Blood draws!

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breenie

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I saw the other thread about blood color, and I have a little story to share, sooo...

Last night I got to try a blood draw for the first time ever! One of my coworkers is a vet student and she's pretty good at blood draws, so she wanted to give me a chance to practice. They don't let inexperienced people like me practice on clients where I work, so when her dogs were due for heartworm tests, she offered her pups as practice!

I was sorta successful. I got blood twice from her dog that sat still, but the other two were wriggly so I didn't get anything from them. She said she first got to practice on anesthetized animals, which sounds like a good idea, given my skill level so far.

So, how has everyone else gotten introduced to this skill? I feel like I'm going to need a lot of practice, but not sure when that's going to come my way. For all you current vet students, do you get much exposure your first years of vet school, or do you have to wait 'til 4th year?

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Well, I have experience drawing blood from dairy cattle-I had a dairy vet internship last summer. We drew blood from the jugular or the tail. And considering the jugular is like the size of a garden hose it's probably not nearly as hard as getting blood from a dog ;).
 
Last night I got to try a blood draw for the first time ever!


Was the blood blue? :p


I got introduced by my boss when I first started at that job. First dog I tried was mine, and it was an epic fail. She's got practically no veins--even the vets can't get blood from her. So another co-worker let me practice on her bunch. After that, anytime we had a patient that would sit still, I called dibs :laugh: I'm pretty decent at it for the most part, not to jinx myself, now. I've actually never tried doing an anesthetized dog...why didnt I think of that???

Some little dogs still can't do. I'm too terrified to try a jug stick on a client's dog, and I've done very few cats. I learned how to put a catheter in, on an English Bulldog. I figured if I could do it with those rolly, twisty, veins on the stubby legs, I could do it on anything :)


ETA: Although, I think the most exciting moment of my life was when my equine vet showed me how to draw blood from the facial vein on a horse(no idea which vein it was...about two inches below the corner of the eye?). It was awesome! And worked great on a horse that wouldn't let you near her neck with a needle.
 
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I'm lucky - I work at a clinic where we are all trained in tech stuff, so I get to do blood draws, iv catheters, cystocentesis, vaccines, etc etc etc. I learned on anesthetized animals for my first couple of tries, then started getting to practice on co-workers' animals. It's a skill you really need to practice to get good at, so I'm grateful that I get to do it on a daily basis.
I've done horses, but again, their jug veins are like 4-lane freeways compared to getting blood on a 4 month old screaming kitten! :laugh:
 
I've done horses, dogs, cats and kittens. Horses were by far the easiest! Like poochlover said, it's like drawing blood from a garden hose. Super easy although you have to be careful not to go too deep.

The first ones I did were on 6-to 8-week-old kittens, though. Super, super hard. I'm still really slow and nervous, so I don't volunteer to do it much because I feel like I slow things down too much (I volunteer as a vet assistant for spay/neuter surgeries at my local humane society). Dogs and adult cats are better, but wiggly dogs are hard, too, I think.

In both of my situations (equine and small animal), I had vets walking me through each step and letting me know if I was doing anything wrong. I've found that vet techs have really good tips too. I'm so jealous of those vets and techs who make draws look SO easy even on the tiniest kittens!
 
Was the blood blue? :p
my thoughts exactly cowgirl LOL! Anyhow i'm excited for you breenie because I was just told by the vet I shadow that she wants me to start learning how to draw blood...so I can imagine your excitement because I'm just as excited and I have not even done it yet :)
 
ETA: Although, I think the most exciting moment of my life was when my equine vet showed me how to draw blood from the facial vein on a horse(no idea which vein it was...about two inches below the corner of the eye?). It was awesome! And worked great on a horse that wouldn't let you near her neck with a needle.

It's the transverse facial vein/facial venous sinus. :)
 
Hitting a moving target is never easy, even if you've done thousands of blood draws. The more you practice, the more confident you'll get.
 
I had done a lot of blood draws on sedated/anesthatized zoo animals with tourniquets....very different than moving critters! The vet I worked with last summer made practice dummies for several pre-vets. She took the plastic that a syringe came in (different sizes for different sized dog models) then used tape to place a strip of surgical tubing through similar to a cephalic vein, then wrapped it with gauze (thin layer) then vet wrap. It really helped to get the feel of popping into a vein, and she would fill the surgical tubing with red (food color) dye. It did help the girls learn how to feel for a held off vein. Then, she did the same thing, but with a hard stuffed dog (the kind you might get at a carnival...not a soft plush, but rather cotton or linen covered hard plush for a jug. After the girls could do it without problems on their own on the models, we would wiggled the models and such...then when we had calmer dogs with big, visible vessels, we would let them do the draw. A little at a time was a good way to learn. We also had them go around for days holding syringes of all sizes and learning to draw the plunger back one handed.
 
I'm behind in everything else, but this is something in which I'm actually competent! I'm lucky in that I've worked as a tech at an animal shelter for about a year and a half. our shelter doesn't have a vet on staff, so it's just us techs (and a tech manager) so we all have to learn how to draw blood. I got to practice a TON-- I'm a master at drawing blood, particularly from cats' in their back leg, just because we get so much practice because we've got to get blood from every animal that comes through our shelter.

but with all that practice I still get ridiculously nervous when I have to draw blood in front of a new person-- like I'm afraid after saying I can draw blood I'm suddenly not be able to do it. last week I had to euthanize a dog with huge veins, which is basically the same skill as drawing blood, but because the animal control manager was in the room I got stage fright! :smack:
 
The first time I attempted to get blood was on a small 8 week old kitten. I failed miserably. My first success was the jugular vein on a boxer (easy, but I did it!) Now I do not have too much trouble getting blood (although I have my bad days). I absolutely prefer to use the jugular vein in both dogs and older cats. I remember one time we were trying to get blood from a rabbit and just about everyone had tried to get blood from this rabbit. So I was the last person to give it a try and I hit that vein on the first poke. Unfortunately, the little bunny wriggled around and the needle came out so I did not get enough blood. I also set catheters and have done a cysto or two. It takes practice and patience but with time you will get better and more confident.

We used to have a "fake arm" for people to practice cath setting/blood draws. We would use an empty paper towel roll and wrap it with a towel or two and then place the line to a LRS bag on the towels. And then wrap it with vet wrap. We would have some areas with little vet wrap and some areas where the vet wrap is super, super thick. Then we add food coloring to the LRS bag and line. Then after someone set the cath/drew blood. You would just unwrap the vet wrap a little pull the line down and tie off above the hole. Then keep going. Eventually, the line would need to be replaced but the LRS bag would last for months. It was a really nice way to train people and have people get used to how to hold the "leg" and how to situate their hands so that they would be comfortable drawing blood/setting a cathether.
 
She took the plastic that a syringe came in (different sizes for different sized dog models) then used tape to place a strip of surgical tubing through similar to a cephalic vein, then wrapped it with gauze (thin layer) then vet wrap. It really helped to get the feel of popping into a vein, and she would fill the surgical tubing with red (food color) dye.

That's ingenious! That would be so helpful for me, I want to try that now... I should suggest that to my vet when I get to learn how to blood draw.
 
The blood was not blue. ;)

I have never seen blood drawn from a horse's face! That sounds amazing!!

I'm jealous of y'all that have easier clinical settings to practice in. Hopefully I can find enough opportunities to get moderately good, and eventually elbow my way into my clinic. ;)

Catheter placement seems intimidating, too, though!
 
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Horses were by far the easiest! Like poochlover said, it's like drawing blood from a garden hose. Super easy although you have to be careful not to go too deep.


The first horse I ever drew blood from was from a day old foal for his IgG. Of course, he was white. Not so easy :laugh:

The mare would not let the vet in the stall, or anywhere near her baby, so I got to do the honors. This was at a facility I worked at, so the mare at least somewhat trusted me, since she'd had a rough pregnancy and I'd been in charge of her care and treatments.

That poor baby...I got the blood easily day 1. Level was Low. Okay, so we manage to practically pin the mother to the wall while the vet administers the IGG. Day 2, colt smartened up, and threw a hissy fit, but still, got the blood without too much splatter. Day 3, IgG was still disgustingly low, and baby wanted nothing to do with me, or the needle in my hand. Poor guy, it took me a couple tries to actually get the needle in the vein, and he just would not stop bleeding. It looked like we butchered him :( Why is it always the white ones that bleed?
 
Funny you should ask because I just did my first blood draw on Wednesday morning! We had a few feral cats in for neuters and also for FIV testing. The first cat had thick skin, and with 3 people watching me I didn't really want to do it, but I tried. I didn't get it. Then I tried the second cat and it was easy peasy (of course they were both out before I even touched them).
 
I worked lab animal for a few years before doing clinical work, which ended up being really awesome for learning some of the tech skills. Of course I still need tons of practice and wouldn't trust myself to keep up with techs, but at least I've done sticks on various animals more than once. I've even taken some courses that train you how to do blood draws, sutures, intubation, catheters, etc. for animals like rats, mice and rabbits.

Birds are my favorite, you can see their veins quite easily and they're right there. Rabbits are also high up on my list. Still working on feeling comfortable with cats and dogs, but it's really fun to practice. It never gets old, I always feel like I'm in a showdown with the vein. Fun times! :D
 
Don't be shy to ask the vet (not the other techs unless they have exceptional technique) because that means it is one less thing they need to do later when you are working. I asked the vet to show me on ferrets and now I am confident when we need blood on dogs cats ferrets etc.

At the clinic I work at most of the techs are much, much better at catheter placement/drawing blood than the vets. It is not that the vets can not do it; it is just the fact that the techs are the ones who do it everyday as a part of their job (basically at the clinic I work the techs do everything besides diagnose and surgery) and the vets really only draw blood when all of the other techs are busy. The vets will often ask to hold the dog/cat/whatever while the one tech who is not busy draws the blood just because they are not as used to doing it. So it really does not matter if you ask the vet or the vet tech to show you how to draw blood they are both equally capable.
 
At the clinic I started in they encouraged us to try drawing blood. Drawing on a Lab? Easy. On a Chihuaha? Ungh....

It's just about practice. Even the vets, who could hit veins I couldn't even see, would sometimes blow one/miss. It's just a learned skill and you're not going to hit every vein, first try, every time.



My first horse stick was....interesting.

Vet: "You can feel the vein, so just stick it in there."
Me: "Just stick it in there?"
Vet: "Yah, real quick and hold onto it so the horse doesn't knock it out when it jumps"
Me: * ****, **** ****, alright...here goes nothing *

But I did hit it. You just get used to it. It's not that bad, really. The hardest part is knowing the client is right there and that that simple procedure will likely form their opinion of you.
 
On my second day in the clinic, the vet, an Army CPT, showed me how to put the TQ on a really nervous 70lb Weimaraner, hands me a syringe and says, "bevel up, low angle". Most dogs are easy - well, big dogs. I don't do well with cats. Probably why I don't intend to do small animal if I can help it.
 
At the clinic where I work, they seem to just show you once and then say, "Go for it!" It's frustrating at first, but once you get it you feel awesome.

I still suck at placing catheters. I need a little more guidance than "Go for it" on old dogs with tough skin and crunchy veins, but I know vet school will help for that.

I REALLY want to learn how to do cystos, but the doctors always do them where I work. I guess that's another thing for vet school!
 
At the clinic I started in they encouraged us to try drawing blood. Drawing on a Lab? Easy. On a Chihuaha? Ungh....

Drawing blood on a chihuahua that is trying to bite you? #*$&. I had that experience more than once on one with renal failure. Why is it the little ones that are always misbehaved?

I worked as a tech in a practice in MA for about a year and part of my training was completing a certain number of dog/cat jug draws. It was a great learning experience. Although I have to say that on cats I usually did a hind leg stick because it's so much easier to restrain them that way without stressing them out too much (especially on diabetic kitties).
 
I feel like i'll be the only vet student who has never drawn blood on a dog or cat before :( . I can do almost everything with mice though! I've even gotten to do a lot of cool surgeries with mice. But I feel so far behind when it comes to small animals because everyone has either been a vet tech or at least knows how to draw blood from them. Of course these skills will be used more than taking blood from mice...until i go into lab animal medicine lol
 
I feel like i'll be the only vet student who has never drawn blood on a dog or cat before :( . I can do almost everything with mice though! I've even gotten to do a lot of cool surgeries with mice. But I feel so far behind when it comes to small animals because everyone has either been a vet tech or at least knows how to draw blood from them. Of course these skills will be used more than taking blood from mice...until i go into lab animal medicine lol

I do not think I would be able to get blood from a mouse. That must be incredibly difficult. I do not think you will have any problems learning how to draw blood from a dog or cat. You should do just fine. I really think the hardest part in learning to draw blood is not even hitting the vein. It is in learning how to hold the syringe and pull the plunger with one hand. Learning where to place my hands and fingers and getting the technique down was the hardest part. Hitting the vein was actually somewhat simple (with exceptions).
 
I've never drawn blood :/
 
I feel like i'll be the only vet student who has never drawn blood on a dog or cat before :( . I can do almost everything with mice though! I've even gotten to do a lot of cool surgeries with mice. But I feel so far behind when it comes to small animals because everyone has either been a vet tech or at least knows how to draw blood from them. Of course these skills will be used more than taking blood from mice...until i go into lab animal medicine lol

You're not alone in this. I feel like I'm going to be way behind in terms of clinical skills... But I'll hold my own if they give me something to clean :laugh:
 
You're not alone in this. I feel like I'm going to be way behind in terms of clinical skills... But I'll hold my own if they give me something to clean :laugh:

Ya, I was going to say-I've got some mad poop removal skills. Y'all better watch out. :cool:
 
I do not think I would be able to get blood from a mouse. That must be incredibly difficult. I do not think you will have any problems learning how to draw blood from a dog or cat. You should do just fine. I really think the hardest part in learning to draw blood is not even hitting the vein. It is in learning how to hold the syringe and pull the plunger with one hand. Learning where to place my hands and fingers and getting the technique down was the hardest part. Hitting the vein was actually somewhat simple (with exceptions).

Nah, I'm with BlackKAT. I have never taken blood from a dog or cat, but mice and rats are second nature to me after years of lab work. In fact, what another poster described for getting facial vein blood from a horse is pretty much exactly the technique used in mice...only you get to hold the mouse immobile in your hand while you do it :). Now injections into the tail vein of black mice, that was a steep learning curve. Those are literally blind sticks until you get lucky enough times to develop muscle memory for where the needle goes.
 
Lol poochlover!

I have drawn twice on anestetized dogs, so certainly not eno0ugh to get a "feel" for it. I'm going to shadow a lovely vet in Montana for two weeks and she's promised to let me do all sorts of things, so that will be fun! Plus VIDA will involve a lot of hands-on stuff too.
 
When it comes to technical skills, most things build upon skills you've already developed. If you can draw blood on a rat, you can draw blood on a cat. If you're proficient at peripheral blood draws, you'll have an easy time learning to place peripheral catheters. Once you are good at that, learning how to do a central line is easy. A cysto uses the same basic skills as a jug stick. The same basic skills apply across the board. It's just a matter of learning any particular considerations for the skill or species, of which there are usually only a few. The only advanced technical skill I can think of that doesn't really rely on basic skills learned earlier is female dog urinary catheters - which might be why they're considered one of the toughest technical skills to master.

So I wouldn't worry about being behind at all. Whatever you don't know, you're probably ready to learn and the learning curve really isn't all that steep.
 
A cysto uses the same basic skills as a jug stick. The same basic skills apply across the board. It's just a matter of learning any particular considerations for the skill or species, of which there are usually only a few.

Hmm...I always thought of a cysto being more like an IM injection since both are at 90 degree angles and need to be straight in and straight out. Anyway, I agree with what you said once you have one thing down the next thing just builds off of it and it just keeps getting easier from there.
 
The similarity for me is the mental game. Both involve hitting fluid-filled entities you can feel but can't necessarily see. So that's where the skills build on each other. Actually, for a cysto you ideally want the needle at a slight angle toward the neck of the bladder, but if the bladder is tiny that's easier said than done!
 
The similarity for me is the mental game. Both involve hitting fluid-filled entities you can feel but can't necessarily see. So that's where the skills build on each other. Actually, for a cysto you ideally want the needle at a slight angle toward the neck of the bladder, but if the bladder is tiny that's easier said than done!

I was always told angles on cystos are bad because if the dog/cat moves it could cause more damage than when the needle is straight up and down. :confused: Anyway, I see what you are saying with the jug and bladder similarities. Bladders are much worse though when they are small, move a lot, or if the animal is fat. Fat animals are so hard to find jug veins and bladders on. For jug veins I like to use the corner of the eye (corner further from the nose) down is about where the vein is in most animals.
 
If the animal moves, the first thing to do is let go of the needle so it can move with the patient. If you keep a grip on it, it is very possible to lacerate something. I've read about aortas being lacerated...which isn't something I want to be involved in at all!

The angle allows the bladder to contract as you withdraw urine. It's theoretically possible to damage the bladder if the needle is at a 90 degree angle since the bladder can't easily contract. I've never actually seen or heard of this happaning, but intuitively it does make a lot of sense.
 
Don't worry BlacKAT, other than stabbing my own cats' front legs and getting blood on about the 4th try, I haven't drawn blood out of anything smaller than a foal's cephalic.

I like drawing blood out of horse faces! Not the best thing to do in front of clients, though.

One of the best tips I ever got about drawing blood (besides taking your time finding the vein before sticking): if you do not get blood right away after going through the skin, do not continue waving the needle around trying to find the vein. Stop, make sure the vein is distended, look at the vein, look at where your needle is in relation to the vein, THEN reposition your needle to go directly into the vein. Easy, huh? :p
 
If the animal moves, the first thing to do is let go of the needle so it can move with the patient. If you keep a grip on it, it is very possible to lacerate something. I've read about aortas being lacerated...which isn't something I want to be involved in at all!

The angle allows the bladder to contract as you withdraw urine. It's theoretically possible to damage the bladder if the needle is at a 90 degree angle since the bladder can't easily contract. I've never actually seen or heard of this happaning, but intuitively it does make a lot of sense.

Yeah I have done a few cystos and as soon as the animal starts moving I instantly let go. I do not want to be responsible for any lacerated organs or vessels. I guess the angle does make sense in allowing the bladder to contract more easily. I have never heard of a bladder being damaged from the 90 degree angle though.

One of the most nerve-wracking things was the first time I was putting a urinary catheter in male dog to obtain a urine sample. It was not hard but it was the first time I was doing it and while I was doing it the vet was telling me a story about when he was in vet school and one of his classmates was doing that for the first time. I guess the catheter hit the back wall of the bladder and curled up on itself. So when he went to pull the catheter back out it tied into a knot inside the bladder. They had to then do surgery on the dog to get the urinary catheter out. Why do they always have to tell you these stories when you are doing nerve-wracking things for the very first time? As if I was not nervous enough now I have to worry about getting the catheter stuck in the dog, thanks.
 
Don't worry BlacKAT, other than stabbing my own cats' front legs and getting blood on about the 4th try, I haven't drawn blood out of anything smaller than a foal's cephalic.

I like drawing blood out of horse faces! Not the best thing to do in front of clients, though.

One of the best tips I ever got about drawing blood (besides taking your time finding the vein before sticking): if you do not get blood right away after going through the skin, do not continue waving the needle around trying to find the vein. Stop, make sure the vein is distended, look at the vein, look at where your needle is in relation to the vein, THEN reposition your needle to go directly into the vein. Easy, huh? :p

Sure. (said incredibly sarcastically) But if you have a chow who has not been groomed recently and has about 20 pounds of fat over its veins. Good luck seeing the vein or even feeling the vein. Shaving helps a little but for some of the hairy dogs it can take five minutes just to find an area of skin. It is more like....well, it should be here so 1,2,3 and YAY BLOOD!

Rolly veins are also really hard. I like to place one finger on the left side of the rolly vein so it can not roll to the left (I am right-handed so reverse for left-handed) then I have the needle go in from the right so the vein has no where to go. I am an expert vein trapper...damn I should have added that to my application..I knew I forgot something. :rolleyes:
 
Sure. (said incredibly sarcastically) But if you have a chow who has not been groomed recently and has about 20 pounds of fat over its veins. Good luck seeing the vein or even feeling the vein. Shaving helps a little but for some of the hairy dogs it can take five minutes just to find an area of skin. It is more like....well, it should be here so 1,2,3 and YAY BLOOD!

Rolly veins are also really hard. I like to place one finger on the left side of the rolly vein so it can not roll to the left (I am right-handed so reverse for left-handed) then I have the needle go in from the right so the vein has no where to go. I am an expert vein trapper...damn I should have added that to my application..I knew I forgot something. :rolleyes:


my coworker and I joke because I hate rolly veins but can get blood from any cat. I always call for backup when I just can't trap the vein! and I'm definitely a keep-the-needle-in-there type of person. you don't have to painfully dig around, but if you know you're right by the vein, it's gonna be nearby.
 
also if any of you would like to trade your acceptance for my blood drawing skills, perhaps we can work out a trade... :D
 
also if any of you would like to trade your acceptance for my blood drawing skills, perhaps we can work out a trade... :D


If someone is willing to trade their acceptance for your blood drawing skills, then I shall trade you your acceptance for my poop removal skills. Yes?
 
Sure. (said incredibly sarcastically) Shaving helps a little :rolleyes:

I probably will have the least experience of just about anybody. Only volunteering and I am really not supposed to do procedures on the "patients."

But thought I might add that shaving is almost never permitted there just for a routine blood draw.
 
DVMDream, sorry, I was trying to be sarcastic with my "easy" comment, not trying to imply that I was some blood-drawing expert. Like I said, I've not really done dogs and cats, but I've had to do some ponies with completely round necks who would try to kill you as soon as you poked them, so I have sympathy with the pray and stick approach. I did find that tip helpful in some situations, though.
 
DVMDream, sorry, I was trying to be sarcastic with my "easy" comment, not trying to imply that I was some blood-drawing expert. Like I said, I've not really done dogs and cats, but I've had to do some ponies with completely round necks who would try to kill you as soon as you poked them, so I have sympathy with the pray and stick approach. I did find that tip helpful in some situations, though.

:laugh: I knew you were being sarcastic. No offense taken at all. I have to say though the first time I get near a horse or pony I will probably be terrified to death of being kicked. I would think that sometimes getting blood from a horse can prove to be just as difficult as getting blood from a dog or cat especially if you have an un-cooperative patient. But I have never been around horses so I am really not sure how anything works in equine/LA med.
 
But thought I might add that shaving is almost never permitted there just for a routine blood draw.


Oh yeah, no, we never shave for a routine blood draw/heartworm/snap test, or anything like that. We have a LOT of show breeders for those fluffy/fuzzy breeds, so shaved spots are a big no-no. Even for major bloodwork, we try to avoid it. Some of the breeders would throw major hissy fits about it :laugh:
 
Oh yeah, no, we never shave for a routine blood draw/heartworm/snap test, or anything like that. We have a LOT of show breeders for those fluffy/fuzzy breeds, so shaved spots are a big no-no. Even for major bloodwork, we try to avoid it. Some of the breeders would throw major hissy fits about it :laugh:

Usually do not shave for routine blood draws either. Just if the animal is really, really hairy and we have already tried once without shaving then we might shave. It really just depends on the tech/situation. I almost never shave instead I use massive amounts of alcohol to flatten the fur and push it out of the way.
 
For all you current vet students, do you get much exposure your first years of vet school, or do you have to wait 'til 4th year?

28 days left in 2nd year. We have not drawn blood on a live animal, however we were shown on a fake leg. :thumbdown: I'm going to guess we learn this sometime, but it has not been part of our classes so far.

As far as hands-on skills, I've learned way more at my clinic than I have at school. In the first two years school is all book knowledge - at least where I'm at.
 
28 days left in 2nd year. We have not drawn blood on a live animal, however we were shown on a fake leg. :thumbdown: I'm going to guess we learn this sometime, but it has not been part of our classes so far.

As far as hands-on skills, I've learned way more at my clinic than I have at school. In the first two years school is all book knowledge - at least where I'm at.

We hired a new grad this past summer, and she said the same thing. Also, she can't draw blood to save her life. Can't do IV catheters, urinary cath, or cystos. I think there is a lot of competition for actually getting to practice this on real animals. Their hospital also trains techs, who ALSO have to learn those skills.
 
Don't know if anyone mentioned it already but an interesting blood draw is from the eye of a mouse using a capillary tube. The DVM professor for my intro to animal science lab showed us how to do it. You insert a capillary tube into the corner eye of a mouse and rupture their orbital sinus. The tube then draws the blood up. It sounds alot worse than it really is - none of the ones I have seen done have posed any harm to the mice. It's kind of hard to do at first but when you get it right you can get blood quickly and painlessly.
 
I feel the same way as some of the other posters who don't have any blood drawing experience. I know I'll learn it eventually, but I'm definitely feeling behind the pack in terms of tech skills. I know at some schools (maybe all?) there's a kind of segregation in the beginning between the students who have vet tech skills and the ones who don't. That's one of the things that makes me most nervous about starting school...but I just hope it turns out to not be as bad as I'm expecting! :)
 
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