Learning to take blood

[scully]

A question for all of you med students: how did your med school teach you to take blood? At the Georgetown interview Mrs. Sullivan said that the students would learn and practice on each other (ouch!) Is this pretty standard?

Thanks for the info!

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[showee]

Hi Scully,
I think practicing on each other is pretty standard. The docs where I work learned that way. In fact, one of them met his wife while practicing to draw her blood. I am currently learning and the doctors let me practice on them. Pretty brave!!

By the way, I saw on another thread that you went to CC! I went there too. I graduated in 1996.

 

[GreatPumpkin]

That is not how we learned. Many of my classmates still suck at taking blood. We were expected to learn by taking blood on our patients during 3rd year. During the day we wouldn't have to since there was a phlebotonist that would do it. But, on nights and weekends either you would get it done or you would have to explain why the labs didn't get back to the resident and attending. The way I learned with I think is the way to go is follow the phlebotonist around for a while, they are the real experts. They will show you the little tricks that can really help out on a tough patient.

------------------
Rob
http://views.vcu.edu/medimf/rob/greatpumpkin.shtml

 

[Djanaba]

I learned last night, on a classmate who is skinny but muscular -- GREAT veins! However, I'm little and not so muscular, and starting an IV on me was a failure. Once you get over being poked by a classmate for the first time, the rest is cake. However, I sincerely hope my first 10 IVs for real are on comatose patients!

 

[GreatPumpkin]

Using a med student as practice is fine. But, not like the real world. Most of your patients will not be healthy, hydrated, and lean. Wait till you try on a dehydrated geriatric patient or IV drug user. Good luck.

 

[Pathologist]

Well, I'm not in medical school, but I did learn as a medical technology student. We first learned on a fake arm that had tubing as it's veins. The tubes were filled with some kind of thickened kool-aid.

 

[GreatPumpkin]

Yummy kool-aid.

That would be good just to get the proceedure down.

[This message has been edited by GreatPumpkin (edited April 12, 2001).]

 

[showee]

Hi Scully,

I don't go to CU. Actually, I was not originally going to go to med school. I was a biochem major with the intent of going to grad school and getting into research. I am now working in a lab in Seattle and will be applying to med school!

And you?

 

[Nanon]

My first "real" pt was a tiny little old lady with veins I could thread through a needle. I wanted to use a butterfly, but my preceptor insisted on the arm. Poor thing. She ended up with a massive hematoma, and five years later, I still feel bad.

By the way, I don't suck at drawing blood, I think because I was the class pin-push. As a friend of mine once said, I have the kind of veins junkies dream about...

Nanon

 

[Winged Scapula]

We first practiced on those fake arms and then on real patients, either at the bank or on the wards.

I let some underclassmen practice on me, but gave up on a few who were scared to kept diggin' that needle around under the skin or would forget to take the tourniquet off while starting an IV.

My first real patient was a great lean guy with ropey veins...I have not had a single patient that easy since.

 

[David511]

I probably shouldn't be admitting this, but I learned while volunteering with a doc...with a straight needle no less! Luckily my first few pts. had horse-veins, hence no major drama.

However (ARGH!!), one time I had to draw on this giant construction worker with absolutely no venous structure...I must have beat on that guy's forearms (and hands and biceps and wrists) for 20 minutes trying to find something. By the time I actually got one to show, my hands were shaking so bad I ended up sticking him 3 or 4 times...I kept losing the sucker. There is nothing worse than a pt. with veins that run away from needles! Also, it didn't help that the guy absolutely hated needles. After the third try I started to feel in danger of losing teeth!

Anyways, I did finally get him drawn, though he had so many holes in him afterwards he could have passed for a junkie with a pretty good habit (needless to say, I just about used the office's supply of bandaids patching him up).

I still feel bad to this day, although the following week I was discussing it with the regular nurse and she expressed that she had done the same thing to him earlier...his veins were just TERRIBLE.

...sticking to the butterflys from now on!

-d

ps: for all you kiddies learning to draw, I gots one message for you: BE SURE TO TAKE OFF THE TOURNIQUET BEFORE REMOVING THE NEEDLE! (Unless you want to turn the office into a scene from Nightmare on Elm Street!)

 

[GreatPumpkin]

One tip you can try when you have a very tough stick. Use your blood pressure cuff as a tourniquet. Blow it up to less than the persons systolic but greater than their diastolic. And, keep it at that pressure for a few minutes. This will usually help.

 

[Winged Scapula]

<font face="Verdana, Arial, Helvetica" size="2">Originally posted by David511:
...sticking to the butterflys from now on!
ps: for all you kiddies learning to draw, I gots one message for you: BE SURE TO TAKE OFF THE TOURNIQUET BEFORE REMOVING THE NEEDLE! (Unless you want to turn the office into a scene from Nightmare on Elm Street!)•

I never had much luck with butterflies. I guess you do best with what you learn first on and feel comfortable with.

I second the motion about taking the tourniquet off. I have forgotten to do this myself during one of my early draws and the nurses had a fit when they saw the blood all over the new clean sheets. Fortunately, for *me*, the patient was delirious and hadn't much of a clue what was going on.

Second hint: going through the skin hurts the most (unless you prang a superficial nerve on the way in), so go in quickly and do your rooting around under the surface of the skin if you have to. Speaking from personal experience, there is nothing worse than an unconfident med student sticking you SLOWLY because they're scared or think it will hurt *less*. Believe me, it doesn't.

 

[scully]

GreatPumpkin, Dave511, and Kimberli -- thanks for the great tips. I will definitely remember those!

Another question (I hope not too dumb): As a practicing physician, how often do you use this skill. In all of my visits to doctors and a few to the hospital, a doctor has never come near me with a needle. The needles were all handled by the phlebotemists and "vampires" (that name scared the heck out of me in the hospital!!) I know it probably depends on your specialty, but in general, do you ever draw blood or give other shots?

Thanks for the great stories--keep them coming!

[This message has been edited by scully (edited April 13, 2001).]

 

[Winged Scapula]

I prefer NOT to have the doctors do any of these procedures on me as I suspect its been awhile since they've done them.

I also suspect its highly variable - some training programs have little to no allied help and you (especially as a junior House Officer) tend to be responsible for all sticks, draws, etc. Unless there is an eager med student around to do them for you. When I was on Medicine, I did all the ABGs - actually got pretty good at them. But now its been 18 months since then and I haven't done one since - I'm sure I'd have to relearn. I worked with some 4th year students who had never started an IV and others who could do heaps of stuff well - depends on your medical school, the patient population (ie, at private hospitals medical students are often discouraged if not prevented from doing procedures), your experience and your motivation and desire to learn the skills.

Some physicians like to keep their skills up and for that reason, will want to do the procedures you've mentioned (which are usually done by the nurses, PAs etc.). I would hope that I'm in that category but the fact remains that if you are swamped, you are more likely to give others responsibilities you know they can handle rather than using that valuable time to keep your skills in order.

Speaking from personal experience I have often drawn blood myself when I knew it would be awhile before we could get a phlebo to the bedside or when it just seemed easier to do it myself than go find someone else to. I'll bet others do the same.

 

[ckent]

I just learned how to draw blood on a classmate last week. It's really not that big of a deal, having your blood drawn does not hurt too much, just make sure you have a competent partner. (I hate needles too and I got through it)

 

[Mikado]

Practicing on yourself is a pretty good way to learn. Especially if you haven't started med school yet and just want to know what its like. You can pick up all the materials needed during your volunteer work.
Believe me if you practice on yourself you get good real quick.

That's probably why junkies usually roll their eyes in dismay at fresh interns trying to get blood out of them.

 

[docuw]

Actaully, practicing on yourself is the worst way you could learn. It goes along with releasing pressure under a nail, setting your own dislocation, etc. Your pain causes the arm that is supposed to be doing the work to get jumpy. Also, you mentally hold back knowing that it will hurt.

 

[Winged Scapula]

...besides, some of us get squeamish when we see our OWN blood!

 

[Mikado]

Ok I don't recomend it unless you have a high pain threshold and a lot of self control. If you have these though its very possible not to flinch at the pain. You're right about reducing and setting your own broken limbs. You really should not do that.

By the way aren't high pain threshold and immense self control exactly what you need in order to stay sitting at your desk studying for the millions of hours that it takes to achieve pre-med grades. It's pretty much the same thing if you ask me.

 

[layne20]

Oh, my goodness, now I am really nervous!! I begin med school this fall, but I hadn't really thought of my fellow classmates practicing on me. I have such small veins that no one can ever get a needle into one of them!!! And, I hate needles!

 

[Winged Scapula]

Originally posted by Mikado:
•Ok I don't recomend it unless you have a high pain threshold and a lot of self control. If you have these though its very possible not to flinch at the pain. You're right about reducing and setting your own broken limbs. You really should not do that.

By the way aren't high pain threshold and immense self control exactly what you need in order to stay sitting at your desk studying for the millions of hours that it takes to achieve pre-med grades. It's pretty much the same thing if you ask me.•

I think I have a pretty high pain threshold but cannot seem to INFLICT pain on myself purposely. I got quite a dressing down during the IDDM lecture and demo when I could NOT prick my finger for BSL testing. You'd think I was telling patients not to do it the way the Diabetes Educator acted.

You do need strong ischial tuberosities for studying and IM Grand Rounds however.

 

[jimmybee]

Hi everyone,
I just wanted to talk about drawing blood for a little bit. Having drawn blood for three years now, I feel I am very familiar with almost everything associated with this task. Throughout my years of experience, however, I have only seen physicians draw blood themselves maybe a handful of times. Normally, when they do attempt to draw blood from their patients, they are almost always unsuccessful and probably shouldn't be even trying in the first place. When the condition arises where the physician is required to draw the blood if they want their lab results, (i.e. cases where phlebotomists are unsuccessful in their attempts) doctors normally do not even bother and cancell of the tests that they had ordered.
With all of this in mind, I am surprised that medical schools even teach students how to draw blood. Maybe it is to get students used to starting IVs or inserting central lines into patients (which is much harder than drawing blood). But, if it is designed just to show students simply how to draw blood, then it is useless.

-jimmybee

 

[GreatPumpkin]

Jimmybee,

Well, I would agree with you except, with all the cut backs at the hospitals. Students, interns and residents are all having to draw blood alot more often. The phlebo. team is only avail. for use during the day, so if we need anything nights or weekends we draw it ourselves. And, at the VA hospital it is even worse. There nursing is not allowed to do any blood draws. Makes no sense to me. Well, at least I am pretty dang good now.

 

[Winged Scapula]

Yeah, it definitely depends on where you do your clinicals. My home university hospital had plenty of allied health staff who would do the draws in the daytime but after hours it was usually me - which was alright because I wanted to learn and lots of times I did it anyway during the day because it was faster if I did it and ran the blood down to the lab. But after rotating through some hospitals where everything was done for you, I knew my skills were teetering on the edge, dying on the vine.

VA hospitals are the worst (here and in OZ); if the medical students and interns didn't do the labs they'd never get done.

It is very true that many physicians don't do it well at all; I'd almost always prefer his nurse do the draw for me!