Taking Blood

[PandaHat]

Hey guys!

I'm a final year medical student. So one of the things I'm doing now is taking blood. I can normally get it fairly reliably (although to be fair if they look like horrendous veins, I'll ask someone more senior to help/do it instead).

What I wanted was advice on how to deal with people that really dislike having blood taken. I've never had a problem with people taking blood from me, so I don't really know what they would prefer I say.

If they say they have difficult veins or really dislike needles, I tend to use a butterfly straight off as it's smaller and therefore a) hurts less and b) is more likely to get blood, although it does take a bit longer to fill containers. I also always ask where is my best shot at getting blood. (Hey, they're the expert about where people are most likely to get blood from, not me!) I also never tell anyone that it's not going to hurt, but instead I say I'll try to make it as painless as possible. (even though I personally don't find it that painful), because I don't see any point in lying about it and eroding people's trusty in their doctors. I also always say "Sharp scratch coming up" immediately before I put the needle in the skin.

Any other advice?
PandaHatxx

Any other advice

[Teskeria]

ask if they prefer to watch. One of my daughter can handle it if she watches. But even though she is an adult, they always try to convince her not to look. Most people know what they can take (as you obviously understand).
I hate getting blood drawn or ivs as they rarely manage with less than 4 attempts and they only one who ever managed to get an iv in me in 1 attempt was a neo-natal supervisor. why was I not surprised that someone who works with babies who's arms tend to be as small or smaller than my finger, is the only one who succeeded first try.
Most assume I am just being a baby when I tell them how hard it is, as the veins are lovely and huge until they try to stick them. (doesn;t help I have a phobia of needles. I will NOT look)

[fireheart]

Talking about the persons interests or what they're doing today can also help. Even playing music works. I will take my iPod in whenever I have blood taken, as I am distracted by the music and I don't even feel the needle coming in.

[KiaKat]

I'm hugely phobic. Have hyperventilated into passing out.

Acknowledge the panic, and empathize, but don't overdo it. The best person I ever dealt with set me up so I couldn't see what she was doing, and distracted me with a lot of conversation. Just nonsensical stuff so I couldn't focus on what was going on. Only time I haven't turned dead white and threatened to (or actually) pass out.

[MoonCat]

I always tell them that I need to be lying down. And it helps if they talk and distract me. My veins are small and roll around. Also the best place to go in is the back of my hand. The ones who don't believe me find out that I'm right. I hate that spot, and it hurts, but it hurts less than having someone poke around in my arm for 10 minutes with a needle.

It's great that you don't tell them it won't hurt. We all know that isn't true!

[KatherineB]

Don't be like one woman I had recently.

Her: Don't watch!
Me: Oh, I prefer to watch. I won't tense up.
Her: It's not about you. I hate people watching when I'm trying to get blood out. You already said you were difficult [it's true; people deserve fair warning] and you watching me is only going to make things harder for me. Look over there!
Me: ...

Incidentally she gave me the biggest bruise I've ever had from a single injection, and it hurt more than any I can remember having. And she was the 'expert' in the room at taking blood from difficult people. (Her colleague had already tried and failed.)

If you don't imitate her, you should be fine!

[trailerparkmedic]

Feet are fair game if they aren't diabetic. Even IV drug users usually have a good vein posterior to the malleolus.

Use two tourniquets (one above the AC, one on the forearm) if their hand veins won't pop. Be patient; veins take a minute to appear. I find rubbing hands works just as well as slapping them and is more respectful. Don't hesitate or wimp out once you start the stick; slow wobbling is more painful than a quick stab.

Thumbs are usually good (I've seen 14s in them) and I can usually eek out 20 ccs (a blood culture) out of a knuckle. When butterflying hands,emphasize the importance of not moving the hand and put the hand in a comfortable position for the patient before sticking them.

If you can't find the vein and you get someone else, stay and watch them do it. Ask to feel what they feel. Go for veins you can feel, not the visible but not palpable superficial ones.

For anxious patients, I tell them when I put the tourniquet on that I'm only looking and won't stick them until I find a vein I love. If I need to get someone else, I tell the patient I'm getting an expert (because I am). Don't let someone who says they're a hard stick put you off; look and see what you can find. Looking doesn't mean you're committing.

Honestly, learn EJs and ultrasound if you have the chance. Those are far more likely to be things you're doing unless you do anesthesia.

[Miss Maple Leaf]

I wouldn't recommend telling people that the sharp scratch is coming up, especially if the person you've got is obviously nervous.

In my case, I hate getting blood drawn and am always really nervous when I have to get it done. I have to turn my head away and close my eyes (so that I don't see anyone else getting it done).

If the person doing it talks to me about something else and distracts me it's not so bad because then I'm not dwelling on it and find the whole process a bit easier to get through.
If, however, they warn me that it's about to happen I get really tense because that's what I end up focusing on and it ends up hurting a lot more than it would otherwise.

...Ugh. Just thinking about getting blood drawn is making me feel nauseous and giving me the shakes.

[kpzra]

Yup, don't let someone who says they are a hard stick scare you. I had one pt tell me that in the ER and it was one of the easiest draws I've done. Take your time, talk to them, and try to warm their hand if you are using it. I personally hate it when they ignore me the person and only pay attention to me the arm. I didn't do routine blood draws (only on ER clinicals) as a Paramedic so I don't have much advice.

[PandaHat]

Thanks for the advice guys! I'll make more of an effort to find out how the patient prefers to handle bloods being taken before going for it. Unfortunately, I'm still at the stage of concentrating really hard to take it, so I'm not quite able to chat about inconsequential things simultaneously, but I'll work up to it!

@Trailerparkmedic: I'm a UK medical student, I have only ever seen ultrasonographers do ultrasound outside of obstetrics and gynaecology. I can tell when there's a baby there, but that's pretty much the extent of my ability to view USS. Glad they send reports out! I hope to become a Psychiatrist, so hopefully my inability to understand USS won't hinder the patients' care too much.

Is EJ elbow jerks? Fortunately, I'm on a neurosurgery block at the minute, shadowing the junior doctors so plenty of opportunities for practice!

[fireheart]

If you're having to take blood with kids, try and distract them.

[Kristev]

A book helps me, most of the time. I'm either reading it or discussing it, so either way, I have something else to think about while they're putting that needle in me.

[Primer]

I have one vein inside my left elbow that is really easy. All the rest are either extremely painful or extremely difficult. If the tech takes my advice and goes for that one vein, I almost never even feel it. The pinch of the tourniquet is worse than the needle stick.

For the IVs in my hand, all I can say is that it's worse than a hornet sting, but not quite as bad as a scorpion. And that's for either the lidocaine OR for an IV without lidocaine.

[fireheart]

For some reason, whenever they take blood, I start hyperventilating. Even though I no longer cry when I have blood drawn
Dunno if that's a normal reaction

ETA: If you're planning on being a GP and getting trained to insert/remove Implanon, I would strongly encourage your patients to bring in an iPod or something similar to distract them during the procedure. While it's fairly minor and you DO receive a shot (or 2-3) of local anaesethic before they insert it, the huge f@#$ing needle can cause some people to panic. Even my friend, who is not normally afraid of needles, baulked the first time she went to have it put in.
I think I made the doctor at the clinic laugh a little bit though because during the procedure, I was dancing around to "Don't Stop Believin" on the table.

[trailerparkmedic]

EJ is external jugular; when we can't get peripheral IVs, that's a good place. In my state, only doctors can start them.

When I mentioned ultrasound, I meant ultrasound for peripheral IVs. My hospital reserves that for the residents but often nurses do it after training. Basically you use a bedside ultrasound to look for the deep veins and to guide the needle. I don't imagine this is common outside of the ER but it's a cool trick and useful tool.

I do work in an ER so that's why things like feet & ultrasound are normal to me. We try very, very hard to avoid central lines and our patient population doesn't always have a juicy AC. I'm not suggesting you actually do feet but think outside the box.

Oh, and if a patient has an implanted port and they need more than a simple blood draw, just get somone to access the port. Their veins are probably crap and it's good to preserve them.