Drawing Blood

[LuckyBambooGirl]

Tomorrow we get to practice drawing blood for the first time. We're practicing on each other, and I'm kind of nervous. What were you're first experiences drawing blood like?

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[deleted77919]

We did this last week and it was no big deal. It's not very painful and pretty easy to get a stick on relatively healthy young people. Try to partner up with some guy who has huge veins.

IV's can be a little trickier, but still generally not too hard on healthy people with good veins.

 

[Wizard of Oz]

Don't sweat it since your classmates should all have good veins. You pick it up in a few sticks.

 

[SoCuteMD]

I got to practice on a fake arm 🙂 which made it easy. If you get a choice about what kind of needle to use - use a butterfly needle. They are easier to manage.

Most young people have good veins, but some don't. Guys are a much better shot than girls are in that department!!

 

[nabeya]

Be nice and use 23 gauge butterfly needles on each other, you can barely feel them.

Drawing blood is easy, just never stick them unless you know for sure you got a good vein that you can hit or they'll be in some pain.

 

[trudub]

I think you should qualify the statement that drawing blood is easy by saying, drawing blood is easy on young, healthy individuals. Drawing blood is most certainly not easy in general. IV's are even tougher. Also, while the butterfly needles are nice, I think you should be able to draw blood without on young, healthy veins. From a cost standpoint, using a standard needle versus a butterfly needle is much more cost-effective when it can be done and that is most of the time. There are relatively few instances where a butterfly needle is really called for.

 

[Agent Splat]

I would also say avoid using butterflies too much at first unless the vein you're sticking requires one.

Also, don't necessarily jump on the first vein you see....if you aren't sure it's a good one, look on the other arm...."look twice, stick once" like a carpenter says "measure twice, cut once."

And don't get too concerned about hurting your patient...there will always be screamers and jumpers no matter how good your technique.

And finally, train one or two fingers to "feel" for the veins, always try to use the same finger. Learn to feel for veins so you can stick the ones you can't see.

It sometimes takes practice; I had a horrible time when I first started learning IVs...be persistent and you can do it!!

Best,
m

 

[deleted109597]

From an ex-phlebotomist, the tighter you tie the tourniquet, the less likely they are to jump when you stick them. Because they can't feel it.

Oh, and when entering the vein, think throwing a dart, not threading a needle. Go fast, not slow.

 

[SoCuteMD]

I'm not sure why everybody wants to avoid using butterflies. That's pretty much ALL we use at the two hospitals I've worked at. I think they are easier to use for your first few (or 50!) times drawing blood. Since I practiced on a couple classmates and then had to start on real patients (many of whom had veins destroyed by IVDU or buried by adipose tissue) I felt like butterflies maximized my chances of getting in the veins and staying there as I drew all the tubes I needed.

 

[AmoryBlaine]

Learn the basics but don't worry too much about it. You can be a GREAT doctor and have no idea how to draw blood.*

It is a job for techs and nurses, you're in med school to learn to think, interpret, and plan. I guarantee you that you will never be graded on your skill or lack thereof in drawing blood.



*unless you want to be an anesthesiologist

 

[fun8stuff]

Tomorrow we get to practice drawing blood for the first time. We're practicing on each other, and I'm kind of nervous. What were you're first experiences drawing blood like?

1) pull the turniquette(sp?) before pulling needle out to avoid giving them a hematoma.

2)try to partner up with an ex-phlebotomist (sp?)

 

[Dr. McDreamy]

we're doing this soon too! i'm scared of needles. i can't even watch my own blood being drawn. surgeries don't bother me, but needles......oh god i'm cringing now. i hate hate hate hate needles. and i have a very low pain threshold. basically, i'm a terrible patient.

can you tell i'm a bit freaked out about this?

 

[Ashers]

we're doing this soon too! i'm scared of needles. i can't even watch my own blood being drawn. surgeries don't bother me, but needles......oh god i'm cringing now. i hate hate hate hate needles. and i have a very low pain threshold. basically, i'm a terrible patient.

can you tell i'm a bit freaked out about this?

During my year off before med school, I was a vampire at a hospital for 7 months. One of the doctors saw how scared of needles I was (I'm still scared of them going into me, but not as bad). He pulled me aside and was like, "It took me 6 months in med school to realize this: It doesn't hurt YOU to poke someone else." It's true, but I was so scared and worried about hurting someone else, that it made me even more nervous.

Try not to use butterflies, they're a crutch, and a lot of places get mad when you use too many because they're more expensive to order (personally, I think they should be used on just about everyone because they hurt less). Most healthy, young people can take 21 gauge straight needles. It's generally the old people with brittle veins and skin, diabetics and chemo patients that need butterflies regularly. Anchor the vein too above and below where you're going to poke with your index finger and thumb, especially if the vein rolls.

 

[Scottish Chap]

.....the tighter you tie the tourniquet, the less likely they are to jump when you stick them. Because they can't feel it.

..and the higher the measured K+ will be - one of the biggest sources of preanalytical variation (especially for K+) in lab values is the tourniquet + fist clenching effect.

 

[LuckyBambooGirl]

McDreamy, if I can do it, you can do it! I will post later and say how it went!

 

[SurgeryChef]

Most importantly - if this kind of stuff makes you queasy, be sure to have a nice big meal beforehand!!! 😱

 

[LuckyBambooGirl]

Well, my blood drawing session is over with, and it was really no big deal! 🙂 They had everybody use butterfly needles. The most "complicated" part was getting everything organized before hand!

 

[Blade28]

Learn the basics but don't worry too much about it. You can be a GREAT doctor and have no idea how to draw blood.*

It is a job for techs and nurses, you're in med school to learn to think, interpret, and plan. I guarantee you that you will never be graded on your skill or lack thereof in drawing blood.



*unless you want to be an anesthesiologist

Not totally true, unfortunately. You will be drawing lots of blood as an intern. 🙂

 

[bjackrian]

Well, my blood drawing session is over with, and it was really no big deal! 🙂 They had everybody use butterfly needles. The most "complicated" part was getting everything organized before hand!

Are you an M2? Just curious because I'm an M2 as well, and I haven't seen any blood drawing on the schedule for our clinical skills classes, so I was wondering if our schedule's dramatically different from a bunch of other school.s

 

[Ashers]

Are you an M2? Just curious because I'm an M2 as well, and I haven't seen any blood drawing on the schedule for our clinical skills classes, so I was wondering if our schedule's dramatically different from a bunch of other school.s

We aren't taught until 3rd year. I think it just depends on the school. I know I asked about it at interviews.

 

[racerx]

..and the higher the measured K+ will be - one of the biggest sources of preanalytical variation (especially for K+) in lab values is the tourniquet + fist clenching effect.

Also leaving the tourniquet on too long before drawing the blood will cause this. If you miss, untie the tourniquet and let the blood flow before retying and trying again. Lab techs hate working with hemolyzed blood.

 

[LuckyBambooGirl]

I am an M2. We are taught during our Blood-Lymph class, but I don't think we actually do it again until third year!

 

[excalibur]

We did it as M2's too. One guy in our class had a vasovagal reaction when he got stuck and fainted. So beware the vasovagal.

Also, the guy instructing us was a pathologist, and he would demonstrate the technique on himself. So he's doing this all one handed into his right arm, and there like 3 previous sticks from him teaching earlier groups. Then, after the stick is successful, he keeps talking to us like normal with the freakin' needle still in his arm wiggling up and down. Gave me the heebie jeebies!

 

[geogil]

To those who are strong advocates of butterflies: the majority of accidental sticks come from those rather than syringes or vacutainers. Also, I advocate using the largest needle you think the patient (and vein) can tolerate. There potential for hemolysis goes up the smaller the needle is. If the patient's a hard stick, you don't want to be going back to explain that they can't run the blood b/c you grossly hemolyzed it. Drawing blood is only 'easy' on the young and healthy. Your heroin addict and your chemo patient are different stories. The heroin addict can usually tell you where his/her remaining vein is though.

 

[@rpy2848]

It's easy if u do it by the book!!!!! If u don't now the procedure don't try it!!! Remember "PRIMUM NON NOCERE" = First do no harm!!!!! 🙂

 

[NonTradMed]

I'm kind of anxious by this too....from what I've heard, I think doing it on each other is optional and we dont' do it our first year. I hate needles and I'm afraid to tell anyone this since people typically reply, "But you're going to be a doctor!!", as if that means I like having medical procedures done on ME.

 

[greytmedic]

Some words of encouragement for people to think about if they are learning blood draws, IV's, etc.

The saying is "First, do no harm." It doesn't say anything about "First, cause no pain." Medical procedures can hurt, the pt will get over it.

If you are sticking someone with a needle, it won't hurt you a bit.

If you tell a pt you will be sticking a needle in their arm and they ask, "Will I be able to play the piano afterward?" Always ask them if they could play the piano before.🙄

Here is one from an old sergeant I used to work with in the military: Grunts(Infantry soldiers) only have to shoot 23 out of 40 targets to be qualified to kill the enemy, medics don't have to get every IV to be qualified to treat soldiers.

And if you're nervous about drawing blood or sticking IV's just wait for interosseous(IO) insertion.

 

[Doctor Bagel]

I'm a wimp I guess, but I would really, really not want other students to practice drawing blood on me. I've got good veins, but they're deep, and they roll. I'm thinking a practice session with a person who has no clue what they're doing would be pretty d@mn painful. Hopefully, my school doesn't require us to practice on each other.

 

[SoCuteMD]

It's easy if u do it by the book!!!!! If u don't now the procedure don't try it!!! Remember "PRIMUM NON NOCERE" = First do no harm!!!!! 🙂

Haha. "If you don't know the procedure don't try it."

That's a good one!

 

[SoCuteMD]

To those who are strong advocates of butterflies: the majority of accidental sticks come from those rather than syringes or vacutainers. Also, I advocate using the largest needle you think the patient (and vein) can tolerate. There potential for hemolysis goes up the smaller the needle is. If the patient's a hard stick, you don't want to be going back to explain that they can't run the blood b/c you grossly hemolyzed it. Drawing blood is only 'easy' on the young and healthy. Your heroin addict and your chemo patient are different stories. The heroin addict can usually tell you where his/her remaining vein is though.

Quote of the summer from the ED re: an unconscious frequent flyer:
"Ok, who knows where Mr. S's veins are?"

 

[DE12MD]

Learn the basics but don't worry too much about it. You can be a GREAT doctor and have no idea how to draw blood.*

It is a job for techs and nurses, you're in med school to learn to think, interpret, and plan. I guarantee you that you will never be graded on your skill or lack thereof in drawing blood.



*unless you want to be an anesthesiologist

It may be true that as a doctor drawing blood isnt your main prerogative, however at the hospital that I work at, when the techs and nurses cant get the blood the house doctor has to be called. So its pretty important to be able to draw blood.

However, practice definitely makes perfect when it comes to phlebotomy. Practice feeling for veins and stick as many people as you can. And don't be skittish, if you miss its not that big of a deal. It hurts more if the needle is put in slowly...

 

[MiesVanDerMom]

I'm a wimp I guess, but I would really, really not want other students to practice drawing blood on me. I've got good veins, but they're deep, and they roll. I'm thinking a practice session with a person who has no clue what they're doing would be pretty d@mn painful. Hopefully, my school doesn't require us to practice on each other.

ooh, me too. they always have to call in the head phlebotomist or nurse because my veins are so hard to get. i don't mind needles though so it would probably be more traumatizing for my partner than me

 

[Rendar5]

Not sure if anyone mentioned this:

Do NOT remove the needle and try again if you miss. This will cause even more pain. At all costs, stay in the arm until u're sure that there is no possible way you can enter the vein. You can feel for teh vein lightly to see how far off you are, then pull out slightly w/o coming out of skin and make a nice sharp turn. I've done 90 degree turns to enter a vein I missed the first time w/o pulling out. The majority of the pain in a stick is really from just breaking the skin and nothing else. And you can impress some people who think you missed by doing this sometimes =).

And if you're doing the back of the hands, don't do what I did first time. Make sure u hold the skin in front AND in back taut, because otherwise u'll stick and the skin will fold before u've entered, leaving the pt w/ pain and no possible way of getting the stick that time. Screwed up an IV on a kid that way twice before the resident took over and showed me how to do it right.

 

[oxeye]

Not sure if anyone mentioned this:

Do NOT remove the needle and try again if you miss. This will cause even more pain. At all costs, stay in the arm until u're sure that there is no possible way you can enter the vein. You can feel for teh vein lightly to see how far off you are, then pull out slightly w/o coming out of skin and make a nice sharp turn. I've done 90 degree turns to enter a vein I missed the first time w/o pulling out. The majority of the pain in a stick is really from just breaking the skin and nothing else. And you can impress some people who think you missed by doing this sometimes =).

And if you're doing the back of the hands, don't do what I did first time. Make sure u hold the skin in front AND in back taut, because otherwise u'll stick and the skin will fold before u've entered, leaving the pt w/ pain and no possible way of getting the stick that time. Screwed up an IV on a kid that way twice before the resident took over and showed me how to do it right.

Ouch! I much prefer when they just take the needle out and try again. I don't have easy veins and it is so painful when they fish around for it.

 

[Rendar5]

really? that's strange cause most of the nerve endings are in the skin and not in the fascia itself. (though i'm not promoting digging, just pulling out partway and pushing in at a new direction w/o approaching the skin). It's how I was taught and when I didn't do it this way I know i've caused more pain in people. I'm not doubting ur story though. It's just doesn't seem to be the standard patient response in my experience.

 

[trudub]

There is definitely a difference between blind digging which can be very painful and someone who is trained who retracts the needle and then redirects with purpose. Most of the pain from digging comes from improper retraction of the needle because the redirection tears tissue if the needle is not retracted. Moral of the story is don't dig, redirect with purpose.

 

[AmoryBlaine]

It may be true that as a doctor drawing blood isnt your main prerogative, however at the hospital that I work at, when the techs and nurses cant get the blood the house doctor has to be called. So its pretty important to be able to draw blood.

However, practice definitely makes perfect when it comes to phlebotomy. Practice feeling for veins and stick as many people as you can. And don't be skittish, if you miss its not that big of a deal. It hurts more if the needle is put in slowly...

Ha ha. If I were on call and someone called me b/c the nurses and techs couldn't get a blood draw I guess I would probably set up for a femoral stick...

It's pretty unlikely an MD is going to hit a vein a good RN can't find...

 

[Scottish Chap]

Also leaving the tourniquet on too long before drawing the blood will cause this. If you miss, untie the tourniquet and let the blood flow before retying and trying again. Lab techs hate working with hemolyzed blood.

That's why they instituted the H-index; sometimes, ones 'sins are covered over' and you can get a reliable result for several blood chemistries.

 

[racerx]

That's why they instituted the H-index; sometimes, ones 'sins are covered over' and you can get a reliable result for several blood chemistries.

Yes, but personal experience has taught me that the techs still complain. Unless, of course, they were thw ones that drew the sample.

 

[Scottish Chap]

Yes, but personal experience has taught me that the techs still complain. Unless, of course, they were thw ones that drew the sample.

From personal experience, most clinicians just want a number--as bad as that is--and the H-index often gets you that. Too bad most clinicians don't hear the conversations in core lab.

 

[8744]

Learn the basics but don't worry too much about it. You can be a GREAT doctor and have no idea how to draw blood.*

It is a job for techs and nurses, you're in med school to learn to think, interpret, and plan. I guarantee you that you will never be graded on your skill or lack thereof in drawing blood.



*unless you want to be an anesthesiologist

Oh no. You are wrong about that. Every doctor should be able to start an IV (and put in lines come to think of it). It's just one of those basic skills. You may be working in a podunk hospital with no phlebotomist in house and your couple of three nurses might have just graduated from nursing school or they just might not be very good at starting IVs.

Don't laugh. It has happened. You might not be graded per se but patients, especially trauma patients, need fast access and you will look good to all your subordinates if you can quickly place an IV (or a central line, femoral access, arterial line, etc.)

It's under the same category as knowing how to run an ACLS code. I am just learning, you understand, but I never want to be one of the wall-flowers standing around thankful that somebody who knows what they're doing is in the room. Again, at a small hospital it might be just you and it doesn't matter if you're derm, FP, or sports medicine as my friend KentW, an FP attending poster, can probably attest.

You can't spend your career positioning yourself to avoid basic skills.

 

[Smurfette]

I draw blood very frequently as a resident. Part of it is, if the pt has no good veins in the arms (or h/o axillary dissections b/l), the MD has to draw the blood...now usually phlebotomy can find something, but sometimes pts are so dehydrated or so bruised (coumadin anyone?) from previous IVs and blood draws that it makes it very tough. I often draw from veins in the feet in these situations. Or you can do a femoral stick.

And, sometimes you need blood drawn STAT...and if phlebotomy and/or the RN isn't available, that leaves YOU.

 

[racerx]

From personal experience, most clinicians just want a number--as bad as that is--and the H-index often gets you that. Too bad most clinicians don't hear the conversations in core lab.

I have heard some conversations that the clinicians wouldn't want to hear! 😀