Phluck you, Phlobotimist!

[Biggirl]

Due to my shit being all fucked up, I have to get blood drawn frequently. Today at the bloodletters, my two favorite vampires were not in. Uh oh.

"Take the blood from the back of my hand. You will not be successful with my inner elbow."

"I have to try there. It's the rules."

Since I've been told this before at this very lab, I don't doubt that it very well may be 'the rules'. I don't give a happy fuck about you rules. But I'm not as nasty in real life as I am here in the Pit, so I left out the part about the 'happy fuck' when I gave her my opinion of the rules. The vampire sighs wearily and ties the rubber thingy above my elbow.

"Miss, perhaps you didn't understand me. You can try to draw blood from that spot but it won't work. And, lemme warn you, if you stick the needle in there and then start digging around with the needle looking for the vein you thought you had in your grasp, I'll most likely kick you in the shin. Not on purpose, but it fucking hurts when you do that."

Miss Vampire studiously ignores me and wipes my inner elbow with a swab, flicks at it with her finger and says triumphantly, "You've got a good vein right here."

"What are you, deaf and retarded? Why won't you fucking LISTEN to me, you bloodthirsty know-it-all? I swear to Chuthulu that if you go digging around in there, I won't kick you in the shin by accident. I will jump up and roundhouse you to the head with my boot!" I said-- in my head. Out loud I said, "It's fooling you. It always does that. You will not get a good stick."

It was like a challenge.

Poke. No blood. Of course not. Slight wiggle of the needle-- I grit my teeth. No blood. Use finger to steady vein while digging around in my arm for-- 1 minute. . . 2 minutes. . . 3 min---- ah blood! Miss Vampire is vindicated!

Um, no. After the first initial gush of blood, there is a drop, drop, drip, drip, dribble, dribble then, nothing. The tube isn't even an eigth of the way filled. I know what's coming next. Oh boy, howdy.

Big sweeping movement of the needle. Now pull it out a little, now stick it in a little, swing it to the left, swing it to the right, angle it up, angle it down. Poke Poke Poke YOU FUCKING BITCH. That FUCKING HURTS! GODDAMN IT, I TOLD YOU!!!!!!!

Finally, she pulls the needle all the way out and then, get this, starts poking the inner elbow of my other arm with her finger.

"NO!" I actually yelled. Then I calmed down enough to say in a normal tone of voice, "Take it from the back of my hand. If you had listened to me in the first place, we'd be done by now."

"I have to try. . ."

"What is wrong with you, you cement-headed little sadist? Just because I didn't roundhouse kick you like I promised myself I would the last time, doesn't mean I won't do it this time. I'll take that piece of rubber shit you're wrapping around my arm and use it on your neck. That way they can collect your blood from you eyeballs!" I say-- in my head. Out loud I say, "You're not going to get a good stick. Really, I've done this before. What makes you think this arm will be any different from the other arm?"

I contemplate just getting up and leaving but I've already taken time off from work to get this done and I'll only have to come back later and go through this again. This time she takes even more time to coax the stubborn bastard up. Me, I can't tell what phlobotimists are looking at when they're looking at the veins in my inner elbow. They are buried deep and I never see the big, juicy thing that they are convinced will deliver buckets of blood.

This time she sticks me with the needle and gets nothing. Not even a dribble. She gives the needle a wiggle and, totally disgusted and angry, I stand up. Talk about freaking out!

Miss Vampire yells at me. "What are you doing? You can't do that! It's very dangerous! You could get hurt!"

"A broken off needle floating around my bloodstream would be a thousand times better than the slow torture you are putting me through, you obstinant quack. Get ready for that roundhouse kick to the head, bitch!" I say-- in my head. Out loud I say, "Sorry. Can you get someone else who'll collect my blood from the back of my hand?"

Yeup, I actually said 'sorry' instead of puncturing her temple with the heel of my boot. The story ends predictably. Miss Vampire herself removes the needle and gets another, smaller one and gets the blood-- from the back of my hand.

[Pullet]

So when are you calling her manager? I wouldn't have left without registuring my displeasure very loudly.

[NicePete]

Next time this happens ask to see her supervisor before she punctures you the first time. Also, ask to have a notation made in your file that your blood is to be taken from your hand. If they won't do it, find a lab that will.

[Biggirl]

So when are you calling her manager? I wouldn't have left without registuring my displeasure very loudly.

She wasn't mean or rude or anything. And I do believe they have a rule about doing the inner elbow first. Plus, I did jump up with the needle in my arm, which is a big no-no. I couldn't complain to her manager that she was following the rules against my wishes.

I have my two technicians who are used to me and know to draw the blood from the back of my hand. They both told me about 'the rule'. One stuck me once in the inner elbow (didn't wiggle or dig. When he came up dry, he removed the needle and did the back of the hand), the other actually listened to me when I said it wouldn't work and didn't try at all.

[Minnie Luna]

I take blood from healthy donors for research purposes. I never stick someone somewhere they don't want to be stuck. Luckily, I know where most of my donors have good veins, and don't try to veer off course. I have one woman who has awful elbow veins, but has a great one in her wrist, and she doesn't mind us getting blood from there.

I have had people go "digging" in my arm, and the feeling is awful, I refuse to do it to someone else. If I don't get you in that first stick and still don't get it after I reposition the needle once, I will remove the needle.

I also always use butterfly needles, which I think are easier to place. The blood doesn't flow as fast, but I only need a couple of cc's, so it isn't that big of a deal.

When I was hospitalized after an accident, I had one of the best. No pain, quick and easy, best I have ever had out of the back of my hand. It may have been the drugs, but I told her she was awesome.

[redtail23]

I'd have asked for a manager from the first "that's the rules" comment.

I don't really care what your rules are. It's MY body!

This really should not be a problem, especially since this is a lab that you visit frequently. Have them check with your regular vamps and put it in your chart.

At this point, I think I'd still call and speak to the lab manager. Explain the problem, tell her what happened (your OP minus the mental asides ;)), explain why you're so familiar with the problem (i.e., regular draws), explain (calmly and politely) how upset you were that this woman completely ignored you in favor of "the rules", then ask why this policy exists, why you were treated this way, and what will be done to prevent similar occurrences (not necessarily just for you) in the future.

IME, it's entirely possible that she's making up "the rules" and/or the absolute need to follow them rather than patient preference. If this is the case, the manager should know how one of his techs is treating patients. If not, then the lab manager needs to spend some time thinking about the arbitrary rules s/he's set up and how it affects patient care.

[Solfy]

I have had people go "digging" in my arm, and the feeling is awful, I refuse to do it to someone else. If I don't get you in that first stick and still don't get it after I reposition the needle once, I will remove the needle.


I agree, and I wonder if anyone around here knows why exactly this hurts so much (beyond the obvious - regular sticks are nothing compared to having them chase after veins under the skin). I'm a blood donor, and I've had two bad sticks over many years. They were memorable and painful enough to make me hessitant about subsequent donations afterwards. (but I sucked it up and did it anyway) I'm not needle phobic, and I think I have a decent pain tolerance, but needle digging brings tears to my eyes.
I really feel for you, Biggirl. Your post made me wince.

[redtail23]

She wasn't mean or rude or anything. I'd differ with you here. I've had a *lot* of dealings with medical staff. Ignoring everything you, the patient and customer, say in order to blindly "follow the rules" IS rude and unprofessional. Some staff (techs, nurses, etc.) get a wee little bit controlling and insist that everything WILL be done their way; I call that mean, but YMMV.

And I do believe they have a rule about doing the inner elbow first. Plus, I did jump up with the needle in my arm, which is a big no-no. I couldn't complain to her manager that she was following the rules against my wishes.Yes, yes you could. While it may be a perfectly valid and common rule for labs, the complete refusal to accomodate patient preferences (especially to the extent of insisting on trying the SECOND arm after you've told her repeatedly to draw from the hand) is very poor behavior on the part of this tech, and well worth a complaint to management.

If management is so micro that techs aren't allowed to make this kind of judgement call, then they (mgt) need to be reamed out.

I have my two technicians who are used to me and know to draw the blood from the back of my hand. They both told me about 'the rule'. One stuck me once in the inner elbow (didn't wiggle or dig. When he came up dry, he removed the needle and did the back of the hand), the other actually listened to me when I said it wouldn't work and didn't try at all.See, exactly. Other techs in the same lab used professional judgement to decide how and when to follow (or not) the lab rules. That is proper patient care.*

This tech was rude, unprofessional, showed poor judgement and provided atrocious patient care. She shouldn't be reported to management, why now?

*FWIW, I'd get a feel for the manager before mentioning this, if you call. If it's a control-freak micro-manager, it could be that the good techs would get in trouble for not "following the rules".

You could also ask to always be assigned to one of these techs or warned if they're not available. The lab may not be able to do this, however.

[Biggirl]

I am going to see about getting a note in my file about that, redtail. In fact, I think I'll call right now. Thanks for the suggestion.

[pbbth]

Best thread title ever!

Sorry about all the pain and thundercuntery.

[Yllaria]

Does the lab have any rules about performing procedures that the patient has not consented to? If you have not consented to having the blood drawn from the inside of your arm, then doing so should be illeagal, shouldn't it?

[OtakuLoki]

I'm still completely flummoxed by the idea of a phlebotomist who so completely ignores the patient's advice and requests. I've got deep veins. They bleed well, once the needle finds them, but they can be a challenge for many a blood-sticker. And although I'm right-handed, it's far, far easier for someone to find the vein in my right arm than in my left. So, while it's normal procedure to go for the 'off' arm, I usually ask that the phlebotomist go for my right arm, first.

On the rare occasions that they don't listen to me, they get one attempt, and then have to listen to me crowing, "I told you so!" :D

I think that, for the benefit of the other patients this twit will be dealing with, you might want to make a complaint after all.

[tdn]

Does the lab have any rules about performing procedures that the patient has not consented to? If you have not consented to having the blood drawn from the inside of your arm, then doing so should be illeagal, shouldn't it?

I was wondering about that too. Do you have to sign a consent form before each draw? I think (and IANAD'sLOALT, STIFWIW), even if you do, you can withdraw consent in the moments before they stick you. Simply refuse.

[Antigen]

Just a voice from the other side - I'm not a phlebotomist but I had to do a lot of outpatient blood draws during my med tech training.

Someone sits down in the chair, doesn't roll up their sleeves, and then says "my veins are bad, you'll need to use a butterfly needle (http://blog.thesmithlife.com/solumedrol_iv/butterfly_needle.png) on my hand". It's a little insulting to have someone tell you how to do your job - but then again, there are some patients who really do have crappy veins in their arms and have learned the hard way through botched blood draws. And there are people who think they have bad arm veins but have actually only had bad phlebotomists who didn't know what they were doing. So it's hard to know what to do, because in the end, the phlebotomist's job is to get a good specimen for the lab to use. You can make the patient very happy and use the needles they like and everything, but if your specimen is no good, he'll have to come back for a second try. It's been my experience that the flow is better from an arm vein, in general, and so you'll have less chance of clotting in the specimen. There's also the problem of phlebotomists forgetting to use a blank tube to compensate for the "dead space" of the tubing, and leaving us with short specimens we can't use.

I think it's a tough job being a phlebotomist - your job is stabbing people, for goodness' sake! But this woman was wrong to go ahead and try both arms before considering that maybe you were telling her the truth about your lousy veins. I can't say that I blame her for trying your arm first, though - I'd have at least put a tourniquet on there and had a poke around to see if there was anything usable. But the "sweeping" of the needle! Ack no! You pull out a tiny bit, change angle, try one more time, that's it! No fishing!! I want to slap all phlebotomists who've been trained to "fish" like that.

[thirdwarning]

I'd let the manager know, and then I'd think about calling someone higher up, to try to get the rule changed.

I've had trouble with needle sticks in recent years, in fact I came out of there once with three little band aid places. The last couple of times I've been in the phlebotomist actually asked me if I had a preference for where she stuck me. If you're doing this on a regular basis, it's a waste of their time and yours, not to mention using extra equipment, to do something so arbitrary that won't work, just because some idiot made a stupid rule. And that should make a difference even if they don't care about hurting you.

I definitely think you should make yourself heard about this. It may be that they've had complaints from other people, too.

[Antigen]

I was wondering about that too. Do you have to sign a consent form before each draw? I think (and IANAD'sLOALT, STIFWIW), even if you do, you can withdraw consent in the moments before they stick you. Simply refuse.

In Canada, at least, it's an "implied consent" situation. You show up with a prescription for blood work, sit in the chair, and give me your arm. That in itself shows you're consenting to having your blood drawn. I don't know how it works here, I've never drawn blood in the States.

[Cat Whisperer]

As a former lab technologist (these are the phlebotomy experts in hospitals and labs, NOT the nurses), I always went for where the vein was. If it wasn't in your elbow, I used the wrist or hand (even feet on some people - usually diabetics whose arm veins are finished). A lab tech has magic fingertips - we know exactly where your vein is, and we know what kind of vein it is. If you have hard, rolly veins, we can tell that from the prodding with our finger (and then we nail that sucker down tight before the needle goes in). You don't just stick a tourniquet on and jab away - you find what you're pretty damned sure is a good vein before you start sticking needles into people's flesh.

We had no "have to try the elbow first" rule - we did have a two stick rule, though. If I couldn't get it in two, I had to call someone else in. The patient always had the last word, though - they could refuse to have blood taken at any time. Then the doctor gets called and he gets to explain to them why they need to co-operate. I would have refused the second elbow stick - she fulfilled what is a stupid rule, now she has to do it your way.

And yeah, standing up with a needle in your arm could easily have injured both you and the tech, Biggirl. I had a patient fold his arm up while I was still taking blood - he bent the needle on his arm bone - it came out with a 90º angle on it. I can't imagine that felt good. I had another patient who jerked his arm as I was taking the needle away, and he caused me to stick the dirty needle in my own thumb. Yell and scream all you want, but stay seated without moving your arms until the needle is in the sharps container, please. Those needles are unbelievably sharp - they'll do damage with just a brush against someone. If you're a fainter, tell the tech at the start and they'll lie you down. I had a large man faint on me (literally); dirty needle in one hand, other hand full of full glass blood tubes, and shoulder propping up a big man.

[Cat Whisperer]

And no, we weren't trained to "sweep" the needle, either - that would blow a vein faster than anything!

[Jackmannii]

It's your fault for having Bad Veins. :)

I'd complain to management, avoiding expletives. Save yourself more problems the next time.

[emmaliminal]

Someone sits down in the chair, doesn't roll up their sleeves, and then says "my veins are bad, you'll need to use a butterfly needle (http://blog.thesmithlife.com/solumedrol_iv/butterfly_needle.png) on my hand". It's a little insulting to have someone tell you how to do your job - but then again, there are some patients who really do have crappy veins in their arms and have learned the hard way through botched blood draws.I had six months of semi-weekly chemo all administered in arm/hand/wrist veins, and I am one of these people. (I do roll up my sleeves, though, so they can see what I'm talking about.) Generally, I say, "I had chemo without a port and my veins have lots of scar tissue, so it can be hard to get blood out of me. Butterfly needles seem to work best." That's not insulting, I hope? Isn't that helping the phlebotomist do their job?

Last time I had a blood draw it took SEVEN sticks, and three different techs, to get the sample. I have even made my peace with the digging and the sweeping (with a butterfly needle, BTW, it hurts a lot less) but seven is a bit much. There wasn't anyone left in the lab to try. I left looking like an especially incompetent heroin addict.

When I was in chemo, I had the world's best phlebotomist ever, no exaggeration. I think a key aspect of her greatitude was that she didn't tell me it wouldn't hurt, and she didn't try to make it not hurt; she tried to do it so she got the blood the first time. That gentle, caring hesitancy so many techs cultivate is (aha ha) bloody murder.

[Biggirl]

So Antigen and featherlou, did you know your stickees were thinking such colorful thoughts as they were being stuck?

As for feeling insulted when a patient tells you where to stick them-- sure you stick 10s of people every day but I am only one person getting stuck, so my experience is quite specific to me.

Also-- my arm vein is so enticing to the technicians. I don't know what it is about it, since I can't see it at all, but they all flick and feel and rub and their eyes light up when the find it-- but it never, ever works. Sometimes it runs away without ever getting stuck. Sometimes it gets stuck, bleeds a little and then hides.

P.S. I get blood drawn 2 or 3 times a month, so I've got a little experience with what will work.

[outlierrn]

tell them you've had the inner elbow done first without success and it's in your chart. then adamantly refuse to allow them to try there, no one's going to wrestle with you

[outlierrn]

ooops

[Dolores Reborn]

I used to get stuck once a month for about a year. All I had to do is remind the swwet phlebotomist that I liked a butterfly needle in the hand, and she never argued. She even said she liked patients to tell her, because she wanted to cause the least amount of pain for the patient. I loved her! She was very gentle.

Now I get stuck every three months by a nice enough guy (different lab,) but he always asks me, "Are you sure? It hurts more there." Yes, I'm sure. And he does hurt me more than the previous vamp. It's still better than missing my vein several times!

Neither of them ever mentioned a "rule."

I agree, you should report him her to a manager.

[Minnie Luna]

I was also taught never to "sweep" and it freaks me out just as much as it does the patient.

I once had a "big guy" come in to donate. He made it through our initial screen (neg for Hepatitis and HIV) so I figured he was "brave" and could make it through a blood draw like he had before.

That was the day I found out why we have the safety bar across the chair. Got him in the chair, get my supplies ready and get him swabbed and ready to go. I get the needle in and I am filling tubes. I needed three tubes (total of about 30 mL of blood, not a whole lot) I start my second tube and notice he is a little clammy and green. I ask if he is alright and he just slumps down. I yell to another tech to get in there, she is shocked, this has never happened before. I ask what do we do, and she says, "Well, finish taking your samples, get a bandage on him and we'll wake him up."

So I finish getting my samples, she gets the smelling salts, I bandage him and we wake him up give him some juice and a cookie and get him on his way. His BP was fine, I think he was just being a big baby....

[emmaliminal]

... my arm vein is so enticing to the technicians. I don't know what it is about it, since I can't see it at all, but they all flick and feel and rub and their eyes light up when the find it-- but it never, ever works. Sometimes it runs away without ever getting stuck. Sometimes it gets stuck, bleeds a little and then hides...Spot on -- mine do that too.

Hey you kids with training in this -- do they teach you about why these fake-out veins happen, how to recognize one, what to do about it, anything?

[Cat Whisperer]

It's always the guys who faint. I'm not sure why - maybe the women who faint are more vocal about telling a tech that they're fainters.

As for patients thinking colourful thoughts, oh yeah, you're well aware. You gotta do what you gotta do, though.

I think talking to management there would be a good idea; if your arm vein feels fat and sassy, it would be very hard to convince a tech not to go there - you're the expert on your own experience, but they're the experts on drawing blood in general. You need to convince someone that your fat, sassy vein is not actually fat and sassy.

ETA: I didn't run across many fake-out veins - if it felt fat and sassy, it almost always was. It might be a rolling vein - seems okay, then rolls away from the needle. Those can be dealt with by stretching the skin tight over it to hold it in place.

[MerryMagdalen]

Phleb here.

I have never heard of anywhere that has an "inside the elbow first" rule; in fact, in some of our patients we're supposed to only stick hands. That's a dumb rule. I thought of a reason they might have that rule though (and it's still sort of dumb); butterfly needles (so I've been told) are more hazardous to the phleb (if you lose control of the wings, the tubing can curl back and cause the phleb to get stuck); they're also probably more expensive.

I can understand the frustration with having your instructions ignored, and with the digging (I'm hard to get blood out of myself). I tend to go with a patient's preferred spot, but there's something to what Antigen says about bad phlebs, unfortunately. About 75% of the time, when the patient says the vein is bad and I think it's good I get blood out on the first stick (the other 25% of the time I take my lumps and go where they told me to). This also works the other way around - sometimes a patient will insist I stick a certain spot, I won't get blood, and then will get blood out of where I would have gone in the first place. Sometimes it is hard to tell the difference between people who have bad veins and people who've had bad phlebotomists.

Biggirl, definitely see about getting a note in your chart, or with your standing order.

Generally, I say, "I had chemo without a port and my veins have lots of scar tissue, so it can be hard to get blood out of me. Butterfly needles seem to work best." That's not insulting, I hope? Isn't that helping the phlebotomist do their job?

I would not have a problem with that at all.

I'm a phleb. I try to get through it with a minimum of pain and mental anguish for everyone involved.

[ENugent]

It's always the guys who faint. I'm not sure why - maybe the women who faint are more vocal about telling a tech that they're fainters.
My theory is that the men are the only ones who faint at the sight of their own blood, because the women are inured to it after cleaning up their own blood every month for years on end.

[madrabbitwoman]

I REALLY understand how you feel.
I had pnuemonia last year and had to have antibiotics via a drip. Technician comes in and starts swabbing my arm Me: er your going to have to use the back of my hand or if worst comes to worst my foot (+ lengthy explaination of what happened with every other drip I have ever had). 35 minutes later, 3 technicians, swearing (me) 10 separate holes in both arms, me nearly fainting - they put the damn thing in the back of my hand - first go no drama.

LISTEN TO ME YOU BASTARDS - Gahhh

[wring]

I don't play that game anymore. I simply state "I'm needle phobic and a hard draw, you have to take it from my hand" and if they argue or protest, I say "I want a different tech, please". I generally go to the hospital vs. a lab in the first place. And I would simply refuse to have it pulled from my elbow.

See, I don't give a rats ass if you think you're a better tech than the hundreds of others who've tried it on my elbow. I'm simply done w/getting poked more than once. You won't get it from my elbow, others have tried. What you'll do is blow my vein, hurt me and you still won't get the sample. I work w/junkies for cristsake, I don't need to return to work w/a bunch of "Tracks" showing, thank you very much.

[beanpod]

Ugh. That sucks, Biggirl. I have veins like pipes. Easy to see, easy to poke, and they drain quickly. No problem with blood donation or IVs--I've even had medical people comment on it in amazement. And even I've run into one stupid bitch who jabbed me incompetently and then fished around for it. Two years later and I still want to go kick her. Only one though, in my entire life--I count my lucky stars. I haven't had to have a ton of blood tests or anything, but I've had a few, and I donate blood--not every time I can, but I try to do it at least once a year, especially since I have type O. It was a harpy working at the Red Cross (who I'm still a little annoyed with, if you can tell) who got me.

This was...oh, I think the 4th or 5th time I'd donated blood, and I knew the routine. I showed up at the Red Cross for my appointment, answered the questions, and went back to the (nurses? phlebotomists? who are those people who take your blood donations? I'll call them nurses for now.) blood-sucking area. Keep in mind that this whole thing probably happened within the space of less than 5 minutes:

The nurse I got was brusque, but I figured whatever, they were busy. I'll refer to her as Vampirella. As she led me to a chair, I warned her that I get dizzy when I sit up, so they should wait until I had a spot to lie down. (I'd been fussed at in the past for not warning the nurse that I get woozy when I donate if I sit up. Now I wonder if Vampirella thought I was rude...) She didn't really acknowledge it, but lead me over to a group of stretchers where a few other people were lying while donating.

I tried to make some cheerful small talk, but she was having none of it. I thought "Ok. Odd," and started to get nervous. But I always get nervous right before they put the needle in, and it always (minus this time) turns out absolutely fine. I started with my deep breathing/happy thoughts/lalala-don'tthinkabouttheneedles-lalala routine, while the pre-bloodletting rituals were performed. Vampirella told me to relax my arm, which I did. Then I felt absolute FIRE explode from inside my left elbow. It honestly felt like I'd been burned.

I wanted to jerk my arm away, but I tried to keep it still. I said "OW! That hurts! It shouldn't hurt that bad."

Vampirella said, "Oh, you'll feel a little pinch, but it'll fade in a few seconds."

I said, "I know--I've donated before and it's never ever felt like this. There's this burning. Please take the needle out and try again."

Vampirella pretends not to hear me, while panic starts to set in my mind. I think: What the hell? Didn't she hear me? Why does it burn? Is there something wrong with the needle? Did I jerk? I don't think I did. Did it break? Did she hit a nerve? Am I being infected with some sort of supervirus? Where is she going...OH THIS BITCH IS NOT WALKING AWAY FROM ME!

Oh yes. She walked away for...probably about fifteen seconds, in hindsight, before coming back. About the time that I was controlling my worries into rage and ready to scream at someone or pull the needle out myself, the dumb whore comes back and flicks at the tubing--sending more fire through my arm with me saying "OW!"

Vampirella seems confused and says, "Huh. That shouldn't hurt."

I interrupt and say, "I know, I've donated before. I know what it's supposed to feel like. This is different. Please take the needle out."

Vampirella continues, ignoring me, "...and we should be getting more blood than this. I might have missed a vein..." and then she grabs the needle and moves it--probably slightly, but it hurt like hell. I was in tears at this point, and she finally looked at my face, and brought over another nurse, explaining her confusion.

I quickly said, "It really burns up and down my arm. Take the needle out," when the new nurse walked up toward me. The new nurse took one look at it and my tears and said "You missed the vein and probably hit a nerve," to Vampirella, and promptly took the needle out of my arm, to my everlasting relief.

I probably missed something, but I think there was a look exchanged, and Vampirella made herself scarce, while the new nurse, curt but at least competent, gave me a pressure bandage and started asking me about how my arm felt. I wanted to leave with Vampirella's head on a platter, but I had to settle for instructions to ice it, not lift anything heavy, and see a doctor if it didn't feel better by the next day.

It hurt off and on in spasms throughout the day, but was better by the next morning. I received a few calls from that Red Cross branch requesting that I donate again--and I explained very thoroughly why I was never setting foot in that facility ever again, and would be donating elsewhere in the future. Pity I couldn't remember Vampirella's name.

[PaulParkhead]

It's always the guys who faint. I'm not sure why - maybe the women who faint are more vocal about telling a tech that they're fainters.



Former blood donor assistant here - my experience was that, of all those who fainted, about 60% were women and 40% men. Every time I saw a small, thin, pale red-headed woman with freckles arrive to donate, my heart would sink. Either she'd faint or we'd be there all day, collecting about 1ml per minute.

The worst folks for fainting, though, were students. Of either sex. Some of our sessions at Glasgow and Strathclyde universities, well, you'd have thought some nasty disease had struck. The place was full of barely-conscious clammy green people.

[Obsidian]

On my left arm, I have a vein that looks great, but is in fact hard to get, a poor producer, and now really full of scar tissue. On my right arm, the vein is a little deeper, but it's fat and a good bleeder-- and it's apparently easy to find once you put the tourniquet on.

It really pisses me of when they insist on digging around in my left arm while I beg them to try the right. And with every botched attempt I get more scar tissue.

When I donate blood I refuse them my left elbow. This is a donation, not a medical need. You'll get it from my right arm or I'll leave. Can't do that with nurses.

It's finally stopped in the last couple of years, since now the scars on my left arm are so obvious, people have stopped trying. It's nice.

[Shayna]

My veins are the exact same way, Biggirl. I also have to get relatively frequent blood draws. I, too, am sick and fucking tired of going home with bruises up and down both arms from the games these morons play with my invisible veins. And every one of them seems averse to using the back of my hand when I ask. It's absurd!

One thing that I've found that does seem to help -- drink 2 or 3 glasses of water within 30 minutes before you go in for your blood draw. Not sure if you've already tried that, but in case you haven't, I thought I'd mention it because it actually makes a big difference with me.

[Leah M]

Oh, phlebotomy.

I was a phlebotomist for a while, and I actually liked the job.

We did have 'guidelines' about where we should try first to get the best specimen, but we also had rules about patient consent. If a patient refused to be drawn, we could do nothing about it. This includes refusal to be drawn from a particular area/site.

It's challenging. Sometimes judgement calls don't go as planned. There are always patients who insist they MUST be drawn with the tiniest butterfly needle available even when they've got huge veins you could hit from across the room with a dart. There are patients who will insist being drawn in a particular spot when you just can't get blood from there. If the patient really insists or refuses something, though, it's the phleb's job to make sure the patient's wishes are respected.

One of the issues at hand is that butterfly needles generally come in smaller gauges, and the risk of hemolysis and clotting is greater than with, say, a vacutainer needle with a larger gauge that draws straight into a tube. (Yes, they are also easier to stick yourself with and they are a good deal more expensive, as previously mentioned.)

Even difficult patients still have rights, though.

If they say don't dig, don't dig.

If they say don't draw from their arm and mean it, don't draw from their arm.

Get a supervisor if you have to, but don't do something that the patient refuses.

Personal discretion is a big part of it, but that comes with experience, too. I had a really big, intimidating-looking tattooed guy in for blood. He was visibly upset and nervous. He said he was usually medicated for blood draws because of needlephobia, but had not been that day. He had huge veins, but I opted for a smaller butterfly needle anyway, in his antecubital.

He passed out mid-draw. His arms locked at the elbows and bent. Luckily, butterfly needles are very flexible, and the needle didn't poke further into him or slip out, it moved with him. If it had been a straight needle or a vacutainer needle, I would have had to pull the needle out to avoid jamming it further into his arm, and because I couldn't get at his elbows because they were locked (I tried unfolding them, I couldn't), it would have bled and caused lots of bruising before I could apply gauze and pressure.

I always did what a patient requested, unless I could rationally talk to them, explain the situation, and had their consent to do otherwise. It was frustrating sometimes, but at least no one ever complained that I treated them poorly.

Even if it's a 'rule', Biggirl, you don't have to consent to it. Don't let them push things on you like that. :( Rules can have exceptions. Sometimes we would get special notes about patients being drawn, so that we made sure their wishes were respected, IE, "Hey, Mrs. X is coming in to have her blood drawn on X date. Her blood is not to be drawn using her arm veins, per special patient request."

[The Second Stone]

Does the lab have any rules about performing procedures that the patient has not consented to? If you have not consented to having the blood drawn from the inside of your arm, then doing so should be illeagal, shouldn't it?

Exactly. Inphorm the Phlobotomist that she does not have your consent to perphorm any procedure on you except to draw blood phrom the back of your hand. Iph she give you pheces about it, tell her that the rules prohibit her phrom doing this and you will sue her and her company phor battery iph she tries it. Tell her to please leave your presence.

Having had blood tests done this summer until I didn't have any elbow veins lepht, they had to use the back of my hand. It hurt like hell. Nobody with a choice does it that way.

Oh, and I told some nurse trying to get phinancial inphormation phrom (phor a wallet biopsy) me to please leave. The look on her phace was priceless. She lepht.

[Cat Whisperer]

<snip>
It's challenging. Sometimes judgement calls don't go as planned. There are always patients who insist they MUST be drawn with the tiniest butterfly needle available even when they've got huge veins you could hit from across the room with a dart. <snip>
My husband has veins like this. He's needlephobic, or I'd be encouraging him to go donate blood, because it would take about five seconds to fill the bag from veins like that. He doesn't particularly like it when I palpate his veins, but they're so beeyootiful! (I think you need to be a former phlebotomist to really appreciate a nice, fat, secure vein.)

[Biggirl]

My husband has veins like this. He's needlephobic, or I'd be encouraging him to go donate blood, because it would take about five seconds to fill the bag from veins like that. He doesn't particularly like it when I palpate his veins, but they're so beeyootiful! (I think you need to be a former phlebotomist to really appreciate a nice, fat, secure vein.)

My husband can't get enough of me palpating his vein, lemme tell ya.

[wring]

My husband can't get enough of me palpating his vein, lemme tell ya.

You don't stick a needle in it, do you?:eek::eek:

[OtakuLoki]

I thought that the Prince Albert was back in fashion these days?

(Wiki link provided, but not broken - NSFW: http: // en.wikipedia.org/wiki/Prince_Albert_piercing)

[Biggirl]

You don't stick a needle in it, do you?:eek::eek:

Nah, just cause it to pulsate and tremble. (http://dictionary.reference.com/browse/palpitate)

[MerryMagdalen]

My husband has veins like this. He's needlephobic, or I'd be encouraging him to go donate blood, because it would take about five seconds to fill the bag from veins like that. He doesn't particularly like it when I palpate his veins, but they're so beeyootiful! (I think you need to be a former phlebotomist to really appreciate a nice, fat, secure vein.)

I do this to my boyfriend all the time too. Then he pretends to sulk and says I only love him for his veins. :D

[irishgirl]

That Phlebotomist was not good and out of line. Next time just refuse your consent- it gives them a get out clause and you know they'll have luck.

Me, I'm green butterfly if they look easy, blue butterfly if they look hard person.

Personally, I have decent veins, no needle phobia and don't find cannulas/blood draws to be that painful, so I let the medical students practice on me first before I set them on the patients. Puts the fear of Og into them, but makes it more likely they'll get it first time so it's a confidence booster.

My blood taking patter is usually,
"Pick an arm, any arm"
Patient proffers arm
"Where's good for taking blood?"
That's where I'll go if I can find a vein- if I can't see one there I'll ask if they mind if I go wherever it is that I CAN see a vein.

As a doctor I get to stick needles wherever I the patients will let me- elbows, wrists, hands, backs of arms, necks and feet are all fair game for me, the nurses and phlebotomists can only go elbow or hand.

I get first time about 90% of the time now-it's a combination of practice, being the person they call when the nurses and phlebotomists can't get blood and knowing that if I can't get it, the next step is to get an anesthetist, a step to be avoided at all costs.

[The Tao's Revenge]

I'm green butterfly if they look easy, blue butterfly if they look hard person.


I tried googling but no luck. What's that saying mean?

[Girl Next Door]

Best thread title ever!
thundercuntery

OMG, best noun ever!

[Antigen]

I tried googling but no luck. What's that saying mean?

"Butterfly needles (http://www.superhealthcare.com/pr-03/svset.jpg)" are attached to tubing and have little "wings" alongside the needle for the phlebotomist to hang onto. Different colors generally mean different thicknesses of needle.

[kaylasdad99]

Wait, they're vampires?

Why don't you just ask them to use your neck?

[Cat Whisperer]

My husband can't get enough of me palpating his vein, lemme tell ya.
I had a feeling my previous post was subject to being interpreted in dirrrty ways. Oh well.

I don't know about the rest of you phlebotomists, but I never liked being called a vampire. It's a toss-up which I liked less, though - vampire or lab nurse.

[Leah M]

(I think you need to be a former phlebotomist to really appreciate a nice, fat, secure vein.)

I haven't worked as a phleb in a while, but still... whenever I see anyone with a really huge vein, I want to touch it. :o

Oh, and The Tao's Revenge - as Antigen said, different colors = different needle thickness/size. A blue one is a smaller size than a green (for us, anyway).

[gotpasswords]

I haven't worked as a phleb in a while, but still... whenever I see anyone with a really huge vein, I want to touch it. :o
Weirdo.
:)

I was at the lab once to have some non-blood work done, and the tech saw my arm and said "Ooh! Nice veins!" and seemed dismayed that they weren't going to be able to stick me.

And what's with the roto-rooting? Is it a sadistic way to sidestep the "Call for assistance if you have two failed attempts" rule since they're not actually withdrawing the needle?

[Cat Whisperer]

Weirdo.
:)

I was at the lab once to have some non-blood work done, and the tech saw my arm and said "Ooh! Nice veins!" and seemed dismayed that they weren't going to be able to stick me.<snip>
I'm guessing that's because your blood draw would have been effortless, and they were anticipating the little old lady diabetic who is next up who needs 10 tubes drawn.

[Lynn Bodoni]

I always tell the tech that I have a nice fat vein deep in my left elbow, but that s/he'll have to pull that tourniquet kinda tight on me to get it to pop up. They always smile and nod at me, but they do pull the tourniquet pretty tight. I also always thank the tech if the stick went well, and I didn't feel it, or hardly felt it. I figure that they get more complaints than compliments, and maybe they'll remember that I was polite. Since I always have to have at least half a dozen tubes drawn, they probably will remember me anyway.

[Really Not All That Bright]

I also always use butterfly needles, which I think are easier to place. The blood doesn't flow as fast, but I only need a couple of cc's, so it isn't that big of a deal.
Butterfly needles are to having blood drawn what anaesthetic is to surgery. Go you!

[Mighty_Girl]

Ugh. That sucks, Biggirl. I have veins like pipes. Easy to see, easy to poke, and they drain quickly. No problem with blood donation or IVs--I've even had medical people comment on it in amazement. And even I've run into one stupid bitch who jabbed me incompetently and then fished around for it. Two years later and I still want to go kick her. Are you me?

Well, it was over 3 years ago, when I was pregnant. I can have blood drawn practically from anywhere. Take a blind stab and you'll hit a vein with me. But somehow this bitch managed to a) miss the vein, b) root around, and c) ignore my complaints. Another phlebotomist had to come rescue me, and I left the lab with a pain that lasted days and a giant purplish-black hematoma.

I am not a needlephobic, I can't be, I have been poked and prodded all my life, but if I ever see that bitch crossing the street I will run over her.*

I make a point of complimenting good phlebs on their techniques if I don't feel like a dart board when I leave.


*Not really, but I fantasized about it for a while.

[Mighty_Girl]

Thanks, oh Admin Goddess. I will sacrifice some chocolate in your honor today.

[Biggirl]

Some one upthread mentioned that the butterfly needles (the ones they use on hands) are more expensive. This may explain 'the rule'.

This lab I go to is in a HIP center (although I do not have HIP insurance, the lab does accept outside insurance). HIP is notorious for their cost cutting ways.

[Mama Zappa]

She wasn't mean or rude or anything. And I do believe they have a rule about doing the inner elbow first. Plus, I did jump up with the needle in my arm, which is a big no-no. I couldn't complain to her manager that she was following the rules against my wishes.

I have my two technicians who are used to me and know to draw the blood from the back of my hand. They both told me about 'the rule'. One stuck me once in the inner elbow (didn't wiggle or dig. When he came up dry, he removed the needle and did the back of the hand), the other actually listened to me when I said it wouldn't work and didn't try at all.
Still - if they have The Rule, and you know damn well it doesn't work for you, refuse to let them even attempt. Find a supervisor if you have to.

The phlebotomist was trying to follow the rule, but they also need to learn to listen to their patients.

This is speaking as a person who also has tough veins. I have one - *exactly* one - good vein, that everyone can find easily. With two exceptions - a lab tech (and I made a note of his name, as he had trouble on two separate occasions) at GWU medical center, and a lab tech at the hospital where my daughter was born. That fool tried two separate spots, failed (and hurt me badly) at both of them, and for the first time in my life I screamed profanities at a medical person and ordered him out of my room. As I was dealing with postpartum emotional roller-coastering, he's lucky that was all I did.

[SpasticKitty]

I'm a nurse, and as a personal preference I like to try the inner elbow first on adults and older children because that seems to be the easiest place to get blood. I'll stick hands too, but those I've found that those veins tend to blow much more easily.

That being said, I would never ignore a patient's request or idea on the best place to get blood. There's just no excuse, and if someone did that to me as a patient I would raise hell.

I try not to dig around with the needle either, especially after some bitch did that to me with a massive 16g needle when I was donating blood a couple years ago. Holy Mother of God, that was painful. And I have good veins!

[XaMcQ]

Wow, what a hideous experience. Stories like this give me the heebie jeebies.

My veins aren't great, but I am a huge needlephobe and I don't make any bones about it when I have to be stuck. Personally, I think this contributes to my getting better experiences, because after I've whined and cringed and cried about my horror of needles, they usually make the most experienced person do it, or else they are really careful. Stoicism doesn't pay when people are coming at you with pointy objects.

[emmaliminal]

Thread can haz nine lives?
Fluffy the Phlebotomist (http://www.rhymeswithorange.com/index.php?date=20081120&view_comic=Get+Comic)

[Ann Onimous]

I had a problem recently at the doctor's office. I went in to be seen for some random ailment, and they needed to draw blood. Okay, fine. Problem was, I donated plasma for years and my veins in my elbows are shot. Massive scar tissue.

I told the woman this, and she went for my forearm! I'm talking halfway down the forearm, between my elbow and my wrist. I have never heard of blood being drawn this way, so I told her, "You're not getting blood from there!" She said, "Well, it's not my fault you screwed up your veins giving plasma."

I went off. I told her in no uncertain terms that she needs to think about things before she says them, and that there was no way in hell she was drawing blood from me. I walked out. The doctor said she could have gotten the same results from a finger stick. I told him I was not allowing her to touch me under any circumstances. Since there was no one else there that could draw blood, I went home with the best guess the doctor could give me. He told me to go to the hospital if it got any worse. Thankfully, his best guess seemed to be right on, as I got better pretty soon after.

I donated plasma on and off for about seven years, and one of those was for a year straight. My ex-boyfiend (yes, I did that on purpose) would not hold down a job, and my job paid okay, but not that well, so I had to do that in order for us to survive. Some people need to show a little more compassion or get out of any kind of business that deals with people.

[Smeghead]

I went in a few weeks ago because of some gut pain. I was worried that the hell that was my bout of chronic pancreatitis was starting up again, as I know it will one day. The clinic guy sent me to get some blood tests to check, as expected. I know I have bad veins, but a good phlebotomist can usually hit one 50% of the time. The lady I got started on my left arm. Try #1 - fail, including the digging around portion of the show. She said she'd try one more time and if she didn't get it, I could come back another time. Um, no, I thought. I would like to know TODAY if I get to go through six months of eating through a nose tube again or not. But whatever, I figured she'd get it on the second try, so I didn't say anything.

Try #2 - in the left arm. Again. I have never had someone try twice in the same area. She did the digging around thing again, and then gave up and said I should come back in a couple of days. (?!!) I pointed out that I still had another arm she hadn't even tried yet, and she seemed shocked that I'd be willing to try again. Well, OK, maybe that was understandable, but I really wanted these results, which I explained to her. She finally hit gold on try #3.

[St. Urho]

I told the woman this, and she went for my forearm! I'm talking halfway down the forearm, between my elbow and my wrist. I have never heard of blood being drawn this way, so I told her, "You're not getting blood from there!" She said, "Well, it's not my fault you screwed up your veins giving plasma."

Theoretically speaking, there's no reason you can't draw blood from a forearm vein. Blood in a vein is blood in a vein. I've found that forearm veins are often a good spot to start IVs. Less painful than hand veins and you don't limit arm movement like with the AC.

St. Urho
Paramedic

[MsRobyn]

I had to have blood drawn on Friday for some routine tests. I've got veins like taps; turn them on and they go. It took two minutes to draw the blood and it was the easiest, most painless stick I've ever had. I mean, the phlebotomist was good.

Afterward, when she was dressing my arm, I thanked her and complimented her on her skill. I made her day. :)

Robin

[thirdwarning]

Theoretically speaking, there's no reason you can't draw blood from a forearm vein.
St. Urho
Paramedic

The last couple of times I've had blood drawn it's been from the forearm. I'd never seen it done that way, but she tried it and it worked. Good enough for me. The second time I actually suggested it. I just want to get in, get stuck, and get out. Fill up the little test tube and let me go. I'd rather leave with one bandaid on my forearm than three in various places.

[Ann Onimous]

Theoretically speaking, there's no reason you can't draw blood from a forearm vein. Blood in a vein is blood in a vein. I've found that forearm veins are often a good spot to start IVs. Less painful than hand veins and you don't limit arm movement like with the AC.

Thanks! I didn't know that. If it's less painful than a hand IV, I may try that. I'll have to bring the EMLA along, though.

She did freak me out, though, and said the wrong thing.

[Lynn Bodoni]

I had to have blood drawn on Friday for some routine tests. I've got veins like taps; turn them on and they go. It took two minutes to draw the blood and it was the easiest, most painless stick I've ever had. I mean, the phlebotomist was good.

Afterward, when she was dressing my arm, I thanked her and complimented her on her skill. I made her day. :)

Robin I have found it very much worth my while to compliment techs if I have an easy blood-drawing experience. My doctor must be keeping a seethe of vampires somewhere, he is always wanting AT LEAST half a dozen tubes of blood from me every 4-6 weeks. The techs remember me as someone who tries to be nice to them.

[MerryMagdalen]

In light of my comments upthread, and the comments subsequent to them, I would like to mention that I regularly get complimented on the painlessness of my blood draws. And this is from hospital inpatients - people who feel worse than the average "victim".

And I thank you from the bottom of my socks. I really appreciate it. Thank you, people who take time to say good things to me. I walk into someone's room, with nothing fun to give...and I get out with no pain, no anger - and I love to be appreciated for it.

[EddyTeddyFreddy]

I give blood regularly, with happy fat gushy veins that do their bag-filling duty pip-pip! I've had only one bad experience, and that was when the blood-drawing was finished; as the tech withdrew the needle I got an electric jolt down my arm into my hand. The tingly weirdness of having a nerve pricked lasted for a day or two, then went away.

That happened in my left inner elbow. Since then, I've always asked to have my right arm done, even though that's my dominant hand, as the veins are bigger and easier to get. When I discussed it with one tech, she told me that the veins on the dominant side tend to be bigger. Is that true?

Like Lynn, I make a point of complimenting the tech whenever possible.

[TroubleAgain]

I donate platelets every three weeks, and while I haven't had too many really bad experiences, I still try to compliment a particularly good stick. (I had one I literally did not feel! It was amazing!)

[outlierrn]

Man, I've done so many blood draws from the forearm. Started IV's there, the neck, the feet, the fingers, the scalp, the bicep, shallow veins on the chest wall.

I will dig for a vein, sometimes it hurts more than starting over, sometimes less, and sometimes it's your only chance.

I always ask a pt what they brought me and where they'd prefer it, and will comply if possible. Of course, some pts are FOS, so not always.

[emmaliminal]

I have had some delightful draws and ALWAYS thank the phleb if it isn't a disaster, with detailed commentary when appropriate. Some of them are just gifted. Some of them aren't, but do their damnedest to learn anyway, and them I particularly love.

As you know, thanking anyone for doing their job well makes the world a better place. [/platitudinosity]

[maladroit]

I get lots of blood draws and I always feel bad for the people that lack confidence when they draw me. I know they don't want to hurt me and are trying their best. One guy stuck me 8 times. He was the only one there at the time, I had to get some kind of diagnostic that required iv. We ended up waiting half an hour or so for another employee to arrive. She had better luck.
I have "bad" veins, as did my mom. I don't know the specifics, rollers or whatever. I appreciate a pro that can get it on the first jab. I used to go to a clinic that had the best phlebotomist. She was ex-military and so efficient. Tie, wipe, poke done!

I'm a big thanker.

[Lynn Bodoni]

I have "bad" veins, as did my mom. Try asking the techs to tie the tourniquet pretty tight. My surface veins are really not so great, but I've got a wonderful vein deep in my left elbow, which will only pop up when the tourniquet is uncomfortably tight. I'd rather have a tight tourniquet for a few minutes for one stick, than have someone poke and prod for several minutes, then finally retying the tourniquet.

[wring]

y'all jinxed me dammit. Went to the hospital for blood draw, warned the tech, she tied off each hand, finally tried right hand, poke dig dig dig. then did my elbow. Today, I've got a bruise 2 inch by 2 inches on my elbow.:(:(