Phluck you, Phlobotimist!

The BBQ Pit
21

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.

22

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

23

ooops

24

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.

25

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…

26

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?

27

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.

28

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.

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.

29

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.

30

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

31

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.

32

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.

33

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.

34

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.

35

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.

36

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. :frowning: 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.”

37

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.

38

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.)

39

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

40

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