How To Draw Blood From A Dehydrated Patient

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Cartoon claret quickly and cleanly is an important skill for doctors, nurses, lab personnel, or phlebotomists. Many venipunctures are routine, but you may occasionally run across some difficult veins. Read on from step number i below for useful information and techniques on hit those veins.^[1]

1. one

   Make certain your tourniquet has been applied properly. Applying a tourniquet increases the amount of blood in the vein to make them stand out more. The tourniquet should not be so tight that it cuts off the circulation.^{[two] [three]}

   • The tourniquet should exist put on the arm about 4 inches in a higher place the vein.
   • A blood force per unit area cuff that is inflated to twoscore–60 mm Hg also works well.

2. 2

   Put a warm pack or water bottle over the area. Warmth volition make the patient's veins dilate and expand, making them easier to see.^[iv]

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3. iii

   Use proper palpation techniques. Contrary to pop culture, y'all should palpate the arm, rather than slapping it. Slapping the skin is poor technique that may upshot in a hematoma. Use your index finger to look for a vein, which feels soft and spongy. Don't utilize your thumb, as it contains its own pulse.

   • The warm pack or h2o bottle should exist put on the surface area earlier it is disinfected. Nothing more should touch the area subsequently it is disinfected.
   • Practice non use the warm pack or water bottle directly to the skin. Wrap it in a thin towel to prevent burns. If it hurts, it is too hot.

4. 4

   Tell the patient to relax. Many people have needle phobias and nervousness and apprehension is a normal response. Stress non merely makes the veins hard to hit, merely information technology could besides negatively affect the test results (particularly for biochemistry panels). Reassure your patient and explicate that the pain is very brief and small-scale.

   • Tell your patient to try visualization and deep breathing.
   • Observe your patient and have them lie downward on their dorsum if yous think they might faint. This volition ameliorate the blood period to their head. It besides reduces their chances of falling and injuring themselves if they practice pass out.

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1. i

   Verify patient information. Verify the patient name, engagement of nascence and reason for blood draw and check the labeling to ensure no mistakes are made. Mislabeling could lead to difficulty processing or even safety issues downwardly the line.

2. 2

   Locate the vein. The inside of the elbow is by and large the preferred location because the median cubital vein is unremarkably hands visible. ^[5]

   • The median cubital vein runs betwixt the muscles and may be conspicuously visible every bit a blueish bulge in the within of your elbow. If it cannot be seen it can normally be felt. Information technology is as well relatively easy to access because the tissue around it prevents it from rolling away from the needle.
   • Avoid drawing claret from a identify where your veins split up or join together. Doing and so increases take a chance of bleeding under the pare.

3. 3

   Disinfect the area. A common disinfectant is seventy per centum alcohol. Wipe an area that is at to the lowest degree ii centimeters by ii centimeters for at to the lowest degree a half a minute. After a minute or two it will take dried.^[6]

   • Alcohol is ameliorate than iodine because if the iodine gets into the blood it can modify values that the lab may be looking for. If you do apply iodine, follow it with a seventy% alcohol swab.
   • Allow the disinfectant to dry out before inserting the needle. Practise not blow on or fan it with your hand every bit this will contaminate the area.

4. 4

   Perform the venipuncture. ^[seven]

   • Anchor the vein by pulling the skin below the vein taut. This will prevent the vein from rolling.
   • Insert the needle in at a 15 to 30 caste angle and then hold information technology still while collecting blood.
   • Fill up the drove tube with claret, following the order of depict as specified past your laboratory.
   • Release the tourniquet after ane minute and before removing the needle. Leaving the tourniquet on for longer than a minute will affect the concentration of red blood cells, possibly altering the test. Withdrawing the needle while the tourniquet is all the same on will upshot in pain.

5. 5

   Apply pressure to the puncture expanse for 5 minutes after the needle is out to stop the bleeding. ^[8]

6. half-dozen

   Dispose of the needle in a hard sided, biohazard container.

7. 7

   Double check the labeling on the tube to make sure it is accurate.

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1. one

   Look for another vein if the median cubital vein is not visible. If you cannot find the vein in the within of the elbow in either arm, wait for another one.^[9]

   • Move down the forearm looking for the basilic vein or cephalic vein. These veins may also be visible through the peel. Take the patient lower their arm and make a fist to brand the veins more obvious.
   • The cephalic vein runs forth the radial side of the forearm. The basilic vein runs forth the ulnar side. The basilic vein is less frequently used than the cephalic. It is more likely to scroll abroad from the needle than the cephalic vein because it is non held equally tightly in identify by the tissues around it.
   • If no veins can exist accessed, find the metacarpal veins on the back of the easily. They are normally very visible and can be palpated. They should not be used for elderly patients because the skin is not as supple and does non support the veins equally well. In addition, the veins themselves become more fragile.

2. ii

   Notice sites to avoid. Do non depict claret from areas that:

   • Are near an infection
   • Accept scarring
   • Have a healed fire
   • Are on an arm that is on the same side as where the patient had a mastectomy or fistula placed
   • Are hobbling
   • Are in a higher place an Iv line
   • Are on an arm where the patient has a cannula, fistula, or vascular graft

3. iii

   Right improper needle placement. Occasionally, you may come across problems with the needle, such every bit going too far into the tissues or inserting it at too low of an angle (and then the bevel is against the wall of the vein and impedes blood flow).^[10]

   • Pull the needle back a picayune chip without removing it from the skin.
   • Change the angle of the needle while it is still under the pare so that it tin be inserted into the vein.

4. 4

   Give up and have a colleague do the procedure if your second attempt fails. Protocol in many laboratories dictates that phlebotomists must try a venipuncture two times, and to have another person practise it if both attempts are unsuccessful.^[11]

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Add New Question

• Question

  Phlebotomists- How do yous arroyo a hard vein? I am yet new and not comfortable with them yet.

  

  Shari Forschen is a Registered Nurse at Sanford Health in Northward Dakota. She received her Family unit Nurse Practitioner Master'south from the University of North Dakota and has been a nurse since 2003.

  

  Master'due south Degree, Nursing, University of Due north Dakota

  Expert Respond

• Question

  I take small veins and have had bug with blood withdrawals. Is there some kind of practise to help meliorate your veins or make them bigger and more than visible?

  

  Shari Forschen is a Registered Nurse at Sanford Health in North Dakota. She received her Family Nurse Practitioner Master's from the University of North Dakota and has been a nurse since 2003.

  

  Master's Degree, Nursing, University of Due north Dakota

  Skilful Answer

• Question

  What if the veins are nearly finished in your arm or hand? Where do I go so?

  

  Shari Forschen is a Registered Nurse at Sanford Health in North Dakota. She received her Family Nurse Practitioner Primary's from the University of North Dakota and has been a nurse since 2003.

  

  Master'southward Degree, Nursing, University of Due north Dakota

  Skillful Reply

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• All materials which have been contaminated with blood should exist disposed of in a biohazard container that is puncture resistant, such as a Sharps container.

• Single use materials such equally needles should never be reused.

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Commodity Summary Ten

If you lot're trying to describe blood from a difficult-to-hit vein, kickoff, tie a tourniquet about 4 inches above where you want to insert the needle. Then, put a warm pack or warm water bottle over the area, since heat makes veins dilate and aggrandize. Adjacent, palpate the arm rather than slap at it, since slapping can give your patient a hematoma. When you've targeted a vein, try to go your patient to relax by having them prevarication downwards or do some deep animate exercises, since stress can brand veins harder to hit. For tips from our Nurse Practitioner on how to detect some other vein if the median cubital vein isn't visible, scroll down!

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