Over the years I have drawn blood from many older patients, learning tips and techniques along the way in dealing with them and drawing blood from them. The elderly need special care and attention when doing a blood test.
They are not as healthy and strong as they once were. Some will come on wheelchairs, using a cane, needing help to walk, move, sit and stand. They may be in a confused, agitated, or combative state of mind. Kindness and helpfulness must be shown to them.
What are some tips and techniques for drawing blood from an elderly person? Below are 5 key areas of importance with tips. These 5 areas include:
- Hospitalized patients
- Fragile veins
- Application of tourniquet
- Options for blood draw
- Proper equipment
Elderly on Wards at Hospitals
From my experience elderly persons on wards are the most difficult sticks. Firstly, they are sick. Secondly, they lay most of the time. Thirdly, they may lose their appetite and drink less fluids. Fourthly, they are not very active, possibly causing lower blood pressure, hence slower blood flow. All these factors contribute to their veins staying low.
As a result, it can be difficult at times to find a vein to draw blood from. Sometimes, it’s even hard to feel them with your finger.
Elderly persons walking in to do blood tests usually have nicer veins, though, there will still be a few difficulties.
The Elderly have Fragile Veins
As the body ages, the skin becomes thinner and blood vessels become weaker. The elderly lose fat tissue as well as muscle mass, making their skin saggy. The loss of support makes it easy for veins to roll causing difficulty in drawing blood. Click here for a previous article I wrote about rolling veins.
Moreover, because their veins are so fragile, the elderly may receive several sticks in order to draw blood or get sufficient blood. Veins may collapse in the process and failed attempts at blood draws lead to hematomas which bring about pain.
Be gentle as you work with the elderly.
Tourniquet Considerations
The elderly are prone to bruising when applying the tourniquet. To avoid bruising, place the tourniquet over the patient’s shirt sleeve if drawing blood from an arm vein.
For hand veins, apply the tourniquet 1-2 inches above the wrist. Do not apply the tourniquet too tightly over the arm or wrist as it could cause injury or collapse the vein.
When the blood draw is complete, gently release the tourniquet. Do not snap it against the patient’s skin as doing so could cause bruising in the area.
Options for Drawing Blood
The 3 main areas to find veins include the antecubital fossa, the forearm, and hand veins. An elderly person’s veins are prone to collapsing, which could mean, you may have to try several times at drawing blood. So, before attempting to draw blood, look at the 3 areas mentioned above for the best veins to access and draw a blood sample.
You want to lessen the number of sticks you give to the elderly. They already have pain, so let’s make the process easier and more comfortable for them.
The Antecubital Fossa
Usually, the antecubital area has the best veins for drawing blood. It is the first area to look for veins. However, for the elderly, it may be difficult. A better vein might be available in the forearm or at the back of the hand.
If necessary, apply the tourniquet and examine the median cubital, cephalic, and basilic veins. See which ones are available and good for drawing blood. If you can’t find a good vein, move to the back of the hand.
Hand Veins
A second option for finding veins and drawing blood are hand veins. Many times, you will have to resort there to draw blood. Stay away from the palm of the hand, fingers and from the wrist area. Going there is risky as you can hit a nerve or tendon.
Check between the knuckles. Sometimes you can find a good one there, though be careful as you insert the needle. Don’t go deep. Insert along the vein.
Survey the hand and choose a vein that you can draw blood from. If you can’t find one, consider the third option, the forearm.
The Forearm
The forearm is about the last place to look. Usually, if you can’t find a vein in the antecubital fossa or at the back of the hand, you will find one in the forearm. Follow the cephalic and basilic veins down the forearm.
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. A doctor can access the femoral vein and others to draw blood.
Use these techniques to find veins and make veins more prominent:
1. Lower the patient’s arm for a few minutes before applying the tourniquet. For patients on wards, raise the head of the bed. For outpatient areas, ask the patient to hold their arms at their side for a few minutes. Gravity will often reveal hand veins you didn’t see earlier. Once veins have been located, return the patient’s arm to the horizontal position for the blood draw.
2. Massage the arm from the wrist to the elbow if using arm veins. This forces blood up and fills the vein. Avoid snapping or tapping veins. This is painful and can bruise the patient.
3. Use alcohol to stimulate the site to make the vein more visible.
4. Apply a heat compress to the area for 3-5 minutes. Commercial heat packs are best. If using wet or damp washcloths, do so with caution. What may be warm to you could burn the elderly.
Select the Proper Equipment
A close look at the site from which you will draw blood will tell you which equipment to use. The veins of one patient may be different in size and quality from another. So, the choice of equipment will change from patient to patient.
For the elderly, using a syringe or the butterfly system is recommended. A 3ml, 5ml or 10ml syringe will work fine. To find out the advantages of the syringe method go here.
Use a 23 gauge needle for small, thin, and weak veins. For bigger and stronger veins you can use a 22 or 21 gauge needle.
Use either a syringe or the luer adapter with the butterfly system. For multiple samples use the luer adapter or a 10 ml syringe.
The number of samples or volume of blood needed will tell you which size syringe to use.
Make sure the patient is doing well before you or they leave.
When done drawing blood, ask the patient if all is well. Make sure they are feeling well before leaving. Make sure bleeding at the puncture site has stopped and the site is cared for.
Read Difficult Blood Draws: Best Tips for Difficult Veins.
Related Questions
Why does blood stop flowing during blood draw? The patient’s vein may have collapsed. The needle may have pulled out of the vein. Remove the needle, take care of the site and repeat the procedure.
The needle is in place but there is no blood flow? The needle has passed through the vein. Pull it back slightly and blood should flow. The needle may also not be in a vein. Adjust it slightly. If no blood flows, pull out the needle and repeat the draw.
What if I can’t find a vein? Get help from another phlebotomist. Get help from a Doctor. Doctors have access to deep veins like the femoral and subclavian vein that other phlebotomists don’t have. That is usually the last resort.
How to stick a rolling vein? Anchor the vein. Using your thumb, pull back on the skin and hold the vein down. Insert the needle into the vein.