Taking a blood sample or starting an IV usually isn’t the highlight of a medical worker’s day… and it’s definitely not a favorite moment for the patient, especially if multiple sticks or other complications are involved. But phlebotomy and venipuncture are necessary, and mastering them can make the experience better for both patient and lab tech.
For starters? Remember that there’s no such thing as normal when it comes to sticking a vein.
“Anybody who expects just routine draws is quickly disappointed,” says Dennis Ernst, director of the Center for Phlebotomy Education in Corydon, Ind. “Because you have five or six categories of patients who present challenges—and you never know who’s going to walk in the door.”
The best rules to remember, of course, are the ones you learned in your medical training, and you should always defer to those techniques or to your administration for proper procedure. But here are a few tips and tricks that can help keep the sample process “flowing smoothly”.
Take A Deep Breath – Not you (though you can if you’d like), but the patient. By asking the patient to take a deep breath just before the stick, it both keeps them occupied and keeps them distracted. Being given something to do helps a person feel more in control of the situation—and this works as the needle is being removed, also.
Anchors Away – Stretching the skin by “anchoring” the vein doesn’t just help you stick the vein on the first try, it also helps make the stick less painful. Remember, your thumb goes below the venipuncture site, and give yourself plenty of room so you don’t accidentally jab your own fingers.
Feelings, Nothing More Than Feelings – Finding the vein and choosing your venipuncture site is perhaps the most difficult part of phlebotomy, especially if your patient’s veins are small, fragile, or non-elastic, and much of selecting the vein comes down to feeling. Not gut feeling, literal feeling.
There’s an old joke about how the first thing lab nurses notice when meeting a new person is how good their arms veins are, and that joke isn’t far from reality. Some patients are gifts from the gods, with veins thick and visible. But others are more of a challenge.
To that end, feeling for the vein (not slapping, despite what you see in movies) will always be the most reliable approach. Palpate for that “spongy firmness”, and feel above and below your target area for a better idea of direction.
The Invisible Vein – Still can’t find a place to stick? Dr. Jabr of Florence, Oregon suggests “to obviate the need for multiple inconvenient and painful attempts at securing the needle, apply a warm pad to the target vein for a few minutes. This helps dilate the vein and makes it more visible and accessible.”
Another trick (from the venipuncture site AimVein.com) is to bend the arm upward if the veins are hiding. This sometimes makes them easier to spot.
Less Than Thirty – You’ve probably heard this a hundred times in your nurses training, but it never hurts to hear again. The World Health Organization guidelines suggest keeping the angle of insertion at 30 degrees or less (15 is ideal) to avoid passing through the vein.
Label Immediately – There’s nothing worse than getting a great stick, drawing a great sample, then forgetting to label it right away. Actually, there is something worse… and that’s mixing up samples because they weren’t labeled at the bedside. For your sake and the patient’s sake, label all sample immediately, even if things are going a mile a minute.
Know When To Quit – Just can’t get that blood sample? Veins just aren’t cooperating? Considering a third or fourth attempt? Here’s something else to consider—getting help. Don’t think of it as failure or defeat, think of it as making the best decision for your patient. Getting a fresh set of eyes on the situation might be all that’s needed to finally draw a good sample, and knowing when to seek help is the mark of a pro.
There’s A Body Attached To That Arm – At the end of the day, though, everything really comes down to how safe and peaceful you make your patient feel. So treat each and every one as if they were a friend or relative, and remember that just because you see needles and blood samples many times a day, this is a fairly rare experience for them. They will often be nervous. Some may faint. Some may be nervous because they’re afraid they’ll faint. It’s up to you to coach them through it and make the experience as positive as possible. The better it goes, the better the chances of that person seeking medical attention in the future, and that’s always a great takeaway.
“Compassion is not antiquated,” writes Dr Larry Dossey. “It remains a crucial factor in healing and will never go out of style. It is always available for any healthcare professional who is wise enough to claim it.”
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