Phluck you, Phlobotimist!

The BBQ Pit
1

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.

2

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

3

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.

4

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.

5

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.

6

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.

7

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.

8

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.

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.

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.

9

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.

10

Best thread title ever!

Sorry about all the pain and thundercuntery.

11

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?

12

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!” :smiley:

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.

13

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.

14

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 abutterfly needle 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.

15

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.

16

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.

17

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.

18

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

19

It’s your fault for having Bad Veins. :slight_smile:

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

20

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.