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Preparing for Needle Sticks for Blood Draws and IVs

Sharon Stingley, retired RN with CRNI certification in infusion therapy, gave permission to share her suggestions for making it easier to find a vein when you have to get stuck for a blood draw or insertion of an IV.


As a nurse in the IV field for many years Needle sticks involve so many factors. I totally agree some techs are better than some nurses at needle sticks and some nurses are better than others. We all cannot be successful at everything. I was considered one of the best and called on even before I joined the IV team at the hospital to help a fellow nurse with a "difficult stick". My experience has been drawing blood or starting an IV on a patient has many factors involved. When patients needed blood work and an IV we would always draw blood off the the IV start catheter before we hooked up the IV fluid-why stick someone twice when you don't need to.

Are you dehydrated? My cousin, very dehydrated with morning sickness in her first trimester of pregnancy, need some fluid so I started her IV with a very small gauge needle and it Really HURT! Her skin was tough to enter and even though I pulled it taunt as I push the needle in I could really feel it drag against the skin. I remember one IV when I,as the patient myself, hurt like hell for at least five minutes before it finally calmed down. I complained to the nurse... I have 2 theories on this: the alcohol prep had not been allowed to dry and as the catheter was advanced took this wet alcohol with it into the vein and caused irritation, or she started it where there was a valve in the vein (valves help push the blood back to her heart) causing a spasm of that valve.

Are you nervous? A dumb question, who isn't? Your autonomic nervous system takes over your body and hides those veins because why would it want your body invaded with a needle by someone you don't even know for some test or medicine you don't really want to have no matter how much good you know it will do!

Are you cold? My most compelling story is the day i was called to the floor for a difficult IV restart. I get to the patient room the same time as physical therapy does to wheel her downstairs.. I let PT have her first, with one condition.. they put a hot towel on her arm before she comes back to the room and the patient will tell the floor to call me as soon as she is back. Well, PT complied and they didn't just wrap her arm in a wet warm towel with a plastic bag around it, they put on one of those BIG packs they use for heat treatments... Wow you should have seen her veins! Ropes, all over her arm. I called everyone who was on the floor in to see this, even the Doctors! Easy good stick! I still see this patient's broad smile when I think of this! In my 20+years of home infusion my "difficult" starts took a hot shower, wrapped up in a blanket and applied moist heat and heating pad to the area for at least a half hour before I arrived. We would evaluate possible sites rotating arms, etc before each visit. Most of the time this This does not mean I did not have patients I could not start or that made me sweat doing it... On more than one occasion I would take a break for a few minutes then come back and get right in.. One gentleman was deathly afraid of needle and had warned me.. i just did not realize how afraid.. He broke out in a dripping sweat and almost fainted on me the first time I did him inhis home. After that we had a wet towel available and a drink of juice right beside his free hand and I think we even had him suck on a candy mint to keep his mind busy and I talked to him continuously.

A needle stick is an invasion to the body and the body does not like invasion as it causes discomfort. Pain threshold is different for everyone, some days you are a 10 (untolerable without a pain medication) and others may only be a 1-2(tolerable to carry on activities of daily living with no pain treatment). Some people can use meditation for uncomfortable situation, like learning to breathe properly for childbirth, chewing gum may keep your mind busy.

The best strategy is when you find someone who is good and you are comfortable with, remember their name and request them if they are on duty. It is worth the wait. Be proactive and keep your best blood draw site ready with warmth and some hand squeezes beforehand. I personally prefer my anticubital (the center bend in the elbow - Everybody has a big vein there!) for any blood draws, and while I do not require it's use, I stick that arm out there nice and straight with my shirt rolled up so it out there for the tech to see. Once they check it they realize it is best choice. I am in no way saying we need to tell everyone where to draw blood or start our IV. It is usually best to let the nurse or tech choose their own best place (we all have them) but it can't hurt to suggest.

Remember where the needle is inserted it NOT the place where it enters the vein and the blood comes from. SOOO after the needle stick, apply pressure with several fingers up from the needle entrance for several minutes. To avoid Bruising... DO NOT BEND YOUR ARM UP... you just push blood out into the surrounding area and cause a bruise, then the site is not good for the next time.

I hope this helps you understand a bit about the best and worst of nurses and techs in these instances. Best wishes Sharon:)