As a phlebotomist, I have been faced with situations where drawing blood from a person was quite difficult. In situations like these, you have to be patient and apply various techniques depending on the reason for the difficulty.
Most times, drawing blood is not that difficult, but there those occasions when you will get a difficult person. Below are several tips and tricks that you can use when you are faced with a difficult blood draw.
Use these tips to reduce the level of difficulty and make your chances more successful. Follow institutional guidelines and policies wherever applicable.
Techniques for Difficult Sticks
1. Use alternate sites (back of hand, forearm)
The first area for venipuncture is in the antecubital fossa. If the median cubital, cephalic, or basilic veins can’t be found, then go to other sites on the arm.
If other sites are resulting in no signs of veins then go back and re-examine the sites.
2. Re-examine the site
- Ask the individual to flex his or her arm a bit. Sometimes, doing so can reveal a vein.
- Extend the arm. This can help individuals with deep veins, who are obese, or with some edema. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly.
- Rotate the wrist while maintaining the position of the arm. Doing so can help move veins and tendons away from each other increasing the likelihood for a vein to show up.
3. Ensure the patient is well hydrated
When the body is properly hydrated, veins become more dilated. If the person is dehydrated or hasn’t been drinking a lot of fluids, get them to drink some and see if that helps.
Very often, drinking water will get veins to show up that were not visible or palpable before.
4. Get the person to relax
Sure, it’s easier said than done when a needle is about to enter a person’s vein, but tension can constrict veins. If the person is tense, try getting them to relax.
Maybe they can listen to some relaxing music, breathe in and out calmly, and encourage them to not be hard on themselves for having difficulty.
5. Massage
Massage the arm. Ask the individual to elevate his or her arm at the elbow. Then, massage from the wrist to the elbow. This will help force blood up and fills the veins making a vein pop up. Do not massage down as doing so will defeat the purpose.
Massage the vein. Once you have located a vein, you can cause increase distention through massaging or exaggerated palpation (pressing repeatedly over the top of 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.
6. Wet Massage
Wetting the area, followed by deep massaging or palpating will oftentimes reveal or confirm vein location.
Using alcohol or some other antiseptic, wet the site. Then, push down with the flat of the finger over the area. This can help reveal the vein.
Water may also be used to perform this technique but not warm water. Follow your institutional guidelines or polices or get advice from qualified personnel.
7. Use gravity to assist you
This technique is especially helpful with hand veins. Gravity alone will help reveal veins that were not visible or palpable earlier.
Ask the person to lower their arm for a few minutes before applying the tourniquet.
For hospitalized patients, raise the head of the bed. Make sure you check with the nurse first for permission.
At outpatient areas, ask the patient to hold their arm at their side for a few minutes.
Once the vein is located, the individual arm can be returned to horizontal position for blood collection.
8. Use heat for vasodilation
Application of heat will cause vasodilation, making veins easier to see or palpate. Follow your institution’s policy when using heat.
Be careful when using wet or damp washcloths. What may be warm to you could be hot or even burn someone else.
Commercial heat-packs are best for this technique as you can choose the temperature you want. Blankets or towels from a warmer can also be used.
Apply heat for about 3 to 5 minutes and then assess for vein. You may have to apply heat more than once.
9. Combine two or three techniques for better results
Many times combining techniques can mean the difference between finding a vein or not. Everyone’s arm anatomy is different and while one technique may work for a person, combining two or three may be the answer for another.
Utilize the combination of massage, heat, and gravity. These three together can help you find a vein.
Get the patient to lower his or her arm. Then, apply heat to the lowered arm. The heat will help dilate the veins and gravity will assist in filling those veins. Then, add massage to the combination.
Massaging may help you in finding a vein if you have not already found one.
10. Use a blood pressure cuff
Another technique is for you to use a blood pressure cuff. It can help veins to pop up, making them probably visible and easier to find.
Follow your institutional policy when using blood pressure cuffs. You may need the approval of a physician or someone else.
Persons must be trained to use the blood pressure cuff. Some guidelines suggest 40mm Hg. Get someone to assist if you are not trained or don’t have experience.
If at the hospital, get nursing staff to assist you. The nurse can take the person’s blood pressure. Inflate cuff to 30mm Hg above systolic reading and maintain pressure for about 1 to 2 minutes.
Then, deflate blood pressure cuff and apply tourniquet.
11. Use a transilluminator to find or confirm vein
A transilluminator is a cool way of finding or confirming veins. It uses high intensity light that is directed down through the skin. Orange light highlights veins as deep as 3 mm. Red light reaches a depth up to 6 mm.
Reflecting off the subcutaneous tissue, the light colors subcutaneous and fat tissue. Veins will appear as a dark line.
These devices are good at locating superficial veins, however, their ability is limited for deeper veins.
The hand and lower arm are the best places for transilluminators. Some veins can be deep in the antecubital fossa area, especially, if there is a lot of fat tissue. The device may be limited in that instance. But sometimes, it can find a vein you didn’t see or feel.
12. Get help from others
Sometimes, you will need another person or two to help you with difficult patients. Someone else may be able to find something that you cannot. So, get help!
What about other resources that may be available? Is there an IV team, anesthesiologist, or other trained personnel that could be of assistance? You could get help from them.
How Can a person Make Their Veins Easier to Find?
Maybe the number one thing that a person can do is to make sure they are well hydrated. Prepare by drinking enough fluids before the blood test. You don’t have to drink tons of water the night before but the recommended daily water intake should suffice.
Just ensure that you have drank some fluids before the test.
Another thing a person can do is to try to be relaxed as much as possible. Your veins will be easier to find and palpate when you are well relaxed, as tension can constrict veins.
Why are Veins Hard to Draw Blood from?
Genetically, we don’t get to choose our veins. The veins we have are the veins we will have for life. However, in addition to our natural vein anatomy, here are several reasons why your veins may pose some difficulty when doing a blood test.
- You have small or deep veins
- You have rolling veins
- You are dehydrated
- You have collapsing veins (elderly)
- Constricted vessels
- Inexperienced technician
- You have a lot of fat tissue
