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. Position the patient and hyperextend the patients arm. Sign up to receive the latest nursing news and exclusive offers. 0000180491 00000 n Place it at the chin and lightly draw a straight line. 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. Has 12 years experience. 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. However, there are numerous things that can go wrong while you draw blood. Sometimes theyre very small, or hard to see. Invert a BP cuff so that the blood can go to the lower regions of the limb. Then, deflate blood pressure cuff and apply tourniquet. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. If necessary, apply the tourniquet and examine the median cubital, cephalic, and basilic veins. What about other resources that may be available? Blood pressure cuff is a great method of extracting blood in case that the veins are not visible enough. Each healthcare system has its own requirements prior to nurses performing blood draws. If the person is tense, try getting them to relax. If properly inserted blood should flash into the catheter. 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. Once the vein is located, the individual arm can be returned to horizontal position for blood collection. When you are retaining water, it increases the total volume of fluid that is being pushed through your blood vessels by your heart. The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. instance: "61c9f514f13d4400095de3de", 8, 9 Even Fasting glucose and hemoglobin A1c (HbA1c) Other tests are performed as indicated by clinical findings. 0000017785 00000 n It can be done by palpating the vessel or via transillumination with a special light. The only way to make sure is by touching it yourself. This, in turn, can cause increases in your blood pressure. These 5 areas include:if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'phlebotomistreport_com-medrectangle-4','ezslot_6',165,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-medrectangle-4-0'); From my experience elderly persons on wards are the most difficult sticks. You can support each other and do twice as much good! If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. Insert along the vein. It is the sharpest part and this will be the best way of insertion. Insert the beveled needle at a 30-degree angle into the vessel. }); Big ppl are not bad to stick at all, especially the ones with edema. Only tighten it if necessary. 0000031735 00000 n If you dont know what a vein feels like, practice by feeling on yourself with you index finger. Afterward, you can easily go upwards. WebIf you are drawing blood from an arm, make sure to sit near the patient, as close as possible. 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. Syringe, vacutainer, and needle size should Fluid retention. We and our partners share information on your use of this website to help improve your experience. The forearm is about the last place to look. Usually, it happens due to squeezing or massaging around the site or due to prolonged application of the tourniquet. Massage the arm. By explaining everything, you make sure there are no surprises ahead. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. A medical expert should stroke them from distal to the proximal vein. While holding patients arm, make sure that your finger is well above the insertion point. A phlebotomist will need to find a good, strong vein from which to draw blood. These devices are good at locating superficial veins, however, their ability is limited for deeper veins. 0000185079 00000 n Make sure to perform venipuncture from patients non-dominant arm (which is usually the left one) as it will allow him to use his dominant arm afterwards. When drawing blood, you will need several tubes for different samples in your equipment. venipuncture is one of the main parts of your job. Nowadays, there is equipment that can help us locate the vein. Firstly, they are sick. Please bring your donor card, driver's license or two other forms of identification. They may be in a confused, agitated, or combative state of mind. Dont be discouraged if at first, you dont access the vein. Some patients have hypovolemia or reduced volume of circulating blood. *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. That means that you can trust us to have reliable, up-to-date information You can do that by gently massaging the arm, from the wrist to the elbow. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Place them one by one in the holder and take samples. Liver function studies. I will say a fair amount of 0000029232 00000 n link to Blood Test Vs Blood Donation (Comparisons), link to No More Blood Tests For Marriage License. Instead of forcefully tapping the vein, it is much better if you start stroking them. Why does blood stop flowing during blood draw? Besides that, there are some additional considerations. After that, you need to see if the patient has any medical condition, if he is using drugs or if he is fasting. Besides proper knowledge, you will also have to have a good head on your shoulders and to make sure you follow these venipuncture guidelines closely. Going there is risky as you can hit a nerve or tendon. Inflate cuff to 30mm Hg above systolic reading and maintain pressure for about 1 to 2 minutes. This will move their fluid and/or tissue out of the way so you can see a good vein. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. 0000031373 00000 n In the case of children or uncooperative individuals, restraints are an option but they should be avoided at all costs. 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. 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 196 45 A lot of patients have the needle phobia. Drawing blood from the elderly, young children, and infants can also be a challenge. A transilluminator is a cool way of finding or confirming veins. This can help individuals with deep veins, who are obese, or with some edema. Without further ado, here are 50 tips that will help you perform this crucial procedure. 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. Once you have selected the right vein finder for an obese patient, it is important to know how to properly use the Properly label the tubes and send them to the laboratory for analysis. In situations like these, you have to be patient and apply various techniques depending on the reason for the difficulty. Blood Test Vs Blood Donation (Comparisons). Continuous interaction can help distract a person during this time. Apply a heat compress to the area for 3-5 minutes. 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. Perform hand hygiene and don proper PPE. A second option for finding veins and drawing blood are hand veins. It will easily increase the smaller veins. They dont harm the patient in any way and can be used regularly to make your job easier and safer. This technique is especially helpful with hand veins. Use your index finger to palpate and trace the standard path of the vein on the arm. glasses of liquids and avoid alcohol over the next 24 hours. } As we mentioned, it is your duty as a medical professional to ensure the patient that everything will be ok. It is the first area to look for veins. 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. They are popular because they are so useful. Usually, if you cant find a vein in the antecubital fossa or at the back of the hand, you will find one in the forearm. Is there an IV team, anesthesiologist, or other trained personnel that could be of assistance? Frail veins can pose a great problem when drawing blood. Do not be afraid to touch your patient. Then, apply heat to the lowered arm. Talk to your doctor or therapist about improving your coping skills and consider these tips to cope with obesity and your weight-loss efforts: Journal. 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. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. 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. Keep the strip bandage on for the next several hours; to avoid a skin rash, clean the area around the bandage with soap and water. 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. 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 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. If no blood flows, pull out the needle and repeat the draw. Pumping fists can lead to pseudohyperkalemia or increased level of potassium in the blood. First, remember where to look. There's so much that a small sample of blood can tell a doctor that you'll likely need, Giving blood is vital as it saves millions of lives every year. With vein locators, you can see where all the veins are. This can cause an overall loss of plasma in the blood, and the sample could be unusable. Most people have normal looking serum. Alternate arms if youve given blood recently. Subscribe for the latest nursing news, offers, education resources and so much more! 0000262624 00000 n Enjoy :). Below are 5 key areas of importance with tips. However, for the elderly, it may be difficult. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with blood draws. Its important to do everything in your power to ensure the comfort of the patient when drawing blood. Insert the needle at a 15 to 30-degree angle into the vessel. When the last one is done, you need to remove the tourniquet. Properly label the tubes and send to the laboratory for analysis. Go to Alexander Street homepage, Blood Collection: Special Considerations, Obese Patients. Premarital blood tests have been done away with. Many times, you will have to resort there to draw blood. 0000000016 00000 n Wear a shirt with sleeves that you can roll up above your elbows. First, gather all of your supplies and discuss with your patient what you are going to be performing. But sometimes, it can find a vein you didnt see or feel. 0000005419 00000 n To make a basic grid for your female body proportions, turn your ruler so its perpendicular to the vertical line you drew. The consent submitted will only be used for data processing originating from this website. When you draw their blood, are you ready for them? 0000027834 00000 n Occasionally, it can also be caused by the longer term IV therapy. Do it by performing a quick backward motion. If you have specific questions, but don't want to wait, give us a call at. 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? If the antecub has already been accessed there are great options for venipuncture. 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. Once veins have been located, return the patients arm to the horizontal position for the blood draw. 5. She hit the vein on the first try. Continue with Recommended Cookies. Gloves are a must. 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. tips on starting IV, drawing blood on obese patient. 0000005243 00000 n 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. Using a tourniquet is something most people are used to seeing during difficult blood draws. The needle may have pulled out of the vein. Label appropriate tubes at the bedside and place them into transport bags. Make sure you check with the nurse first for permission. just like everyone else. Luckily, got it on the first stick. Donating Platelets? Please enter a valid e-mail address. See which ones are available and good for drawing blood. The veins of one patient may be different in size and quality from another. 0000019017 00000 n Afterward, make sure to store them properly. Create an account and get 24 hours access for free. When the body is properly hydrated, veins become more dilated. Thank you. At nurse.org, we believe that no one knows nurses better than, well, nurses. 0000010671 00000 n My trick is to press on their hand or arm with both of my thumbs. 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. If you are going to start an IV in the hand always have the patient pump their fist. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. You need to overcome those fears by exuberating confidence and persuading a person that everything will be alright. You should never tie it too tightly at first. Venous access should always be based on feel, not looks. Apply the tourniquet one to two inches above the wrist if drawing a hand vein. professionals to write our content whenever possible. Other times, they dont want to pop out or raise for the phlebotomist to be able to draw successfully. If you do otherwise, you are going to injure the patient. Sometimes, its even hard to feel them with your finger. More than one-third of U.S. adults and 16% of U.S. children are obese. 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 This will cause a lot of mess. On average, it is much harder to find veins in people with darker skin tone. It needs to remain loose. Once you remove the needle, gauze should be applied for a bit. Doctors usually mistake if for hyperkalemia when assessing the results. I'm having a hard time finding veins then starting IV or drawing blood on obese patients. Fourthly, they are not very active, possibly causing lower blood pressure, hence slower blood flow. Everyones arm anatomy is different and while one technique may work for a person, combining two or three may be the answer for another. 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. You can try several approaches mentioned earlier in our venipuncture guidelines that will increase the vein. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. This is painful and can bruise the patient. Even with all these guidelines, perhaps the best approach is if you ask the patient from which vein they usually draw his blood. Only major veins should be used here. That's why we rely on registered nurses and other experienced healthcare Identify the patient using two patient identifiers as mandated by JCAHO. 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. 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 The elderly need special care and attention when doing a blood test. 0000012940 00000 n 1 Article; A 3ml, 5ml or 10ml syringe will work fine. You could get help from them. 0000009423 00000 n They are not as healthy and strong as they once were. Follow the cephalic and basilic veins down the forearm. One thing that I find that helps is using two tourniquets - take them together and tie it. The elderly are prone to bruising when applying the tourniquet. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. Slapping can lead to contraction which can further decrease the veins, producing an adverse result. Be careful when using wet or damp washcloths. Think of an anecdote or a story you would like to share. If you cant find a good vein, move to the back of the hand. window.ClickTable.mount(options); What may be warm to you could be hot or even burn someone else. of water (or other nonalcoholic drink) before your appointment. Obese patients, particularly those considered to be extremely obese, have reported being treated with disrespect by physicians and other medical staff. This study guide will help you focus your time on what's most important. You may need the approval of a physician or someone else. Doctors have access to deep veins like the femoral and subclavian vein that other phlebotomists dont have. 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. The loss of support makes it easy for veins to roll causing difficulty in drawing blood. 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. Drink an extra four (8 oz.) Word of caution: make sure to remove the substance before rubbing the vein with alcohol. Manage Settings Alternate arms if youve given blood Excess fat around the waist can put you at an even higher risk for obesity-related health problems, including heart disease and type 2 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 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. Web Place the tourniquet over the patients sleeve of the patient shirt sleeve if drawing an arm vein. However, this article will take you through the basics of drawing blood so you can understand the steps and guidelines. WebApply a warm cloth or towel to the arm to cause the veins to dilate. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. 0000001848 00000 n Specializes in ER, progressive care. 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. While traditionally a nurse would use their hands to feel for a vein, many hospitals are now using vein finders to help reduce the amount of time it takes to find a vein and start treatment. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Use alcohol to stimulate the site to make the vein more visible. As a result, this will lead to the release of histamine increasing the vein. 0000025579 00000 n Specializes in PICU, Sedation/Radiology, PACU. Contact should be limited and you shouldnt place the locator on burned skin. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. What constitutes a difficult vein? 0000036112 00000 n Maybe the number one thing that a person can do is to make sure they are well hydrated. If you are drawing from a leg, the extremity needs to be placed over the bed so Perform good hand hygiene and don appropriate PPE. The site should not be warmed to a temperature higher than 42 EC. It can really make the veins pop. In the case of elderly patients, make sure to use smaller needles and to be extra gentle. Just my opinion. Also, avoid cotton as fibers may stay in the wound and reopen it later on. In order to reduce the risk of thrombosis, lines need to be flushed with a solution of heap in. For hospitalized patients, raise the head of the bed. It is also possible to apply multiple tourniquets. Extend the arm. So, before attempting to draw blood, look at the 3 areas mentioned above for the best veins to access and draw a blood sample. Finding difficult veins isnt impossible, but it can require a few different methods to be put into place. of water (or other nonalcoholic drink) before your appointment. Instead, make sure to remove tourniquet first and then remove the needle followed by instant pressure on the insertion point. Get the patient to lower his or her arm. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. Dismiss. With the foot- some places require a specific order r/t other dx that can increase DVT risk :). In fact, based on this, the entire procedure can be harder or easier. Blood tests are one of the most important diagnostic techniques available to physicians. As a phlebotomist, I have been faced with situations where drawing blood from a person was quite difficult. Your veins will be easier to find and palpate when you are well relaxed, as tension can constrict veins. The needle should fully penetrate it. All e-mails from the system will be sent to this address. As the body ages, the skin becomes thinner and blood vessels become weaker. Some will come on wheelchairs, using a cane, needing help to walk, move, sit and stand. You need to make sure there is no resistance whatsoever. Some patient-friendly advice for getting blood drawn include the following: As a phlebotomist, though, you cant expect patients always to follow perfect procedures to make drawing blood easier, and you may even find that some patients are rude. 0000001196 00000 n Please wait while we send your information. So, get help! After all, you want the experience to be as pleasant for them as possible. Also, it is the basis of diagnostics. The paramedic immediately brought out a large flash light and pressed it to the patients arm. Below are several tips and tricks that you can use when you are faced with a difficult blood draw. Often, even a loose bind can help a vein to pop. One of our Enrollment Services Representatives will be contacting you shortly. A doctor can access the femoral vein and others to draw blood. Looking for a change beyond the bedside? Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Unfortunately, some veins are significantly easier to see than others. If none of the above options enable you to find a strong vein, you may need to find another puncture site. The needle may also not be in a vein. How to Use a Vein Finder on Obese Patient. 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.

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