tips for drawing blood on obese patients

Stay away from the palm of the hand, fingers and from the wrist area. 0000001512 00000 n Prepare by drinking enough fluids before the blood test. There are two main ways to find a vein to draw blood. Talk to your doctor or therapist about improving your coping skills and consider these tips to cope with obesity and your weight-loss efforts: Journal. It includes preparation of the patient, finding the right vein, insertion of the needle, disposal of waste and handling of potential hazards. As you get older, most of you systems tend to shrink and they become more fragile. Ask the individual to flex his or her arm a bit. The veins we have are the veins we will have for life. We and our partners share information on your use of this website to help improve your experience. 0000031373 00000 n Throw everything in proper containers. Weight gain. If a vein is not prominent enough to see easily, you can feel around for it. To expedite your donation, start your RapidPass on the day of your appointment. 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. This is a common misconception - pumping the hand does not increase venous circulation. Warn the patient that they will experience a sharp scratch. Why does blood stop flowing during blood draw? Avoid snapping or tapping veins. These 5 areas include:if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'phlebotomistreport_com-medrectangle-4','ezslot_6',165,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-medrectangle-4-0'); From my experience elderly persons on wards are the most difficult sticks. Make sure you check with the nurse first for permission. You can support each other and do twice as much good! In the case of children or uncooperative individuals, restraints are an option but they should be avoided at all costs. You have to palpate first and decide from there. What Does Blood Draw or Venipuncture Training Involve? On average, it is much harder to find veins in people with darker skin tone. The only way to make sure is by touching it yourself. WebOnce veins have been located, return the patients arm to the horizontal position for the blood draw. Your approach is something that can vastly affect the patient, making the whole experience more or less enjoyable. In fact, based on this, the entire procedure can be harder or easier. A 3ml, 5ml or 10ml syringe will work fine. Next step is explaining the procedure. In the event that you cant locate the appropriate vein strictly by vision, this can be a great alternative method. 3,377 Posts. Dont be discouraged if at first, you dont access the vein. My trick is to press on their hand or arm with both of my thumbs. A syringe is a great technique for blood drawing! Some patients have hypovolemia or reduced volume of circulating blood. Also, avoid cotton as fibers may stay in the wound and reopen it later on. 0000029592 00000 n 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. Label appropriate tubes at the bedside and place them into transport bags. When the last one is done, you need to remove the tourniquet. Remove the needle, take care of the site and repeat the procedure. This can cause an overall loss of plasma in the blood, and the sample could be unusable. Big ppl are not bad to stick at all, especially the ones with edema. In a way, you have to entertain a person during phlebotomy. Get someone to assist if you are not trained or dont have experience. In that case, you would use the order of Draw (venipuncture). Dont do any heavy lifting or vigorous exercise for the rest of the day. WebTo clarify: The serum on the left is what normal serum looks like, but actually comes from an obese patient middle aged or older with metabolic issues (the patients I normally work with). The loss of support makes it easy for veins to roll causing difficulty in drawing blood. Alternate arms if youve given blood Depending on whether it is for transfusion or simple blood analysis, your cannula size will vary. Those veinfinders are worthless. 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. The other day I saw another nurse do a different variation of this, and she put one tourniquet above the AC (like usual), and another 2 inches below the AC. Being able to find a usable vein quickly is crucial, and something you learn throughout your training. professionals to write our content whenever possible. Only tighten it if necessary. In order to prevent hematoma, you should only puncture the uppermost wall. This is due largely to the fact that patient factors will vary greatly when it comes to drawing blood. Continue with Recommended Cookies. What about other resources that may be available? Massage the arm from the wrist to the elbow if using arm veins. If you really can't see a vein they usually will have one on their hand just between the 4th and 5th finger on the top of the hand. This instructional video, from the Blood Collection series produced by Medcom, Inc., is about special precautions for drawing blood from obese patients. You dont have to drink tons of water the night before but the recommended daily water intake should suffice. The elderly are prone to bruising when applying the tourniquet. 0000008644 00000 n There are numerous situations where you should refrain from using a tourniquet as a part of your equipment. If you are certain that youve hit a vein and there is still no blood coming from it, this is an indication that you have hit a necrotic vein. 0000019017 00000 n Wear a shirt with sleeves that you can roll up above your elbows. Scar tissue can especially be problematic as it is hard to penetrate. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. 2023 Carrington College. WebInflate cuff to 30mm Hg above systolic reading and maintain pressure for about 1 to 2 minutes. In this module, you'll learn why the right approach is critical when drawing from overweight patients, and you'll have a newfound appreciation for what it's like for too many patients when they encounter insensitive healthcare professionals. To find out the advantages of the syringe method go here. If you are drawing from a leg, the extremity needs to be placed over the bed so Dismiss. Let us know if you have a preferred arm or particular vein that has been used successfully in the past to draw blood. This can pose a real problem as their veins collapse quicker. How to Select a Right Vein Finder for an Obese Patient - Healtholine Perform good hand hygiene and don appropriate PPE. Provide a password for the new account in both fields. In most cases, simply following best practices and knowing how to find a difficult vein is the best way to carry out a successful draw. If you havent rested properly, this can affect your ability to perform venipuncture and can lead to critical mistakes which you, as a professional, cannot afford. However, there are numerous things that can go wrong while you draw blood. For example, the veins of a middle-aged man will likely be easier to find than that of a woman, unless shes extremely active. Unfortunately, some people have difficult veins to work with due to obesity, dehydration, and a variety of other issues. If the person is tense, try getting them to relax. Properly label the tubes and send to the laboratory for analysis. Press the space key then arrow keys to make a selection. 0000009535 00000 n If nothing works, try with vein locator. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Another technique is for you to use a blood pressure cuff. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds. Always try to draw blood from veins that are lowest. 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. All information provided to Carrington College shall be subject to our Privacy Policy. 1-917-426-3524, By using the site you agree to our Privacy, Cookies, and Terms of Service Policies. You can try several approaches mentioned earlier in our venipuncture guidelines that will increase the vein. Massaging may help you in finding a vein if you have not already found one. Before you can start, you need to ask the patient if he has any allergies to drugs. Dont go deep. Password must have at least 1 special character(s). It used to be that all 50 states required blood tests before getting a marriage license but that is no longer the case. This will move their fluid and/or tissue out of the way so you can see a good vein. Top Vein Sites Used in Phlebotomy | PhlebotomyU | CPT1 Course The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. This is the first and crucial rule of venipuncture. Get the latest on all things nursing by joining our email newsletter. Feel out all your possible options before you decide to go for it. Patients who are severely dehydrated can also make it difficult to find a vein. Phlebotomy Pages advises that individuals use touch as their primary indicatorwhen looking for the vein from which to draw blood.1 Veins will often feel as though they are slightly risen beneath the skin. When done drawing blood, ask the patient if all is well. Common Reasons People Miss Veins When Starting IVs & Drawing Blood In order for the nurses to be successful when drawing blood, there are several key things they must know including. This is painful and can bruise the patient. Another thing a person can do is to try to be relaxed as much as possible. For patients on wards, raise the head of the bed. Follow institutional guidelines and policies wherever applicable. Ask the patient to make a fist and not pump the hand. I have had patients tell me nurses are more successful in one arm than the other, etc. There are various reasons to perform a phlebotomy. The gratification of giving blood is a feeling you'll want to share. Frail veins can pose a great problem when drawing blood. Instead of forcefully tapping the vein, it is much better if you start stroking them. Insert the needle into the vein. When performing venipuncture, make sure to sit whenever you can. A trick I use sometimes is putting a second tourniquet 2 inches above the first tourniquet. Instead, make sure to remove tourniquet first and then remove the needle followed by instant pressure on the insertion point. Some will come on wheelchairs, using a cane, needing help to walk, move, sit and stand. One thing that I find that helps is using two tourniquets - take them together and tie it. Rotate the wrist while maintaining the position of the arm. For hospitalized patients, raise the head of the bed. Whether youre becoming a nurse, a doctor or a certified medical assistant, youll probably have to draw blood countless times over the course of your career. Has 7 years experience. It uses high intensity light that is directed down through the skin. Once the vein is located, the individual arm can be returned to horizontal position for blood collection. WebTips for Drawing Blood Always feel the vein rather than see it! Invert a BP cuff so that the blood can go to the lower regions of the limb. Has 9 years experience. Thank you. This will lead to a better compression that will properly regulate the pressure. Commercial heat-packs are best for this technique as you can choose the temperature you want. Some patients are easier than others because of the prominence of their veins. Sometimes you can find a good one there, though be careful as you insert the needle. At some time in life, every person will do a blood test, and not only one but multiple as life goes on. This is mainly due to the fact that different people have different biological systems which can make it harder to find and puncture the vein. While holding patients arm, make sure that your finger is well above the insertion point. You know all nursing jobs arent created (or paid!) This is the main reason why a lot of tests go array. Call us at 1-866-236-3276 to report any additional health information that you forgot to tell us, if you have any problems or if you needed medical care after giving blood. Hemolysis is one of the most common things that interfere with the tests. A better vein might be available in the forearm or at the back of the hand. Phlebotomy basics Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. This represents the massive concentration of certain molecules in the blood. The person performing venipuncture can administer 10 units of bacteriostatic saline which need to be injected intradermally. Obesity Screening: MedlinePlus Medical Test 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. Venous access s Follow your institutional guidelines or polices or get advice from qualified personnel. Also, you can gently press the needle against the venipuncture site for several seconds before insertion so that the nerves can get accustomed. This will help force blood up and fills the veins making a vein pop up. With vein locators, you can see where all the veins are. Still, if you prepare yourself for any possible variable, you should be able to make drawing blood second nature. 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. It is also possible to apply multiple tourniquets. 0000012539 00000 n WebFor routine blood draws, 70% isopropyl alcohol or 70% ethyl alcohol is recommended. Dispose of contaminated materials and needles in the designated hospital-approved containers. Any time that you need blood drawn for lab work,, I'm Lou, and welcome to Phlebotomy Examiner! For the elderly, using a syringe or the butterfly system is recommended. Adjust it slightly. Syringe, vacutainer, and needle size should 6. They need to be labeled in advance. hb``g`` @16 N$00Le@L,9$)_5M2APPP*dW;b]0D&0dxAAmCfFO7008X`&` *7h_P tex4\T'# ` 1 endstream endobj 239 0 obj <>/Filter/FlateDecode/Index[33 163]/Length 27/Size 196/Type/XRef/W[1 1 1]>>stream 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. This is an extremely large vessel and if stuck properly can yield excellent blood results. 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. tips on starting IV, drawing blood on obese patient. Anchor the vein. Most of the time, the visibility of the vein depends on the patient. But lots of people swear by it, so there might be something to it! Blood If a person doesnt have enough experience, he might make a mistake by not removing the tourniquet before the needle. This study guide will help you focus your time on what's most important. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Blood tests are no longer Hi! Veins will appear as a dark line. If you have an issue finding the vein, do not hesitate and call for a senior, more proficient colleague. Average delivery time is 5-10 business days. A lot of patients have the needle phobia. 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. Fasting glucose and hemoglobin A1c (HbA1c) Other tests are performed as indicated by clinical findings. Application of heat will cause vasodilation, making veins easier to see or palpate. This Use your index finger to palpate and trace the standard path of the vein on the arm. With this in mind, you should be sure that youre getting any requisite or helpful information from your patient before beginning to draw blood. I'm Kadia. The consent submitted will only be used for data processing originating from this website. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. Insert along the vein. If you are drawing blood from an arm, make sure to sit near the patient, as close as possible. No matter how a patient looks like, it is necessary for a medical professional to protect himself. Liver function studies. Please bring your donor card, driver's license or two other forms of identification. They already have pain, so lets make the process easier and more comfortable for them. By placing a warm towel over the veins, you are increasing the blood vessels which will make them more visible. WebPatients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. If youre a phlebotomist who has encountered this problem before, you know how frustrating it can be. Even with all these guidelines, perhaps the best approach is if you ask the patient from which vein they usually draw his blood. 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. 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. allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 These can include: Learning about your 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. I have to say, I started off doing venipuncture for lab draws prior to IVs and found that a good way to learn. These devices are good at locating superficial veins, however, their ability is limited for deeper veins. If you cant find one, consider the third option, the forearm. Specializes in RN-BC, CCRN, TCRN, CEN. Follow your institutional policy when using blood pressure cuffs. Also, it is the basis of diagnostics. However, thats not always a luxury most phlebotomists are afforded. var options = { Below are 5 key areas of importance with tips. Has 1 years experience. That is usually the last resort. These three together can help you find a vein. If you cant find a good vein, move to the back of the hand. Our members represent more than 60 professional nursing specialties. An example of data being processed may be a unique identifier stored in a cookie. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. Thyroid function tests. So, the choice of equipment will change from patient to patient. Luckily, got it on the first stick. At nurse.org, we believe that no one knows nurses better than, well, nurses. It is a medical problem that increases the risk of heart disease, diabetes and certain cancers. The information provided should not be used for diagnosing or treating a health problem or disease. Patients As a result, it can be difficult at times to find a vein to draw blood from. 0000276013 00000 n WebUsing consistent, proficient personnel to per-form blood draws. qG@OWdeDHj5b$Ze+QPbk8oo9uDP+GJXU'X96B@;"p4-BBR'@;Z6U`[VTk^9@(} f4qa l8pE2xr/4A-\1~},HZU!6)QH` T@C 6y@ Eh7| c"qnN n Qf3NQA(d2=d9 yN|1*XYa28YSIkefHIly `zhMs\\U@>fU^s,'/ksc>M# /jD/[7=6e*6c\u1_UL3Rll5nd;m,&!w{,`YNk 3 ]^]u>mrA- k`JM4>!Aoa0z't@l"4vl~"Frq}}]#)V1Z/8BnMs^|^x}^%0)&f3FY8I'wU\`Osd{z_b|{Q30Sck-BT[@'hJV2y )lw[;w]p39=%=N|=}|60m2}Edt/#2x!Ta}$n8x4py}` lt endstream endobj 202 0 obj <>stream Obesity Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. Once you remove the needle, gauze should be applied for a bit. 0000025579 00000 n instance: "61c9f514f13d4400095de3de", In certain cases, the patient may move a bit which may result in you sticking the needle in your own finger. Just my opinion. Word of caution: make sure to remove the substance before rubbing the vein with alcohol. If none of the above options enable you to find a strong vein, you may need to find another puncture site. This illuminated the veins that he could not palpate. 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. I understand that consent is not required to purchase any goods or services from this school and that my consent can be revoked at any time. }()); Drawing blood from a patient can be a daunting task, but it also is a necessity for nurses. 0000005129 00000 n Blood Test Vs Blood Donation (Comparisons). 0000000016 00000 n When performing venipuncture, he needs to convince a person that he is capable of drawing blood safely. HlV7WF#J$% r!h {7@)RRXZ4J9(e??@!o]h&Do?Y[L *fIXH^ Looking for a change beyond the bedside? Alternate arms if youve given blood recently. If they come in for their appointment well-prepared, it should be easier to find a vein almost immediately. Its important to do everything in your power to ensure the comfort of the patient when drawing blood. WebApplied Muscle Tension (AMT) is a series of simple exercises that help your blood pressure stay up and improve blood flow, so your chance of experiencing any side effects, like Ask the patient where they usually get stuck. I have had patients tell me nurses are more successful in one arm than the other, etc. One thing that Patients health is your priority. Tips for Drawing Blood The needle should fully penetrate it. Spaces are not allowed; punctuation is not allowed except for periods, hyphens, apostrophes, and underscores. If you are going to start an IV in the hand always have the patient pump their fist. To use a tourniquet to draw blood correctly, you should tie it three or four inches directly above the puncture site. 0000279572 00000 n Has 12 years experience. Explain the procedure and reason for the blood draw to the patient. The hand and lower arm are the best places for transilluminators. That's why we rely on registered nurses and other experienced healthcare All rights reserved. Become a Part of the Nurse.org Community! If you are drawing from a leg, the extremity needs to be placed over the bed so that the blood can easily flow into it. Going there is risky as you can hit a nerve or tendon. 0000005243 00000 n go-to source for nursing news, trending topics, and educational resources. Get help from a Doctor. We use cookies to ensure that we give you the best experience on our website. Please enter a valid e-mail address. How Does Donating Blood Affect Your Body? CMAA exam 1 Flashcards | Quizlet Some individuals will have far more noticeable veins than others, some will be calm about the procedure and others will require a great deal of calming down, etc. Be careful, though. You can do that by gently massaging the arm, from the wrist to the elbow. Then, deflate blood pressure cuff and apply tourniquet. 5. 0000036112 00000 n The practice of phlebotomy is not something that can strictly be learned from watching videos or reading a how-to guide but something that must be practiced repeatedly in a controlled environment with other trained professionals. Drawing blood from the elderly, young children, and infants can also be a challenge. Bloating. Premarital blood tests have been done away with. What if I cant find a vein? I'm not sure I understand how this works, as the valves are already in place to prevent backflow. Without further ado, here are 50 tips that will help you perform this crucial procedure.

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tips for drawing blood on obese patients

tips for drawing blood on obese patients