FIRST find the vein, THEN stick me for drawing blood!

The BBQ Pit
41

If someone said, ‘you get one take at it’, I would always tell them that is fine, and I would always give them the option to have someone else draw, if they didn’t feel comfortable with me. Really not a big deal to me.
Lanecia and I just took the patients who had standing orders, chemo patients, and the infants. Those were the hard stick, and pretty much they knew and requested us.

I am sure most people would find that story appalling. My point wasn’t ha ha, they’re gonna get you, it was be careful what you say and how you say it, because there are a lot a Lanecias and Janes out there, in any business.
It’s generally a good idea not to be demanding or mean to people anyway. People try to do the best they can when people are just nice, everyday people.

Oh well.

Also, if you have the phleb fill a glove with water, and microwave it for about a minute, you can place the warm/hot glove on your anticubital, crook of your elbow, and leave it there for a couple of minutes. This will help your veins pop up. I use to do this on babies.

42

Hmm…yesterday was testing day at the cancer hospital for me.
Usually, I come out a mass of bruises, but i’m getting damn tired of it. So, I overhydrated…then when the 7AM blood draw was going to be handed over to a student…I just refused. I pointed out my history (pheresis donor for 18 months straight, so all the decubital veins are scar tissue, plus 8 years as a cancer patient, so no veins are really good), then examined the orders. Since it was only 3 tubes, I pointed out a good vein between the knuckles that they could get with a 26 or 28 butterfly. (Smaller numbers, bigger needle, bigger numbers, smaller needle.) One try and goodbye.

3 hours later it’s CT scan time. As I begin the first glass of Vile Liquid (now available in Banana, Apple and Berry) I remind them to have the IV team on speed dial. When I get to the back and have changed clothes, I start to tell them to call, and they recognize me. (5 months ago, 3 RN’s at 3 sticks each, 2 IV team members at 3 sticks each, and finally a doctor to do a cutdown, as everything else is bruises.) I’m on liver protocol, so it has to be an 18 gague needle. (Bigger than the lead in a #2 pencil.) IV team lady comes in, looks at the decubitals, and wants to try. Yeah, like i’m letting that happen. I offer a mid-inside forearm vein instead.

One stick, and it’s there. After this many years, I can sense what’s gonna work. Now all I gotta do is convince them to listen.

43

Oh, also, if the facility you are in doesn’t have butterfly needles, it’s probably because they are more expensive. Many labs only give their PSC’s a certain number per month, and a stash is put to the side for children only.
Also, if you have really large veins, and they use a butterfly, it could hemolyse your blood and make the results inaccurate, and sometimes untestable. In that case, you might have to come back and be stuck again, or just keep the inaccurate results.

44

I have great veins, the kind that makes the folks at the lab or the blood center really, really happy. But I always warn 'em anyway, they only get one shot. I fought the fight with X-ray techs every three months while my daughter was growing up and had to have spinal X-rays and I wanted to minimize her exposire, and time after time after time I’d get idiots who WOULD NOT listen to me. So I don’t even try with folks who come at me with needles.

OTOH, I had a nurse putting an IV in last week before I had knee surgery who was so busy chatting that she poked my nice prominent vein on my hand before she was really prepped, and there I was gushing blood all over the bed. I had to uncap the tubing for her so she could attach it to the IV. Sheesh. I’d TOLD her that I’m an easy stick. They don’t listen to you when you tell them that, either!

You needle-phobic and tough stick guys have my sympathy. It’s bad enough when you’re an easy stick!

45

I hate it when they decide that as a matter of pride they are going to find that vein in there even if they have to dig all day. My veins roll away when they try to stick them. I am not at all needle phobic, but I had a nurse basically tear open a vein when hunting for my rolling vein. I do not tolerate that anymore. I don’t mind being stuck, but i can’t stand them hunting around.

The last time they did a blood draw, the nurse hunted despite me telling her ahead of time not to, and she kept hunting after I repeatedly told her to stop. I had to shout, “I withdraw consent to all treatment! I withdraw consent to all treatment!” That finally got her to take the needle out of my arm. As I started to pack up, a doctor came in and I explained the situation. He got me another nurse who did not fish around. It did take two sticks, but that I don’t mind.

What are the butterflies anyway? I know they use them on me a lot, but not always.

46

Lee,
It’s just a thinner needle (23 gauge) (they do come in larger gauges) that is easier to maneuver. The thinner ones are intended for little veins.
They tend to sting more than a larger needle, being that they are so thin. If I am drawing myself, I have to use a butterfly, so I can handle it better, but I use a 21 gauge, because I have nice size veins.

47

One other problem we’ve had with the thinner gauge butterfly needles is that they have a tendancy to hemolize the blood. If you need whole blood cells for diagnostic purposes, then the hemolized blood is no good, or so our lab people have told me. The larger the guage of needle, the less chance of damaging the blood cells in the draw.

48

What kills me is when they insist on using the hand, even when they can’t see or feel anything, even when you tell them repeatedly that there’s a perfectly good vein in the elbow that nobody ever misses. I went through this twice last Friday, first at the ER, then again at the day surgery center.

At the ER, she tried a blind stick in the hand before moving on to the elbow. She got a good flash, but it wouldn’t feed. So she taped the catheter in with about a third of it hanging out. I routinely put 20g lines into 10# cats. This was a 22g, and she couldn’t get it into a human who weighs…well, it’s more than 10#, all right?

At the day surgery center, they managed to blow the hand vein so badly that it’s still bruised as hell, nearly a week later. Then, instead of trying to go a little higher in the elbow, they went for the wrist, and it hurt like a bitch. It went so badly it started to infiltrate by the end of the surgery, which was only 45 minutes, and the inside of my wrist is till bruised as hell, nearly a week later.

Now, I know my veins aren’t that bad, because the folks at the blood center used to pop 16g lines into my elbows all the damn time. There’s no real reason for people to have that much trouble getting a 22g into me. Especially in the damned elbow.

49

I was pretty nervous about the IV when I had my daughter a couple years ago…

The only other IV I had ever had was when I was in the hospital as a teenager for a kidney biopsy. They collapsed every vein on the back of both hands and inside each wrist. I ended up with an IV inside the crook of my elbow with my arm taped flat to a board and bruises all the way up both arms and the tops of my hands were black and blue for weeks.

My veins or the IV people’s skills improved since then thankfully!

50

Aha! Thank you. I figured they were more expensive, but I didn’t realize they could affect the results of the tests. I don’t think my veins are big enough that THAT would be a problem, but fortunately, the last few times they went at me, it went very smoothly.

51

As an RN I can tell you that veins are not always what they appear to be. Sometimes a person is dehydrated, sometimes they have lots of valves, sometimes they just can’t sit still. Sometimes the nurse/phlebot is having a bad day.

Everyone always gets freaked out when told they have rolling veins. If you get the tourniquet on nice and tight and pull the skin taut, the vein should be pretty stable.

If I can offer any advice to a person who knows they are a hard stick. By all means tell us. If there is a particular person who always does a good job with you, we will see if they are available. If you always pass out, that would be a good thing to know too.

Just try to relax, cooperate and follow instructions. Try to keep your eyes open and breath normally. If you squeeze your eyes shut and hold your breath, you will be more focused on the pain–those of you who have had lamaze know exactly what I am talking about.

Don’t freak out when someone chooses what seems to you an odd place to stick. Sometimes a vein will not be very apparent but it feels like a garden hose under the skin. Those are much preferable to trying for a thin but visible vein on the inner wrist or something.

One of my favorite veins is the basilic. It runs on the ulnar side of the arm (side furthest away from the body between the wrist and elbow) and is generally the largest in the forearm. But because it is difficult to see unless you turn the palm over it is not used very often. People look at me like I’m insane when I look there but are always amazed how great the vein is if the arm is positioned right.

In my experience the worst ones to try to start an IV on are the young males 18-25. They hold their breath or hyperventilate, twitch, grab my hand and/or pull their arms away just as you insert the needle causing you to blow the vein. Of course, it’s my fault I didn’t get them on the first try.

That said, an experienced professional will usually not attempt to stick someone if they don’t see or feel anything there or if they feel it is above their skill level. To try anyway because you don’t want to acknowledge that is abuse.

52

The last time (and I mean last time) I gave blood, I think I had the worst phlebotomist ever.

Background on me: I have very visible veins on both arms. High tolerance for pain. Given blood lotsa times, always been told I’m a good bleeder. And I like free t-shirts, cookies, and juice.

I climb into the blood bus, and I am presented with a visibly uncertain 19-year-old girl holding a donation kit. I sit down, knowing that if they trust her with doing the procedure, that’s good enough for me. I try not to judge others based solely on age. She opens the kit and begins aiming the needle at the elbow region.

I have not had my arm tied off. As forgiving and trusting as I am, I still find this alarming.

I point out that she has not yet tied my upper arm off, so she makes this giggly “Oopsie!” noise that I find vaguely unsettling. She ties me off, and the veins rise out of my arm. OK, back on track, everything’s good. She again comes at me with that needle, because apparently she thinks that just anywhere on the arm is good enough. She aims it at one of the risen veins and sticks it on in there. She of course totally misses the vein. I am watching in a mixture of horror and bemusement. You see, when she put the needle in, she managed to push the surface vein away and slide right past it.

She yanks the needle out and apologizes again with her giggly noise. I am far too timid for my own good at this point, because I do not call for an immediate halt to this procedure. She comes after me with the needle again and this time, manages to stick it in the vein (internal, quiet cheer on my part) and then all the way through the vein and right into my ulna. (Non-meds: Hold your palm up away from you. The bone running from the inside of your wrist to your elbow is the ulna.)

This is an interesting sensation, to say the least. Her enthusiasm has caused a little overexertion, and now I have the tip of a needle poking my ulna. I think she realizes something is wrong, because veins are not normally hard. To add to my not-quite-pain-but-something-is-definitely-wrong sensation, she accidentally brushes the end of the needle with a stray finger while pulling her hand away in surprise. Those of you who know about levers know that at this point my vein is being used as a fulcrum and my bone is being scraped by a needle. In my calmest tone, I ask her to please take the needle out, because I believe that bone marrow transplants are beyond her skill and in any case not something I signed up for. The needle comes out, and there has been some, um, tearing, of the tissue.

A small stick has become a decent-sized hole, about twice the size it should be. The vein is perforated, one hole on each side, and all I get is a cotton ball to hold over it. This is not as bad as it could be, though, because I’m a good clotter too.

At this point, you are no doubt assuming that I raced out of the blood bus as quickly as I could. You are assuming wrong. She calls someone over to do it for her and says I’m a “hard stick”. The new one ties off the other arm and pulls a pint out with no problem. I take my juice and my cookies and my t-shirt and depart as quickly as decorum allows. The next day, my true reward becomes clear: a purplish yellow bruise the size of a couple of half-dollars in the crook of my elbow.

And I haven’t been back.

53

Rubber veins? I got your rubber veins right here. Heh!!!

I found a snarlly lip and rolleyes with a bit of a ‘sigh’ will be all the punishment the clumsy stickers ever need.

::::: snicker ::::

54

A month ago today I was put in the hospital with meningitis caused by the West Nile Virus. I’d been having a SERIOUS headache and was barfing for 4 days when the dr figured out there was SOMETHING wrong (stupid bitch said it was my GALLBLADDER!!) and put me in the hospital. Upstairs the lovely nurses tried getting an iv in. 4 nurses x 3 sticks/digs each= WTF are you DOING?!? They finally got a nurse in from the NICU downstairs and she got it on the first try :smiley: (TY Betty!!) Then the vampire came in and took some blood from the back of my hand. They needed a platelet count because I was having gallbladder surgery the next day. (I’ll take a second to tell you that she took the blood with a 24g butterfly and a PEDE tube)
Downstairs the next day getting ready for surgery, the anesthesiologist told me my platelets were too low and that they might have to cancel the operation because they didn’t have any available. After 20 minutes of consulting and rechecking they found that my platelets were fine. The reason for the reduced numbers?? The smaller tube used the night before to take my blood and the fact that when the woman took my blood she said “hmm, it’s clotting already. shrug I guess it will be ok” as she took the needle out of my hand. Guess what dumbass it’s clotting and that will affect the test results. They are testing FOR PLATELETS :rolleyes: :smack: :dubious: Because of your incompetence I had to be stuck THREE MORE TIMES before surgery. Thanks bitch. :mad:

FTR I was stuck a total of 37 times in three days and thats including 3 spinal taps. :frowning:

55

pencilpusher, ay yi yi!

An update on my arm…I’ve got a “knot” in one of the places she stuck me. I’m hoping that it’s just a sort of internal scab. It’s not painful, but it does feel funny. If it doesn’t go down a lot by Monday, then I’ll be back in the doctor’s office. The doc has assured me that I need to see her if I’m having ANY problems, since this infection is clearing up so very slowly.

56

** thanks for this - I was (and still am) really concerned by the attitude that Jersey said her co-workers did (and why she would tacitly sit back and allow it -as she described -is another issue)

Of course I know this. OTOH, once you’ve been truly assaulted by some sadist with a needle, it becomes that much more difficult. and hearing, as we did here, that in some cases, a good tech will intentionally allow a bad tech to take on some one who’s verbalized that they have issues is all the more disconcerning.

I absolutely agree. and it happens.

and if, as it happens all too frequently, in addition to that, they keep on prodding and poking hoping to get lucky, well, it’s absolutely my right as a patient to tell 'em that they’ve got one crack at it. If you’re not dead certain that you’ve got a viable vein, don’t push the needle in. Especially after being warned that you’re a hard draw.

57

I’m participating in a series of clinical trials this weekend. Yesterday I had the worst series of punctures I’ve ever had - at least four times they had to dig for a vein (you know what that’s like) and at least twice they had to change arms. I’ve never had trouble like that before. And apparently they weren’t doing so well with anyone else, either.

Did I mention the room is bloody cold?

Hmm, think that might explain something?