Click to visit Blood Collection: Special Considerations, Obese Patients WebA measurement around your waist. If you can find a vein with that desirable characteristic, youll know that youve discovered a usable vein, even if its not prominent. So, the choice of equipment will change from patient to patient. These exercises can be performed throughout your donation and afterwards in the refreshment area. Drawing blood from the elderly, young children, and infants can also be a challenge. This illuminated the veins that he could not palpate. The WHO has best practices that are key to preventing infection and being successful during blood draws. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. Big ppl are not bad to stick at all, especially the ones with edema. My trick is to press on their hand or arm with both of my thumbs. Put ur finge For the elderly, using a syringe or the butterfly system is recommended. Extend the arm. First, gather all of your supplies and discuss with your patient what you are going to be performing. Sometimes you won't be able to see the veins at all, but you will be able to palpate them. Why does blood stop flowing during blood draw? Next step is explaining the procedure. Rolling up gown sleeves (rather than pushing sleeves up) to enhance tourniquet visibility. Create well-written care plans that meets your patient's health goals. Average delivery time is 5-10 business days. Blankets or towels from a warmer can also be used. 0000006606 00000 n I have to say, I started off doing venipuncture for lab draws prior to IVs and found that a good way to learn. 0000005243 00000 n Ask the patient to make a fist and not pump the hand. To avoid bruising, place the tourniquet over the patients shirt sleeve if drawing blood from an arm vein. Get the latest on all things nursing by joining our email newsletter. These other sites should always only be considered when there are no other viable options available to you. See which ones are available and good for drawing blood. If youre a phlebotomist who has encountered this problem before, you know how frustrating it can be. For example, in a case of a patient with fragile veins, it is much better to skip a tourniquet as it may cause the vein to blow out. That means that you can trust us to have reliable, up-to-date information Explain the procedure and reason for the blood draw to the patient. Please wait while we send your information. The site should not be warmed to a temperature higher than 42 EC. All information provided to Carrington College shall be subject to our Privacy Policy. Superficial veins often times can't handle an IV bolus or radiology contrast. Properly label the tubes and send them to the laboratory for analysis. When you encounter such a case, make sure to use blood pressure cuff or try one of the other tricks we shared in our guidelines. I was in a patients home a few days ago and had to call EMS, the patient was obese and her spouse said she had terrible veins. The worst thing you can do is to continue stabbing the patient. Follow your institutional guidelines or polices or get advice from qualified personnel. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. A syringe is a great technique for blood drawing! Contact Us | Work @ Carrington | Privacy Policy | Terms of Service | Do Not Share My Personal Information | Sitemap | Student Consumer Information. If they come in for their appointment well-prepared, it should be easier to find a vein almost immediately. Next, identify the vein that you will be using. While holding patients arm, make sure that your finger is well above the insertion point. I am a Licensed Phlebotomist and Certified Medical Assistant of 15+ years with 14+ years of clinical experience. The gratification of giving blood is a feeling you'll want to share. I Feel Stuck - Like My Options Are Limited, Ethical Arguments Against Mandatory Vaccination, Nursing Student on Spring Break Saves Collapsed Man's Life, Candida Auris: Dangerous Fungus Spreading in US Health Care Facilities, Nurses Week 2023 | Best Discounts, Freebies, and More. Finding difficult veins isnt impossible, but it can require a few different methods to be put into place. Commercial heat packs are best. Your approach is something that can vastly affect the patient, making the whole experience more or less enjoyable. So, before attempting to draw blood, look at the 3 areas mentioned above for the best veins to access and draw a blood sample. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. If necessary, apply the tourniquet and examine the median cubital, cephalic, and basilic veins. Weight gain. Increased body mass can also lead to issues during venipuncture. 0000005419 00000 n The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. Do not massage down as doing so will defeat the purpose. It will stop the bleeding and prevent the creation of hematoma. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. Please bring your donor card, driver's license or two other forms of identification. 4. Another thing a person can do is to try to be relaxed as much as possible. A medical expert should stroke them from distal to the proximal vein. What may be warm to you could be hot or even burn someone else. They will be much easier to spot and throbbing. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with blood draws. Sometimes, you will need another person or two to help you with difficult patients. Don't take aspirin for 2 days before your appointment. To make a basic grid for your female body proportions, turn your ruler so its perpendicular to the vertical line you drew. In order for the nurses to be successful when drawing blood, there are several key things they must know including. 0000022045 00000 n Think of an anecdote or a story you would like to share. Avoid excessive probing. Would hate for the patient to have to come back and drink that Glucola again. 0000001512 00000 n Create an account and get 24 hours access for free. Always avoid drawing blood from areas where the skin is damaged, inflamed, infected or burned. Sometimes theyre very small, or hard to see. Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. Insert along the vein. Web Place the tourniquet over the patients sleeve of the patient shirt sleeve if drawing an arm vein. Place it at the chin and lightly draw a straight line. There are numerous considerations when performing venipuncture or phlebotomy. Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks, Proper safety standards to avoid a needle stick, standards for quality care for patients and health workers, including, availability of appropriate supplies and protective equipment, availability of post-exposure prophylaxis (PEP), avoidance of contaminated phlebotomy equipment. WebPatients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. They should be spread distally from proximal joint to the insertion site. Please enter a valid e-mail address. You dont have to drink tons of water the night before but the recommended daily water intake should suffice. They already have pain, so lets make the process easier and more comfortable for them. 0000008110 00000 n Blood pressure cuff is a great method of extracting blood in case that the veins are not visible enough. Top Cheap and Fast Online RN to BSN Programs, Affordable Online Nurse Practitioner Programs, Top Direct-Entry Nurse Practitioner Programs, Top Psychiatric Nurse Practitioner Programs, Top Pediatric Nurse Practitioner Programs, Top Acute Care Nurse Practitioner Programs, Top Online Family Nurse Practitioner Programs, Top RN to Psychiatric Nurse Practitioner Programs, Top Womens Health Nurse Practitioner Programs, How to Get an Associate Degree in Nursing. Can You Get an Associate Degree in Nursing Online? Hopefully, these 50 tips will help you establish what is ok and what is not. Instead, make sure to remove tourniquet first and then remove the needle followed by instant pressure on the insertion point. You are able to confuse the nerves before the insertion. ARe there any tips on how to be more successful? Gloves are a must. Some jumping jacks or push-ups can make your veins pop out. Some will come on wheelchairs, using a cane, needing help to walk, move, sit and stand. Drink plenty of water an hour before the draw. This, in turn, can cause increases in your blood pressure. For bigger and stronger veins you can use a 22 or 21 gauge needle. Afterward, you can easily go upwards. venipuncture is one of the main parts of your job. By submitting this form, I authorize and agree that a representative of Carrington College can contact me about educational services and future offers by email, phone and/or text messaging at the email and telephone number provided above using an automated telephone dialing system, and/or an artificial or pre-recorded voice or text message. A close look at the site from which you will draw blood will tell you which equipment to use. Enjoy :). On top of that, there are a lot of individuals who fear (or dislike) going to a doctor. Get the patient to lower his or her arm. (function() { allnurses is a Nursing Career & Support site for Nurses and Students. Stay away from the palm of the hand, fingers and from the wrist area. If you are having difficulty finding a vein or is unsuccessful at drawing blood, ask for assistance from another experienced phlebotomist or you can get help from a doctor. Sometimes, the patient may experience hemoconcentration. After a few minutes, gently tap the site of the puncture with your fingers to make the vein pop out. It uses high intensity light that is directed down through the skin. Dismiss. tips on starting IV, drawing blood on obese patient. Congratulations, you just took the first step towards a new future by furthering your education. If a vein is not prominent enough to see easily, you can feel around for it. instance: "61c9f514f13d4400095de3de", Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. Unfortunately, some people have difficult veins to work with due to obesity, dehydration, and a variety of other issues. Its important to remember that the patient is actually your most valuable resource during this process. This will move their fluid and/or tissue out of the way so you can see a good vein. Dont be discouraged if at first, you dont access the vein. The elderly lose fat tissue as well as muscle mass, making their skin saggy. WebTips for Drawing Blood Always feel the vein rather than see it! While traditionally a nurse would use their hands to feel for a vein, many hospitals are now using vein finders to help reduce the amount of time it takes to find a vein and start treatment. Elderly persons walking in to do blood tests usually have nicer veins, though, there will still be a few difficulties. Select a donation type and find a convenient time that works best for you. Over the years I have drawn blood from many older patients, learning tips and techniques along the way in dealing with them and drawing blood from them. hbba`b``3~0 U endstream endobj 197 0 obj <>/Metadata 31 0 R/Pages 30 0 R/StructTreeRoot 33 0 R/Type/Catalog/ViewerPreferences<>>> endobj 198 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 193>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 199 0 obj <> endobj 200 0 obj [/Separation/Beaumont#20Blue 221 0 R<>] endobj 201 0 obj <>stream Any time that you need blood drawn for lab work,, I'm Lou, and welcome to Phlebotomy Examiner! At nurse.org, we believe that no one knows nurses better than, well, nurses. Blood Test Vs Blood Donation (Comparisons). Below are 5 key areas of importance with tips. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. Persons must be trained to use the blood pressure cuff. Patients who are severely dehydrated can also make it difficult to find a vein. With the foot- some places require a specific order r/t other dx that can increase DVT risk :). If other sites are resulting in no signs of veins then go back and re-examine the sites. However, there are numerous things that can go wrong while you draw blood. If the blood is not delivered in a timely manner it can cause hemolysis and skew the lab results. 0000260220 00000 n A lot of patients have the needle phobia. WebIn this module, you'll learn why the right approach is critical when drawing from overweight patients, and you'll have a newfound appreciation for what it's like for too many Call us at 1-866-236-3276 to report any additional health information that you forgot to tell us, if you have any problems or if you needed medical care after giving blood. It allows the phlebotomist to control the vacuum, which is good because it is much less traumatic on a patient's vein. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Finally, an ER tech came up and he used a venoscope, which is basically a fancy flashlight - basically the same thing that bruali described in their post. By placing a warm towel over the veins, you are increasing the blood vessels which will make them more visible. ), 2023 Center for Phlebotomy Education All Rights Reserved, Phlebotomy Continuing Education Exercise (ATM): Phlebotomy and the Obese Patient. Nitroglycerine is yet another substance that can help you out during phlebotomy. They need to be labeled in advance. 0000012539 00000 n Gravity alone will help reveal veins that were not visible or palpable earlier. 5. This allowed him to see the vein and was able to get the IV in. If you are drawing blood from an arm, make sure to sit near the patient, as close as possible. Position the patient and hyperextend the patients arm. Some patient-friendly advice for getting blood drawn include the following: Drink plenty of water an hour before the draw. Dont do any heavy lifting or vigorous exercise for the rest of the day. 0000007172 00000 n 8, 9 Even Another technique is for you to use a blood pressure cuff. Perform hand hygiene and don proper PPE. However, for the elderly, it may be difficult. As a result, it can be difficult at times to find a vein to draw blood from. 0000185079 00000 n Spend a decent amount of time looking for good veins. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with bl They can be riskier, especially if you need to draw a lot of blood. A trick I use sometimes is putting a second tourniquet 2 inches above the first tourniquet. It can really make the veins pop. The other day I saw a Maybe you have the right environment, chair, and equipment to draw from them successfully, but do you give them the respect that's often lacking in healthcare? Usually, if you cant find a vein in the antecubital fossa or at the back of the hand, you will find one in the forearm. When performing venipuncture, he needs to convince a person that he is capable of drawing blood safely. You need to make sure there is no resistance whatsoever. Once you have located a vein, you can cause increase distention through massaging or exaggerated palpation (pressing repeatedly over the top of the vein). 0000013386 00000 n You may have to apply heat more than once. Thirdly, they may lose their appetite and drink less fluids. While not commonly taught in nursing school programs, many recommend that nursing students take extra courses in how to draw blood to learn this skill. On the surface, it seems as a rudimentary procedure, one that doesnt require any special training. These devices are good at locating superficial veins, however, their ability is limited for deeper veins. Some veins can be deep in the antecubital fossa area, especially, if there is a lot of fat tissue. It used to be that all 50 states required blood tests before getting a marriage license but that is no longer the case. 0000001196 00000 n Excess fat around the waist can put you at an even higher risk for obesity-related health problems, including heart disease and type 2 Instead of forcefully tapping the vein, it is much better if you start stroking them. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. that's continuously reviewed to ensure its as relevant and accurate as You can support each other and do twice as much good! If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. When the last one is done, you need to remove the tourniquet. If you havent rested properly, this can affect your ability to perform venipuncture and can lead to critical mistakes which you, as a professional, cannot afford. WebOnce veins have been located, return the patients arm to the horizontal position for the blood draw. Press the space key then arrow keys to make a selection. That's why we rely on registered nurses and other experienced healthcare 0000036112 00000 n If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. One thing that I find that helps is using two tourniquets - take them together and tie it. Apply a heat compress to the area for 3-5 minutes. However, you will need a doctors permission for this. Dont go deep. Have iron-rich foods, such as red meat, fish, poultry, beans, spinach, iron-fortified cereals or raisins. A transilluminator is a cool way of finding or confirming veins. Many times combining techniques can mean the difference between finding a vein or not. When performing venipuncture, make sure to sit whenever you can. Ask the individual to elevate his or her arm at the elbow. I have had patients tell me nurses are more successful in one arm than the other, etc. } In fact, based on this, the entire procedure can be harder or easier. You have to palpate first and decide from there. 0000007667 00000 n Fluid retention. Besides proper knowledge, you will also have to have a good head on your shoulders and to make sure you follow these venipuncture guidelines closely. Blood tests are no longer Hi! If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Always try to draw blood from veins that are lowest. He got her first stick, and i will definately try this in the future if i have trouble. WebFor routine blood draws, 70% isopropyl alcohol or 70% ethyl alcohol is recommended. In fact, the majority of intensive care units require their nurses to possess these skills. Youll be the first to know about nursing news, trending topics and educational resources. What about other resources that may be available? Do not snap it against the patients skin as doing so could cause bruising in the area.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-banner-1','ezslot_5',168,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-banner-1-0'); The 3 main areas to find veins include the antecubital fossa, the forearm, and hand veins. It happens! More than one-third of U.S. adults and 16% of U.S. children are obese. If possible, look at areas that tend to have less subcutaneous fat, such as the back of the hand, the thumb, the wrist, and even the top of the foot. H\@E|E/g#0tW Y3y(N> CA}G)H6GUab/Jqk;gy>>n5%sLWorayo|zEnmn;4d~{;m/E. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. Throw everything in proper containers. }; Our mission is to Empower, Unite, and Advance every nurse, student, and educator. No matter what, always take your time to find just the right vein. Gravity will often reveal hand veins you didnt see earlier. No matter how a patient looks like, it is necessary for a medical professional to protect himself. If the antecub has already been accessed there are great options for venipuncture. First, remember where to look. Make sure that no one gets directly exposed to blood. They may be in a confused, agitated, or combative state of mind. If the veins are deep and not visibly popping out, use a tourniquet and have the patient lower their arm. Additional equipment such as goggles and splash shields should also be worn in extreme situations. Then, push down with the flat of the finger over the area. This technique is especially helpful with hand veins. Take a look at these tips for drawing blood successfully: When you receive your initial instruction on how to conduct basic blood draws, your instructor will most likely tell you to locate the vein you are targeting by sight. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. If possible, look at areas that tend to have less subcutaneous fat, such as the back of the hand, the thumb, the wrist, and even the top of the foot. Also, avoid cotton as fibers may stay in the wound and reopen it later on. Sure, its easier said than done when a needle is about to enter a persons vein, but tension can constrict veins. Ideally, try to work with your patient ahead of time, or give them information about what they can do to make their blood draw experience easier. Insert the beveled needle at a 30-degree angle into the vessel. Patients health is your priority. With vein locators, you can see where all the veins are. Press enter to open the dropdown list, then press tab and enter to choose the language. Remove the tourniquet as the last amount of blood is drawn. If a person is overweight, it might be harder for a professional to find the vein. Also, by palpation, you can sometimes feel valves in people and learn to avoid them. Putting some rolled towels underneath or a pillow helps, too (just make sure to put some chux on top of them in case you make a mess!). Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. The person performing venipuncture can administer 10 units of bacteriostatic saline which need to be injected intradermally. I'm Kadia. These 5 areas include:if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'phlebotomistreport_com-medrectangle-4','ezslot_6',165,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-medrectangle-4-0'); From my experience elderly persons on wards are the most difficult sticks. Using your thumb, pull back on the skin and hold the vein down. WebIf the finger or heel is cold to the touch, pre-warming the site for a few minutes with a warm compress or commercial heel warmer will increase the flow of blood through the capillary beds. When the body is properly hydrated, veins become more dilated. In that case, you would use the order of Draw (venipuncture). 0000018898 00000 n In order to prevent hematoma, you should only puncture the uppermost wall. The WHO has set forth the following standards of patient care for hospitals to adhere by: They also identify dangerous and unsafe practices for blood draws including, >> Related: Arterial Blood Gases (ABGs) Explained. (Immediate download. In the end, they can only lead to injuries. The Highest Paying Jobs For Nurses With a BSN, Types of Masters in Nursing Degrees & Specialties, Pros & Cons of Getting a Master's Degree in Nursing, Nurse Practitioner vs Physician Assistant, Highest Paid Nurse Practitioner Specialties, How to Conduct a Nursing Head-to-Toe Assessment, How to Read an Electrocardiogram (EKG/ECG), Understanding and Interpreting the Glasgow Coma Scale, Complete List of Common Nursing Certifications.
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tips for drawing blood on obese patients 2023