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Phlebotomy is an art that is easily teachable, but that cannot truly be mastered without experience. In order to really learn it, you need to do it, and do it a lot. Because there are so many different kinds of patients with so many different conditions and types of veins, knowing a few tricks of the trade before going in can make the stick a much better experience for both you and the patient.
Locating the Vein
Develop your sense of touch when it comes to finding veins. If you rely on site alone and never strengthen this skill, you'll have difficulty finding veins on many of your patients. Practice finding veins without using you eyes at all. Practice this skill while wearing gloves.
If you have trouble locating a patient's vein, try one of several tricks. First, replace the standard tourniquet with an inflated blood pressure cuff. If this is not successful, have the patient dangle her arm at her side while you prepare a warm compress. Heat can often bring a vein to the surface. You alos can try gently rubbing or tapping the area, however, it is a myth that slapping the area is appropriate. Slapping the site of puncture can hemolyze the surrounding blood cells and render some tests inaccurate.
Do not have the patient pump her fist in order to assist you in finding a vein. This has been known to increase potassium and can interfere with the accuracy of lab test results.
Use the appropriate size tube with the appropriate sized needle. For example, use the smaller tubes if you're drawing from the hand with a butterfly or small needle. Using the large 10 ml tubes with a 23 gauge needle will likely blow out the vein.
Don't fish. It's common practice in many blood collection centers to fish for a vein or move the vein around inside the patient's body. This is painful for the patient and unprofessional on your behalf. If you miss the stick, withdraw the needle, replace it and try again.
Don't re-stick a patient with the same needle if you miss the vein. This can lead to serious infection. Single-use needles also dull after one stick, making future attempts more painful for the patient and more difficult for you.
Don't rush. Even if you have 100 more patients to stick in the next two hours, take your time and approach each patient in a calm, self assured manner. Rushing leads to mistakes and mistakes lead to re-draws, missed sticks and damaged veins and ultimately causes you to spend more time on your draws.
Never leave a tourniquet on a patient for more than one minute. It can hemolize the blood surrounding the draw site and can bruise or damage the skin of delicate patients.
Carry a chart in your pocket or on our tray that identifies the different tube colors and types associated with each type of test. This will save you time in the beginning as you learn.
Do not blow on the draw site to make the alcohol decontamination solution dry faster. This recontaminates the area.
Working with Patients
Be sure to ask if the patient is taking any blood thinners before you collect a sample. These patients will bleed more and faster than other patients and will need a little extra care.
Also, ask the patient if they're allergic to latex or or band-aid adhesives. Use paper tape instead of band-aids on fragile skin.
Verify that the testing conditions have been met before drawing to avoid wasting a sample. For example, if the sample is supposed to be fasting, verify the last time the patient ate.
Have your patient count to three, then take a deep breath. As the patient inhaled, perform the stick. This decreases anxiety by giving the patient something to focus on, and often times, it helps a patient to be still as you stick.