Blood draws are not rocket science...

[theantichick 2,204]

I just have to rant a little.

I had my pre-op testing done this morning. The nurse was very nice and competent. Until it came time for the blood draw.

I was a Paramedic. I used to start IV's bouncing down the road in the back of an ambulance with poor lighting. I was an ICU and ER nurse. I have worked with patients who are VERY difficult sticks with teen-einey little fragile veins. I wasn't a vein whisperer like some of the people I've worked with, but I was pretty darned good. Co-workers would ask me to take a look if they'd already tried a couple of times and hadn't come up with anything.

It's a skill, yes. But it is not rocket science. I hadn't started an IV in 20+ years when I went back to nursing school, and didn't get much opportunity to practice in school. But it wasn't very long on the new job before I got my groove back. Like riding a bike so to speak.

Basically, I have a lot of experience to back up this rant.

I have good veins. I was the one everyone wanted to practice on in Paramedic school (by the time I went to Nursing school, they'd stopped allowing practice on fellow students). They aren't all that visible, which is a little surprising considering my skin is incredibly light. But they palpate (finding by feel) VERY easily.

Drawing blood isn't nearly as difficult as IV sticks, for a bunch of technical reasons I'll spare you. If anyone misses my veins, either I'm dehydrated, or they need more practice. Blowing the vein, or going through it, that happens a lot. So I know exactly what the bruise pattern looks like for each. Blowing it can't always be predicted. Going through (transecting) it, that is usually sloppy technique with normal sized veins.

Lady COMPLETELY missed the vein in the bend of my elbow. That vein is a HUGE pipe, it's the go-to spot for most emergency medicine providers because it's a gimme. Mine is not overly large, but it's a good solid vein. She had the tourniquet on my arm a good 3 minutes trying to FIND the vein. She even admitted that she wasn't any good at feeling veins, that she needed to see them. (Gotta say, more times than not for whatever reason - skin color, scars, tattoos, hair, etc, you CAN'T see the vein. Anyone worth their salt doing IV's or blood draws needs to learn to feel them.)

THEN she managed to get the blood draw on the second stick in my forearm, but she went through the vein. I knew watching her she'd done it, but I wanted the draw over so I didn't say anything. The bruise tells the story though. And it'll still be there next week when I go in for surgery, since I bruise like fruit.< /p>

She's been a nurse for a long while, so it's not a newbie error. She just hasn't had the opportunity (or taken the time) to get trained in good technique and practice. But she does this many many times a day as a pre-op intake nurse. There are videos on YouTube teaching how to have better draw/IV technique, and tips and tricks all over the internet. I even have a half dozen on my Pinterest board.

Sticks, especially with the little needles for blood draws, don't hurt me very much at all. I didn't care that she took two sticks on me, it's an eh kinda thing for me. But the whole drive back to the office, I thought about all the patients who don't have good veins that she's sticking over and over. She did say she won't stick anyone more than twice (most hospitals have a policy of two or three sticks, then find someone else), so that's good. But some people find needles traumatizing and incredibly painful.

There is even technology that illuminates the veins for more accurate sticks, but it hasn't become widespread. Heck, I can go on Amazon and by a cheap-o vein illuminator for $30... won't be as good as some of the ones made for hospitals, but if I were as bad at it as she is, I'd do anything to get an edge.

I don't know what the purpose of this rant is... people who want to get better at blood draw/IV sticks generally can. She apparently doesn't. Which saddens me as a nurse and as a patient.

[Christinamo7 4,042]

I am sorry you had this experience.

almost everyone has a difficult time getting my blood - IV's are worse. I am the patient even the Red Cross told - look we appreciate your willingness to donate, but it takes so long to get you hooked up we loose out on several other donors. boo.

[summerset 5,265]

Ah yes, placing needles (usually for administering contrast agents)- I could sing a song or two (or more) about this issue.

[Djmohr 6,965]

I have to say, I love your rant! I have often wondered WTH the problem is for me.

I could totally understand when I was 310lbs and maybe my veins were buried deep but I am thin now and my veins actually pop out at you.

For my bypass surgery, I was stuck 8 times before they finally gave up and got the anesthesiologist to do it.

For my cervical fusion 9 months later and 100lbs lighter, they stuck me 6 times before getting help and even talked about doing it in the or. ???really?

Now, with those surgeries I was certainly dehydrated and apparently my veins roll which makes it harder.

In the fall I had to have an adrenal test completed where they dose you with some crap and then take your blood every 30 minutes and we found out the hard way it's a stick each time. We found that out because they stupidly used the IV site to draw my blood. Laying flat on my back for 2 hours and I had to completely redo the test another day. So they got one of those fancy vein finding tools down there and used that.

Since that time I have had 3 surgeries and many blood draws. WTH, how can getting my vein be that hard?

I had Brachioplasty 3 weeks ago and you guessed it, missed the first time, went to the 2nd arm but could only get a tiny needle in, so I woke up with a rather large IV in my foot.

Am I really this big of a pain in the arse when getting blood work or IV or what gives. Oh and anytime they decide to use lidocaine first, it's definately a no go, my veins just shrivel away.

I am good about making it clear that I have problem veins so they start out by getting the vein whisperer but it never works out that way, someone always has to try 1,2,3,4 times before they give up.

I really don't care about the sticks, I am used to it. It makes me feel bad when they struggle, so my goal in telling them is that it is expected and it never lets me down.

You should have seen the phlebotomist that did my last round of labs for Bariatric testing 2 months ago. She had her 13 vials and had to read directions for each test because they never do these tests. She only blew through the vein once so it was a two stick day. LOL.

Maybe someone can help me understand why I am a problem and how to help these guys. In 9 weeks I am having my next plastics and I am guessing I will be right back with more bruises.

I still have two big bruised on both forearms from the IVs 3 weeks ago. The one on my foot cleared up right away as did all the Lipo bruising but the IV bruises, still there. HUH?

[AvaFern 3,516]

Lol, when i read your subject I was going to give you a lesson on the point that sometimes blood draws are hard. Then I read the rest of your post, and now I'm laughing. I was a medic too and when you can do an IV in the back of the truck going down the road, you get to judge all you want someone who can't do a simple blood draw at the AC in a controlled hospital. I also got stuck a lot in medic school when we were all learning so I don't really care much when someone can't manage to do it correctly and sticks me a few times, but the point of the matter is that a blood draw, not even an IV on a critical patient, is a very basic skill that should have been mastered well before now.

[ShelterDog64 2,364]

Excellent rant! I've got vessels like fire hoses, when I had surgery the night nurse insisted on restarting a blown IV in the middle of my forearm instead of the antecubital space. Here's the outcome of that:.

And 7 weeks later, I still have copper staining in the area.


Sent from my iPhone using the BariatricPal App

Edited August 10, 2016 by ShelterDog64

[gettingsleeved1 79]

I took this 2 weeks after my surgery ☹️

Sent from my iPhone using the BariatricPal App

[theantichick 2,204]

This is from yesterday's blood draw. With a butterfly.

sent from mobile device

[theantichick 2,204]

Excellent rant! I've got vessels like fire hoses, when I had surgery the night nurse insisted on restarting a blown IV in the middle of my forearm instead of the antecubital space. Here's the outcome of that:ImageUploadedByBariatricPal1470798253.662731.jpg.

And 7 weeks later, I still have copper staining in the area.

Sent from my iPhone using the BariatricPal App

I actually prefer forearms to AC because the AC tend to be so positional. But someone who only knows how to put IV's in AC's will mess up a forearm because it's less forgiving. The ones I absolutely despise are in the hand. I had one transected in my hand and bled so much it was like instant arthritis in the joints for a couple of weeks after!!

[chycky 671]

A butterfly did that? I hope that she was just having an "off day" that is terrible!

[theantichick 2,204]

A butterfly did that? I hope that she was just having an "off day" that is terrible!

Yep, and it was a blue one, so it was probably a 25ga. And she wasn't having an off day. She flat out told me she can't really feel veins, she needs to see them. She couldn't even feel them by popping the tip off her glove on one finger. Anyone who's done this knows you have to feel them to get proficient. She had the tourniquet on both times for about 3 minutes to find the veins in the first place. It's only by feel that you know what direction they're going, how deep they are, generally how big they are, and if they feel healthy or fragile. If she can't feel them with her fingers, then she's likely not feeling when she pops through the wall, which is why she transects.

The one on my forearm you can see a mile off, she just went straight through it and then backed up until she got return. That's sloppy technique, and won't work for IV's, only blood draws. I knew as soon as she stuck that I'd bruise. I'm actually glad she missed my AC because she'd likely have transected it as well, and that makes a HUGE bruise for weeks.

Like I said, I'm not upset for me. I just know enough about it to know that this is sloppy and she needs to look for a mentor to help her learn the proper technique. Who I really feel sorry for is people who have needle issues or feel the sticks more severely than I do, or who are hard sticks. I really and truly am an easy stick. I just hope she can recognize when she flat out won't be able to get it, and calls for help often.

[ShelterDog64 2,364]

Excellent rant! I've got vessels like fire hoses, when I had surgery the night nurse insisted on restarting a blown IV in the middle of my forearm instead of the antecubital space. Here's the outcome of that:ImageUploadedByBariatricPal1470798253.662731.jpg.

And 7 weeks later, I still have copper staining in the area.

Sent from my iPhone using the BariatricPal App

I actually prefer forearms to AC because the AC tend to be so positional. But someone who only knows how to put IV's in AC's will mess up a forearm because it's less forgiving. The ones I absolutely despise are in the hand. I had one transected in my hand and bled so much it was like instant arthritis in the joints for a couple of weeks after!!

Oh, absolutely if it's a primary or even the second site. But this was my 4th IV site (I was getting IV potassium, so I was shredding veins every 8 hours or so) I finally ended up with one in the elbow that lasted for my last bag of K. They started with my hand, which blew ugly and big, then forearm, another forearm, then finally AC. Those smaller veins clearly weren't designed to withstand potassium, at least in my body! And isn't it amazing what it feels like to have to absorb all that blood? My IV issues were by far the most difficult part of my hospital stay

[James Marusek 5,244]

I am a hard draw. It takes someone who is more of a specialist to find my veins. So whenever I get blood drawn, I warn them, and if the nurse who initially tries to draw blood fails, she gets someone who has the knack.

Now that I am 3 years post-op, I have noticed that the nurses seem to be able to find my veins easier because I have lost the excess fat.

This is important because after RNY gastric bypass surgery, I have an annual blood workup and they take almost 10 viles of blood with each workup.

[theantichick 2,204]

Excellent rant! I've got vessels like fire hoses, when I had surgery the night nurse insisted on restarting a blown IV in the middle of my forearm instead of the antecubital space. Here's the outcome of that:ImageUploadedByBariatricPal1470798253.662731.jpg.

And 7 weeks later, I still have copper staining in the area.

Sent from my iPhone using the BariatricPal App

I actually prefer forearms to AC because the AC tend to be so positional. But someone who only knows how to put IV's in AC's will mess up a forearm because it's less forgiving. The ones I absolutely despise are in the hand. I had one transected in my hand and bled so much it was like instant arthritis in the joints for a couple of weeks after!!

Oh, absolutely if it's a primary or even the second site. But this was my 4th IV site (I was getting IV potassium, so I was shredding veins every 8 hours or so) I finally ended up with one in the elbow that lasted for my last bag of K. They started with my hand, which blew ugly and big, then forearm, another forearm, then finally AC. Those smaller veins clearly weren't designed to withstand potassium, at least in my body! And isn't it amazing what it feels like to have to absorb all that blood? My IV issues were by far the most difficult part of my hospital stay

Ugh. I didn't realize you were getting K+. I'd never try to put that through a hand vein. Ew, ew, ew, ew, ew. Did they at least dilute it by piggybacking it to some regular IV solution? I think doctors should have to endure some of this stuff in medical school. They don't stop to think about how hard it is on the patient sometimes when they write orders. If the patient can tolerate volume, K+ comes pre-mixed in a very dilute solution that isn't nearly as hard on the veins, but the docs will order the tiny concentrated bags without even thinking about it. When I was bedside, if a doc ordered that, before I even went to get the meds, I'd ask him to order an additional volume of saline or whatever the patient needed so I could dilute it a bit into the veins.

[theantichick 2,204]

I am a hard draw. It takes someone who is more of a specialist to find my veins. So whenever I get blood drawn, I warn them, and if the nurse who initially tries to draw blood fails, she gets someone who has the knack.

Now that I am 3 years post-op, I have noticed that the nurses seem to be able to find my veins easier because I have lost the excess fat.

This is important because after RNY gastric bypass surgery, I have an annual blood workup and they take almost 10 viles of blood with each workup.

There are definitely people who are hard draws. And excess fat makes it really hard to feel the veins and get a good stick. If we can't feel the veins, we're sticking blind. We generally know where stuff should be, so it's an informed blind stick, but it's still blind.

Unfortunately, I have had WAY more people in the ER tell me they are "hard sticks" than actually are. There are a lot of nurses out there who try to blame the patient when they miss or blow a stick than to own up to it. They'll tell the patient that their vein rolled, or they've got valves. News flash: EVERYONE's veins roll, and EVERYONE has valves. Now, an athletic person (especially runners) will have more valves and sometimes it adds a level of challenge, but learning to "trap" a vein so it can't roll away from the needle is just part of developing the skill.

And, certain treatments like dialysis and chemo, absolutely destroy veins. What we can find is fragile as spun glass. IV drug users get their veins scarred up and it's a real challenge to start one (but ask them, they'll know what's still accessible). People who donate blood a LOT or sell plasma tend to get their AC's scarred up badly, and we need to go somewhere else for it. Elderly patients' veins tend to be more fragile and also more engorged, there's a few tricks to sticking them without blowing up the vein. There *are* challenges. But if I had a nickel for every patient who told me they were such a hard stick, and I had zero trouble getting it on the first try, I'd be able to buy a car.

When I would miss or blow a vein, I tried not to blame it on the patient, and just owned up to it. And I let the patient decide if they trusted me to try again or if they wanted me to get someone else.