tips for drawing blood on obese patients

hbba`b``3~0 U endstream endobj 197 0 obj <>/Metadata 31 0 R/Pages 30 0 R/StructTreeRoot 33 0 R/Type/Catalog/ViewerPreferences<>>> endobj 198 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 193>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 199 0 obj <> endobj 200 0 obj [/Separation/Beaumont#20Blue 221 0 R<>] endobj 201 0 obj <>stream If its possible for you to give your patients some tips ahead of time, this can make hard-to-find veins for a blood draw so much easier. If you donate frequently, be sure to take multivitamins with iron to ensure you continue to. Gravity will often reveal hand veins you didnt see earlier. Think of an anecdote or a story you would like to share. Properly label the tubes and send to the laboratory for analysis. 0000036112 00000 n Avoid snapping or tapping veins. At nurse.org, we believe that no one knows nurses better than, well, nurses. Veins will appear as a dark line. However, thats not always a luxury most phlebotomists are afforded. If you have an issue finding the vein, do not hesitate and call for a senior, more proficient colleague. If the person is tense, try getting them to relax. They need to be labeled in advance. Slapping can lead to contraction which can further decrease the veins, producing an adverse result. Subscribe for the latest nursing news, offers, education resources and so much more! Password must have upper and lower case letters. 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. Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks, Proper safety standards to avoid a needle stick, standards for quality care for patients and health workers, including, availability of appropriate supplies and protective equipment, availability of post-exposure prophylaxis (PEP), avoidance of contaminated phlebotomy equipment. 8, 9 Even 0000029592 00000 n Try light exercise beforehand. In that case, you would use the order of Draw (venipuncture). Once you have located a vein, you can cause increase distention through massaging or exaggerated palpation (pressing repeatedly over the top of the vein). Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. For example, the veins of a middle-aged man will likely be easier to find than that of a woman, unless shes extremely active. While not commonly taught in nursing school programs, many recommend that nursing students take extra courses in how to draw blood to learn this skill. Attach the needed tubes or syringes to remove the proper volume of blood. 6. Get help from a Doctor. This can help individuals with deep veins, who are obese, or with some edema. Occasionally, it can also be caused by the longer term IV therapy. 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. Its important to remember that the patient is actually your most valuable resource during this process. Spend a decent amount of time looking for good veins. Someone else may be able to find something that you cannot. They will be much easier to spot and throbbing. Pull it back slightly and blood should flow. 0000011603 00000 n Ideally, try to work with your patient ahead of time, or give them information about what they can do to make their blood draw experience easier. 0000016460 00000 n 1) Phlebotomy Pages, Words of Wisdom From and to Phlebotomists, 2014,http://www.phlebotomypages.com/expert_tips.htm, 2) The American Red Cross, Tips For A Successful Donation, 2015,http://www.redcrossblood.org/donating-blood/tips-successful-donation. The needle is in place but there is no blood flow? When the last one is done, you need to remove the tourniquet. 0000031373 00000 n Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. Otherwise, it may indicate that you have missed which is when you should immediately back up. Every so often I'll go in an area where I'm not sure whether I feel anything or not, but know there's usually a vein there. Although this is something you mightve seen a lot in the movies, you should always avoid it. Afterward, you can easily go upwards. This is painful and can bruise the patient. What about other resources that may be available? Medicine is a very serious profession. Venous access should always be based on feel, not looks. Weight gain. It will easily increase the smaller veins. Depending on whether it is for transfusion or simple blood analysis, your cannula size will vary. Choosing a selection results in a full page refresh. That is usually the last resort. Our members represent more than 60 professional nursing specialties. Eat a healthy meal, avoiding fatty foods like hamburgers, fries or ice cream. 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. This makes sense, as many individuals, particularly those with very low body fat in their arms, will have extremely visible veins. Even with all these guidelines, perhaps the best approach is if you ask the patient from which vein they usually draw his blood. 3,377 Posts. Instead, make sure to remove tourniquet first and then remove the needle followed by instant pressure on the insertion point. 2. It happens! It used to be that all 50 states required blood tests before getting a marriage license but that is no longer the case. This instructional video, from the Blood Collection series produced by Medcom, Inc., is about special precautions for drawing blood from obese patients. Lab gives us an 8 minute window (+/- 4 minutes from exactly one hour from when they finish their glucose) to get the draw. 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. Why does blood stop flowing during blood draw? As you get older, most of you systems tend to shrink and they become more fragile. The other day I saw another nurse do a different variation of this, and she put one tourniquet above the AC (like usual), and another 2 inches below the AC. 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. If you dont know what a vein feels like, practice by feeling on yourself with you index finger. I have had patients tell me nurses are more successful in one arm than the other, etc. Massage the arm. A better vein might be available in the forearm or at the back of the hand. It can help veins to pop up, making them probably visible and easier to find. 196 0 obj <> endobj xref 0000008998 00000 n The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail. WebObesity isn't just a cosmetic concern. Best practices in phlebotomy involve the following factors: Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Apply a heat compress to the area for 3-5 minutes. It can be done by palpating the vessel or via transillumination with a special light. See which ones are available and good for drawing blood. If at the hospital, get nursing staff to assist you. They can be riskier, especially if you need to draw a lot of blood. Always start by thinking that a patient is infectious and that he can spread a disease. For the elderly, using a syringe or the butterfly system is recommended. The veins of one patient may be different in size and quality from another. Rolling up gown sleeves (rather than pushing sleeves up) to enhance tourniquet visibility. 0000012539 00000 n The heat will help dilate the veins and gravity will assist in filling those veins. Be sure that youre doing everything in your power to keep a level mindset before and during the blood drawing process. No matter how a patient looks like, it is necessary for a medical professional to protect himself. Make sure you have one in your venipuncture equipment. Follow your institutional guidelines or polices or get advice from qualified personnel. Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. In the end, they can only lead to injuries. trailer <<1A62135BA6734AC3B0AC4ED47D445652>]/Prev 812906/XRefStm 1512>> startxref 0 %%EOF 240 0 obj <>stream Make sure bleeding at the puncture site has stopped and the site is cared for. Its important to do everything in your power to ensure the comfort of the patient when drawing blood. just like everyone else. Commercial heat packs are best. Persons must be trained to use the blood pressure cuff. Use alcohol to stimulate the site to make the vein more visible. Each healthcare system has its own requirements prior to nurses performing blood draws. The Highest Paying Jobs For Nurses With a BSN, Types of Masters in Nursing Degrees & Specialties, Pros & Cons of Getting a Master's Degree in Nursing, Nurse Practitioner vs Physician Assistant, Highest Paid Nurse Practitioner Specialties, How to Conduct a Nursing Head-to-Toe Assessment, How to Read an Electrocardiogram (EKG/ECG), Understanding and Interpreting the Glasgow Coma Scale, Complete List of Common Nursing Certifications. Without proper specimens, unhelpful or even harmful medical treatment could happen. 0000180491 00000 n You want to lessen the number of sticks you give to the elderly. If you are a bit stiffer while rubbing the alcohol, it will prepare the hand for the procedure. Choosing a specialty can be a daunting task and we made it easier. The paramedic immediately brought out a large flash light and pressed it to the patients arm. Sure, its easier said than done when a needle is about to enter a persons vein, but tension can constrict veins. What are some tips and techniques for drawing blood from an elderly person? 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. Talk about pressure! You have to palpate first and decide from there. The only way to make sure is by touching it yourself. The elderly lose fat tissue as well as muscle mass, making their skin saggy. In the case of children or uncooperative individuals, restraints are an option but they should be avoided at all costs. 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. Drink an extra four (8 oz.) In this guide, well cover how to find a standard vein and what you can do if that vein isnt proving to be a good option. Carrington College does not recruit or enroll residents of the European Union. Fluid retention. Everyones arm anatomy is different and while one technique may work for a person, combining two or three may be the answer for another. Your veins will be easier to find and palpate when you are well relaxed, as tension can constrict veins. So, get help! Youll be the first to know about nursing news, trending topics and educational resources. 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 He got her first stick, and i will definately try this in the future if i have trouble. Firstly, they are sick. Some will come on wheelchairs, using a cane, needing help to walk, move, sit and stand. WebBy using a syringe and needle to draw the patient's blood, you can control the pressure and speed at which the blood is removed by varying the rate that you pull back on the This will move their fluid and/or tissue out of the way so you can see a good vein. These other sites should always only be considered when there are no other viable options available to you. 1-917-426-3524, By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. They are not as healthy and strong as they once were. Utilize the combination of massage, heat, and gravity. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! First, remember where to look. Position the patient and hyperextend the patients arm. Be careful, though. tips on starting IV, drawing blood on obese patient. The information provided should not be used for diagnosing or treating a health problem or disease. 196 45 We strive to be the It will stop the bleeding and prevent the creation of hematoma. If you do otherwise, you are going to injure the patient. Wetting the area, followed by deep massaging or palpating will oftentimes reveal or confirm vein location. However, in addition to our natural vein anatomy, here are several reasons why your veins may pose some difficulty when doing a blood test. Ask the individual to flex his or her arm a bit. 0000012097 00000 n If all else fails, you can always use drugs. Please wait while we send your information. Password must have at least 8 character(s). Check between the knuckles. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. To use a tourniquet to draw blood correctly, you should tie it three or four inches directly above the puncture site. If necessary, apply the tourniquet and examine the median cubital, cephalic, and basilic veins. Do it by performing a quick backward motion. They are springy and bouncy. Sometimes, you may see a tendon thinking that it is a vein. Alternate arms if youve given blood recently. 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. 5. You could get help from them. Has 12 years experience. Moreover, because their veins are so fragile, the elderly may receive several sticks in order to draw blood or get sufficient blood. You need to make sure there is no resistance whatsoever. This, in turn, can cause increases in your blood pressure. WebIf the finger or heel is cold to the touch, pre-warming the site for a few minutes with a warm compress or commercial heel warmer will increase the flow of blood through the capillary beds. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Some guidelines suggest 40mm Hg. They dont harm the patient in any way and can be used regularly to make your job easier and safer. Explain the procedure and reason for the blood draw to the patient. go-to source for nursing news, trending topics, and educational resources. Then, add massage to the combination. For an experienced professional, this is typically a relatively easy job. Check out our Facebook page and give it a like: http://www.redcrossblood.org/donating-blood/tips-successful-donation. Wear a shirt with sleeves that you can roll up above your elbows. In fact, based on this, the entire procedure can be harder or easier. Make sure to find a vein that is properly hydrated. There is no easy way to draw blood. An example of data being processed may be a unique identifier stored in a cookie. If you allow the visible stress or discomfort of your patient to permeate your own mentality, then youre far more likely to make a mistake or miss the vein. In doing so, this will enable students to learn basics prior to graduation. }; The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. A transilluminator is a cool way of finding or confirming veins. 2023 Carrington College. While this process is one of the more basic tasks that you will be assigned when working in a hospital, clinic, or medical practice, it can be daunting for many professionals. As a result, this will lead to the release of histamine increasing the vein. Do not snap your fingers over the vein as doing so can be painful and can initiate clotting activity, resulting in erroneous test results. Please bring your donor card, driver's license or two other forms of identification. Dispose of contaminated materials and needles in the designated hospital-approved containers. Then, deflate blood pressure cuff and apply tourniquet. She hit the vein on the first try. 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!). 0000018898 00000 n Whether youre becoming a nurse, a doctor or a certified medical assistant, youll probably have to draw blood countless times over the course of your career. While holding patients arm, make sure that your finger is well above the insertion point. 0000006606 00000 n These three together can help you find a vein. Use either a syringe or the luer adapter with the butterfly system. It helps us establish if there is something wrong with the body and what to look out for. Blood tests are one of the most important diagnostic techniques available to physicians. They should be spread distally from proximal joint to the insertion site. Follow your institutional policy when using blood pressure cuffs. We and our partners use cookies to Store and/or access information on a device. Elderly persons walking in to do blood tests usually have nicer veins, though, there will still be a few difficulties. In situations like these, you have to be patient and apply various techniques depending on the reason for the difficulty. I Feel Stuck - Like My Options Are Limited, Ethical Arguments Against Mandatory Vaccination, Nursing Student on Spring Break Saves Collapsed Man's Life, Candida Auris: Dangerous Fungus Spreading in US Health Care Facilities, Nurses Week 2023 | Best Discounts, Freebies, and More. mount_type: "" Measure the distance from the top of the head to the chin. For bigger and stronger veins you can use a 22 or 21 gauge needle. The needle should fully penetrate it. I once had a patient who was a VERY difficult stick - I brought in the best of the best IV starters that were working that night, but no luck. On top of that, there are a lot of individuals who fear (or dislike) going to a doctor. With vein locators, you can see where all the veins are. All information provided to Carrington College shall be subject to our Privacy Policy. Blood tests are no longer Hi! There are numerous situations where you should refrain from using a tourniquet as a part of your equipment. How to stick a rolling vein? 0000007172 00000 n Before you start injecting needles into people, make sure to get a proper training and get used to the entire process. Additional equipment such as goggles and splash shields should also be worn in extreme situations. Agree with other posters - ask them where they usually get stuck, heat packs, gravity, tie that tourniquet tight and give them a stress ball to squeeze. of water (or other nonalcoholic drink) before your appointment. 0000012940 00000 n Ask the patient where they usually get stuck. I have had patients tell me nurses are more successful in one arm than the other, etc. One thing that Ask the patient to make a fist and not pump the hand. With the foot- some places require a specific order r/t other dx that can increase DVT risk :) Thirdly, they may lose their appetite and drink less fluids. Avoid excessive probing. 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. Remove the tourniquet as the last amount of blood is drawn. Perform hand hygiene and don proper PPE. When performing venipuncture, he needs to convince a person that he is capable of drawing blood safely. 11. We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. If you have specific questions, but don't want to wait, give us a call at. This illuminated the veins that he could not palpate. 0000008110 00000 n The loss of support makes it easy for veins to roll causing difficulty in drawing blood. Another thing a person can do is to try to be relaxed as much as possible. Fasting glucose and hemoglobin A1c (HbA1c) Other tests are performed as indicated by clinical findings. They may be in a confused, agitated, or combative state of mind. 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 link to Blood Test Vs Blood Donation (Comparisons), link to No More Blood Tests For Marriage License. 0000014430 00000 n In most cases, simply following best practices and knowing how to find a difficult vein is the best way to carry out a successful draw. For hospitalized patients, raise the head of the bed. The practice of phlebotomy is not something that can strictly be learned from watching videos or reading a how-to guide but something that must be practiced repeatedly in a controlled environment with other trained professionals. In fact, the majority of intensive care units require their nurses to possess these skills. window.ClickTable.mount(options); Sometimes the veins are deeper so therefore you will have to go deeper. This Finding difficult veins isnt impossible, but it can require a few different methods to be put into place. Spaces are not allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores. During phlebotomy, the doctor is the one that needs to ensure everything goes well. 0000005243 00000 n Since 1997, allnurses is trusted by nurses around the globe. I have to say, I started off doing venipuncture for lab draws prior to IVs and found that a good way to learn. You can do that by gently massaging the arm, from the wrist to the elbow. N. Cleanse the puncture site: Cleanse the site with 70% isopropyl alcohol until clean. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. 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. 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. Get the patient to lower his or her arm. Applied 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 fainting, stays low. 0000279572 00000 n Do not massage down as doing so will defeat the purpose. All rights reserved. We'll need to know about all prescription and over-the-counter medications you're taking. WebApply a warm cloth or towel to the arm to cause the veins to dilate. WebPatients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. While doing all of this, make sure to penetrate the skin with one quick move. 0000005419 00000 n 0000260220 00000 n This can help reveal the vein. Apply a tourniquet approximately 3-4 inches above the selected site. Massage the arm from the wrist to the elbow if using arm veins. Create an account and get 24 hours access for free. of water (or other nonalcoholic drink) before your appointment. 0000015433 00000 n glasses of liquids and avoid alcohol over the next 24 hours. An elderly persons veins are prone to collapsing, which could mean, you may have to try several times at drawing blood. Going there is risky as you can hit a nerve or tendon. They are popular because they are so useful. If the veins are deep and not visibly popping out, use a tourniquet and have the patient lower their arm. In the event that you cant locate the appropriate vein strictly by vision, this can be a great alternative method. %PDF-1.4 % Contact should be limited and you shouldnt place the locator on burned skin. Using a tourniquet is something most people are used to seeing during difficult blood draws. The gratification of giving blood is a feeling you'll want to share. 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. If you are drawing blood from an arm, make sure to sit near the patient, as close as possible. If you cant find one, consider the third option, the forearm. With thumb, spread the skin.

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