Difficult veins are veins that easily collapse or roll, are too thin, or are hard to find. These veins are most often associated with people who require butterfly needles, such as children or geriatric patients. In reality, anyone can have difficult veins, which may require more assistance for blood draws.
As a phlebotomist, ‘hard stick’ patients may be frustrating to handle. With PhlebotomyU’s five tips on finding problematic veins, this process can become much more manageable.
Most Common Veins Used in Phlebotomy
There are four common sites phlebotomists use for blood draws: median antecubital, cephalic, basilic and dorsal hand. While each vein is viable for a blood draw, it is important to understand each draw site’s potential risks.
MEDIAN ANTECUBITAL VEIN
The median antecubital vein is the most common for blood draws. It is in the inner arm, anterior of the elbow joint. This vein is associated with minimal pain and is the most prominent when anchored.
CEPHALIC VEIN
Located on the lateral portion of the arm, the cephalic vein is the second most common draw site choice. The cephalic vein is a safe alternative to the median antecubital vein when necessary.
BASILIC VEIN
Similar to the top two choices, the basilic vein is on the medial side of the arm. Drawing blood from this area does pose a greater likelihood of the vein rolling or collapsing because it is difficult to anchor. This vein is also closer to the artery and nerve which makes it more challenging to draw from.
DORSAL HAND VEINS
Dorsal hand veins are often the last resort for phlebotomists, but they can be successful. These veins are found above the hand, near the wrist, and by the thumb.
How to Find a Vein to Draw Blood
First, palpate the patient’s arm for a vein. Most veins are not visible to the naked eye, and touching may be the only way to find a problematic vein. Learning to feel what is a viable vein or not is a critical skill for a phlebotomist. When doing this, ensure that you are being gentle and have found a vein, not an artery.
Next use a tourniquet to anchor the vein. When tying the tourniquet, it is better to start loose then get tighter if need be. Going too tight at the beginning can result in the loss of plasma in the blood, impacting the test results. If these three steps did not work, finding a new draw site may be necessary.
What If I Still Can’t Find the Vein?
If the typical method doesn’t work, here are five tips for finding a difficult vein:
- Warm the area with a heating pad. This simple trick can enhance the vein’s visibility for the phlebotomist. Be careful as you do not want to burn the patient.
- Ask the patient to make a fist and open their hand. This task allows the phlebotomist to see where they should feel for a vein.
- Try illuminating the vein. The phlebotomist may find a vein from the direct lighting of a flashlight rather than a standard ceiling light.
- Ask for assistance from another phlebotomist or medical professional. If you cannot successfully locate a vein on a hard stick patient, don’t hesitate to ask for help. Depending on the healthcare facility, there may be protocols in which other medical personnel must assist.
- Let the patient relax for 10-15 minutes and try again. Sometimes, time is the only thing that can help. Give the patient some water and try again later to minimize injury.
Why Are Some Veins More Difficult?
Veins can be difficult for a variety of reasons. Some people are genetically predisposed to having problematic veins, or their age causes the veins to be smaller or hidden. In most instances, however, it is a matter of the patient being dehydrated. If the patient is not hydrated for a blood draw, their veins will be more likely to collapse or roll and are too small to find.
Other Tips to Help Make Blood Draw Procedure Easier on Difficult Veins
When confronted with a problematic vein, ask the individual if there has been an area that has worked in the past. This one question could save everyone time and energy throughout this process. Adding a warm compress to the vein for a few minutes may also help. If neither of these strategies work, exercise their arms. Similar to a workout, the veins will become more visible and are often easier to access. The movements shouldn’t be too vigorous, but a few light bicep curls or jumping jacks could make a difference.
If you have a patient that is notorious for being a hard stick, tell the client to drink plenty of water and avoid caffeine 24 hours before the test. Coffee, teas, caffeinated beverages, and alcohol can cause dehydration and the veins to shrink.
The time of day may also influence difficult veins’ ability to be drawn from. Drawing blood in the afternoon may be more successful, as some veins may not be as prominent in the mornings. Recommending a later appointment time may alleviate the stress of this process.
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