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Old 11-03-2015, 11:52 AM
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Default Phlebotomy frustration thread #912

So................... usually my research participant blood draws go well, but I currently have 2 participants whose veins give me problems. I hate having to put research participants through more than 1 stick.

My current problem child has palpable veins and I get in and get a flash and then nothing. I try pulling back and still nothing. It is like the vein just deflates. so aggravating.

Any ideas on technique for this?
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Old 11-03-2015, 12:46 PM
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Ya gotta fill those veins so full they can't possibly collapse.
1. Put on BP cuff enough to obstruct venous drainage but not enough to prevent arterial flow
2. Hang arm down below heart level...all the way down
3. Wait a sec until arm is really engorged, pump up the cuff a little more
4. Lean on vein distally to prevent backwards flow up against nearest valve, and do stick.
(Assuming you aren't doing local-critical chemistries, like lactate or something)
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Old 11-03-2015, 01:22 PM
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Originally Posted by crunch View Post
So................... usually my research participant blood draws go well, but I currently have 2 participants whose veins give me problems. I hate having to put research participants through more than 1 stick.

My current problem child has palpable veins and I get in and get a flash and then nothing. I try pulling back and still nothing. It is like the vein just deflates. so aggravating.

Any ideas on technique for this?
It is weird that this is still going on. Sometimes you get a batch of defective vacutainers. Is it possible that those tubes are expired or previously tampered with in some way? Because when the tube has lost the negative pressure you will get a flash and then nothing.

Is your problem child pediatric or elderly, obese, an IV drug user?
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Old 11-03-2015, 01:37 PM
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[Is your problem child pediatric or elderly, obese, an IV drug user?[/quote]

Sorry. She is in her 80's and has always had to have multiple draws and reportedly issues with hematomas.

I did grab a different vacutainer tube, but same brand. Interestingly the commercial lab downstairs does not use this type because of issues with them, but for the research draws I have to use them.

I know I was in her vein, but once I failed to fill the tube it was not palpable at all any longer. like a balloon that has deflated.
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Old 11-03-2015, 01:54 PM
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Could you just draw with a syringe and then inject into a (vented!!) tube? or get permission from your committee to change brands due to performance issues?
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Old 11-03-2015, 03:30 PM
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Here's a suggestion. Try to feel your veins then go take a nice warm bath. Every vein in your arms is dilated and palpable after a warm bath.
An elderly person has less muscle mass and collagen and volume. Especially if she is npo for fasting labs. Odds are she is prone to bruising due to taking aspirin or some other medication. It may help to apply warm moist heat using a towel and a plastic bed pad for 10-20 minutes to plump up her veins.
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Old 11-04-2015, 02:32 AM
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My tips for getting a good blood draw:

1. Get warm blankets from the warmer and wrap each arm from the biceps down to the fingertips in the warm blankets. Leave them on for 15-20 minutes

2. Make sure your pt is hydrated (IV fluids, water, etc.)

3. Once you hit the vein, pop the tourniquet, but anchor the vein from the side to keep it from rolling away from your needles

4. You may need to have the patient squeeze or flex arm/wrist muscles to help bring up some of the veins. If you have a squeezy-ball, it works well for this. If not, have them squeeze a rolled up washcloth.
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Old 11-04-2015, 06:46 AM
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Thanks for all the great tips.

Can't use syringe or different tubes since this is a trial and it is all dictated by protocol.

The frustrating thing is I did tell her to hydrate well and she did. i felt that vein and I know I was in and then pffffffft. Had flash. Just frustrating.

I try really hard to make research visits as pleasant as possible because they are already going through so much. That doesn't include multiple sticks!

You can have 20 good ones, but it is the bad one that makes you grit your teeth!
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Old 11-04-2015, 09:30 AM
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Can having large valves inside your veins cause such a problem with draws? As I've gotten older I keep hearing about that every other time I have to have blood drawn as the frustrated phlebotomist glares at my arms.
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