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. 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 Depending on whether it is for transfusion or simple blood analysis, your cannula size will vary. If you have an issue finding the vein, do not hesitate and call for a senior, more proficient colleague. While holding patients arm, make sure that your finger is well above the insertion point. Increased body mass can also lead to issues during venipuncture. Place it at the chin and lightly draw a straight line. It is the best thing for patients with low blood pressure. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. However, there are numerous things that can go wrong while you 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. glasses of liquids and avoid alcohol over the next 24 hours. If the veins are deep and not visibly popping out, use a tourniquet and have the patient lower their arm. Properly label the tubes and send them to the laboratory for analysis. A syringe is a great technique for blood drawing! I will say a fair amount of Has 10 years experience. When you draw their blood, are you ready for them? Find a convenient blood drive near you and schedule an appointment to donate today. He got her first stick, and i will definately try this in the future if i have trouble. window.addEventListener('click-table-loaded', function(){ 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. window.ClickTable.mount(options); In situations like these, you have to be patient and apply various techniques depending on the reason for the difficulty. Looking for a change beyond the bedside? Thank you. If other sites are resulting in no signs of veins then go back and re-examine the sites. With vein locators, you can see where all the veins are. The heat will help dilate the veins and gravity will assist in filling those veins. 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. Apply heat for about 3 to 5 minutes and then assess for vein. This causes the veins to engorge and become visible. 11. If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. Rotate the wrist while maintaining the position of the arm. Select a donation type and find a convenient time that works best for you. Everyones arm anatomy is different and while one technique may work for a person, combining two or three may be the answer for another. Additionally, you will have to consider the reason why you are performing insertion of the needle. This is a common misconception - pumping the hand does not increase venous circulation. 196 0 obj <> endobj xref If you are drawing from a leg, the extremity needs to be placed over the bed so that the blood can easily flow into it. Provide a password for the new account in both fields. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. Fourthly, they are not very active, possibly causing lower blood pressure, hence slower blood flow. Our members represent more than 60 professional nursing specialties. Going there is risky as you can hit a nerve or tendon. You need to overcome those fears by exuberating confidence and persuading a person that everything will be alright. Insert the needle into the vein. 0000014430 00000 n I'm Kadia. Premarital blood tests have been done away with. Blood Test Vs Blood Donation (Comparisons). The elderly are prone to bruising when applying the tourniquet. After all, you want the experience to be as pleasant for them as possible. You have to palpate first and decide from there. Bloating. Check out our Facebook page and give it a like: http://www.redcrossblood.org/donating-blood/tips-successful-donation. element: document.getElementById("fbct7c991c3d"), Veins become more visible when blood is forced into them. How to stick a rolling vein? In the end, if other medical experts managed to draw blood from a particular vein, you can do the exact same thing. Remove the needle, take care of the site and repeat the procedure. Each healthcare system has its own requirements prior to nurses performing blood draws. If you can see the vein clearly, then this will only help you ensure that you place the needle correctly the first time. Additional equipment such as goggles and splash shields should also be worn in extreme situations. Do it by performing a quick backward motion. With thumb, spread the skin. Follow us and never miss out on the best in nursing news. Some patients are easier than others because of the prominence of their veins. Learning the anatomy of the main veins and arteries in the body is essential to becoming competent in phlebotomy. 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 All these factors contribute to their veins staying low. With this in mind, you should be sure that youre getting any requisite or helpful information from your patient before beginning to draw blood. It can really make the veins pop. Its important to remember that the patient is actually your most valuable resource during this process. Over the years I have drawn blood from many older patients, learning tips and techniques along the way in dealing with them and drawing blood from them. We use cookies to ensure that we give you the best experience on our website. Maybe the number one thing that a person can do is to make sure they are well hydrated. Drawing blood from the elderly, young children, and infants can also be a challenge. If you are going to start an IV in the hand always have the patient pump their fist. Specializes in ER, progressive care. WebObesity isn't just a cosmetic concern. %PDF-1.4 % How to Use a Vein Finder on Obese Patient. Gloves are a must. Check out our list of the top non-bedside nursing careers. Feel out all your possible options before you decide to go for it. Drink an extra 16 oz. Elderly persons walking in to do blood tests usually have nicer veins, though, there will still be a few difficulties. The rightvein should feel somewhat bouncy as you press on it. ), 2023 Center for Phlebotomy Education All Rights Reserved, Phlebotomy Continuing Education Exercise (ATM): Phlebotomy and the Obese Patient. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. This technique is especially helpful with hand veins. So, before attempting to draw blood, look at the 3 areas mentioned above for the best veins to access and draw a blood sample. var options = { You need to make sure there is no resistance whatsoever. If at the hospital, get nursing staff to assist you. Once you remove the needle, gauze should be applied for a bit. 0000011603 00000 n With the foot- some places require a specific order r/t other dx that can increase DVT risk :) Also, by palpation, you can sometimes feel valves in people and learn to avoid them. 0000001689 00000 n Pumping fists can lead to pseudohyperkalemia or increased level of potassium in the blood. If they come in for their appointment well-prepared, it should be easier to find a vein almost immediately. Kindness and helpfulness must be shown to them. 0000006606 00000 n Properly label the tubes and send to the laboratory for analysis. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses need to learn. 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 The information provided should not be used for diagnosing or treating a health problem or disease. Only tighten it if necessary. 0000027834 00000 n venipuncture is one of the main parts of your job. Deliver blood specimens to the laboratory promptly. 196 45 Massage the arm from the wrist to the elbow if using arm veins. 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!). This is the first and crucial rule of venipuncture. 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. Is there an IV team, anesthesiologist, or other trained personnel that could be of assistance? Once you have located a vein, you can cause increase distention through massaging or exaggerated palpation (pressing repeatedly over the top of the vein). Also, avoid cotton as fibers may stay in the wound and reopen it later on. This is an extremely large vessel and if stuck properly can yield excellent blood results. They need to be labeled in advance. If you are certain that youve hit a vein and there is still no blood coming from it, this is an indication that you have hit a necrotic vein. WebApplied 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 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. This is the main reason why a lot of tests go array. Has 7 years experience. Please wait while we send your information. This can be a real time saver and it is also the best way of finding the right insertion point. Unfortunately, some people have difficult veins to work with due to obesity, dehydration, and a variety of other issues. First, remember where to look. Be careful when using wet or damp washcloths. Perform good hand hygiene and don appropriate PPE. An elderly persons veins are prone to collapsing, which could mean, you may have to try several times at drawing blood. Please enter a valid e-mail address. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. Dont go deep. This can help reveal the vein. One of our Enrollment Services Representatives will be contacting you shortly. It will stop the bleeding and prevent the creation of hematoma. Some patient-friendly advice for getting blood drawn include the following: Drink plenty of water an hour before the draw. possible. Follow the cephalic and basilic veins down the forearm. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. See which ones are available and good for drawing blood. If you're drawing blood cultures, be sure to follow the policy and procedure at your facility. Instead of forcefully tapping the vein, it is much better if you start stroking them. Word of caution: make sure to remove the substance before rubbing the vein with alcohol. 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. Explain the procedure and reason for the blood draw to the patient. Specializes in OBGYN, Urogynecology. Weight gain. Use alcohol to stimulate the site to make the vein more visible. By explaining everything, you make sure there are no surprises ahead. Get someone to assist if you are not trained or dont have experience. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. You need to keep their attention and make sure they do not notice the needle. trailer <<1A62135BA6734AC3B0AC4ED47D445652>]/Prev 812906/XRefStm 1512>> startxref 0 %%EOF 240 0 obj <>stream 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. 0000007172 00000 n These devices are good at locating superficial veins, however, their ability is limited for deeper veins. It all depends on your preparation and equipment. If nothing works, try with vein locator. They are springy and bouncy. just like everyone else. If a vein is not prominent enough to see easily, you can feel around for it. I have had patients tell me nurses are more successful in one arm than the other, etc. It used to be that all 50 states required blood tests before getting a marriage license but that is no longer the case. It helps us establish if there is something wrong with the body and what to look out for. Most times, drawing blood is not that difficult, but there those occasions when you will get a difficult person. Your veins will be easier to find and palpate when you are well relaxed, as tension can constrict veins. Sometimes, the patient may experience hemoconcentration. Get the latest on all things nursing by joining our email newsletter. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Blood pressure cuff is a great method of extracting blood in case that the veins are not visible enough. When the body is properly hydrated, veins become more dilated. After identifying the site for the blood draw, gather the appropriate supplies needed. This is also called the practice of venipuncture. Venipuncture or drawing blood is one of the most common procedures performed in any medical center. So, get help! For bigger and stronger veins you can use a 22 or 21 gauge needle. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. That's why we rely on registered nurses and other experienced healthcare A tourniquet should also never be left on for more than one minute. 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. If I can't feel it then I let SWAT come in with the ultrasound. 0000008998 00000 n Extend the arm. I had one not too long ago where I had to do a 1 hour glucose tolerance test and was having trouble finding a vein. It is also possible to apply multiple tourniquets. Blood tests are one of the most important diagnostic techniques available to physicians. Spaces are not allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores. Remove the needle from the patients arm and press down on the vessel with gauze. Web Place the tourniquet over the patients sleeve of the patient shirt sleeve if drawing an arm vein. First, gather all of your supplies and discuss with your patient what you are going to be performing. Then, add massage to the combination. 0000019017 00000 n In fact, most of the procedures cannot be performed if you dont have a clear head on your shoulders. This illuminated the veins that he could not palpate. However, this article will take you through the basics of drawing blood so you can understand the steps and guidelines. Just my opinion. Insert the needle at a 15 to 30-degree angle into the vessel. The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. Avoid excessive probing. } Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. In the event that you cant locate the appropriate vein strictly by vision, this can be a great alternative method. At nurse.org, we believe that no one knows nurses better than, well, nurses. If the median cubital, cephalic, or basilic veins cant be found, then go to other sites on the arm. When the last one is done, you need to remove the tourniquet. Unfortunately, some veins are significantly easier to see than others. Patients health is your priority. 0000012940 00000 n Afterward, you can easily go upwards. Use a transilluminator to find or confirm vein A transilluminator is a cool way of finding or confirming veins. 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. 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 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!). Alternate arms if youve given blood 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. After that, pressure needs to be applied on insertion point. Reflecting off the subcutaneous tissue, the light colors subcutaneous and fat tissue. 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. 0000031373 00000 n 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. Make sure that no one gets directly exposed to blood. This, in turn, can cause increases in your blood pressure. You should never tie it too tightly at first. 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. Dispose of contaminated materials and needles in the designated hospital-approved containers. Obese patients, particularly those considered to be extremely obese, have reported being treated with disrespect by physicians and other medical staff. Nursing schools do not teach this skill due to legality issues. Specializes in Wound Care. The elderly lose fat tissue as well as muscle mass, making their skin saggy. If youre a phlebotomist who has encountered this problem before, you know how frustrating it can be. Relax for a few minutes in our refreshment & recovery area have some cookies or other snacks youve earned it! Make sure that tourniquet is removed before the needle. Occasionally, it can also be caused by the longer term IV therapy. A second option for finding veins and drawing blood are hand veins. Confirm the ordered tests and fill out the appropriate forms and labels. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. Some veins can be deep in the antecubital fossa area, especially, if there is a lot of fat tissue. I'm Kadia. Commercial heat-packs are best for this technique as you can choose the temperature you want. The region from which you are drawing blood has to have a healthy tissue. On top of that, there are a lot of individuals who fear (or dislike) going to a doctor. Veins will appear as a dark line. This can help individuals with deep veins, who are obese, or with some edema. You can do that by gently massaging the arm, from the wrist to the elbow. Excess fat around the waist can put you at an even higher risk for obesity-related health problems, including heart disease and type 2 allnurses is a Nursing Career & Support site for Nurses and Students.
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