Taking Blood

[Seshat]

Also, most of these sites might sound barbaric, but if we're hunting that hard for a site we really, really need your blood and you really need some medicine. Even dilala comes in tablets; when it comes down to it, there's only a few medicines that really MUST be given IV.

Also, the femoral artery and vein are among the largest accessible vessels in the body - they're near the surface when you're at the top of the thigh (on the inside); and feed the entire leg - including those nice bulky walking muscles.

The armpit might be another accessible place, but probably really uncomfortable for patients. The arms' main arteries and veins go through there: if you study your own armpit you can probably see the tracery of red and blue.

[PandaHat]

Was asked to take blood from a patient in HDU today, one whom a nurse told me had horrendous veins. Literally could not see/feel any veins at all. As I was looking, the patient told me that they'd been stuck upwards of 140 times since they'd come in. I decided I wasn't comfortable trying - i'd literally be guessing. Patient thanked me profusely!

[Sapphire Silk]

Also, the femoral artery and vein are among the largest accessible vessels in the body - they're near the surface when you're at the top of the thigh (on the inside); and feed the entire leg - including those nice bulky walking muscles.

The armpit might be another accessible place, but probably really uncomfortable for patients. The arms' main arteries and veins go through there: if you study your own armpit you can probably see the tracery of red and blue.

Nurses can't access the femoral vein or artery, and it is really dangerous; you can bleed out very quickly if you screw it up. It's a doctor skill and thank goodness.

Armpit's are too unsanitary, and painful.

Though I did have a colleague put an IV in a guy's eyebrow once (only vein he had). We routinely use scalp veins in infants.

[fireheart]

Though I did have a colleague put an IV in a guy's eyebrow once (only vein he had). We routinely use scalp veins in infants.

Not so much the IV in the head for infants....(cause I don't see enough infants hooked up to an IV) but the image of an adult having a needle poking out of his eyebrow while he nonchalantly reads a book is hilarious

[Miss Maple Leaf]

Though I did have a colleague put an IV in a guy's eyebrow once (only vein he had).

Okay, now I have a mental image of an adult sitting there with an IV in his eyebrow calling out to random people "Hey guys! Check out this badass new piercing. Pretty sweet, huh?" while gesturing to the IV pole and smirking.

...My brain scares me sometimes.

[Seshat]

Nurses can't access the femoral vein or artery, and it is really dangerous; you can bleed out very quickly if you screw it up. It's a doctor skill and thank goodness.

When I've had doctors puncture me for whatever reason, it's inevitably been nasty.

Nurses or phlebotomists (there are specialists in blood draw here who aren't otherwise nursing trained) are almost always better at it, in my experience.

But I can quite understand not wanting to mess around with the femoral blood vessels.

[PepperElf]

I once was dehydrated enough they couldn't put an IV in me... almost. they kept trying the hand first, and finally found a vein in the side of my right forearm that worked. they could have used my elbow but they said that was a last resort because they didn't want to immobilize me.


Oh and I had one guy... I dunno what he did but he fucked up a normal blood-sample draw. Before he could put the test tube on, blood started shooting out in a tiny arch! I'm not sure what was worse for the guy... that he screwed it up like that... or that I thought it was hilarious.

[dalesys]

Oh and I had one guy... I dunno what he did but he fucked up a normal blood-sample draw. Before he could put the test tube on, blood started shooting out in a tiny arch! I'm not sure what was worse for the guy... that he screwed it up like that... or that I thought it was hilarious.

Did you start singing the Beverly Hillbillies theme? ... red gold ...

[Maria]

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!)

Thank you. From someone who usually engage in a screaming match, just to be believed, THANK YOU for just having that perspective! People who have a difficult time, whether it's physical or emotional, may already kind of feel bad about it (I know I do). So when you ask those questions, it communicates that you're cool with whatever challenges are involved. I hope you realize you rock, just for that.

I wanted to add, if you know you've got a nervous one, resist the urge to start touching veins other than where you both agreed to try first. That can be freaky to someone who's already been through crap. You might even find it helpful to fold your hands when asking questions, to show that you intend to listen before you act. Oh... and if it takes a couple tries, or your patient yelps or cries, it might make you feel bad, but some of us have bodies that just do that.

The one other thing I have to offer is this - remember that people who are nervous or flat-out afraid, there's usually a darn good reason in there somewhere. For me, I once refused a blood draw because the order was a mistake, the doctor and I had already agreed not to do the test and he forgot to cross it off on the paper. But the nurse insisted in spite of me verbally and physically refusing her, to the point that she broke my arm in the process of doing it. And that's not even the worst story I've ever heard. There's nothing you can do to ever make those kinds of things magically disappear, but just the process of asking questions and respecting the answers, tells your patient that you're one of the Good Ones, and it's seriously appreciated.

And if any of you people ever run into a patient who stares you down like an injured badger, and needs the blue butterfly, back of left hand, count to 3, talk about their cat the whole time, and still expect a couple screams and some crying... I really am sorry, it's a hassle for me too, but thank you for working with me anyway.

[jedimaster91]

Oh and I had one guy... I dunno what he did but he fucked up a normal blood-sample draw. Before he could put the test tube on, blood started shooting out in a tiny arch! I'm not sure what was worse for the guy... that he screwed it up like that... or that I thought it was hilarious.

Sounds like he managed to hit an artery instead of a vein. That takes skillz.

I once refused a blood draw because the order was a mistake, the doctor and I had already agreed not to do the test and he forgot to cross it off on the paper. But the nurse insisted in spite of me verbally and physically refusing her, to the point that she broke my arm in the process of doing it.

That's really horrible and I'm sorry that happened to you. I hope you reported that nurse. There were two things drilled into me in school: one is you do not touch a patient without an order. Second, if the patient says stop, you stop. Do not pass GO, do not collect $200.

[PepperElf]

No, I didn't sing - I just laughed.

And I don't think he hit an artery... it wasn't pulsing, just a long thin stream that arched. but hey you never know i guess...

[iPanda]

For some reasons, the nurses or whoever is trying to put in the initial needle always shrug me off when I warn them that someone experienced needs to do it for my grandmother; I explain to them in full detail, as to WHY they need to heed my warning. My grandmother's veins are very obvious and seem like they're easy -- oh, but oh noo, it's a trap. Her veins are slippery and even when it seems like the needle is going to go in - SLIP - nope, it's away and you're now bruising her arm in all sorts of places just to get the first needle in. They go up and down the arm and by the end of the day, 2 to 3 people will have come by to try it and her arm will be bruised, black and blue from her knuckles to her elbow.
It's absolutely terrible. My grandmother never complains, only asking if they could get someone experienced, not a student or newcomer, but after they've left the room, then my grandmother shows how much pain she's in.
In the end, they usually give up on trying to put the needle in until they absolutely NEED to get some fluids in or blood out.
Ugh.
And this isn't a one time deal because I go to the hospital frequently with my grandmother. In a span of 3 months we went to 3 or 4 hospitals and it was always the same situation.
They'd ignore me even when I laid it out to them in a simple, calm manner.

Once, they thought they had gotten the IV in and then put some medicine of something in.... few minutes later, POP, the iv popped out and the liquid spilled out too. Now, that's a fail.

[Andara Bledin]

Next time they ignore you, take pictures of the results. Use them to show the next crew that she's a problem stick and if they still try to ignore you, talk about how they're committing elder abuse by torturing the poor woman. Because, really, that is what they're doing.

^-.-^

[Bronzebow]

Here's how I cope with getting needles. (Note that I'm usually a hard stick, and that I have a pain disorder (fibromyalgia) which makes it even worse.)

I bring one of my comfort toys (I have two plush tigers) to cuddle with whichever arm they're not attempting. Even if you're not in a pediatric unit, it might be worth investing in a generic, friendly-expression teddy bear. One that can take some serious washing.*

I lie down if possible, sit down if not. I'm usually easier to stick if I'm lying down.

Immediately after I'm torniqued, I start pumping my fist. (making a fist then releasing it)
Note: the torniquet is inevitably quite painful for me. To be tight enough to be useful, it has to be tight enough to hurt quite a bit.

I always look away.

I babble at the phlebotomist. About anything or nothing.

I ask not to be told when the needle insertion is about to happen.

Oh dear sweet merciful heaven, this is about the only thing that'll keep me from fainting. I can't look at the needle, I can't look at the blood, I can't look at the bandage if it starts turning red, and I certainly can't think about it.

I sing songs from Lion King and Aladdin when I'm getting stuck just to make sure I don't think about it. If I fail, I come close to fainting. Ugh!

Once, I'd gotten blood drawn and was on the road leaving the doctor's office about five minutes after. I saw blood on the bandage on my arm and started almost fainting right then and there. That was the first and only time it took so long to react, and it scared the life out of me. I'm very lucky a gas station was right off the road, so I could pull in and blast some cold air. Now, I bring pre-peeled oranges and the nurses know to make me lay down for a few minutes after.

I really have no idea why my mental reaction is so strong. It just is, and it sucks.

Edit: I actually got light headed typing this post. 0.o

[Seshat]

I had a gastroscopy this year, and was a hard stick for it. Ended up with a butterfly in my right hand - and a splatter of blood all over the hand.

I know, because I woke up with the dried blood still on my hand.