mount_type: "" Click to visit Blood Collection: Special Considerations, Obese Patients hb``g`` @16 N$00Le@L,9$)_5M2APPP*dW;b]0D&0dxAAmCfFO7008X`&` *7h_P tex4\T'# ` 1 endstream endobj 239 0 obj <>/Filter/FlateDecode/Index[33 163]/Length 27/Size 196/Type/XRef/W[1 1 1]>>stream The person performing venipuncture can administer 10 units of bacteriostatic saline which need to be injected intradermally. Approach Considerations. Before you start injecting needles into people, make sure to get a proper training and get used to the entire process. I've been an RN for almost 3 years and an ED tech prior to that (which is where I learned my IV skills- nursing school sure didn't teach me much!). Enjoy :). Always try to draw blood from veins that are lowest. Firstly, they are sick. It all depends on your preparation and equipment. You could get help from them. When the last one is done, you need to remove the tourniquet. After a few minutes, gently tap the site of the puncture with your fingers to make the vein pop out. Any time that you need blood drawn for lab work,, I'm Lou, and welcome to Phlebotomy Examiner! 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. You want to lessen the number of sticks you give to the elderly. While this process is one of the more basic tasks that you will be assigned when working in a hospital, clinic, or medical practice, it can be daunting for many professionals. window.ClickTable.mount(options); Orange light highlights veins as deep as 3 mm. All e-mails from the system will be sent to this address. These can include: Learning about your Patients who are severely dehydrated can also make it difficult to find a vein. In fact, the majority of intensive care units require their nurses to possess these skills. This can help individuals with deep veins, who are obese, or with some edema. For routine antisepsis, you can use a standard alcohol prep pad or alcohol-impregnated swabs. If a person is overweight, it might be harder for a professional to find the vein. The Highest Paying Jobs For Nurses With a BSN, Types of Masters in Nursing Degrees & Specialties, Pros & Cons of Getting a Master's Degree in Nursing, Nurse Practitioner vs Physician Assistant, Highest Paid Nurse Practitioner Specialties, How to Conduct a Nursing Head-to-Toe Assessment, How to Read an Electrocardiogram (EKG/ECG), Understanding and Interpreting the Glasgow Coma Scale, Complete List of Common Nursing Certifications. Ask the patient where they usually get stuck. I have had patients tell me nurses are more successful in one arm than the other, etc. One thing that Sometimes, its even hard to feel them with your finger. This is an extremely large vessel and if stuck properly can yield excellent blood results. For example, in a case of a patient with fragile veins, it is much better to skip a tourniquet as it may cause the vein to blow out. The elderly lose fat tissue as well as muscle mass, making their skin saggy. 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 Has 12 years experience. Doctors have access to deep veins like the femoral and subclavian vein that other phlebotomists dont have. By placing a warm towel over the veins, you are increasing the blood vessels which will make them more visible. But when dealing with a particularly disruptive or difficult individual, its imperative to balance both sympathy and professionalism in this matter. Webwhy might it be difficult to draw blood from an elderly patient The skin becomes thin and blood vessels become weaker how much whole blood is needed to yield 5 mL of serum Then, apply heat to the lowered arm. Next, locate the vein you will be using for the blood draw. They can be riskier, especially if you need to draw a lot of blood. You can try several approaches mentioned earlier in our venipuncture guidelines that will increase the vein. 0000022045 00000 n However, this article will take you through the basics of drawing blood so you can understand the steps and guidelines. 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. 0000029232 00000 n 0000005419 00000 n The rightvein should feel somewhat bouncy as you press on it. There are tips for making veins pop out when taking blood. Donating Platelets? Has 7 years experience. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with blood draws. If the person is dehydrated or hasnt been drinking a lot of fluids, get them to drink some and see if that helps. Most times, drawing blood is not that difficult, but there those occasions when you will get a difficult person. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. 0000031735 00000 n If necessary, apply the tourniquet and examine the median cubital, cephalic, and basilic veins. On top of that, there are a lot of individuals who fear (or dislike) going to a doctor. First, gather all of your supplies and discuss with your patient what you are going to be performing. The number of samples or volume of blood needed will tell you which size syringe to use. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. Deliver blood specimens to the laboratory promptly. Another technique is for you to use a blood pressure cuff. Dismiss. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. Follow the cephalic and basilic veins down the forearm. Persons must be trained to use the blood pressure cuff. 0000008644 00000 n This will move their fluid and/or tissue out of the way so you can see a good vein. 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 After identifying the site for the blood draw, gather the appropriate supplies needed. 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. This is the name displayed to others on any playlists or clips you share, Copyright 2023 by Alexander Street, part of Clarivate, Logo of Alexander Street, part of Clarivate. Should RaDonda Vaught Have Her Nursing License Reinstated? Before you can start, you need to ask the patient if he has any allergies to drugs. Using a tourniquet is something most people are used to seeing during difficult blood draws. Many times combining techniques can mean the difference between finding a vein or not. Doing so can help move veins and tendons away from each other increasing the likelihood for a vein to show up. All rights reserved. You may have to apply heat more than once. This will lead to a better compression that will properly regulate the pressure. Lastly, you will have to mix tubes with an anticoagulant. Throw everything in proper containers. Without proper specimens, unhelpful or even harmful medical treatment could happen. Follow your institutional policy when using blood pressure cuffs. Usually, it happens due to squeezing or massaging around the site or due to prolonged application of the tourniquet. If you dont know what a vein feels like, practice by feeling on yourself with you index finger. Also, it is the basis of diagnostics. If you are drawing blood from an arm, make sure to sit near the patient, as close as possible. 0000007172 00000 n Superficial veins often times can't handle an IV bolus or radiology contrast. Would hate for the patient to have to come back and drink that Glucola again. The needle should fully penetrate it. link to Blood Test Vs Blood Donation (Comparisons), link to No More Blood Tests For Marriage License. As you get older, most of you systems tend to shrink and they become more fragile. 0000185079 00000 n 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. Has 9 years experience. Spend a decent amount of time looking for good veins. Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. Next step is explaining the procedure. WebObesity isn't just a cosmetic concern. So, before attempting to draw blood, look at the 3 areas mentioned above for the best veins to access and draw a blood sample. In order to prevent hematoma, you should only puncture the uppermost wall. Massaging may help you in finding a vein if you have not already found one. 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. The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. Make sure not to press too hard! Do it by performing a quick backward motion. Whether youre becoming a nurse, a doctor or a certified medical assistant, youll probably have to draw blood countless times over the course of your career. On the surface, it seems as a rudimentary procedure, one that doesnt require any special training. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. It is the first area to look for veins. Maybe they can listen to some relaxing music, breathe in and out calmly, and encourage them to not be hard on themselves for having difficulty. Dont be discouraged if at first, you dont access the vein. However, in addition to our natural vein anatomy, here are several reasons why your veins may pose some difficulty when doing a blood test. This study guide will help you focus your time on what's most important. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. The information provided should not be used for diagnosing or treating a health problem or disease. Then, massage from the wrist to the elbow. Password must have at least 8 character(s). Otherwise, it may indicate that you have missed which is when you should immediately back up. As a phlebotomist, venipuncture is one of the main parts of your job. 0000013386 00000 n Sometimes you can find a good one there, though be careful as you insert the needle. Everyones arm anatomy is different and while one technique may work for a person, combining two or three may be the answer for another. When you are retaining water, it increases the total volume of fluid that is being pushed through your blood vessels by your heart. 0000012940 00000 n Secondly, they lay most of the time. Make sure you check with the nurse first for permission. There are numerous situations where you should refrain from using a tourniquet as a part of your equipment. In most cases, simply following best practices and knowing how to find a difficult vein is the best way to carry out a successful draw. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. When performing venipuncture, make sure to sit whenever you can. They are springy and bouncy. Fourthly, they are not very active, possibly causing lower blood pressure, hence slower blood flow. Specializes in RN-BC, CCRN, TCRN, CEN. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Use either a syringe or the luer adapter with the butterfly system. However, for the elderly, it may be difficult. Slapping can lead to contraction which can further decrease the veins, producing an adverse result. This can cause an overall loss of plasma in the blood, and the sample could be unusable. This is especially important for babies and small children that have the natural aversion to needles. Genetically, we dont get to choose our veins. 0000012097 00000 n Just my opinion. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. 6. Sometimes, the patient may experience hemoconcentration. An important tip - take extra supplies into the patients room in case you need to attempt a second 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. There are two main ways to find a vein to draw blood. During phlebotomy, the doctor is the one that needs to ensure everything goes well. }; Most of the time, the visibility of the vein depends on the patient. Liver function studies. Other times, they dont want to pop out or raise for the phlebotomist to be able to draw successfully. 0000027834 00000 n The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Then, deflate blood pressure cuff and apply tourniquet. Do not snap your fingers over the vein as doing so can be painful and can initiate clotting activity, resulting in erroneous test results. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. I have had patients tell me nurses are more successful in one arm than the other, etc. If using wet or damp washcloths, do so with caution. As a result, this will lead to the release of histamine increasing the vein. Standard data rates may apply. If I can't feel it then I let SWAT come in with the ultrasound. WebSome obese people are no prob, but some have deep veins, rolly pollies, etc. Apply heat for about 3 to 5 minutes and then assess for vein. Use your index finger to palpate and trace the standard path of the vein on the arm. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. I am a Licensed Phlebotomist and Certified Medical Assistant of 15+ years with 14+ years of clinical experience. 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? For example, Red Cross Blood has pointed out that many individuals will have had blood drawn before and may be able to point out the vein that was used in that procedure.2 If this is the case, you can streamline the process of locating the proper vein to draw from. Invert a BP cuff so that the blood can go to the lower regions of the limb. If you donate frequently, be sure to take multivitamins with iron to ensure you continue to. Before and after the insertion, the tube should be left in the holder. Create an account and get 24 hours access for free. HlV7WF#J$% r!h {7@)RRXZ4J9(e??@!o]h&Do?Y[L *fIXH^ Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. 196 45 Call us at 1-866-236-3276 to report any additional health information that you forgot to tell us, if you have any problems or if you needed medical care after giving blood. They already have pain, so lets make the process easier and more comfortable for them. I'm having a hard time finding veins then starting IV or drawing blood on obese patients. Also, avoid cotton as fibers may stay in the wound and reopen it later on. Ask the individual to elevate his or her arm at the elbow. Sometimes, it can still be hard to find the vein after applying the tourniquet. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. 0000028908 00000 n Place it at the chin and lightly draw a straight line. Massage the arm. Fluid retention. 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. This will fill them up much quicker which is a great way to finish procedure faster if you have a troublesome patient. Ask the patient where they usually get stuck. Press the space key then arrow keys to make a selection. Its important to do everything in your power to ensure the comfort of the patient when drawing blood. Get a good night's sleep the night before your donation, eat healthy foods and drink extra liquids. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. In the event that you cant locate the appropriate vein strictly by vision, this can be a great alternative method. The hand and lower arm are the best places for transilluminators. That is usually the last resort. However, thats not always a luxury most phlebotomists are afforded. Blood tests are no longer Hi! Thank you. Sure, its easier said than done when a needle is about to enter a persons vein, but tension can constrict veins. Best practices in phlebotomy involve the following factors: Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Blood Test Vs Blood Donation (Comparisons). If the needle site starts to bleed, apply pressure and raise your arm straight up for 5-10 minutes or until bleeding stops. 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. Fat, or obese patients, have more fat around their veins which can make it difficult to find the vein for drawing blood or starting an IV. Do not massage down as doing so will defeat the purpose. I hope you find my posts helpful. The practice of phlebotomy is not something that can strictly be learned from watching videos or reading a how-to guide but something that must be practiced repeatedly in a controlled environment with other trained professionals. 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. Once you have located a vein, you can cause increase distention through massaging or exaggerated palpation (pressing repeatedly over the top of the vein). 2. This instructional video, from the Blood Collection series produced by Medcom, Inc., is about special precautions for drawing blood from obese patients. If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. What Does VEAL CHOP Stand For in Nursing? 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. 0000036112 00000 n If the veins are deep and not visibly popping out, use a tourniquet and have the patient lower their arm. Anchor the vein. Use left/right arrows to navigate the slideshow or swipe left/right if using a mobile device. This forces blood up and fills the vein. It is also possible to apply multiple tourniquets. I am a full time phlebotomist and I enjoy my job. The worst thing you can do is to continue stabbing the patient. Insertion point should be under 15 to 30 degrees angle. The forearm is about the last place to look. You dont have to drink tons of water the night before but the recommended daily water intake should suffice. Once you remove the needle, gauze should be applied for a bit. 0000000016 00000 n 1-917-426-3524, By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. Application of heat will cause vasodilation, making veins easier to see or palpate. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! The WHO has best practices that are key to preventing infection and being successful during blood draws. 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. Make sure that tourniquet is removed before the needle. Insert the beveled needle at a 30-degree angle into the vessel. qG@OWdeDHj5b$Ze+QPbk8oo9uDP+GJXU'X96B@;"p4-BBR'@;Z6U`[VTk^9@(} f4qa l8pE2xr/4A-\1~},HZU!6)QH` T@C 6y@ Eh7| c"qnN n Qf3NQA(d2=d9 yN|1*XYa28YSIkefHIly `zhMs\\U@>fU^s,'/ksc>M# /jD/[7=6e*6c\u1_UL3Rll5nd;m,&!w{,`YNk 3 ]^]u>mrA- k`JM4>!Aoa0z't@l"4vl~"Frq}}]#)V1Z/8BnMs^|^x}^%0)&f3FY8I'wU\`Osd{z_b|{Q30Sck-BT[@'hJV2y )lw[;w]p39=%=N|=}|60m2}Edt/#2x!Ta}$n8x4py}` lt endstream endobj 202 0 obj <>stream The device may be limited in that instance. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. 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. Try light exercise beforehand. I'm Kadia. Reflecting off the subcutaneous tissue, the light colors subcutaneous and fat tissue. 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. More than one-third of U.S. adults and 16% of U.S. children are obese. But lots of people swear by it, so there might be something to it! WebApplied Muscle Tension (AMT) is a series of simple exercises that help your blood pressure stay up and improve blood flow, so your chance of experiencing any side effects, like Carrington College does not recruit or enroll residents of the European Union. The needle is in place but there is no blood flow? This can help reveal the vein. Then, add massage to the combination. You need to keep their attention and make sure they do not notice the needle. However, you will need a doctors permission for this. Unfortunately, some veins are significantly easier to see than others. When the blood draw is complete, gently release the tourniquet. Nitroglycerine is yet another substance that can help you out during phlebotomy. If they come in for their appointment well-prepared, it should be easier to find a vein almost immediately. Over the years I have drawn blood from many older patients, learning tips and techniques along the way in dealing with them and drawing blood from them. WebInflate cuff to 30mm Hg above systolic reading and maintain pressure for about 1 to 2 minutes. Perform hand hygiene and don proper PPE. Follow us and never miss out on the best in nursing news. of water (or other nonalcoholic drink) before your appointment. 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. allnurses is a Nursing Career & Support site for Nurses and Students. go-to source for nursing news, trending topics, and educational resources. The site should not be warmed to a temperature higher than 42 EC. Kindness and helpfulness must be shown to them. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. Linkedin, How to Identify a Usable Vein for Blood Draws. If the antecub has already been accessed there are great options for venipuncture. They can help you to find a usable vein quickly, so you can get the blood draw you need, and your patient can remain comfortable throughout the experience. Anchor the vein from below with your non-dominant hand by gently pulling on the skin distal to the insertion site. We'll need to know about all prescription and over-the-counter medications you're taking. This represents the massive concentration of certain molecules in the blood. 0000001848 00000 n They should be spread distally from proximal joint to the insertion site. In the case of elderly patients, make sure to use smaller needles and to be extra gentle. Finding difficult veins isnt impossible, but it can require a few different methods to be put into place. Dispose of contaminated materials and needles in the designated hospital-approved containers. venipuncture is one of the main parts of your job. I'm Kadia. This will cause a lot of mess. Veins may collapse in the process and failed attempts at blood draws lead to hematomas which bring about pain. Scar tissue can especially be problematic as it is hard to penetrate. Password must have upper and lower case letters. While doing all of this, make sure to penetrate the skin with one quick move. tips on starting IV, drawing blood on obese patient. professionals to write our content whenever possible.

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