Question about drawing blood

[Kara31191]

Today the vet told the vet assistant and I to draw blood on a cat. I was restraining/holding for the blood draw, and the vet assistant was drawing the blood.

A. I have restrained very few cats before... Like maybe 10.
B. The vet assistant had never drawn blood on her own before. So... good time.

Well anyways, something didn't go right (obviously) and she couldn't get the blood and I think the vet said something about the vein "blew"... However, I'm not sure. It was on the back leg just incase that helps. I was sort of "karate chopping" the top of the leg.

Would this be from me not holding off with enough pressure, or the blood being drawn badly?

Thank you!

PS... Turns out the vet WAS watching. She was testing us and was ready to intervene! And she did...

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[banditalfi]

It's really hard to say without watching, but the way I hold off on the back is by doing the "karate chop" so that sounds in order. Sometimes cat's have baby veins on their back legs (ok ok... they have them everywhere) and it's just really hard to hit the veins. Sometimes you get a flash and go in, but to no avail, other times you never hit it at all. I have seen everyone blow a vein, from experienced techs to first timers, and sometimes it's because they've messed up, but most of the time it's because the animal moves, or there are baby veins, or the stars aren't aligned, etc etc etc.

 

[Kara31191]

Thank you!

I was restraining firmly, partly because I was nervous. The vet did say the veins were small and the person drawing the blood said that the cat moved a little!

I'm trying to improve... That's all. Thank you again!🙂

 

[168135]

I have yet to see someone take blood from a cat's leg at our clinic. They always take it from the throat... they have a kitty bag and everything in case the cat is squirmy or aggressive.

 

[ShelterGirl]

When veins blow it can be due to a number of reasons, such as:

- The animal has small or weak veins (e.g. kittens, older cats)
- The person drawing the blood somehow poked through the vein completely (for example, if the cat jerks the leg quickly and the needle stabs in further as a result)
- The vein doesn't get held off long enough or quickly enough once the needle is removed

It doesn't sound like it was your holding off technique. Sometimes it just happens and sometimes the person drawing makes a mistake 🙂

 

[OSJ]

It doesn't sound like you did anything wrong. Some cats just have weak veins and if they move a little the veins blow- happens to even the most experienced!

 

[david594]

Back legs are kind of a pain. The veins are relatively small and if you pull too fast will collapse. Some cats just seem to have bad blood and it will clot incredibly fast in the needle. In general where I work we will only go for the back leg if we are grabbing a few drops of blood to do a SNAP test. For any significant amount we always go for the jug. If the cat isnt insane to begin with the jug is just less stressful. Pull the blood much quicker, don't have to restrain the cat as much. Now if its a fractious cat then it will be the back leg.

 

[Kara31191]

Thank you all! I've been a dork lately and I'm looking up how to restrain different animals I see at work. Usually when we are doing something I'll restrain, or try, and even though my hands are in the right place, I'll have no idea what I'm actually doing (like why I'm holding the head a certain way, where I'm supposed to be to be out of the way of the vet, etc.). So maybe I could learn a bit on my own and be more helpful at work. I'm sick of being the poop picker upper while everyone gets to learn everything. She says I'm doing well lately, so that's good. I don't want to have to be the one to ask all the "obvious" questions like "What does holding off mean?" 🙄

 

[Emio]

I don't want to have to be the one to ask all the "obvious" questions like "What does holding off mean?" 🙄

lol, gotta start somewhere!

 

[Kara31191]

You're right! It's hard to get the questions in though. She doesn't exactly take time to "teach". She just says hold like this, and do this. And I hav no idea what I'm doing! 😀 Good times!

 

[rexosaurus]

You're right! It's hard to get the questions in though. She doesn't exactly take time to "teach". She just says hold like this, and do this. And I hav no idea what I'm doing! 😀 Good times!

In many cases, the reason for restraining an animal a certain way (other than to not get injured) is to align the vessels in best way in order to access a vein without causing any damage. For instance, when you do the "karate chop", the leg is most likely flat so the vein is in a predictable place ( I don't know if you are bleeding out of the femoral or saphenous vein) if it cannot be visualized. Then you hold off to fill the vein with blood while the other tech takes a sample. Similar reasons for "hanging" a cat, holding off the cephalic (usually to place a catheter) and "rolling" such that the vein doesn't wiggle , is tight, right on the top of the leg in a predictable manner, etc. Hope this helps just a litte!

 

[meadow36]

More than likely the inexperienced assistant severed the vein causing a small hematoma to form, hence the term "blown" vein. That's why you always start as low as possible so you can go above that if the vein should happen to blow. You have to go real slow and gentle on small weak veins like those in the back.

It would have been 100 times easier to pull from a jugular.

 

[banditalfi]

It would have been 100 times easier to pull from a jugular.

Everyone is such a fan of the jug, but most experienced techs I work with prefer a back leg - so much easier to hold off and easy to hit if you know how. A squirmy cat is such a pain for a jug! But, yes, if the veins are tiny, go jug all the way.

 

[Kara31191]

Thank you for the responses. Since you're all so open to asking questions; On difficult animals, she uses a "butterfly needle". I think that's what she called it anyways. If it's easier, why wouldn't you always use that? What's the difference? It seems to pull the blood more efficiently... I'm not understanding the whole process so thank you for helping me, especially rexosaurus! That was a very helpful response! =)

 

[banditalfi]

The butterfly needle is tinier, but also has that long tubing before you actually get to the syringe. This way the animal can wiggle a little bit and it wont pull the needle out.

 

[meadow36]

Hmmm .... In my 10 years of experience I would have to disagree. I would never choose a back leg over a jug. As a matter of fact it's a rule in the ER clinic where I work to always to take blood from a jug. If the animal is restrained properly then squirming shouldn't be a problem.

 

[banditalfi]

Hmmm .... In my 10 years of experience I would have to disagree. I would never choose a back leg over a jug. As a matter of fact it's a rule in the ER clinic where I work to always to take blood from a jug. If the animal is restrained properly then squirming shouldn't be a problem.

It's actually the ER clinic where we normally do the back legs! Now that I think about it though, in several cases we're worried about clotting, so that could also be a reason we go for a back leg over a jug.

 

[168135]

Thank you all! I've been a dork lately and I'm looking up how to restrain different animals I see at work. Usually when we are doing something I'll restrain, or try, and even though my hands are in the right place, I'll have no idea what I'm actually doing (like why I'm holding the head a certain way, where I'm supposed to be to be out of the way of the vet, etc.). So maybe I could learn a bit on my own and be more helpful at work. I'm sick of being the poop picker upper while everyone gets to learn everything. She says I'm doing well lately, so that's good. I don't want to have to be the one to ask all the "obvious" questions like "What does holding off mean?" 🙄

I've never learned how to restrain a cat, and I was taught to restrain a dog once, so you are pretty lucky. I did pretty much the same thing when I volunteered... and the vets would either call on someone more experienced or I would be in the wrong place at the wrong time. When I was job-shadowing one day, my favorite vet took me into an exam room and had me restrain a dog that needed stitches taken out of its chest. Oy, that was fun. I'm holding the dogs head back... "Am I doing this right?!?!" "Doesn't matter, as long as she doesn't move her head!" Her head came down really quickly and I ended up getting hit with the doc's scissors. Here I was, not knowing what the heck I was doing, the dog was backing itself into the wall, the dog's owners were giggling, and the vet was going on about how he was almost done. The dog was a sweetheart... that was quite the experience there 😛

 

[Kara31191]

Could there be more danger if the person messes up and puts the needle in too far if they are drawing fro the jugular? 😕 Maybe that's why she would have her draw from the back leg? I'm not sure...

 

[Kara31191]

I've never learned how to restrain a cat, and I was taught to restrain a dog once, so you are pretty lucky. I did pretty much the same thing when I volunteered... and the vets would either call on someone more experienced or I would be in the wrong place at the wrong time. When I was job-shadowing one day, my favorite vet took me into an exam room and had me restrain a dog that needed stitches taken out of its chest. Oy, that was fun. I'm holding the dogs head back... "Am I doing this right?!?!" "Doesn't matter, as long as she doesn't move her head!" Her head came down really quickly and I ended up getting hit with the doc's scissors. Here I was, not knowing what the heck I was doing, the dog was backing itself into the wall, the dog's owners were giggling, and the vet was going on about how he was almost done. The dog was a sweetheart... that was quite the experience there 😛

HAHA. That's me on a daily basis! =) From my research this weekend I think I'm getting a better idea of where and why I'm holding certain ways! Finally!

 

[tealamutt]

Could there be more danger if the person messes up and puts the needle in too far if they are drawing fro the jugular? 😕 Maybe that's why she would have her draw from the back leg? I'm not sure...

another good reason to use jugular is that way you don't risk blowing a vein that might be needed for an IV cath

 

[chris03333]

The butterfly needle is tinier, but also has that long tubing before you actually get to the syringe. This way the animal can wiggle a little bit and it wont pull the needle out.

The needle is not tinier, they come in the same gage/length as syringe needles. The wings of the butterfly allow for more control of placement. This comes in handy when you have "rolly veins". The tubing helps when you have a squirmy animal so the needle doesn't move and you can continue to draw. It is extremely helpful when you have to give am IM injection to a pig (or any other animal which may be in the process of running away from you when you are injecting.)

Why don't we use them always? Well the tubing does make you need more blood/more chance of clot. Also the butterfly is not appropriate for certain areas (jug anyone???) of the body. The other reason is they are very expensive.😉

 

[Kara31191]

Chris, would there be more danger if an inexperienced person was drawing from the jugular? Or is it the same as drawing from the leg?

Thank you!

 

[ShelterGirl]

As a matter of fact it's a rule in the ER clinic where I work to always to take blood from a jug. If the animal is restrained properly then squirming shouldn't be a problem.

🙂 Having a good holder is everything. There are only a couple of folks I trust to hold well enough to let me draw from the front half (jug or cephalic). Others ... go with the back leg. It's good that you're learning to restrain, Kara - it will make you a valuable coworker - seriously!

Oh, and I'm not sure about the questions around jug being more dangerous. It does have higher pressure and faster blood flow, so theoretically it would bleed more if not clotted off quickly. However, you're only putting a small puncture in it with the needle - not slicing it open. Hopefully the DVMs can answer that one.

 

[Kara31191]

🙂 Having a good holder is everything. There are only a couple of folks I trust to hold well enough to let me draw from the front half (jug or cephalic). Others ... go with the back leg. It's good that you're learning to restrain, Kara - it will make you a valuable coworker - seriously!

Oh, and I'm not sure about the questions around jug being more dangerous. It does have higher pressure and faster blood flow, so theoretically it would bleed more if not clotted off quickly. However, you're only putting a small puncture in it with the needle - not slicing it open. Hopefully the DVMs can answer that one.

That makes sense! Thank you!

It would probably be easier to have her drawing from the back leg with me, an inexperienced holder. I could see, based on the above response, why drawing from the jug in our situation would have been more dangerous.

The reason why I asked if it would be more dangerous is because a few months ago, there was a dog fight in the clinic between the vet's dog and her employee's dog. Well, she was all worried about something around the neck. I assumed it was a vein or something, but I'm not sure. Therefore, I wasn't sure if it was dangerous if she hit something wrong in the neck. I know in reptiles there's a vein, I believe, that runs down the stomach and if it's cut into, the herp would bleed to death... so I wasn't sure if there was something like that in cats and dogs.

It seems as if once I learn the basic skills of restraining, I could be more valuable to the vet and the technicians there and I could actually help. Since I will work full time in the summer again, I would like to learn how to restrain really well so I could just jump in and help.

The doctor laughs and lets me hold macaws and toos, but it's the cats and dogs I'm not so comfortable with. It's amusing to most people there.

I appreciate all the responses! 🙂

 

[168135]

That makes sense! Thank you!

It would probably be easier to have her drawing from the back leg with me, an inexperienced holder. I could see, based on the above response, why drawing from the jug in our situation would have been more dangerous.

We have a "kitty bag". If we are having trouble getting blood from the jug because the cat is squirmy or aggressive, we put the cat in the little white bag and zip up the back. Only the cat's head and neck are not in the bag, and it makes the cat a hundred times easier to restrain. http://www.doctordog.com/catbook/1-10cvg.gif

 

[squeegee]

it's interesting to hear so many experiences where the majority of the time you choose jug. aside from individual preferences (there's one guy that i work with who almost always goes for jug no matter how much blood you need) very rarely do we go for the neck at my practice. i personally always go back leg first, then front, then jug as a last resort, unless i need a lot of blood or if clotting is a factor (PT/PTT, etc). i guess it's all in how you learn 🙂

 

[banditalfi]

it's interesting to hear so many experiences where the majority of the time you choose jug. aside from individual preferences (there's one guy that i work with who almost always goes for jug no matter how much blood you need) very rarely do we go for the neck at my practice. i personally always go back leg first, then front, then jug as a last resort, unless i need a lot of blood or if clotting is a factor (PT/PTT, etc). i guess it's all in how you learn 🙂

Speaking of clotting factors, we run two tests - APPT and PT (I think). What are the differences between these two tests? I asked a few techs and they didn't know.

 

[pupsforseeing]

Speaking of clotting factors, we run two tests - APPT and PT (I think). What are the differences between these two tests? I asked a few techs and they didn't know.

PT is prothrombin time and PTT is partial thromboplastin time. They measure the extrinsic and intrinsic coagulation cascades, respectively, as well as the common pathway.

 

[CookieBear]

it's interesting to hear so many experiences where the majority of the time you choose jug. aside from individual preferences (there's one guy that i work with who almost always goes for jug no matter how much blood you need) very rarely do we go for the neck at my practice. i personally always go back leg first, then front, then jug as a last resort, unless i need a lot of blood or if clotting is a factor (PT/PTT, etc). i guess it's all in how you learn 🙂

It is the same scenario in the practice where I worked. For cats, blood is usually drawn from the back leg, catheters placed in a front leg, and on occasion, blood would be taken from the jug.

I think it's a matter of what someone is comfortable with, has done in the past, how he/she was trained, and what the 'custom' is in that particular hospital.

 

[squeegee]

Speaking of clotting factors, we run two tests - APPT and PT (I think). What are the differences between these two tests? I asked a few techs and they didn't know.

yeahhh i don't know that much about it, i'm just an assistant though i try to pick up what i can. however, i asked the doctor, and to supplement the abovementioned info from pupsforseeing it measures different parts in the clotting cascade, specifically different molecules. so if one time is normal and the other is abnormal it can give the doctor more information as to what exactly might be the problem. don't quote me though! 🙂

 

[VeganSoprano]

Chris, would there be more danger if an inexperienced person was drawing from the jugular? Or is it the same as drawing from the leg?

Thank you!

You do have to be familiar with basic anatomy before drawing from the jug because you can't see what you are doing as well, but it's still hard to do any real damage. And you are right that there are more structures that are essential to life in the neck than in the leg. You don't want to poke the trachea, for example. It's still going to be almost impossible to make a mistake that will have serious long-lasting consequences (the most likely exception would be if the animal has a coagulopathy and you don't hold off properly after sticking), but it is important to have a healthy respect for all the important things that go on in the neck. 🙂

The tough thing about jug sticks is that you often can't see the vein. You have to hold off properly, feel it, remember where you felt it, and then stick where you felt the vein. If you don't get blood right away, it can be challenging to tell where the vein actually is in relation to your needle because unlike a leg, you can't see if you are to the side or above or below the vein in relation to the skin.

Most places will train you to become proficient in leg blood draws before letting you try jugs, just because legs are overall easier.

 

[david594]

The tough thing about jug sticks is that you often can't see the vein. You have to hold off properly, feel it, remember where you felt it, and then stick where you felt the vein. If you don't get blood right away, it can be challenging to tell where the vein actually is in relation to your needle because unlike a leg, you can't see if you are to the side or above or below the vein in relation to the skin.

That isn't always the case though right? With a cat when you hold off below where you are going to stick, the jug will inflate and become fairly obvious. If you then let up with the hand you are holding off with, you can see the vein deflate and then you will know that you are actually looking at the jug and not something else. Hold off again and it will reinflate and then you are good to stick it.

Its less obvious in some animals, but you arn't shooting totally blind. Not trying to argue or anything, just sharing my experiences with it. This has turned into a really interesting thread.

 

[chris03333]

Chris, would there be more danger if an inexperienced person was drawing from the jugular? Or is it the same as drawing from the leg?

Thank you!

Both areas contain a vein, artery and nerve. Once you learn where each is you are less likely to hit the artery/nerve.

Hit an artery in the leg...likely hematoma and have to hold off for a long time.
Hit an artery in the neck...that's likely the carotid and that sucker (pumping to the brain) is much more powerful then the one you would be holding off in the leg.

Hit a nerve in the leg...crap that probably really hurt. Worse case senario you paralyze leg musculature (very unlikely)

Hit a nerve in the neck...Crap you could paralyze the diaphragm (muscle which is key in breathing) also unlikely but probably worse then the leg.

Also there is the possibility of hitting the trachea in the neck.

So is there more danger in an inexperienced blood draw at the jugular...yes

BUT if you have someone to teach you and a good holder, it isn't very difficult.

 

[VeganSoprano]

That isn't always the case though right? With a cat when you hold off below where you are going to stick, the jug will inflate and become fairly obvious. If you then let up with the hand you are holding off with, you can see the vein deflate and then you will know that you are actually looking at the jug and not something else. Hold off again and it will reinflate and then you are good to stick it.

Its less obvious in some animals, but you arn't shooting totally blind. Not trying to argue or anything, just sharing my experiences with it. This has turned into a really interesting thread.

It really depends. Where I work, we don't shave animals for any blood draws unless it's a true emergency such as if we're trying to get an I-stat on an animal who's coding. If you do shave, you can usually see what you're doing. But without shaving, you can pretty much only see jugs on certain breeds such as Boxers and Dobermans and the rare Sphynx or Rex cat.

And then you have the dogs who are so lumpy they're even hard to feel. Finding a jug on a really fat Cocker Spaniel, for instance, is ridiculously difficult!

So it depends, but more often than not you really can't rely on your eyes. You have to feel what you are doing, and you can feel the vein inflate and deflate when you hold off.

 

[Kara31191]

Thank you! I thought there had to be a way to do damage being near (well not directly) the spine, trachea, and everything that connects the body in the neck near the jugular. So that's why I was wondering!

This really is an interesting thread! Thank you everyone for responding! 😀

 

[xyukixxxchanx]

hay i m taking Wilson tech for veterinary assisting and i have midterms starting tomorrow

anyways... how do i restrain to draw blood from the jugular vein, is it sternal recombancy or is their another restraint used?😕 i don't remember can someone plz help me out

thanks

 

[HopefulAg]

Uhhhh no idea....didn't know the holds had names.

 

[cowgirla]

Uhhhh no idea....didn't know the holds had names.

Basically there's sternal and lateral recumbency....sternal, the animal is laying normally. Handler uses one hand to position the head upwards, pointing nose towards the ceiling, other arm leans over the shoulders and keeps the patient still.
Cats, I find it easier to have them on the edge of the table, one hand holding the front legs down off the edge, the other hand holding the head up, with the body tucked between my elbow and my arm. I don't know if there's a name for that, it's not quite the same sternal recumbency as dogs.


Lateral, the patient is on their side, handler has one arm across the neck to hold the bottom front leg, the other across the hind quarters to hold the bottom back leg.

Sternal, on a cooperative patient is the best for jugular blood draws.
However, my wonderfully talented vet can also hit the jug while the patient lateral. That's only for the naughty ones though!

Or, if the dog is cooperating, it can be done while he's standing...the handler uses one hand to hold the head in position against their shoulder, the other hand is under the belly, keeps him from laying down or going somewhere.

I think that covers most of the basics, but I'm sure someone will come along with all the proper terminology. 🙂

ETA: And there's dorsal recumbency, for ultrasounds and xrays and stuff where the patient needs to be on their back. I usually need an extra set of hands for this one.

 

[xyukixxxchanx]

thanks

do you know if the strech is used on cats to draw blood from the femoral vein

 

[cowgirla]

thanks

do you know if the strech is used on cats to draw blood from the saphanous vein

Yes, you stretch them out along your forearm.

 

[xyukixxxchanx]

thank you

Im sure ill ace my midterms now as long as i don't forget that the vein in the cats hind leg is called the femoral and not the saphanous ^_^

thanks for all the help🙂

 

[xyukixxxchanx]

one more thing, I'm still confusing the vaccine schedules

the core vaccines such as the FVRCP is a set of 2, 4 weeks apart than annually or is that the optional vaccines?
just to be sure, the rabies starts at 12 weeks, is fallowed up one year later an than every 3 years?

 

[cowgirla]

one more thing, I'm still confusing the vaccine schedules

the core vaccines such as the FVRCP is a set of 2, 4 weeks apart than annually or is that the optional vaccines?
just to be sure, the rabies starts at 12 weeks, is fallowed up one year later an than every 3 years?

Vaccines vary by area and then by vet, so take this with a grain of salt.

For kittens, my vet does a set of three for FDRCV, at 8, 12 and 16 weeks.
Rabies is 12 weeks, 1 yr, and then for cats, we don't use a 3 year vaccine. We've seen way too many injection-site sarcomas from the three year in cats.
Leukemia is 16 and 20 weeks, then yearly.

Dogs:
Da2pp #1 is 8 weeks
#2 and 3 are 12 and 16 weeks, and have lepto included. We booster both yearly, until the age of 5 or so, then Da2pp is every three years, but lepto stays as an annual.
Rabies is 12 weeks, 1 year, and then every three years. Some states near us require every two years.
Lyme is 16 and 20 weeks, then yearly
Bordatella is 16 and 18 weeks, then yearly unless boarding frequently...then we'll booster it every 6 months if necessary.

I'm heading to bed now, so good luck studying.

 

[xyukixxxchanx]

thanks ^_^🙂

 

[alliecat44]

thank you

Im sure ill ace my midterms now as long as i don't forget that the vein in the cats hind leg is called the femoral and not the saphanous ^_^

thanks for all the help🙂

You draw blood from the medial saphenous in a cat's rear leg, and the lateral saphenous in a dog's rear leg.

Good luck!

 

[bunnity]

Different vets use different vaccination schedules.

In my shelter for kittens we do FVRCP every three weeks until they get adopted, up to a total of four. For adults we do not boost FVRCP. It can also depend on if you are using killed or modified live vaccines.

So I think for this one you would need to go with what you were taught in school for the test, because you're going to get different answers from us.

 

[CookieBear]

one more thing, I'm still confusing the vaccine schedules

the core vaccines such as the FVRCP is a set of 2, 4 weeks apart than annually or is that the optional vaccines?
just to be sure, the rabies starts at 12 weeks, is fallowed up one year later an than every 3 years?

This link may be useful regarding cat vaccinations:
http://secure.aahanet.org/eweb/imag...03_technician/153_CURRENT RECOMMENDATIONS.pdf

 

[twelvetigers]

Yeah, we don't do rabies until 16 weeks here. And, it's still yearly in OK.

 

[variegata]

Jeez, after reading this, I'm even more grateful than I already was for happening to work/volunteer at places where they told me exactly what to do when I was learning!

We do nearly all of our blood draws from the jugular. When we're first learning, we do it on anesthetized pets only and get it signed off, so my first jugular draws were with the animal lateral. It's not that weird (once you've done it a few times). They have us learn to draw on all 3 main veins in both species first while they're under, then we get a new sheet where we get to do it on awake animals with RVT supervision. Our clinic wouldn't put you in there if you didn't know what you were doing--and if you went in not know what you were doing, you'd most likely get a good talking-to for not finding someone more qualified.