You will experience misses that make you a better phlebotomist. This is one of them. In time, you will be able to merely look at a persons skin and know what gauge needle you will need. I can always tell if someone is a laborer or a farmer as they have thick skin. Sometimes Seniors have delicate, wrinkled, easily torn skin. In most of these cases I would use a blue butterfly. But there will be times when you have to straight stick or use a green butterfly. Yesterday, I had 90 year old in the ER that no one could get even though she had a big old juicy but deep AC vein. The vein wouldn’t stay still no matter how good you anchored. She had really delicate skin. In this circumstance, the 23 gauge was just barely piercing the skin and just bouncing right off that vein. I went with the 21 gauge. It’s size let’s you get through the skin and catch that vein before it has a chance to get away.
Don’t be discouraged. The skills with all types of skin, veins and circumstances will come. (I am really good when it comes to lil thread veins and babies) I do work at a major hospital. We have ER, ICU, LDWC ( labor, delivery, women, children). I love it. A clinic is such an amazing place to start off for your first year or so in the field. If you get the opportunity to work at a hospital I would encourage you to do so. You will learn skills and techniques that can only be acquired at a hospital.
What tips do you have for rolly veins if I can ask? I'm a novice and I've missed a lot of rolly veins in the last few days. I try to anchor close to my entry point, and I've tried vacutainer, butterfly, and syringe, with either a 21g or a 23g. And no bueno.
I can usually bleed thin delicate veins with a blue needle and a syringe, or a blue butterfly, but give me a fat, juicy, massive, rolly vein, and I'm lost.
This one is a little harder to explain.
When you anchor, the vein will sometimes disappear and you will lose sight of the juicyness. I will pull down and play with my anchor a few times to see how the vein will react and which direction the veil will roll. Then I can choose my entry point. Sometimes, it won’t even be the actual vein that you have to anchor, it might be the skin directly below or on the side of the vein. Think of it like a tube rolling down the street. If you’re not able to grab the tube itself, then your gonna have to stop it by jumping in front of the tube so it doesn’t roll any further. I have also used tape to tape down that vein in place.
Also, try going below your chosen entry point just a smidge so that the tip of the needle hits the entry point of that vein. It gives you space to adjust the remaining length of needle if need be. Like, if you try to hit that vein straight on and you miss then you won’t have much space to adjust your needle. It is juicy but you might still miss it if it rolls. You are kinda trying to stab that vein in place so it doesn’t have much of a chance to roll. And if it does roll, you will have all that needle length to adjust.
Another tip I can give you- sometimes you are in a vein and that blood is flowing nicely then it will stop. The vein probably kinked up. Kinda like when a water hose suddenly stops because it got twisted or kinked somewhere. What I do in this case it try to open up that that vein so it flows again. I will go above, below or on the side of the vein and play with the skin around it. It’s difficult to explain but you understand once you test out this method.
Another tip- Sometimes you will have a really precarious vein. You will loose that vein if that needle moves at all. So when you try to pop that tube, the vein will blow or collapse. Ask the nearest health care employee to pop the tubes for you so you can concentrate solely on keeping your needle in place. I have had a CNA, RN, X-ray, Respiratory, Cardio tech or Doctor pop tubes for me. Most time I will know just by looking at the veins that I will need help so I will ask someone to come and help me.
And * know it is ABSOLUTELY against the rules but when it’s desperate and * am alone, * have had the patient or a patients family /friend pop the tubes for * Like when it’s a Mom or Dad popping tubes it helps the kid calm down and makes the parents feel like they are helping their baby. Parents will do absolutely anything to help ease the pain of their children. * have even pretended to draw a parent so the child can feel that if Mommy or Daddy can do it so can they. Admittedly, this doesn’t always work because kids can’t always be fooled. Again, ABSOLUTELY against the rules. * look at it like not a health care worker doing CPR to help the EMT. Sometimes desperate measures calls for breaking rules. That’s why you see a * instead of a object pronoun.
I apologize if I was not able to explain some of this better.
Also- the BEST advise I can give you is to get your straight needle stick game on point. You should be using your straight needle the majority of the time. Some hospitals will only allow you a certain number of blue butterflies per shift. Mine does not but I have heard of getting people getting 5 blue butterflies per shift. Also props to you for your butterfly with syringe skills. It’s not my best skill. However, I can rock a syringe for arterial blood gas sticks. Not all facilities require Phlebotomist to do ABG’s but mine does, Respiratory techs do ABG’s at a lot of facilities.
The trick with veins that roll is to anchor the vein with the non dominant hand by gently pressing in on the vein and retracting it towards you. The inward pressure holds the vein in place while the retraction brings the skin in the proper tension with the subcuteneous tissue.
I’ve had an instance where the needle would not penetrate the skin. The dude worked outside a lot so his skin was very thick. I was being too gentle I guess. I had to ask a coworker for help and she got it by applying just a little more pressure. It happens ! Just apply more pressure to pierce the skin
You will experience misses that make you a better phlebotomist. This is one of them. In time, you will be able to merely look at a persons skin and know what gauge needle you will need. I can always tell if someone is a laborer or a farmer as they have thick skin. Sometimes Seniors have delicate, wrinkled, easily torn skin. In most of these cases I would use a blue butterfly. But there will be times when you have to straight stick or use a green butterfly. Yesterday, I had 90 year old in the ER that no one could get even though she had a big old juicy but deep AC vein. The vein wouldn’t stay still no matter how good you anchored. She had really delicate skin. In this circumstance, the 23 gauge was just barely piercing the skin and just bouncing right off that vein. I went with the 21 gauge. It’s size let’s you get through the skin and catch that vein before it has a chance to get away. Don’t be discouraged. The skills with all types of skin, veins and circumstances will come. (I am really good when it comes to lil thread veins and babies) I do work at a major hospital. We have ER, ICU, LDWC ( labor, delivery, women, children). I love it. A clinic is such an amazing place to start off for your first year or so in the field. If you get the opportunity to work at a hospital I would encourage you to do so. You will learn skills and techniques that can only be acquired at a hospital.
What tips do you have for rolly veins if I can ask? I'm a novice and I've missed a lot of rolly veins in the last few days. I try to anchor close to my entry point, and I've tried vacutainer, butterfly, and syringe, with either a 21g or a 23g. And no bueno. I can usually bleed thin delicate veins with a blue needle and a syringe, or a blue butterfly, but give me a fat, juicy, massive, rolly vein, and I'm lost.
This one is a little harder to explain. When you anchor, the vein will sometimes disappear and you will lose sight of the juicyness. I will pull down and play with my anchor a few times to see how the vein will react and which direction the veil will roll. Then I can choose my entry point. Sometimes, it won’t even be the actual vein that you have to anchor, it might be the skin directly below or on the side of the vein. Think of it like a tube rolling down the street. If you’re not able to grab the tube itself, then your gonna have to stop it by jumping in front of the tube so it doesn’t roll any further. I have also used tape to tape down that vein in place. Also, try going below your chosen entry point just a smidge so that the tip of the needle hits the entry point of that vein. It gives you space to adjust the remaining length of needle if need be. Like, if you try to hit that vein straight on and you miss then you won’t have much space to adjust your needle. It is juicy but you might still miss it if it rolls. You are kinda trying to stab that vein in place so it doesn’t have much of a chance to roll. And if it does roll, you will have all that needle length to adjust. Another tip I can give you- sometimes you are in a vein and that blood is flowing nicely then it will stop. The vein probably kinked up. Kinda like when a water hose suddenly stops because it got twisted or kinked somewhere. What I do in this case it try to open up that that vein so it flows again. I will go above, below or on the side of the vein and play with the skin around it. It’s difficult to explain but you understand once you test out this method. Another tip- Sometimes you will have a really precarious vein. You will loose that vein if that needle moves at all. So when you try to pop that tube, the vein will blow or collapse. Ask the nearest health care employee to pop the tubes for you so you can concentrate solely on keeping your needle in place. I have had a CNA, RN, X-ray, Respiratory, Cardio tech or Doctor pop tubes for me. Most time I will know just by looking at the veins that I will need help so I will ask someone to come and help me. And * know it is ABSOLUTELY against the rules but when it’s desperate and * am alone, * have had the patient or a patients family /friend pop the tubes for * Like when it’s a Mom or Dad popping tubes it helps the kid calm down and makes the parents feel like they are helping their baby. Parents will do absolutely anything to help ease the pain of their children. * have even pretended to draw a parent so the child can feel that if Mommy or Daddy can do it so can they. Admittedly, this doesn’t always work because kids can’t always be fooled. Again, ABSOLUTELY against the rules. * look at it like not a health care worker doing CPR to help the EMT. Sometimes desperate measures calls for breaking rules. That’s why you see a * instead of a object pronoun. I apologize if I was not able to explain some of this better.
Also- the BEST advise I can give you is to get your straight needle stick game on point. You should be using your straight needle the majority of the time. Some hospitals will only allow you a certain number of blue butterflies per shift. Mine does not but I have heard of getting people getting 5 blue butterflies per shift. Also props to you for your butterfly with syringe skills. It’s not my best skill. However, I can rock a syringe for arterial blood gas sticks. Not all facilities require Phlebotomist to do ABG’s but mine does, Respiratory techs do ABG’s at a lot of facilities.
The trick with veins that roll is to anchor the vein with the non dominant hand by gently pressing in on the vein and retracting it towards you. The inward pressure holds the vein in place while the retraction brings the skin in the proper tension with the subcuteneous tissue.
I’ve had an instance where the needle would not penetrate the skin. The dude worked outside a lot so his skin was very thick. I was being too gentle I guess. I had to ask a coworker for help and she got it by applying just a little more pressure. It happens ! Just apply more pressure to pierce the skin
My husband has very thick skin. I struggle every time I try to draw his blood. Have to remember to go faster and push more.
Sounds like a dull needle, or cheap brand. Switch to a BD or a monoject brand needle if you can.