fully penetrate it. Blood tests are no longer Hi! In order to prevent hematoma, you should only puncture the uppermost wall. 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!). Avoid excessive probing. You could get help from them. Rotate the wrist while maintaining the position of the arm. Instead of forcefully tapping the vein, it is much better if you start stroking them. The paramedic immediately brought out a large flash light and pressed it to the patients arm. If at the hospital, get nursing staff to assist you. Depending on whether it is for transfusion or simple blood analysis, your cannula size will vary. I Feel Stuck - Like My Options Are Limited, Ethical Arguments Against Mandatory Vaccination, Nursing Student on Spring Break Saves Collapsed Man's Life, Candida Auris: Dangerous Fungus Spreading in US Health Care Facilities, Nurses Week 2023 | Best Discounts, Freebies, and More. Invert a BP cuff so that the blood can go to the lower regions of the limb. Confirm the ordered tests and fill out the appropriate forms and labels. If a patient is reluctant or fearful, it can interfere with drawing blood. The person performing venipuncture can administer 10 units of bacteriostatic saline which need to be injected intradermally. How to Use a Vein Finder on Obese Patient. Alternate arms if youve given blood Check between the knuckles. Since 1997, allnurses is trusted by nurses around the globe. Get the patient to lower his or her arm. Additionally, you will have to consider the reason why you are performing insertion of the needle. WebDrink an extra 16 oz. Drink an extra 16 oz. Blankets or towels from a warmer can also be used. Often, even a loose bind can help a vein to pop. Like most medical procedures, phlebotomy can be really easy or really hard. Perform hand hygiene and don proper PPE. Do not massage down as doing so will defeat the purpose. Make sure bleeding at the puncture site has stopped and the site is cared for. var options = { Pump the fists! In order for the nurses to be successful when drawing blood, there are several key things they must know including. If the person is tense, try getting them to relax. In situations like these, you have to be patient and apply various techniques depending on the reason for the difficulty. Using alcohol or some other antiseptic, wet the site. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. The gratification of giving blood is a feeling you'll want to share. Blood pressure cuff is a great method of extracting blood in case that the veins are not visible enough. If you donate frequently, be sure to take multivitamins with iron to ensure you continue to. To expedite your donation, start your RapidPass on the day of your appointment. Big ppl are not bad to stick at all, especially the ones with edema. Slapping can lead to contraction which can further decrease the veins, producing an adverse result. 0000018898 00000 n Thyroid function tests. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. It allows the phlebotomist to control the vacuum, which is good because it is much less traumatic on a patient's vein. 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. This can be a real time saver and it is also the best way of finding the right insertion point. These can include: Learning about your Being able to find a usable vein quickly is crucial, and something you learn throughout your training. You know all nursing jobs arent created (or paid!) I've been an RN for almost 3 years and an ED tech prior to that (which is where I learned my IV skills- nursing school sure didn't teach me much!). An example of data being processed may be a unique identifier stored in a cookie. Medicine is a very serious profession. The order of venipuncture sites is vital to follow. Check out our list of the top non-bedside nursing careers. To find out the advantages of the syringe method go here. Although this is a benign, temporary effect, it can be quite misleading and can lead to the bad diagnosis. 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 0000029232 00000 n If properly inserted blood should flash into the catheter. If its possible for you to give your patients some tips ahead of time, this can make hard-to-find veins for a blood draw so much easier. It uses high intensity light that is directed down through the skin. Elderly persons walking in to do blood tests usually have nicer veins, though, there will still be a few difficulties. 0000015433 00000 n WebIn this module, you'll learn why the right approach is critical when drawing from overweight patients, and you'll have a newfound appreciation for what it's like for too many This technique is especially helpful with hand veins. Below are several tips and tricks that you can use when you are faced with a difficult blood draw. The patients vein may have collapsed. You can try several approaches mentioned earlier in our venipuncture guidelines that will increase the vein. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. Apply a tourniquet approximately 3-4 inches above the selected site. 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. Specializes in ER, progressive care. I am a full time phlebotomist and I enjoy my job. 0000031373 00000 n 0000016460 00000 n A transilluminator is a cool way of finding or confirming veins. There are tips for making veins pop out when taking blood. Frail veins can pose a great problem when drawing blood. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. Find a convenient blood drive near you and schedule an appointment to donate today. Approach Considerations. The veins of one patient may be different in size and quality from another. To make a basic grid for your female body proportions, turn your ruler so its perpendicular to the vertical line you drew. It is also possible to apply multiple tourniquets. WebApply a warm cloth or towel to the arm to cause the veins to dilate. Use either a syringe or the luer adapter with the butterfly system. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses need to learn. Perform hand hygiene and don proper PPE. As a result, it can be difficult at times to find a vein to draw blood from. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. It needs to remain loose. 0000031735 00000 n Phlebotomy basics : Nursing made Incredibly Easy - LWW A lot of patients have the needle phobia. I am a Licensed Phlebotomist and Certified Medical Assistant of 15+ years with 14+ years of clinical experience. Rolling up gown sleeves (rather than pushing sleeves up) to enhance tourniquet visibility. The veins we have are the veins we will have for life. Next step is explaining the procedure. After identifying the site for the blood draw, gather the appropriate supplies needed. that's continuously reviewed to ensure its as relevant and accurate as Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Then, add massage to the combination. Gloves are a must. This helps you build trust with a patient even further. Can You Get an Associate Degree in Nursing Online? Otherwise, it may indicate that you have missed which is when you should immediately back up. Apply heat for about 3 to 5 minutes and then assess for vein. I'm not sure I understand how this works, as the valves are already in place to prevent backflow. Veins may collapse in the process and failed attempts at blood draws lead to hematomas which bring about pain. WebIf you are drawing blood from an arm, make sure to sit near the patient, as close as possible. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. Although this is something you mightve seen a lot in the movies, you should always avoid it. 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). In this module, you'll learn why the right approach is critical when drawing from overweight patients, and you'll have a newfound appreciation for what it's like for too many patients when they encounter insensitive healthcare professionals. One thing that I find that helps is using two tourniquets - take them together and tie it. Blood Obesity Screening: MedlinePlus Medical Test If nothing works, try with vein locator. Continuous interaction can help distract a person during this time. With the foot- some places require a specific order r/t other dx that can increase DVT risk :). All these factors contribute to their veins staying low. Tips for technicians to improve phlebotomy skills - DVM 360 Don't take aspirin for 2 days before your appointment. Properly label the tubes and send to the laboratory for analysis. hb``g`` @16 N$00Le@L,9$)_5M2APPP*dW;b]0D&0dxAAmCfFO7008X`&` *7h_P tex4\T'# ` 1 endstream endobj 239 0 obj <>/Filter/FlateDecode/Index[33 163]/Length 27/Size 196/Type/XRef/W[1 1 1]>>stream Sometimes, doing so can reveal a vein. Maybe the number one thing that a person can do is to make sure they are well hydrated. Reflecting off the subcutaneous tissue, the light colors subcutaneous and fat tissue. You are able to confuse the nerves before the insertion. This will move their fluid and/or tissue out of the way so you can see a good vein. You need to overcome those fears by exuberating confidence and persuading a person that everything will be alright. If none of the above options enable you to find a strong vein, you may need to find another puncture site. Perform good hand hygiene and don appropriate PPE. This will help force blood up and fills the veins making a vein pop up. Please wait while we send your information. 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. 2023 Carrington College. If you are drawing from a leg, the extremity needs to be placed over the bed so Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. Password must have at least 8 character(s). Commercial heat packs are best. trailer <<1A62135BA6734AC3B0AC4ED47D445652>]/Prev 812906/XRefStm 1512>> startxref 0 %%EOF 240 0 obj <>stream Feel out all your possible options before you decide to go for it. Lower the patients arm for a few minutes before applying the tourniquet. Besides that, there are some additional considerations. Have iron-rich foods, such as red meat, fish, poultry, beans, spinach, iron-fortified cereals or raisins. A phlebotomist will need to find a good, strong vein from which to draw blood. Water may also be used to perform this technique but not warm water. They are springy and bouncy. They can be riskier, especially if you need to draw a lot of blood. Doctors usually mistake if for hyperkalemia when assessing the results. When you draw their blood, are you ready for them? Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. What are some tips and techniques for drawing blood from an elderly person? However, there are numerous things that can go wrong while you draw blood. Average delivery time is 5-10 business days. Without proper specimens, unhelpful or even harmful medical treatment could happen. Sometimes I get lucky, sometimes I get nothing. Medical Care for Obese Patients: Advice for Health Care - AAFP The site should not be warmed to a temperature higher than 42 EC. Firstly, they are sick. Tips for Drawing Blood BLOOD venipuncture is one of the main parts of your job. Patients 5. Maybe you have the right environment, chair, and equipment to draw from them successfully, but do you give them the respect that's often lacking in healthcare? Manage Settings 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. tips on starting IV, drawing blood on obese patient. Use alcohol to stimulate the site to make the vein more visible. The elderly need special care and attention when doing a blood test. Luckily, got it on the first stick. Think of an anecdote or a story you would like to share. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 Linkedin, How to Identify a Usable Vein for Blood Draws. So, the choice of equipment will change from patient to patient. There is no easy way to draw blood. We and our partners share information on your use of this website to help improve your experience. The first area for venipuncture is in the antecubital fossa. } If you are going to start an IV in the hand always have the patient pump their fist. The needle has passed through the vein. I will say a fair amount of 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 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. 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. Massage the arm from the wrist to the elbow if using arm veins. Apply the tourniquet one to two inches above the wrist if drawing a hand vein. If the median cubital, cephalic, or basilic veins cant be found, then go to other sites on the arm. Make sure that tourniquet is removed before the needle. (Immediate download. instance: "61c9f514f13d4400095de3de", The heat will help dilate the veins and gravity will assist in filling those veins. Even with all these guidelines, perhaps the best approach is if you ask the patient from which vein they usually draw his blood. The number of samples or volume of blood needed will tell you which size syringe to use. However, thats not always a luxury most phlebotomists are afforded. Utilize the combination of massage, heat, and gravity. Blood You can support each other and do twice as much good! One of our Enrollment Services Representatives will be contacting you shortly. H\@E|E/g#0tW Y3y(N> CA}G)H6GUab/Jqk;gy>>n5%sLWorayo|zEnmn;4d~{;m/E. Feel out all your possible options before you decide to go for it. Agree with other posters - ask them where they usually get stuck, heat packs, gr This is a common misconception - pumping the hand does not increase venous circulation. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. Our members represent more than 60 professional nursing specialties. Patients who are severely dehydrated can also make it difficult to find a vein. Nowadays, there is equipment that can help us locate the vein. We use cookies to ensure that we give you the best experience on our website. }); Make sure to find a vein that is properly hydrated. Has 12 years experience. While it is important to know the best veins to access its also important to know which areas to avoid. Also, it is the basis of diagnostics. just like everyone else. ), 2023 Center for Phlebotomy Education All Rights Reserved, Phlebotomy Continuing Education Exercise (ATM): Phlebotomy and the Obese Patient. 0000008998 00000 n Quizlet Do not apply the tourniquet too tightly over the arm or wrist as it could cause injury or collapse the vein. Once you remove the needle, gauze should be applied for a bit. Wear a shirt with sleeves that you can roll up above your elbows. Sometimes theyre very small, or hard to see. 0000001848 00000 n Remove the needle from the patients arm and press down on the vessel with gauze. However, you will need a doctors permission for this. Always avoid drawing blood from areas where the skin is damaged, inflamed, infected or burned. If I can't feel it then I let SWAT come in with the ultrasound. They are not as healthy and strong as they once were. Weight gain. Obese patients, particularly those considered to be extremely obese, have reported being treated with disrespect by physicians and other medical staff. Properly label the tubes and send them to the laboratory for analysis. Once the vein is located, the individual arm can be returned to horizontal position for blood collection. That is usually the last resort. You know what to look for and where to look for it, so sometimes a gentle touch can make finding a usable vein easier than looking for it. Superficial veins often times can't handle an IV bolus or radiology contrast. There are two main ways to find a vein to draw blood. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds. Scar tissue can especially be problematic as it is hard to penetrate. Without further ado, here are 50 tips that will help you perform this crucial procedure. 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 Next, identify the vein that you will be using. The only way to make sure is by touching it yourself. I am a full time phlebotomist and I enjoy my job. If you havent rested properly, this can affect your ability to perform venipuncture and can lead to critical mistakes which you, as a professional, cannot afford. The device may be limited in that instance. Before you start injecting needles into people, make sure to get a proper training and get used to the entire process. 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. 0000005129 00000 n Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. A syringe is a great technique for blood drawing! 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. 0000016846 00000 n The elderly are prone to bruising when applying the tourniquet. It is crucial to use needle and cannula that is smaller than the patients vein. Is there an IV team, anesthesiologist, or other trained personnel that could be of assistance? Some patients have hypovolemia or reduced volume of circulating blood. For outpatient areas, ask the patient to hold their arms at their side for a few minutes. Liver function studies. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. You may have to apply heat more than once. 6. Patients hand should be dangling so that the blood can rush down and fill the veins. Inflate cuff to 30mm Hg above systolic reading and maintain pressure for about 1 to 2 minutes. Specializes in OBGYN, Urogynecology. Moreover, because their veins are so fragile, the elderly may receive several sticks in order to draw blood or get sufficient blood. of water (or other nonalcoholic drink) before your appointment. Nursing schools do not teach this skill due to legality issues. Instead, make sure to remove tourniquet first and then remove the needle followed by instant pressure on the insertion point. It can be done by palpating the vessel or via transillumination with a special light. How to Make Your Veins Pop Out to Give Blood 0000025579 00000 n If you have specific questions, but don't want to wait, give us a call at. Unfortunately, some people have difficult veins to work with due to obesity, dehydration, and a variety of other issues. Remove the tourniquet as the last amount of blood is drawn. If using wet or damp washcloths, do so with caution. Below are 5 key areas of importance with tips. Only tighten it if necessary. In doing so, this will enable students to learn basics prior to graduation. Then, push down with the flat of the finger over the area. The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. Dont do any heavy lifting or vigorous exercise for the rest of the day. It can really make the veins pop. Web Place the tourniquet over the patients sleeve of the patient shirt sleeve if drawing an arm vein. Fourthly, they are not very active, possibly causing lower blood pressure, hence slower blood flow. 0000005243 00000 n More than one-third of U.S. adults and 16% of U.S. children are obese. How To Draw Blood | A Step-by-Step Guide - Nurse.org I have had patients tell me nurses are more successful in one arm than the other, etc. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to.