Drawing Blood: Hand Veins | Phlebotomist Report

I have resorted to the back of the hand on many occasions when drawing blood. It is my second choice. I usually find myself looking at hand veins when I cannot find a vein in the antecubital area. Drawing blood from hand veins can sometimes be awkward depending on the position of the vein and the type of equipment you are using to draw blood. I have found out a few tips and below I share them with you. How do you draw blood from hand veins? To draw blood from hand veins follow these steps below: First, wash your hands with soap and water or sanitize it if it's not too soiled. Put on gloves. Assess the patient's hand, looking at the veins, their location, and the general anatomy of the hand. Apply the tourniquet about 2 inches above the wrist. Ask the patient to make a fist. Examine the veins and choose one you will use for the procedure. Then apply an alcohol swab to the area you are going to insert the needle. Let air dry. Setup Equipment Anchor the selected vein, insert the needle and draw. Release tourniquet before removing the needle. After the draw is complete remove the needle. Then apply cotton ball or gauze to the insertion site. Discard the needle. Write the patient’s details on the sample tube. Wish the patient a good day. Clean up and sanitize the working area. Discard off used supplies. Send samples to the lab for processing. These steps may seem like a lot but once you get the hang of it the process becomes natural. The best way to master this is to practice, practice, and practice! Follow the steps in order. Clean your Hands Wash your hands with soap and water or sanitize it with alcohol rub before starting the procedure. Then dry them with a paper towel. Put on gloves when done. Survey the Back of the Hand Now you are ready to start the procedure. Survey the area. This will give you the advantage as you start, giving you an idea of the veins you are going to be working with and therefore giving you confidence. You get an idea of which equipment to use whether a syringe or butterfly needle. Also, if this is going to be a difficult stick or an easy one! Don’t spend too much time surveying the hand. Just a few seconds. Apply the Tourniquet about 2 Inches above the Wrist After surveying the hand apply the tourniquet. Surveying is just to give you a general idea of what to expect and which tools you may need. Applying the tourniquet slows down the blood flow in the veins causing it to swell. Any hiding veins will begin to show. The tourniquet should only stay on for about 1 minute. Keeping it for longer can cause hemoconcentration and affect lab test results. If you can’t apply the tourniquet, find the vein, clean the insertion area, insert the needle, and draw blood in under 1 minute then release the tourniquet. Some people have really good veins and are very easy to find. In those cases you can perform the procedure within 1 minute. In other cases it may take longer than 1 minute so make sure to release the tourniquet. You may need to reapply. Make a fist This is important especially if the person has rolling veins. Making a fist tightens the skin, adding more stability to the vein. Gripping a pillow or a soft ball will also make the veins more prominent. Select a Vein to Stick Choose a vein preferably one that is straight. Sometimes a straight vein may not be available so choose the best that is available. At other times there may be several veins that are good. Just choose anyone. For more help read this article Mastering Vein Selection. If the patient has difficult veins and it seems like this is a hard stick don’t be shy to get some assistance from another phlebotomist. Just observe and learn. Don’t be afraid to challenge yourself as well and to do a hard stick because doing it yourself will give you confidence for the next time. When I started my journey doing phlebotomy that’s what I did. In the beginning I would get help from others that were more experienced than me but one day I had to do it on my own. And I was so glad I did. That’s how I improved, gained confidence and became successful. Stay away from veins in the palm of the hand, fingers, and near the wrist area. Clean Site with 70% Alcohol Allow a few seconds for the vein you chose to pop up. Once it shows up go ahead and clean the site starting from the center working your way downward and outward. Clean the site thoroughly and properly. Then let air dry. Setup Equipment While the insertion site is air drying go ahead and set up equipment. You have already surveyed the hand and chosen a vein. The veins will always tell you which equipment to use. For the back of the hand use either a syringe or butterfly needle and preferably a 23 gauge needle. Hand veins are usually smaller than the veins found in the antecubital area. So going for a smaller needle is best. Knowing which equipment to use will come with practice over time. What may work in this instance may not work in another. So use your judgment as you go about doing this. Anchor the Selected Vein, Insert the Needle and Draw Using your thumb pull back on the skin or vein to anchor it. That will further stabilize the vein making it more difficult to move. Remember to not touch the insertion site when anchoring. Insert the needle at a 15 to 30 degree angle. Insert until you see a flash of blood. Then straightened the needle along the vein. The butterfly system has plastic wings to support it on the hand. If using a syringe hold the barrel with one hand while using your other hand to pull on the plunger. Draw blood. Release Tourniquet before Removing the Needle When you are drawing the final tube release the tourniquet. Don’t remove the needle while the tourniquet is applied. Move it first. Remove Needle After the draw is complete remove the needle. Apply the cotton ball to the insertion site. Then ask the patient to apply some pressure to the cotton ball using their finger. Discard the used needle into a sharps container. Enter Patient’s Details Write the patient’s name, date of birth, gender, time sample was collected and the date on the sample tube. Include your signature as well. That makes you responsible if anyone has queries. Warm Wishes Wish your patient a good day as they leave. This is not really a step but it’s important. Interact with the patient before, during and after the blood test. You don’t have to be the patient friend to talk to him or her. This approach will get the patient to know you a little, build some confidence in you and make the process of drawing blood easier for both of you. Next time the patient comes he or she is going to ask for you! Bingo! You scored! They liked and remembered the experience they had with you the first time. Clean up and sanitize your working area. Discard off used equipment. You want your working area to be clean for the next patient coming in. Sample Processing Before sending the samples to the lab for processing check that you have entered all the patient's details and that no sample is unlabeled.