tips for drawing blood on obese patients

Blood For example, in a case of a patient with fragile veins, it is much better to skip a tourniquet as it may cause the vein to blow out. 0000009535 00000 n We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. They are springy and bouncy. The needle is in place but there is no blood flow? Patients hand should be dangling so that the blood can rush down and fill the veins. Veins become more visible when blood is forced into them. Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. All e-mails from the system will be sent to this address. The site should not be warmed to a temperature higher than 42 EC. When drawing blood, you will need several tubes for different samples in your equipment. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. obese patient Gloves are a must. An elderly persons veins are prone to collapsing, which could mean, you may have to try several times at drawing blood. trailer <<1A62135BA6734AC3B0AC4ED47D445652>]/Prev 812906/XRefStm 1512>> startxref 0 %%EOF 240 0 obj <>stream 0000029232 00000 n Nowadays, there is equipment that can help us locate the vein. Ideally, try to work with your patient ahead of time, or give them information about what they can do to make their blood draw experience easier. The rightvein should feel somewhat bouncy as you press on it. Identify the patient using two patient identifiers as mandated by JCAHO. Always start by thinking that a patient is infectious and that he can spread a disease. Next step is explaining the procedure. 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. Usually, it happens due to squeezing or massaging around the site or due to prolonged application of the tourniquet. Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. 0000007667 00000 n It is the sharpest part and this will be the best way of insertion. This will give you more stability and it will relax you. Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. They can help you to find a usable vein quickly, so you can get the blood draw you need, and your patient can remain comfortable throughout the experience. Put ur fingers on the bottom of their arm and press the tops with your thumbs. Blood Collector's ATM: Phlebotomy and the Obese Patient Obesity When performing venipuncture, make sure to sit whenever you can. Venipuncture or drawing blood is one of the most common procedures performed in any medical center. Use either a syringe or the luer adapter with the butterfly system. Lab gives us an 8 minute window (+/- 4 minutes from exactly one hour from when they finish their glucose) to get the draw. I Feel Stuck - Like My Options Are Limited, Ethical Arguments Against Mandatory Vaccination, Nursing Student on Spring Break Saves Collapsed Man's Life, Candida Auris: Dangerous Fungus Spreading in US Health Care Facilities, Nurses Week 2023 | Best Discounts, Freebies, and More. Would hate for the patient to have to come back and drink that Glucola again. He got her first stick, and i will definately try this in the future if i have trouble. WebUsing consistent, proficient personnel to per-form blood draws. It uses high intensity light that is directed down through the skin. venipuncture is one of the main parts of your job. If you allow the visible stress or discomfort of your patient to permeate your own mentality, then youre far more likely to make a mistake or miss the vein. What if I cant find a vein? Blood Test Vs Blood Donation (Comparisons). We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. WebIf you are drawing blood from an arm, make sure to sit near the patient, as close as possible. They are not as healthy and strong as they once were. I was in a patients home a few days ago and had to call EMS, the patient was obese and her spouse said she had terrible veins. The paramedic immedi While doing all of this, make sure to penetrate the skin with one quick move. If you are going to start an IV in the hand always have the patient pump their fist. But sometimes, it can find a vein you didnt see or feel. Be sure that youre doing everything in your power to keep a level mindset before and during the blood drawing process. The medical expert needs a certain amount of practice as there are many things that can go wrong. Its important to do everything in your power to ensure the comfort of the patient when drawing blood. Another technique is for you to use a blood pressure cuff. That means that you can trust us to have reliable, up-to-date information Place it at the chin and lightly draw a straight line. 0000010671 00000 n Avoid excessive probing. Phlebotomy basics : Nursing made Incredibly Easy - LWW On the surface, it seems as a rudimentary procedure, one that doesnt require any special training. Phlebotomy basics Has 1 years experience. What about other resources that may be available? Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. If you are drawing from a leg, the extremity needs to be placed over the bed so Commercial heat packs are best. A lot of patients have the needle phobia. The order of venipuncture sites is vital to follow. Top Vein Sites Used in Phlebotomy | PhlebotomyU | CPT1 Course Take a look at these tips for drawing blood successfully: Feel & Touch When you receive your initial instruction on how to conduct basic blood draws, your 2. If youre a phlebotomist who has encountered this problem before, you know how frustrating it can be. You have to palpate first and decide from there. WebA measurement around your waist. This is painful and can bruise the patient. With the foot- some places require a specific order r/t other dx that can increase DVT risk :) When the last one is done, you need to remove the tourniquet. Avoid exaggerated hyperextension, which can be uncomfortable for the elderly. Nitroglycerine is yet another substance that can help you out during phlebotomy. The only way to make sure is by touching it yourself. It is also possible to apply multiple tourniquets. The nurse can take the persons blood pressure. 1 Article; Ask the patient to make a fist and not pump the hand. Massage the arm from the wrist to the elbow if using arm veins. Create well-written care plans that meets your patient's health goals. 0000008644 00000 n Select a donation type and find a convenient time that works best for you. Make sure bleeding at the puncture site has stopped and the site is cared for. What may be warm to you could be hot or even burn someone else. I had one not too long ago where I had to do a 1 hour glucose tolerance test and was having trouble finding a vein. This will cause a lot of mess. Everyones arm anatomy is different and while one technique may work for a person, combining two or three may be the answer for another. I am a Licensed Phlebotomist and Certified Medical Assistant of 15+ years with 14+ years of clinical experience. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses need to learn. My trick is to press on their hand or arm with both of my thumbs. Still, if you prepare yourself for any possible variable, you should be able to make drawing blood second nature. Usually, the antecubital area has the best veins for drawing blood. 0000001512 00000 n You know what to look for and where to look for it, so sometimes a gentle touch can make finding a usable vein easier than looking for it. Use alcohol to stimulate the site to make the vein more visible. Weight gain. While not commonly taught in nursing school programs, many recommend that nursing students take extra courses in how to draw blood to learn this skill. All rights reserved. This helps you build trust with a patient even further. Thirdly, they may lose their appetite and drink less fluids. For example, the veins of a middle-aged man will likely be easier to find than that of a woman, unless shes extremely active. How to Select a Right Vein Finder for an Obese Patient - Healtholine Using heat (such as a warm towel) or placing the extremity in a dependent position (to allow gravity to fill the veins) can help, too. You want to lessen the number of sticks you give to the elderly. I hope you find my posts helpful. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. 0000005129 00000 n Below are several tips and tricks that you can use when you are faced with a difficult blood draw. They need to be labeled in advance. Be careful, though. It is the best thing for patients with low blood pressure. If you cant find a good vein, move to the back of the hand. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. During phlebotomy, the doctor is the one that needs to ensure everything goes well. Any time that you need blood drawn for lab work,, I'm Lou, and welcome to Phlebotomy Examiner! Average delivery time is 5-10 business days. You can support each other and do twice as much good! Gravity alone will help reveal veins that were not visible or palpable earlier. Follow us and never miss out on the best in nursing news. The heat will help dilate the veins and gravity will assist in filling those veins. that's continuously reviewed to ensure its as relevant and accurate as Using your thumb, pull back on the skin and hold the vein down. Fat, or obese patients, have more fat around their veins which can make it difficult to find the vein for drawing blood or starting an IV. If none of the above options enable you to find a strong vein, you may need to find another puncture site. You may need the approval of a physician or someone else. obese Thank you. If you encounter such a person, make sure to draw blood from larger veins instead of the smaller ones. This causes the veins to engorge and become visible. Place them one by one in the holder and take samples. If you can find a vein with that desirable characteristic, youll know that youve discovered a usable vein, even if its not prominent. This is a common misconception - pumping the hand does not increase venous circulation. WebBy using a syringe and needle to draw the patient's blood, you can control the pressure and speed at which the blood is removed by varying the rate that you pull back on the This can help reveal the vein. Prepare by drinking enough fluids before the blood test. Superficial veins often times can't handle an IV bolus or radiology contrast. Sometimes I get lucky, sometimes I get nothing. You dont have to drink tons of water the night before but the recommended daily water intake should suffice. Scar tissue can especially be problematic as it is hard to penetrate. I will say a fair amount of Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. It can really make the veins pop. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. In order to reduce the risk of thrombosis, lines need to be flushed with a solution of heap in. You need full access to the arm so you will have to sit in front of the patient, a bit to his side. The elderly lose fat tissue as well as muscle mass, making their skin saggy. Wetting the area, followed by deep massaging or palpating will oftentimes reveal or confirm vein location. Become a Part of the Nurse.org Community! I once had a patient who was a VERY difficult stick - I brought in the best of the best IV starters that were working that night, but no luck. Also, it is the basis of diagnostics. Massaging may help you in finding a vein if you have not already found one. Fourthly, they are not very active, possibly causing lower blood pressure, hence slower blood flow. Phlebotomy teams generally only make rounds at specific times in hospital settings, therefore, if a lab test is ordered immediately it could be the responsibility of the nursing staff to draw the specimen. If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. In the end, they can only lead to injuries. 0000029592 00000 n For patients on wards, raise the head of the bed. This is the main reason why a lot of tests go array. If you dont know what a vein feels like, practice by feeling on yourself with you index finger. What are some tips and techniques for drawing blood from an elderly person? Red light reaches a depth up to 6 mm. If a person is overweight, it might be harder for a professional to find the vein. Often, even a loose bind can help a vein to pop. Carrington College does not recruit or enroll residents of the European Union. This, in turn, can cause increases in your blood pressure. Premarital blood tests have been done away with. Once the vein is located, the individual arm can be returned to horizontal position for blood collection. Follow institutional guidelines and policies wherever applicable. A transilluminator is a cool way of finding or confirming veins. The worst thing you can do is to continue stabbing the patient. Get the patient to lower his or her arm. Instead of forcefully tapping the vein, it is much better if you start stroking them. Blood Additional equipment such as goggles and splash shields should also be worn in extreme situations. WebPatients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. This represents the massive concentration of certain molecules in the blood. Then, add massage to the combination. If using wet or damp washcloths, do so with caution. Attach the needed tubes or syringes to remove the proper volume of blood. Difficult Blood Draws: Best Tips For Difficult Veins 0000005419 00000 n go-to source for nursing news, trending topics, and educational resources. A tourniquet should also never be left on for more than one minute. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. Invert a BP cuff so that the blood can go to the lower regions of the limb. Perform hand hygiene and don proper PPE. Password must have upper and lower case letters. It worries me to see so many people in this thread and others talk about seeing veins and palpating them only if you can't see one. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. Web Place the tourniquet over the patients sleeve of the patient shirt sleeve if drawing an arm vein. Geriatric Patients: Best Tips For Drawing Blood - Phlebotomist Additionally, you will have to consider the reason why you are performing insertion of the needle. 0000016846 00000 n A trick I use sometimes is putting a second tourniquet 2 inches above the first tourniquet. It can really make the veins pop. The other day I saw a Stay away from the palm of the hand, fingers and from the wrist area. 0000276013 00000 n Finding difficult veins isnt impossible, but it can require a few different methods to be put into place. For an experienced professional, this is typically a relatively easy job. Obese patients, particularly those considered to be extremely obese, have reported being treated with disrespect by physicians and other medical staff. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. In order to prevent it, professional will have to avoid phlebotomy from a hematoma and to avoid drawing plunger forcefully. Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. Re: the 2 tourniquet trick (above and below). For hand veins, apply the tourniquet 1-2 inches above the wrist. Make sure you have one in your venipuncture equipment. Sometimes, doing so can reveal a vein. Use these tips to reduce the level of difficulty and make your chances more successful. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. If you are a bit stiffer while rubbing the alcohol, it will prepare the hand for the procedure. draw ), 2023 Center for Phlebotomy Education All Rights Reserved, Phlebotomy Continuing Education Exercise (ATM): Phlebotomy and the Obese Patient. Obesity Screening: MedlinePlus Medical Test Specializes in PICU, Sedation/Radiology, PACU. 0000180491 00000 n Adjust it slightly. With vein locators, you can see where all the veins are. Insertion point should be under 15 to 30 degrees angle. The paramedic immediately brought out a large flash light and pressed it to the patients arm. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. These exercises can be performed throughout your donation and afterwards in the refreshment area. Specializes in OBGYN, Urogynecology. Has 9 years experience. Relax, listen to music, talk to other donors or read while you donate. Try light exercise beforehand. If you have an issue finding the vein, do not hesitate and call for a senior, more proficient colleague. (function() { A 3ml, 5ml or 10ml syringe will work fine. This Some will come on wheelchairs, using a cane, needing help to walk, move, sit and stand. 0000014430 00000 n Depending on whether it is for transfusion or simple blood analysis, your cannula size will vary. Check out our Facebook page and give it a like: http://www.redcrossblood.org/donating-blood/tips-successful-donation. glasses of liquids and avoid alcohol over the next 24 hours. Blankets or towels from a warmer can also be used. Even with all these guidelines, perhaps the best approach is if you ask the patient from which vein they usually draw his blood. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Avoid snapping or tapping veins. Always avoid drawing blood from areas where the skin is damaged, inflamed, infected or burned. You could get help from them. Dismiss. Relax for a few minutes in our refreshment & recovery area have some cookies or other snacks youve earned it! Has 12 years experience. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. 0000012539 00000 n 0000005243 00000 n For hospitalized patients, raise the head of the bed. Sometimes the veins are deeper so therefore you will have to go deeper. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. Use your index finger to palpate and trace the standard path of the vein on the arm. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail. N. Cleanse the puncture site: Cleanse the site with 70% isopropyl alcohol until clean. This will help force blood up and fills the veins making a vein pop up. Confirm the ordered tests and fill out the appropriate forms and labels. professionals to write our content whenever possible. In order to prevent hematoma, you should only puncture the uppermost wall. In a way, you have to entertain a person during phlebotomy. To find out the advantages of the syringe method go here. Without further ado, here are 50 tips that will help you perform this crucial procedure. Massage the arm. One of our Enrollment Services Representatives will be contacting you shortly. 0000027834 00000 n The needle should fully penetrate it. Press the space key then arrow keys to make a selection. If you are drawing blood from an arm, make sure to sit near the patient, as close as possible. However, you will need a doctors permission for this. Moreover, because their veins are so fragile, the elderly may receive several sticks in order to draw blood or get sufficient blood. Same goes with veins. WebOnce veins have been located, return the patients arm to the horizontal position for the blood draw. Ask the person to lower their arm for a few minutes before applying the tourniquet. This can be a real time saver and it is also the best way of finding the right insertion point. Most people have normal looking serum. Measure the distance from the top of the head to the chin. Alternate arms if youve given blood recently. Liver function studies. Obesity Get help from another phlebotomist. However, in addition to our natural vein anatomy, here are several reasons why your veins may pose some difficulty when doing a blood test. I'm having a hard time finding veins then starting IV or drawing blood on obese patients. Keep the strip bandage on for the next several hours; to avoid a skin rash, clean the area around the bandage with soap and water. window.addEventListener('click-table-loaded', function(){ WebDrink an extra 16 oz. Deliver blood specimens to the laboratory promptly. Doctors have access to deep veins like the femoral and subclavian vein that other phlebotomists dont have. What constitutes a difficult vein? Finally, an ER tech came up and he used a venoscope, which is basically a fancy flashlight - basically the same thing that bruali described in their post. Ask the individual to flex his or her arm a bit. Before you can start, you need to ask the patient if he has any allergies to drugs.
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