Phlebotomist Report – This site is for phlebotomists who want tips for drawing blood and individuals who want tips for preparing and doing a blood test.

Ever encounter rolling veins? That middle vein in the center of the antecubital fossa is my favorite. It’s just so easy to stick! Rolling veins though are not that easy. You are going to come across many since most people have them. I have drawn blood from many people with rolling veins and I have learnt a few tips that have helped me to draw blood from them successfully. Below I share those tips with you. How do you prevent veins from rolling when drawing blood? The number one thing is to anchor the vein you have chosen using your thump. Other things you could do that will help is after identifying the area and the vein you are going to use to draw blood, ask the person to make a fist if using the back of the hand or to extend their arm forward if using the antecubital fossa. As you draw blood you will find the size and position of rolling veins vary. That all depends on the person’s anatomy. Whether assessing a 6 month old baby, a 12 year old child, an adult or the elderly the steps and tips to prevent rolling veins are the same. Anchoring the Vein The most important technique to prevent a vein from rolling is to stabilize it. If you do that each time you encounter rolling veins you will have success. The first step is to ask the patient to extend their arm or to bring the inside of the elbow forward. At the arm’s normal position the skin of the arm is loose making it easy for the vein to move when the needle is inserted but extending the arm to a 180 degree angle will taut the skin naturally and make the vein more stable. Making a fist does the same to the back of the hand. When the hand is relaxed the skin is also loose and the vein moves easily but making a fist tightens the back of the hand making the vein more difficult to move. Getting another phlebotomist to help may also be necessary especially in cases when the patient has saggy skin or is moving. Taut the skin at the back of the hand or on the forearm or in the antecubital area. If moving, try talking the patient into staying stable and hold the arm or hand so that there is little or no movement. After following the above steps hold down the vein you have chosen using your thumb and insert the needle. You can either hold down the vein below or above the insertion point. Do the one that is comfortable for you. Holding down the vein in that way will further stabilize the vein and prevent any rolling. What Causes Veins to Roll What do you see sometimes in the elderly? Excess skin, right? Yes, excess skin! The process of aging makes the elderly’s skin thin and weak. That results in saggy skin. They lose a lot of muscle mass. Loss of fat tissue also causes the same. Ever seen someone who has lost a lot of weight? You see hanging skin. That causes the vein to roll. Superficial veins found in the hand, the forearm or in the antecubital area also roll. These veins are usually just under the skin surface and are not supported by a lot of muscle. They roll very easily. A person who moves when the needle is inserted into their skin will cause the vein to roll. Any movement of the antecubital area, the forearm or the hand will cause the vein to roll. This happens a lot when drawing blood from children and from anyone who is afraid of needles. Additionally, do not forget to stabilize the vein with your thumb otherwise it will roll. Which Equipment and Size of Needle to Use Rolling veins are special and need some extra attention when drawing blood from them. It is best to use a syringe or the butterfly system to take the blood. You want to have some control and be comfortable when sticking the vein with the equipment you are using. A syringe or the butterfly method will allow for that control. To find out some advantages of the syringe method go here. It is easier to adjust a syringe or a butterfly needle than a vacutainer when the patient moves or is moving in the case of a child. In the case of the elderly it is also better to use a syringe or the butterfly needle since using the vacutainer exerts more pressure inside the vein which can cause the vein to collapse. The elderly’s veins are not as strong as they used to be. Using a 21, 22, or 23 gauge needle is perfect depending on the size of the vein of the patient being assessed. Always look at the size of the vein and assess what size of needle to use. The size of the vein will tell you. The age of the patient may or may not give a hint because there are adults who have small veins and children who have big veins. For small veins use the 23 gauge needle. For bigger veins use the 21 gauge. Sometimes a patient may prefer a particular size of needle. So bear that in mind. A man with a big vein who is afraid of needles may want you to draw blood from him with a 23 gauge instead of a 21 gauge needle. Give him his wishes. He is more comfortable with the smaller needle. Draw Blood Once all the steps to stabilize the vein have been followed and you have inserted the needle go ahead and draw the amount of blood sample that is needed. Follow the order of draw and other phlebotomy procedures as required. Related Questions What to do if I miss the vein? It’s possible to miss the vein after having followed the above tips. Probably the patient moved the arm or the hand or maybe the vein itself moved to the side when trying to stick it. In a case like that get another phlebotomist or someone who can assist. The person can help stay the arm or hand or taut the skin. What to do if I did not have a successful draw? Redo the procedure. Assess what caused the unsuccessful draw and take the necessary corrective actions to make the second draw successful. Get assistance from another phlebotomist if needed. Read How to Draw Blood from the Back of the Hand.

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