Plz don't take my bloods, I need them.
March 5, 2010 10:34 AM   Subscribe

Why am I having trouble having blood drawn? The Life Insurance Company won't sell me a policy if I can't prove I have blood running through my veins.

In the course of buying some new life insurance prior to the arrival of New Guy, I've had to undergo a brief physical. All seems normal as expected, except that the nurse can't seem to get any blood out of me.

She came to the house last Tuesday and tried both arms to no avail. It's quite possible I was dehydrated after the 6 hour fast and a heavy workout. I'm quite certain she was in the vein on my right arm.

This morning she came by the office (I'm the only one here on Fridays) and tried again. She got about half a vial (of the two full ones needed) out of my right arm and then it stopped. Next we tried my left hand. She was really obviously in my vein this time and got no more than a few drops.

What's happening here? This time I was careful to be fully hydrated. It's not freezing cold in here (low-mid 60s) and my blood pressure is normal (120s/70s). My pulse is quite slow, but it's always like that. Why can't I bleed properly? We're going to try again on Monday; what can I do to make this likely to work next time?
posted by GodricVT to Health & Fitness (30 answers total) 1 user marked this as a favorite
 
It might just be how you are. I've had so many bad experiences with people trying to draw blood (like having to get stuck seven or eight times before actually being able to get any blood out) that I've quit letting people do it unless it's absolutely necessary.
posted by dortmunder at 10:38 AM on March 5, 2010


Try being even more hydrated, drink a lot of water. Maybe get some blood flowing through the arms in advance by making tight fists or squeezing a stress ball. Some coffee or other caffeine may temporarily increase either your heart rate or blood pressure for a little bit and that may help.
posted by Diplodocus at 10:41 AM on March 5, 2010


I have a friend that's the same way. Have you ever had blood drawn before and it went fine? If not, then that's probably just how you are.
posted by Nattie at 10:41 AM on March 5, 2010


Just reading this is making me feel nauseated (I hate having blood drawn and it always takes a ton of painful tries for me)--try one of the veins on the back of your hand/side of your wrist. I have always had much better luck w/ those.
posted by leesh at 10:42 AM on March 5, 2010


Try putting a heating pad on your upper arm shortly before/during the blood draw. A nurse tried that on me when my blood was flowing really slowly, and it did the trick.
posted by castlebravo at 10:45 AM on March 5, 2010 [3 favorites]


My mother has them draw blood out of the back of her hand because it's almost impossible to get it out of her arms.
posted by Kimberly at 10:46 AM on March 5, 2010


Best answer: It's not freezing cold in here (low-mid 60s)

My wife would tell you that, yes, that is freezing cold. Go warmer, at least 72-74.

Take a hot, hot shower right before the blood draw to raise your core temp. Dunk your hands in hot water to loosen things on the back of your hand. Try some heating pads.

There are multiple places to stick -- the crook of each arm, the inside the arm, the back of each hand -- that's six right there. A good phlebotomist knows even more. Do you have a good phlebotomist (i.e. a real nurse)?

I'm a terrible stick, but the difference between someone that knows what they're doing and someone that doesn't is miles and miles. My old doctor that was five minutes from retirement was the best I've ever seen; the crazy lady at the clinic doesn't know what the hell she's doing.
posted by Cool Papa Bell at 10:48 AM on March 5, 2010 [2 favorites]


Seconding that some people are just like that. People who are obese, drug addicts who have used up all their veins, and people who are severely hypovolemic (a fancy word for dehydrated) can be very difficult, but there are other people who just don't have easily stuck veins. People who are on steroids can have very fragile veins that "blow" easily. There are a variety of tricks that are supposed to make it easier, but they don't always work; I assume a nurse who draws blood as part of her job would know most of them. Your arterial blood pressure really doesn't have much bearing on how easy it is to hit your veins, but staying well-hydrated is a good idea. Do you have a regular physician? If so, they might have someone in their office who can give it a try; I know sometimes I am struggling to get an IV (I have been starting IV's for 20 year on patients ranging from 500 gram premies to 250 kg adults) and someone else with a fresh set of hands comes in and gets it right away.
posted by TedW at 10:53 AM on March 5, 2010 [1 favorite]


I am the same. I request the most experienced nurse available before letting anyone near me, I usually end up full of holes from inexperienced nurses unable to draw blood.
posted by fire&wings at 10:57 AM on March 5, 2010


Nthing that you may want to talk to your regular doctor about this. You need a nurse who is really experienced (some people are just better at this than others), you should be really well hydrated, and with me anyway a butterfly needle helps.

When I was in the hospital for surgery, they were trying to get a line for an IV and having trouble. I kind of got fussy since I was not feeling well and they had been sticking me a few times with no luck. They then paged their most experienced nurse, who spent at least five minutes checking out various spots visually as well as tapping gently on various veins, before finally picking a place on the back of my wrist and getting it right in the first time.
posted by gudrun at 11:15 AM on March 5, 2010


Best answer: Drink a ton of water -- not just the day of, but for the whole weekend. I'm not sure why but the helpfulness of the hydration works better if its consistent.

You can also try tying off at two points -- one above your arm where the nurse is trying to hit and the other around the wrist.

Also, if you're trying to do your arm, do a few push-ups or use your arms to lift from the chair.

I've also found running hot water over the point where you're trying to stick makes the veins pop a bit.

Some people have hard to hit veins or veins that roll and a lot of nurses who don't do this more often can be less than able to do it. I always have to ask for the nurse who's the best phlebotomist because I know they will have trouble hitting me. Those that ignore me do so at their own frustration.
posted by MCMikeNamara at 11:18 AM on March 5, 2010


It's a relief to know that I'm not the only one who goes through this, thanks all!
posted by mareli at 11:19 AM on March 5, 2010


This exact thing happened to me. The nurse tried on three separate occasions with no success. The insurance company finally sent out the guy who "could get blood out of anyone" and he had NO problems whatsoever. Ask for a very experienced nurse.
posted by rabbitrabbit at 11:21 AM on March 5, 2010


About tying off a two points -- don't leave it that way for very long or it will be very counterproductive for trying to hit you.
posted by MCMikeNamara at 11:21 AM on March 5, 2010


Are you obese or a heroin addict? Either of those things make it hard to draw blood (and execute people).
posted by dfriedman at 11:27 AM on March 5, 2010


I believe you are basically in too good a shape for this to work.

I read an article recently saying that endurance athletes who have pushed their resting pulse rates down into the 30's will occasionally faint when they stand up abruptly because they happen to hit the lull between beats just right. Essentially, your body's compensation for the blood pressure drop involved in standing up is partially dependent on a ratchet driven by heart beats.

I suggest 3 tricks to get past this:

1. Bring your stair climber to work and get your pulse rate up above 100 before the blood draw.

2. Lie down on an incline with head below your feet and your hand dangling below that.

3. Take the draw from your lower leg.
posted by jamjam at 11:29 AM on March 5, 2010


Echoing the recommendation to ask for a better phlebotomist. A good one makes all the difference in the world and will know all the tricks being suggested here and then some. Hydration helps, yes, but not as much as a skilled phlebotomist.
posted by gingerbeer at 11:41 AM on March 5, 2010


A former boyfriend worked as a phlebotomist while in college and gave me some advice on this when I had had problems. Most of his advice was to avoid MDs, and inexperienced nurses. The people who are best at drawing blood from difficult veins are those who work in pediatrics and maternity.

As mentioned before, obesity, and drug use can make things more complicated. Also having dark skin decreases the contrast of the veins and can make it more difficult. I remember him coming home one night from work and telling me that he'd missed the vein on a patient (for the first time in three years) who was morbidly obese and African American. He was really upset because he prided himself on being able to stick the more challenging patients.

I'd suggest going to a clinic or hospital to have the blood draws done. They usually have more experience and can tell you if you're just difficult or there's honestly something weird going on.
posted by sciencegeek at 11:46 AM on March 5, 2010


Endurance athletes' low resting pulse has nothing to do with whether one can have blood drawn. That assertion makes no sense.
posted by dfriedman at 11:47 AM on March 5, 2010


Nthing experienced nurse.
posted by cashman at 12:40 PM on March 5, 2010


Friend has this problem as well, and only really awesome, experienced nurses and phlebotomists can get blood out of her. She's not obese or a drug user or anything like that - the spectrum of natural human variation definitely includes 'people whose veins are a total bugger to get blood out of'!

We actually have advice that if you fail twice getting blood out of a patient, go and find someone with more experience/seniority - difficult blood draws are a fact of life. Any of the things above mentioned that can increase your peripheral blood flow (warmth, hydration etc) will help, but it might just be the way you're built. But don't despair - there will be someone who can get blood out of you.
posted by Coobeastie at 12:54 PM on March 5, 2010


Oh I feel your pain, I have this problem all the time. To the point that the blood donation people told me, thanks but don't bother coming back again :) When I was pregnant I had to get blood draws often, and they just sent me to a lab for a phlebotomist to do it, the office nurses had no luck. I asked a question about it on here a while back, you might find helpful tips there too!
posted by Joh at 1:43 PM on March 5, 2010


Try being even more hydrated, drink a lot of water. Maybe get some blood flowing through the arms in advance by making tight fists or squeezing a stress ball.

This. I frequently have difficulty getting blood taken too, because of my supposedly small veins and low pulse. At the blood donation place they often give me a ball to squeeze while the blood is being drawn.

Some coffee or other caffeine may temporarily increase either your heart rate or blood pressure for a little bit and that may help.

I'm told to drink lots of water and avoid caffeine before giving blood. I'm not sure which affect of caffeine would be more significant, the dehydration or the heart rate acceleration but I imagine there would be other ways you could get your heart rate up.
posted by fuse theorem at 2:03 PM on March 5, 2010


Best answer: Look at it this way, dfriedman, in order for blood to enter the collecting tube when a needle is inserted in a vein, the needle must offer a pathway to the blood with comparable or less resistance than the vein itself, which is a considerable challenge partly because the diameter of the needle is much smaller than the vein, and because resistance to fluid flow increases as tube diameter decreases (and because of the Bernoulli effect and because the heart actually functions as a suction pump for part of its cycle). The tourniquet reduces venous blood flow at a point downstream of the needle (I presume arterial flow is reduced less or pressure could not build up in the vein), and this ordinarily makes veins inflate with blood like a water balloon, and the elasticity of those inflated veins gives enough back pressure for blood to be forced into the tube.

Endurance athletes have developed their circulatory systems to have the capacity for a much greater volume of blood flow per second than the average person's has, and this means that their veins are harder to inflate to the elastic point that makes for back pressure, because of greater volume of the veins and (I think) because venous return in deeper veins which are not so easily cut off by the tourniquet is better developed.

If GodricVT has very elastic collagen (a la Marfan's) I imagine the effect could be similar.
posted by jamjam at 2:13 PM on March 5, 2010 [1 favorite]


Best answer: Actually, jamjam, I love to see physically fit people come to the OR because they usually have great veins. You are right that the tourniquet has to impede venous return but not arterial flow, so a too-tight tourniquet can make getting into a vein more difficult. In fact, the blood pressure monitor we use has a "venipuncture" setting that inflates the blood pressure cuff to below the arterial blood pressure but greater than venous blood pressure and works very well. Also, the size of the needle is important, but more so in that too large of a needle will occlude the vein and prevent blood from passing distally; blood does not travel from the proximal vein because veins have valves.

I could go on and on about this but don't want to derail things; the take home message is that while some people treat venipuncture (whether for IVs or phlebotomy) as simply sticking a needle in a tube, there is more to it than that.
posted by TedW at 3:26 PM on March 5, 2010


Yeah, butterfly needle and hydration and skilled tech really really help. I've had to get blood drawn every day for a few weeks now and I *am* a former IV drug user who pretty much blew most of the veins in my left arm.

So, I always have them do the right, make sure to drink a glass of water just before and if needed, guide them as to which veins are likely to work. Some people (like me) have veins that roll, so the phlebotomist has to know how to follow them without poking you too much.
posted by Maias at 4:06 PM on March 5, 2010


Best answer: > The tourniquet reduces venous blood flow at a point downstream of the needle (I presume
> arterial flow is reduced less or pressure could not build up in the vein), and this ordinarily
> makes veins inflate with blood like a water balloon, and the elasticity of those inflated veins
> gives enough back pressure for blood to be forced into the tube.

This--depending on blood pressure alone to force blood into a collection needle--occurs only when you're donating a pint. For any kind of clinical test, the blood is sucked into a sterile Vacutainer (evacuated) tube or into a syringe the plunger of which is being physically pulled out by the phlebotamist, so that the fluid flow is strongly helped along by atmospheric pressure differential (760mm Hg outside, much less than that inside the Vacutainer tube or syringe. The patient is essentially like a tube of toothpaste that's being squeezed with the cap off. Get your needle into a good venipuncture site and the blood does just what the toothpaste does, for the same reason.

What exactly does "being experienced" mean in blood drawing? I worked my way through college as a sticker at Emory Univ. hospital. Turnover is pretty high in that job (you learn all the vampire jokes there are; not that there are all that many, you just hear the same damn ones over and over) and since I kept it for four years I eventually became the go-to sticker for the impossible cases. A beginning phlebotamist only knows about the puncture site shown in the book, and knows nothing at all about what an invisible vein down under the surface feels like. If that one textbook site doesn't work, what to do? The more experience you get, (and the more you're helped and guided by others who've been at it longer) the more other possible stick sites you learn about and the more you depend on touch rather than sight to find the veins. And, just as important, you build up a store of memories of other potatoes you have successfully stuck. Now then, in the past when they sent me to get half a dozen 20ml tubes from someone who "has no veins" I've found gusher sites around here... and over here... and up here... So you concentrate your tactile search there... and there... and there.
posted by jfuller at 5:37 PM on March 5, 2010


Don't ask for a nurse, but specifically asked for an experienced phlebotomist. Sometimes nurses don't do a whole lot of blood draws... 2 nurses at my old doctor's office nearly made me faint once from the pain they caused, and I don't typically faint/get weak. Now I specifically request phlebotomists.

While they may have more luck with the wrist, I prefer not to let anyone draw from the inside of my wrist because I find it hurts a lot more. I would rather have it taken out of the back of my hand, if the inside of my elbow isn't working.

I had to Google to find the name of this but a couple of years ago they announced the Vein Viewer. It uses near-infrared light to "read" your arm and project an image of the veins onto your arm. You might ask around if any nearby doctors' offices own one of these.
posted by IndigoRain at 6:33 PM on March 5, 2010


Best answer: As a former "go-to sticker" who could get blood from a turnip, I also recommend asking for an experienced phlebotomist. Some insurance companies will allow you to take the "kit" to a lab/hospital so that they can draw your blood and send it to the designated lab for testing (if you are not satisfied with the insurance company nurse).

If that is not an option (or even if it is), be sure to drink plenty of water (will not affect fasting results), warm up your arm using a warm washcloth or those hand warmer thingys that skiiers use, lie down (if possible), keep your arm very straight, slap the vein silly, and squeeze a ball. And, by all means, don't tell the sticker they have "only one chance" or you "hope they know what they're doing" or something similar as that will just jinx them or piss them off. Trust me, they want to stick you only once and they don't want to hurt you - it's the ultimate challenge and they take pride in being able to "get" the hard sticks.

If your arm veins roll, collapse, or are really deep and hard to feel (it was much easier to feel veins back before the advent/awareness of AIDS & other bloodborne pathogens necessitated having to wear gloves), the phlebotomist may choose to stick your hand with a butterfly needle. Again, an experienced phlebotomist/tech/nurse will find the right option.

She was really obviously in my vein this time and got no more than a few drops. What's happening here?

It sounds like she was using a vacutainer and the suction from the tube collapsed your vein. Or, if she was using a syringe, she pulled back too hard on the syringe and collapsed the vein.

Some people just have "poor" veins and need some extra care and attention by the right person to find and properly stick them. It's not your fault. Good luck. It's a shame you've had to endure such a bad experience. I hope it goes better for you next time!
posted by ourroute at 8:01 PM on March 5, 2010


Response by poster: Thanks for all the answers and support folks- automated mathowie says I should do a follow-up, so I certainly will.

The same lady came back for a third try. This time I did everything suggested here- drank a lot of water, got quite warm, got my pulse up a bit, etc. Ultimately we failed again in both arms and successfully got one vial from my hand (with a butterfly) before it stopped again. I think ourroute might be right about the vacutainer collapsing my veins.

Regardless, it's done with, and next time this comes up I'm going straight to the hospital to have a full-time phlebotomist do it.

jamjam- thanks for the flattery about my fitness! I'm in pretty good physical condition, but not in the kind of shape TedW describes.
posted by GodricVT at 9:31 AM on April 5, 2010


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