Having trouble "feeling" with gloves on

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nightowl

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Hi all. I'm actually a future M1 and am training to be a phlebotomist until then. I thought this forum would be the best place to ask about it. I'm having a lot of trouble feeling for veins with gloves on. I can locate it without gloves, but when I put them on and sterilize the area, I can't feel it most of the time. It's really frustrating, though I'm hoping it'll get better. Pulling the tip of my glove tight doesn't seem to help much. What really worries me is that I'll have the same problem with other procedures and even with surgery (I think I might be interested in a surgical specialty). Anyone else deal with this, and have tips? Am I just weird or what?! Thanks, y'all.
 
You're not alone. 😉 I'm also a future med student and training for phlebotomy this semester.

It's hard with gloves on, especially if you're going from one type of glove to another (latex, nitrile etc.) and if you don't always have the right size available.

Get the patient to make a fist (don't pump, but hold their hand closed) to help the veins stand out more, and make sure their elbow is straight because that will bring the veins closer to the surface. One of the most useful things I've learned is not to feel for a cord-like thing by shape, but to push down on the entire antecubita fossa and the veins will be the ones that are springy and bounce back. Just because you can see it doesn't mean it's there, you have to press kind of firmly and feel the differences in the surrounding tissues. Try it on your own arm or a friend's to get some confidence just feeling for the veins. Try palpating without looking at the veins. It's hard, and at first you just want to stick veins you can see and pass the difficult ones to someone else, but with practice you'll be able to get it.

Don't be afraid to look at the other arm or on the forearm/hand either. Sometimes patients have better veins in areas other than the antecubital fossa.

And most importantly, don't worry about missing veins. It happens. No one's perfect, and we all have to learn somehow. There's one guy I work with who only feels for the vein after he's put his glove on, while I like to feel before I've cleaned the site, and then make a mental note of where I'm going to be inserting the needle.

Good luck! You can PM me if you want to chat about anything else.
 
From a DO student with hopefully above-average palpatory skills (at least I should after all those hours of OMM)...

Make sure you palpate with the pads (not the tips) of your fingers and that you always use your dominant hand. Then once you think you are close to the vein you want, close your eyes. It's amazing how much more you can feel with your eyes closed.

Also, make sure your gloves fit really well. Try a size smaller if you need to.
 
Great advice above, although I actually found that my tactile sense for small, mobile, compressible things like that was better when I used a looser glove. 😳
 
nightowl said:
Hi all. I'm actually a future M1 and am training to be a phlebotomist until then. I thought this forum would be the best place to ask about it. I'm having a lot of trouble feeling for veins with gloves on. I can locate it without gloves, but when I put them on and sterilize the area, I can't feel it most of the time. It's really frustrating, though I'm hoping it'll get better. Pulling the tip of my glove tight doesn't seem to help much. What really worries me is that I'll have the same problem with other procedures and even with surgery (I think I might be interested in a surgical specialty). Anyone else deal with this, and have tips? Am I just weird or what?! Thanks, y'all.

It's one of those things you develop through practice, practice, practice.

I started back in the dark ages when nurses didn't wear gloves to draw blood, start IVs, etc. (HIV? What's that?) I found that using a small glove really helped; kind of like a second skin.

First of all learn the anatomy; that will help. Try lightly tapping on the vein you want to use; you can also try just lightly stroking the vein with the tip of your fingernail (gloves on, of course). Try looking for a landmark where you felt the vein, like a freckle (sounds weird, but it works). I've also tried closing my eyes, too, and that also worked sometimes.

You're going to find that all of a sudden you will start "getting more sticks" than missing them, and pretty soon you'll be able to get a draw on the first stick. Just remember that everyone has days when they couldn't it the broad side of a barn.

Also remember that big, fat veins do not always= "easy stick." Sometimes those are the ones that roll away from you or are otherwise difficult to access. Conversely, sometimes the vein you're sure won't work will be a great stick.

Like I said, mostly it comes down to practice.
 
nightowl said:
Hi all. I'm actually a future M1 and am training to be a phlebotomist until then. I thought this forum would be the best place to ask about it. I'm having a lot of trouble feeling for veins with gloves on. I can locate it without gloves, but when I put them on and sterilize the area, I can't feel it most of the time. It's really frustrating, though I'm hoping it'll get better. Pulling the tip of my glove tight doesn't seem to help much. What really worries me is that I'll have the same problem with other procedures and even with surgery (I think I might be interested in a surgical specialty). Anyone else deal with this, and have tips? Am I just weird or what?! Thanks, y'all.
HINTS:
1. Tie a tourniquet on the arm approximately 2-3 inches above a potential venipuncture site. Don't tie it too far or else it would take forever for the vein to pop up.
2. Feel for a vein that rebounds (bounces) when pushed or tapped on. This procedure is best performed WITHOUT a protective glove. Palpate for a viable vein first, then select equipment, put gloves on and then perform the venipuncture. Once you've found a vein keep an eye on it while you get your stuff ready or make a mental note where it's at (i.e., close to that certain odd looking nevi :laugh: , etc...)
3. Sometimes when you push too hard you can't find a vein but when you tap lightly you can. If everything fail use a 23 3/4 butterfly and aim straight for a blue looking spider vein. You can't feel a thing but just aim straight at it at a 45 degree angle. It always work. Just go slow. Start shallow then go deep. The inside of the wrist also have a lot of surface veins. Be careful when drawing this area as it is painful. Also, stay at the surface... don't go too deep as you will hit nerves... any deeper you will hit the artery.
4. Slap the skin with an open hand on the puncture site. Tell the patient what you're doing first... or else you'll get a patient yelling "abuse" and the next thing you see is a nurse standing behind you. :laugh:
 
I wouldnt worry too much about it in terms of procedures and surgery as a med student/doctor. Most of the stuff you are trying to "feel" is larger than veins in the patient's arm. Typically you are also using other senses (i.e. seeing things) and dont have to operate purely based on feel.

Not to mention the more practice you have the easier it will get.
 
Being a former phlebotomist before medschool, I think one of the best tips is to use lots of alcohol. Make sure you get the area quite wet and also wet your glove. You will be surprised how much more sensitive you are with wet gloves.
 
nightowl said:
Hi all. I'm actually a future M1 and am training to be a phlebotomist until then. I thought this forum would be the best place to ask about it. I'm having a lot of trouble feeling for veins with gloves on. I can locate it without gloves, but when I put them on and sterilize the area, I can't feel it most of the time. It's really frustrating, though I'm hoping it'll get better. Pulling the tip of my glove tight doesn't seem to help much. What really worries me is that I'll have the same problem with other procedures and even with surgery (I think I might be interested in a surgical specialty). Anyone else deal with this, and have tips? Am I just weird or what?! Thanks, y'all.

A good way to practice "feeling with latex gloves on" is to use condoms. If you can feel there, then you'll be fine.
 
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