Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. 11. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. Carrington College does not recruit or enroll residents of the European Union. Try light exercise beforehand. There is a nice way to fill the tubes faster. When you are retaining water, it increases the total volume of fluid that is being pushed through your blood vessels by your heart. Do not apply the tourniquet too tightly over the arm or wrist as it could cause injury or collapse the vein. Veins may collapse in the process and failed attempts at blood draws lead to hematomas which bring about pain. If the person is tense, try getting them to relax. A trick I use sometimes is putting a second tourniquet 2 inches above the first tourniquet. It can really make the veins pop. The other day I saw a Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses need to learn. Additionally, these steps only apply to the adult and pediatric population and not neonates. Do not snap it against the patients skin as doing so could cause bruising in the area.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-banner-1','ezslot_5',168,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-banner-1-0'); The 3 main areas to find veins include the antecubital fossa, the forearm, and hand veins. Be careful when using wet or damp washcloths. If a vein is not prominent enough to see easily, you can feel around for it. In order to reduce the risk of thrombosis, lines need to be flushed with a solution of heap in. By placing a warm towel over the veins, you are increasing the blood vessels which will make them more visible. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. With vein locators, you can see where all the veins are. The gratification of giving blood is a feeling you'll want to share. Use left/right arrows to navigate the slideshow or swipe left/right if using a mobile device. Specializes in OBGYN, Urogynecology. Check out our list of the top non-bedside nursing careers. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. Usually, if you cant find a vein in the antecubital fossa or at the back of the hand, you will find one in the forearm. Spend a decent amount of time looking for good veins. Try tourniquets, hot packs, gravity, and ask the patient where they usually have luck with bl It used to be that all 50 states required blood tests before getting a marriage license but that is no longer the case. If a patient is reluctant or fearful, it can interfere with drawing blood. Check between the knuckles. Often, even a loose bind can help a vein to pop. Nursing schools do not teach this skill due to legality issues. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. All these factors contribute to their veins staying low. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. The elderly need special care and attention when doing a blood test. Everyones arm anatomy is different and while one technique may work for a person, combining two or three may be the answer for another. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Word of caution: make sure to remove the substance before rubbing the vein with alcohol. This is mainly due to the fact that different people have different biological systems which can make it harder to find and puncture the vein. 0000036112 00000 n These 5 areas include:if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'phlebotomistreport_com-medrectangle-4','ezslot_6',165,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-medrectangle-4-0'); From my experience elderly persons on wards are the most difficult sticks. This will fill them up much quicker which is a great way to finish procedure faster if you have a troublesome patient. Finally, an ER tech came up and he used a venoscope, which is basically a fancy flashlight - basically the same thing that bruali described in their post. Don't take aspirin for 2 days before your appointment. Create well-written care plans that meets your patient's health goals. Medicine is a very serious profession. Secondly, they lay most of the time. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Luckily, got it on the first stick. Gravity alone will help reveal veins that were not visible or palpable earlier. Follow the cephalic and basilic veins down the forearm. This one goes without saying but is still something that needs to be emphasized. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. 0000001512 00000 n Blood tests are no longer Hi! To find out the advantages of the syringe method go here. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. These three together can help you find a vein. Orange light highlights veins as deep as 3 mm. You need to keep their attention and make sure they do not notice the needle. I understand that consent is not required to purchase any goods or services from this school and that my consent can be revoked at any time. link to Blood Test Vs Blood Donation (Comparisons), link to No More Blood Tests For Marriage License. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. So, the choice of equipment will change from patient to patient. You can try several approaches mentioned earlier in our venipuncture guidelines that will increase the vein. H\@E|E/g#0tW Y3y(N> CA}G)H6GUab/Jqk;gy>>n5%sLWorayo|zEnmn;4d~{;m/E. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. 0000022045 00000 n Before you can start, you need to ask the patient if he has any allergies to drugs. Then, deflate blood pressure cuff and apply tourniquet. Then, push down with the flat of the finger over the area. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. WebTo clarify: The serum on the left is what normal serum looks like, but actually comes from an obese patient middle aged or older with metabolic issues (the patients I normally work with). The needle may have pulled out of the vein. 2023 Carrington College. Dont do any heavy lifting or vigorous exercise for the rest of the day. This can help individuals with deep veins, who are obese, or with some edema. venipuncture is one of the main parts of your job. When the body is properly hydrated, veins become more dilated. They can help you to find a usable vein quickly, so you can get the blood draw you need, and your patient can remain comfortable throughout the experience. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. 0000015433 00000 n No matter how a patient looks like, it is necessary for a medical professional to protect himself. It will stop the bleeding and prevent the creation of hematoma. Those veinfinders are worthless. I have had patients tell me nurses are more successful in one arm than the other, etc. If you are having difficulty finding a vein or is unsuccessful at drawing blood, ask for assistance from another experienced phlebotomist or you can get help from a doctor. There is no easy way to draw blood. Youll be the first to know about nursing news, trending topics and educational resources. Make sure bleeding at the puncture site has stopped and the site is cared for. Talk to your doctor or therapist about improving your coping skills and consider these tips to cope with obesity and your weight-loss efforts: Journal. Make sure they are feeling well before leaving. Unfortunately, some veins are significantly easier to see than others. We use cookies to ensure that we give you the best experience on our website. Another way that prednisone can increase blood pressure is weight gain. Before you start injecting needles into people, make sure to get a proper training and get used to the entire process. It worries me to see so many people in this thread and others talk about seeing veins and palpating them only if you can't see one. Venous access s If the antecub has already been accessed there are great options for venipuncture. Venous access should always be based on feel, not looks. If you're drawing blood cultures, be sure to follow the policy and procedure at your facility. The ability to obtain blood samples rapidly without altering cells in the sample is essential to maximize diagnostic quality. 196 0 obj <> endobj xref tips on starting IV, drawing blood on obese patient. This is the name displayed to others on any playlists or clips you share, Copyright 2023 by Alexander Street, part of Clarivate, Logo of Alexander Street, part of Clarivate. }()); Drawing blood from a patient can be a daunting task, but it also is a necessity for nurses. Has 9 years experience. hb``g`` @16 N$00Le@L,9$)_5M2APPP*dW;b]0D&0dxAAmCfFO7008X`&` *7h_P tex4\T'# ` 1 endstream endobj 239 0 obj <>/Filter/FlateDecode/Index[33 163]/Length 27/Size 196/Type/XRef/W[1 1 1]>>stream You could get help from them. If you have an issue finding the vein, do not hesitate and call for a senior, more proficient colleague. In order to prevent it, professional will have to avoid phlebotomy from a hematoma and to avoid drawing plunger forcefully. Once you have located a vein, you can cause increase distention through massaging or exaggerated palpation (pressing repeatedly over the top of the vein). Alternate arms if youve given blood Webwhy might it be difficult to draw blood from an elderly patient The skin becomes thin and blood vessels become weaker how much whole blood is needed to yield 5 mL of serum The forearm is about the last place to look. If you experience dizziness or lightheadedness, stop what youre doing and sit down or lie down until you feel better; avoid performing any activity where fainting may lead to injury for at least 24 hours. Anchor the vein from below with your non-dominant hand by gently pulling on the skin distal to the insertion site. If you are a bit stiffer while rubbing the alcohol, it will prepare the hand for the procedure. 0000185079 00000 n Nitroglycerine is yet another substance that can help you out during phlebotomy. I was in a patients home a few days ago and had to call EMS, the patient was obese and her spouse said she had terrible veins. The paramedic immedi Additional equipment such as goggles and splash shields should also be worn in extreme situations. of water (or other nonalcoholic drink) before your appointment. My trick is to press on their hand or arm with both of my thumbs. For multiple samples use the luer adapter or a 10 ml syringe. In order to prevent hematoma, you should only puncture the uppermost wall. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. This is due largely to the fact that patient factors will vary greatly when it comes to drawing blood. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. The medical expert needs a certain amount of practice as there are many things that can go wrong. For bigger and stronger veins you can use a 22 or 21 gauge needle. However, for the elderly, it may be difficult. 0000276013 00000 n Perform good hand hygiene and don appropriate PPE. Please bring your donor card, driver's license or two other forms of identification. %PDF-1.4 % Fat, or obese patients, have more fat around their veins which can make it difficult to find the vein for drawing blood or starting an IV. WebPatients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. 0000018898 00000 n qG@OWdeDHj5b$Ze+QPbk8oo9uDP+GJXU'X96B@;"p4-BBR'@;Z6U`[VTk^9@(} f4qa l8pE2xr/4A-\1~},HZU!6)QH` T@C 6y@ Eh7| c"qnN n Qf3NQA(d2=d9 yN|1*XYa28YSIkefHIly `zhMs\\U@>fU^s,'/ksc>M# /jD/[7=6e*6c\u1_UL3Rll5nd;m,&!w{,`YNk 3 ]^]u>mrA- k`JM4>!Aoa0z't@l"4vl~"Frq}}]#)V1Z/8BnMs^|^x}^%0)&f3FY8I'wU\`Osd{z_b|{Q30Sck-BT[@'hJV2y )lw[;w]p39=%=N|=}|60m2}Edt/#2x!Ta}$n8x4py}` lt endstream endobj 202 0 obj <>stream Even with all these guidelines, perhaps the best approach is if you ask the patient from which vein they usually draw his blood. In fact, most of the procedures cannot be performed if you dont have a clear head on your shoulders. 0000260220 00000 n If you donate your blood to organizations like the American Red Cross, then you can rest easy knowing, A phlebotomist is a medical professional whose main job is drawing blood. WebDrink an extra 16 oz. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Measure the distance from the top of the head to the chin. When performing venipuncture, make sure to sit whenever you can. This helps you build trust with a patient even further. Make sure you check with the nurse first for permission. To expedite your donation, start your RapidPass on the day of your appointment. Massage the arm. Medical professional also has to be a salesman of the sort. This study guide will help you focus your time on what's most important. Keep the strip bandage on for the next several hours; to avoid a skin rash, clean the area around the bandage with soap and water. Persons must be trained to use the blood pressure cuff. It is also possible to apply multiple tourniquets. When drawing blood, you will need several tubes for different samples in your equipment. Password must have at least 1 special character(s). If you are going to start an IV in the hand always have the patient pump their fist. In this module, you'll learn why the right approach is critical when drawing from overweight patients, and you'll have a newfound appreciation for what it's like for too many patients when they encounter insensitive healthcare professionals. Remove the needle from the patients arm and press down on the vessel with gauze. 0000005419 00000 n Scar tissue can especially be problematic as it is hard to penetrate. Pump the fists! It helps us establish if there is something wrong with the body and what to look out for. This can pose a real problem as their veins collapse quicker. Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. If possible, look at areas that tend to have less subcutaneous fat, such as the back of the hand, the thumb, the wrist, and even the top of the foot. Using heat (such as a warm towel) or placing the extremity in a dependent position (to allow gravity to fill the veins) can help, too. Some guidelines suggest 40mm Hg. Confirm the ordered tests and fill out the appropriate forms and labels. For an experienced professional, this is typically a relatively easy job. For example, the veins of a middle-aged man will likely be easier to find than that of a woman, unless shes extremely active. Insert the beveled needle at a 30-degree angle into the vessel. Patients who are severely dehydrated can also make it difficult to find a vein. They are not as healthy and strong as they once were. Occasionally, it can also be caused by the longer term IV therapy. As the body ages, the skin becomes thinner and blood vessels become weaker. With the foot- some places require a specific order r/t other dx that can increase DVT risk :). Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. A close look at the site from which you will draw blood will tell you which equipment to use. Get the latest on all things nursing by joining our email newsletter. Apply heat for about 3 to 5 minutes and then assess for vein. Follow institutional guidelines and policies wherever applicable. WebFor routine blood draws, 70% isopropyl alcohol or 70% ethyl alcohol is recommended. If they come in for their appointment well-prepared, it should be easier to find a vein almost immediately. The consent submitted will only be used for data processing originating from this website. Blood tests are one of the most important diagnostic techniques available to physicians. Put ur fingers on the bottom of their arm and press the tops with your thumbs. Once you have selected the right vein finder for an obese patient, it is important to know how to properly use the Get help from another phlebotomist. They need to be labeled in advance. Create an account and get 24 hours access for free. WebA measurement around your waist. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. Wear a shirt with sleeves that you can roll up above your elbows. 0000001689 00000 n It all depends on your preparation and equipment. There's so much that a small sample of blood can tell a doctor that you'll likely need, Giving blood is vital as it saves millions of lives every year. Relax for a few minutes in our refreshment & recovery area have some cookies or other snacks youve earned it! Once the vein is located, the individual arm can be returned to horizontal position for blood collection. You have to palpate first and decide from there. What about other resources that may be available? Dismiss. Our members represent more than 60 professional nursing specialties. You may have to apply heat more than once. In the end, they can only lead to injuries. I am a full time phlebotomist and I enjoy my job. Next, identify the vein that you will be using. Standard laboratory studies in the evaluation of obesity should include the following: Fasting lipid panel. Is there an IV team, anesthesiologist, or other trained personnel that could be of assistance? This can be a real time saver and it is also the best way of finding the right insertion point. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. 0000000016 00000 n A better vein might be available in the forearm or at the back of the hand. For routine antisepsis, you can use a standard alcohol prep pad or alcohol-impregnated swabs. Sometimes, doing so can reveal a vein. I hope you find my posts helpful. ), 2023 Center for Phlebotomy Education All Rights Reserved, Phlebotomy Continuing Education Exercise (ATM): Phlebotomy and the Obese Patient. The order of venipuncture sites is vital to follow. A second option for finding veins and drawing blood are hand veins. Donating Platelets? 0000012097 00000 n Extend the arm. One thing that I find that helps is using two tourniquets - take them together and tie it. To use a tourniquet to draw blood correctly, you should tie it three or four inches directly above the puncture site. That means that you can trust us to have reliable, up-to-date information Patients hand should be dangling so that the blood can rush down and fill the veins. Big ppl are not bad to stick at all, especially the ones with edema. My trick is to press on their hand or arm with both of my thumbs. Put ur finge Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. 0000016460 00000 n Massaging may help you in finding a vein if you have not already found one. Additionally, you will have to consider the reason why you are performing insertion of the needle. What constitutes a difficult vein? This forces blood up and fills the vein. A phlebotomist will need to find a good, strong vein from which to draw blood. But when dealing with a particularly disruptive or difficult individual, its imperative to balance both sympathy and professionalism in this matter. possible. It uses high intensity light that is directed down through the skin. HlV7WF#J$% r!h {7@)RRXZ4J9(e??@!o]h&Do?Y[L *fIXH^ Premarital blood tests have been done away with. Top Student Loan Forgiveness Programs for Nurses, Top Nursing Interview Questions & Answers, How to Create a New Graduate Nurse Resume, Best White Shoes for Nurses and Nursing Students, Best Stethoscopes for Nurses and Nursing Students, How to Work in the US as a Foreign-Educated Nurse, Why Nursing is a Great Career Choice for Men. WebTips for Drawing Blood Always feel the vein rather than see it! Remove the needle, take care of the site and repeat the procedure. 6. Do not be afraid to touch your patient. You need to have a firm, strong grip on patients hand. When the last one is done, you need to remove the tourniquet. Your approach is something that can vastly affect the patient, making the whole experience more or less enjoyable. What may be warm to you could be hot or even burn someone else. Rolling up gown sleeves (rather than pushing sleeves up) to enhance tourniquet visibility. The device may be limited in that instance. It happens! Massage the arm from the wrist to the elbow if using arm veins. Thirdly, they may lose their appetite and drink less fluids. Many times combining techniques can mean the difference between finding a vein or not. Place it at the chin and lightly draw a straight line. 0000005129 00000 n It is the best thing for patients with low blood pressure. If you donate frequently, be sure to take multivitamins with iron to ensure you continue to. Firstly, they are sick. *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. If you really can't see a vein they usually will have one on their hand just between the 4th and 5th finger on the top of the hand. That's why we rely on registered nurses and other experienced healthcare Veins become more visible when blood is forced into them. You can do that by gently massaging the arm, from the wrist to the elbow. Your veins will be easier to find and palpate when you are well relaxed, as tension can constrict veins. Only major veins should be used here. First, remember where to look. Get a good night's sleep the night before your donation, eat healthy foods and drink extra liquids. Usually, the antecubital area has the best veins for drawing blood. Properly label the tubes and send to the laboratory for analysis. The elderly lose fat tissue as well as muscle mass, making their skin saggy. Ask the individual to elevate his or her arm at the elbow. Below are several tips and tricks that you can use when you are faced with a difficult blood draw. Ask the patient to make a fist and not pump the hand. It can help veins to pop up, making them probably visible and easier to find. trailer <<1A62135BA6734AC3B0AC4ED47D445652>]/Prev 812906/XRefStm 1512>> startxref 0 %%EOF 240 0 obj <>stream Wetting the area, followed by deep massaging or palpating will oftentimes reveal or confirm vein location. If that is the case, the patient should bend arm upwards which will make the vein more visible. They are springy and bouncy. Also, it is the basis of diagnostics. On top of that, there are a lot of individuals who fear (or dislike) going to a doctor. The heat will help dilate the veins and gravity will assist in filling those veins. As a result, it can be difficult at times to find a vein to draw blood from. I've been an RN for almost 3 years and an ED tech prior to that (which is where I learned my IV skills- nursing school sure didn't teach me much!). Extend the arm. Red light reaches a depth up to 6 mm. Have iron-rich foods, such as red meat, fish, poultry, beans, spinach, iron-fortified cereals or raisins. A lot of patients have the needle phobia. While it is important to know the best veins to access its also important to know which areas to avoid. Sometimes, the patient may experience hemoconcentration. But sometimes, it can find a vein you didnt see or feel. Frail veins can pose a great problem when drawing blood. 3,377 Posts. This is a common misconception - pumping the hand does not increase venous circulation. Learning the anatomy of the main veins and arteries in the body is essential to becoming competent in phlebotomy. By explaining everything, you make sure there are no surprises ahead. The patients vein may have collapsed. If at the hospital, get nursing staff to assist you. Water may also be used to perform this technique but not warm water. You can support each other and do twice as much good! Quiz and answer key included. Syringe, vacutainer, and needle size should As a result, this will lead to the release of histamine increasing the vein. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. These other sites should always only be considered when there are no other viable options available to you. The bevel of the needle should go upwards. What are some tips and techniques for drawing blood from an elderly person? WebApplied Muscle Tension (AMT) is a series of simple exercises that help your blood pressure stay up and improve blood flow, so your chance of experiencing any side effects, like Otherwise, it may indicate that you have missed which is when you should immediately back up.
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tips for drawing blood on obese patients 2023