Very painful blood draw - what happened? What care should I take?
April 4, 2017 3:55 PM Subscribe
I went to my doctor's office for a routine blood test to check on my iron levels. The instant the needle pricked my skin it was an extremely sharp pain. It hurt badly the entire time (only one small vial) and then after she took it out, it still hurt really bad as I tried to continue on with my day. The draw site still twinges with pain. Normally I don't feel anything at all when I have blood drawn, but wow, this hurt bad... More below.
Typically the draw site stops bleeding after only a few minutes with the tape and gauze, but two hours later, it was still very slowly oozing blood. (And no, I haven't taken any Aspirin or medications that would prevent clotting.) So, I put a band-aid on it and then put an ice pack over it and applied pressure, and it eventually stopped bleeding, but it has left a tiny little scab, which has never happened to me before. The area is also slightly raised in a small bump.
What the hell did she do when she took my blood? Googling about painful blood draws and lingering bleeding leads to some rather scary tales of nerve damage and torn veins. The only thing I noticed is she didn't ask me to make a fist, which they normally do, and she went sort of fast -- she did put a strap around my arm and tightened, checked the spot quickly and then plunged the needle in.
Anything I should do to take care of it or anything I need to pay attention to and respond to if it happens? Can I still use my arm like normal? I was going to lift weights today. It still hurts now, a couple hours later, but the very sharp pain seems gone now that the bleeding has stopped.
Also, given that if I lost the function of my right arm I'd be screwed since I am right-handed, should I start having my blood drawn in my left arm? Just in case I am one of the unlucky ones to get some sort of permanent damage from it? I never realized nerve damage or complications were a possibility from routine blood draws until this moment. Does it matter which arm they take blood from and is there any reason they always do my right?
Thank you to any medical experts or people who have had similar experiences!
Typically the draw site stops bleeding after only a few minutes with the tape and gauze, but two hours later, it was still very slowly oozing blood. (And no, I haven't taken any Aspirin or medications that would prevent clotting.) So, I put a band-aid on it and then put an ice pack over it and applied pressure, and it eventually stopped bleeding, but it has left a tiny little scab, which has never happened to me before. The area is also slightly raised in a small bump.
What the hell did she do when she took my blood? Googling about painful blood draws and lingering bleeding leads to some rather scary tales of nerve damage and torn veins. The only thing I noticed is she didn't ask me to make a fist, which they normally do, and she went sort of fast -- she did put a strap around my arm and tightened, checked the spot quickly and then plunged the needle in.
Anything I should do to take care of it or anything I need to pay attention to and respond to if it happens? Can I still use my arm like normal? I was going to lift weights today. It still hurts now, a couple hours later, but the very sharp pain seems gone now that the bleeding has stopped.
Also, given that if I lost the function of my right arm I'd be screwed since I am right-handed, should I start having my blood drawn in my left arm? Just in case I am one of the unlucky ones to get some sort of permanent damage from it? I never realized nerve damage or complications were a possibility from routine blood draws until this moment. Does it matter which arm they take blood from and is there any reason they always do my right?
Thank you to any medical experts or people who have had similar experiences!
Neurologist here, and frequent sufferer of poor phlebotomists. Sharp pain is almost always neuropathic. Was it localized to the spot where the needle was, or did it radiate up or down your arm? If the latter, it's possible that the needle touched a nerve on its way to your vein (similar to hitting your funny bone, except different location, different nerve). The fact that the sharp neuropathic pain has gone now that the bleeding has stopped also supports this theory that a sensory nerve was pinched briefly. Did you say anything to the phlebotomist? When this happens to me, it usually goes away when they reposition the needle.
I would probably give yourself a break from lifting weights today, since increased blood flow to the area may swell the bruise slightly and impinge further on the nerve. But I would be very surprised if you had any sort of permanent damage from that sort of injury. Even totally transected peripheral nerves grow quickly -- if they didn't no one could ever have surgery. Also, sensory nerves (what sounds like might have been involved for you) are different from motor nerves, though they sometimes do travel together. If you can use your arm/hand now, there's no reason why you couldn't in future.
posted by basalganglia at 4:21 PM on April 4, 2017 [21 favorites]
I would probably give yourself a break from lifting weights today, since increased blood flow to the area may swell the bruise slightly and impinge further on the nerve. But I would be very surprised if you had any sort of permanent damage from that sort of injury. Even totally transected peripheral nerves grow quickly -- if they didn't no one could ever have surgery. Also, sensory nerves (what sounds like might have been involved for you) are different from motor nerves, though they sometimes do travel together. If you can use your arm/hand now, there's no reason why you couldn't in future.
posted by basalganglia at 4:21 PM on April 4, 2017 [21 favorites]
I also don't know about drawing blood, but I do bruise super easily, and I do a couple things: 1) I always just put my left arm out (I'm very right handed). It's never been a problem nor have they objected or even really noticed. 2) I always ask them to use a butterfly, because it's less painful and I bruise way less with them (but I think that's when I'm getting multiple vials and the bruising comes from pushing them in and out). Either way, I find it more pleasant with a butterfly. I've never had them object to that either.
posted by brainmouse at 4:22 PM on April 4, 2017
posted by brainmouse at 4:22 PM on April 4, 2017
You can request a specific arm for blood draws, and for shots.
Places that have a little table your right next to the blood draw chair, they usually like to do your right arm. If the little table is on the left side, your left arm.
Sometimes phlebotomist prefer to use your non-dominant arm.
I often have a preference for what arm I would like to get blood drawn from, so I'll just say "Hey, can we do the right/left arm today?" in a friendly tone. No one has ever seemed the least bit put out by this. It does seem to result in more reaching if they are not seated next to the little table, so I can see why they would default to a certain arm.
posted by yohko at 4:31 PM on April 4, 2017
Places that have a little table your right next to the blood draw chair, they usually like to do your right arm. If the little table is on the left side, your left arm.
Sometimes phlebotomist prefer to use your non-dominant arm.
I often have a preference for what arm I would like to get blood drawn from, so I'll just say "Hey, can we do the right/left arm today?" in a friendly tone. No one has ever seemed the least bit put out by this. It does seem to result in more reaching if they are not seated next to the little table, so I can see why they would default to a certain arm.
posted by yohko at 4:31 PM on April 4, 2017
Response by poster: No pain radiating anywhere -- the sharp pain was only at the entry site. If the pain was radiating throughout my arm, I'd probably be more worried. And I didn't say anything because once it was already in, the procedure was basically done -- it took only about 5 seconds to draw the needed blood.
The whole thing just really freaked me out. Something so routine ended up being shockingly painful. I'd put it at like a 7 on the pain scale... which is pretty high! Then when I googled it, the first hit was the story of a woman who suffered permanent damage in her arm from getting blood drawn. So I'm gonna start using my left arm in the future I think, based on the experiences some of you have shared. I don't think it's worth risking my right arm.
posted by AppleTurnover at 4:48 PM on April 4, 2017
The whole thing just really freaked me out. Something so routine ended up being shockingly painful. I'd put it at like a 7 on the pain scale... which is pretty high! Then when I googled it, the first hit was the story of a woman who suffered permanent damage in her arm from getting blood drawn. So I'm gonna start using my left arm in the future I think, based on the experiences some of you have shared. I don't think it's worth risking my right arm.
posted by AppleTurnover at 4:48 PM on April 4, 2017
I have better veins in my left arm. The last time I had blood drawn, I wasn't really paying attention and presented my right arm. It was awful and even though he couldn't actually draw blood, it bruised like hell. Hurt the rest of the day and was still twingy the next day. He was a student, which I was okay with, but it was just a bad draw on the wrong arm. He was fine when I switched arms.
posted by Ruki at 4:51 PM on April 4, 2017
posted by Ruki at 4:51 PM on April 4, 2017
I wonder if the phlebotomist may have tapped a small artery by mistake. It happens but thankfully is a pretty rare occurrence. Arterial sticks hurt significantly more and tend to bleed more/take longer to clot. I think the phlebotomist should have noticed (it would have produced a notably pulsatile flow), but the kind of inexperience that leads to tapping an artery could also go hand in hand with not recognizing what you've done.
In any case, this is a rare complication and I'll echo all the replies above that you are unlikely to have worsening anything (pain, nerve damage, etc) from this point onward.
posted by telegraph at 6:12 PM on April 4, 2017 [1 favorite]
In any case, this is a rare complication and I'll echo all the replies above that you are unlikely to have worsening anything (pain, nerve damage, etc) from this point onward.
posted by telegraph at 6:12 PM on April 4, 2017 [1 favorite]
Ask them to use a butterfly needle next time. The needles in them are much smaller and this is much less likely to occur as a result.
posted by Maias at 6:39 PM on April 4, 2017
posted by Maias at 6:39 PM on April 4, 2017
You should totally be able to ask for a specific arm. If you get someone who seems to be a better phlebotomist you can ask them what they'd suggest for future draws. I've had some phlebotomists tell me which spots seemed easier on me when they had a harder time. Also if you have to do it again and have a choice maybe ask for a different person to do the blood draw? My docs office got a new person and both me and my husband had more pain than usual on recent blood draws.
posted by oneear at 8:16 PM on April 4, 2017
posted by oneear at 8:16 PM on April 4, 2017
Butterfly (pediatric needle) FTW!
Makes a big difference in the stick, and sometimes you can dodge the bullet because the inexperienced ones won't want to mess with it.
I've had enough blood draws in my long and adventurous life so that now I don't screw with a phlebotomist that can't get the stick done in a MINIMUM of two sticks, and I ask for somebody else.
Sometimes s*t just happens on a bad day--my favorite person, who never ever misses and can slip a needle in so you can't even feel it, managed to booger it up. Didn't hurt, but I had a swelling and spectacular bruise all down my arm last time.
When you go to get a blood draw, do yourself and the phlebotomist a favor and drink plenty of fluids. Makes a difference if your properly hydrated.
posted by BlueHorse at 9:52 PM on April 4, 2017
Makes a big difference in the stick, and sometimes you can dodge the bullet because the inexperienced ones won't want to mess with it.
I've had enough blood draws in my long and adventurous life so that now I don't screw with a phlebotomist that can't get the stick done in a MINIMUM of two sticks, and I ask for somebody else.
Sometimes s*t just happens on a bad day--my favorite person, who never ever misses and can slip a needle in so you can't even feel it, managed to booger it up. Didn't hurt, but I had a swelling and spectacular bruise all down my arm last time.
When you go to get a blood draw, do yourself and the phlebotomist a favor and drink plenty of fluids. Makes a difference if your properly hydrated.
posted by BlueHorse at 9:52 PM on April 4, 2017
What did they use to clean your skin first, before the needle puncture?
It's possible that there was a thick enough residue of alcohol or iodine or what have you, so that when the needle went in your skin, the chemical made contact with the tissues under the skin, and caused a localized reaction. If this is the case, it's worth finding out so that you can avoid that disinfectant next time.
posted by metaseeker at 10:22 PM on April 4, 2017
It's possible that there was a thick enough residue of alcohol or iodine or what have you, so that when the needle went in your skin, the chemical made contact with the tissues under the skin, and caused a localized reaction. If this is the case, it's worth finding out so that you can avoid that disinfectant next time.
posted by metaseeker at 10:22 PM on April 4, 2017
Response by poster: The disinfecting was normal -- they always use those little wipe packets so I doubt it was that. Unless she didn't wait for it to dry? I don't know. My arm actually feels fine now, but it really hurt like a MFer until I got to (finally) stop bleeding. I'll see if I end up with any bruising.
This was informative. Thanks everyone.
posted by AppleTurnover at 10:52 PM on April 4, 2017
This was informative. Thanks everyone.
posted by AppleTurnover at 10:52 PM on April 4, 2017
I'm late to the show here but for anyone still reading...
I am an experienced phlebotomist. Most likely a nerve was hit or a valve. There are small valves in veins and sometimes the needle happens to go into one or very close and that can cause a bit of extra pain, but there is no way to know from looking where the valves are going to be, there is no lasting damage and it doesn't happen often. If a nerve was hit but there are no lingering nervy sensations, then no problem. If there is any lasting nerve pain or tingling or numbness then get checked out by your doctor.
Please, please don't ask for a butterfly needle. Butterflies come in all the same gauges as straight needles. They are needed for shallow surface veins due to their lower angle of entry and for specific tests like blood cultures. They are not better or more painless for a regular AC area vein. ( AC being the crease on the inside of the elbow area.) Also, a pediatric butterfly (or pediatric straight needle) used on a normal sized AC vein has a good chance of hemolysing the blood and having the sample be rejected or giving an incorrect test result.
Feel free to ask for the most experienced phlebotomist to do your draw. They know the tricks to anchoring the vein, how deep and how fast to go in and how to hold the the skin to minimize pain, but please don't tell them which tool to use for the job.
posted by mismatchedsock at 7:16 PM on April 5, 2017 [2 favorites]
I am an experienced phlebotomist. Most likely a nerve was hit or a valve. There are small valves in veins and sometimes the needle happens to go into one or very close and that can cause a bit of extra pain, but there is no way to know from looking where the valves are going to be, there is no lasting damage and it doesn't happen often. If a nerve was hit but there are no lingering nervy sensations, then no problem. If there is any lasting nerve pain or tingling or numbness then get checked out by your doctor.
Please, please don't ask for a butterfly needle. Butterflies come in all the same gauges as straight needles. They are needed for shallow surface veins due to their lower angle of entry and for specific tests like blood cultures. They are not better or more painless for a regular AC area vein. ( AC being the crease on the inside of the elbow area.) Also, a pediatric butterfly (or pediatric straight needle) used on a normal sized AC vein has a good chance of hemolysing the blood and having the sample be rejected or giving an incorrect test result.
Feel free to ask for the most experienced phlebotomist to do your draw. They know the tricks to anchoring the vein, how deep and how fast to go in and how to hold the the skin to minimize pain, but please don't tell them which tool to use for the job.
posted by mismatchedsock at 7:16 PM on April 5, 2017 [2 favorites]
Huh, mismatchedsock, I ask for a butterfly because I was told by a phlebotomist to always ask for one when she saw how badly I bruised. I went from horrible bruises with every blood draw to no bruises at all (and always less pain). But I get regular, multiple-vial blood draws. Other than the reason you state for the pediatric butterfly, why do you advise against it?
posted by brainmouse at 7:41 PM on April 5, 2017
posted by brainmouse at 7:41 PM on April 5, 2017
brainmouse,
The size of the needle should be matched to the size of the vein to prevent clotting and/or hemolysis of the sample. The results to a chemistry test can be skewed when the broken blood cells get in the plasma, and a CBC will be rejected entirely (I work in the lab as well.) Going in with a butterfly at too shallow of an angle can sometimes hurt because the needle doesn't end up positioned in the vein correctly.
The solution to the bruising depends on the cause. You should definitely explain that you bruise easily to the person drawing your blood. If you are bruising due to blood thinners then wrapping tightly with coban and leaving it on for 30 min should help. If it is because you have small veins that "blow" then a small needle is in order but not necessarily a butterfly. I sometimes choose a straight needle with a syringe that is smaller than any of our butterflies to use on really tiny veins that look like they might not hold. Sometimes a butterfly is the solution, if the vein is so close to the surface that in order to keep the bevel all the way in, the tip would go out the other side. A good phleb should be able to make that determination.
posted by mismatchedsock at 8:11 PM on April 5, 2017 [2 favorites]
The size of the needle should be matched to the size of the vein to prevent clotting and/or hemolysis of the sample. The results to a chemistry test can be skewed when the broken blood cells get in the plasma, and a CBC will be rejected entirely (I work in the lab as well.) Going in with a butterfly at too shallow of an angle can sometimes hurt because the needle doesn't end up positioned in the vein correctly.
The solution to the bruising depends on the cause. You should definitely explain that you bruise easily to the person drawing your blood. If you are bruising due to blood thinners then wrapping tightly with coban and leaving it on for 30 min should help. If it is because you have small veins that "blow" then a small needle is in order but not necessarily a butterfly. I sometimes choose a straight needle with a syringe that is smaller than any of our butterflies to use on really tiny veins that look like they might not hold. Sometimes a butterfly is the solution, if the vein is so close to the surface that in order to keep the bevel all the way in, the tip would go out the other side. A good phleb should be able to make that determination.
posted by mismatchedsock at 8:11 PM on April 5, 2017 [2 favorites]
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posted by Jubey at 4:16 PM on April 4, 2017 [2 favorites]