Draw up, draw up, ladies and gentlemen! Behold, the Amazing Human Pincushion!
September 10, 2012 4:37 AM   Subscribe

What are your tried-and-true tips for having blood drawn from historically difficult veins?

I recently took a drug that requires monitoring my blood every 3 days for the next few weeks. Nurses and phlebotomists have always had a very hard time getting even a little blood out of me. Yesterday, I was stuck 7 times before one managed to get a little bit out of my hand. It was unpleasant, to say the least. I normally have no psychological problems with needles and the pain, but atm, can feel the panic building up at the thought that this will happen again on Wednesday.

Apart from staying hydrated and applying heat to the area, are there any other tricks for making this easier?
posted by catch as catch can to Health & Fitness (27 answers total) 4 users marked this as a favorite
When I was having a lot of blood drawn, I would walk into the lab and say, "Who is the person you go get when you're having trouble? Let's start with that person." This cut down dramatically on the number of useless, digging-around sticks. Once I found a phlebotomist who did a good job with me, I asked about her schedule so I'd know when to come in, and I asked for her by name.

I have a friend who told me recently that her best vein is in her foot, and she has learned to just ask them to use her foot. It's very unusual and something that had never occurred to me. She says it's hard to talk them into it (I have the same problem when I tell them I want them to go straight to the back of my hand and not waste time trying to get the vein in my arm) but has made a big difference for her.

That's all I've got. Good luck.
posted by not that girl at 4:49 AM on September 10, 2012 [4 favorites]

Was going to say drink a lit of water and wear a warm sweater, but you've got that covered. You might try pinching yourself elsewhere just before the needle goes in - it distracts me from the needle and I experience less anxiety.
posted by bunderful at 4:51 AM on September 10, 2012

The trick, in my experience, lies in getting the right nurse/phlebotomist. I've had one nurse try six or seven times in each arm, and then call another nurse in who hit gold on the first jab. This has happened more than once.

I was told by one nurse that veins 'hide' when you're nervous (presumably blood flow to the skin and extremities is reduced in stressful situations). So try to relax.

One one occasion I suggested to a nurse that she might as well go straight for the vein in the back of my hand, unless they were very good at finding veins. She took my advice, and we avoided a lot of unnecessary stabbing.
posted by pipeski at 4:52 AM on September 10, 2012 [1 favorite]

Yeah, I have tiny veins too. Good advice upthread, especially to "find your best vein". One person says it is in her hand, for me it is on the side of my arm-- not the landing strip near my elbow, but on the inside part of my forearm just down from my bicep. It hurts a little more, but I know that is the best spot for me. Find a good phlebotomist, and insist that only that person draws your blood, and find your own best spot. Other than that, people like us just suffer a little bit more. Good luck!
posted by seasparrow at 5:03 AM on September 10, 2012

Best answer: After two jabs, ask them for someone new. That was protocol in the unit where I had my baby (and went for a million other things). Two tries, they had to give me a break and find someone else, no human pincushion and kept them from getting frustrated.

I also just tell them factually that I'm a hard stick. A lot of people exaggerate how hard it is for them and they brush it off so instead of a subjective statement I use an anecdote. For you this would be:

"Just so you know, last time it took 7 tries to get a vein and we ended up using my hand."

That gives them an idea of what to expect.
posted by the young rope-rider at 5:08 AM on September 10, 2012 [3 favorites]

Ask for the most experienced nurse/phlebotomist definitely. I chatted with one about her work and she said it was more experience than specific techniques. I have argued and been told to just suck it up "they knew better" and then suffered through several sticks before they realised I wasn't joking about how difficult it is. Now I say that I was told by a doctor to always do X, Y and Z with the most experienced nurse and that overrides the desire for a student nurse to play hunt the vein.

Personally, I like the butterfly needle thing - very tiny - for the vein on top of my hand. It also bruises less dramatically and isn't as painful the next day to use my hand, as my arm is.
posted by viggorlijah at 5:10 AM on September 10, 2012

You want the paediatric phlebotomist. Ring in advance to find out where they are. Keep as hydrated as you can. Keep warm but not overheated. Most companies should have a policy of no greater than two attempts. But you'll always have the cowboy who reckons they will be the superstar that will be able to get it.

Butterfly needles do not necessarily get you a better result. You want a phlebotomist to use the tool they are most comfortable using. So don't insist they use something they don't think is appropriate.

If you happen to live in Sydney, Australia, I'll take your blood. I was THE one, back in the day.
posted by taff at 5:22 AM on September 10, 2012 [1 favorite]

Absolutely get the best nurse/phlebotomist. Experience counts for a lot - results have been dramatically better on my end with nurses who are out of their 20s/early 30s. Also, oddly, with male nurses, although that's probably just a small sample size.
posted by Holy Zarquon's Singing Fish at 5:25 AM on September 10, 2012

Keep in mind that there is often no "best" phlebotomist - you want the one who can find YOUR veins, it's often the case that the "best" or most experienced one still won't have the mojo working for your veins. Even the most experienced phlebotomists can have trouble with certain people. Find one who can find your veins, and use that one.
posted by biscotti at 5:28 AM on September 10, 2012

For me, everything said above plus dunking my hand in a bucket of hot water. I'm getting queasy just reading this thread.
posted by matildaben at 7:15 AM on September 10, 2012

Dude, I feel ya. I too am a VERY hard stick. My veins roll, have scar tissue and dry up for no reason.

nthing get the person who can stick heroin addicts.

I have a hard time with this because on one hand, I don't want to psyche someone out, so I give them a chance, but after doing right, left, crook of the arm, up on top, etc, it gets kind of hairy.

I find that relaxation and deep breathing helps me get in the right frame of mind.

A little prayer before hand never hurt anything.
posted by Ruthless Bunny at 8:12 AM on September 10, 2012

Tell them up front you are trouble and ask for whoever is best at this. They all had to learn, and no nurse wants you to suffer!

I got to know a lot of nurses when I was a big platelet donor. One day a new nurse or nursing student came by to practice, and another donor -- herself a nurse -- volunteered her arm. Well, she'd been giving blood & platelets for years, and when the tiny needle hit all her scar tissue it simply folded. The nurse whose arm it was didn't even pause her conversation, but the girl holding the syringe almost passed out.

Have you ever used the vein on the side of your wrist? I used that one sometimes during platelet pheresis, even though I am blessed with hose for veins.

Distractions help!
posted by wenestvedt at 8:38 AM on September 10, 2012

Best answer: It can be tricky to ask for the best person, in my experience. A lot of phlebotomists have gotten pretty offended when I've said that I need their most experienced one since I'm a hard stick, so figure out how to ask this in the nicest, most polite and self-effacing way possible. :| I had the most trouble with this as a kid, which seems weird, so ymmv.

I also know where my one good vein is and I've found that if I say why the other veins are bad (totally blocked up with scar tissue from getting my blood drawn so many damn times) and that they're welcome to try there but it won't work, that tends to help. This is my little spiel:

First I just stick out my right arm. They ask if I am right handed and suggest I use the left. I say, "There aren't any good veins there; too much scar tissue. You're welcome to try, but this hasn't worked in that arm for 15 years." They put the tourniquet on the right arm and as they're tapping I say "They usually draw from right here or here," and I point at my good veins. They pick one of my good veins (if they don't, I say "oh, that one is going to give you trouble; it always does") and when it finally flows I say "Hey that wasn't that bad, you're good at this!" and then when it's over I thank them.

If they try more than five sticks I say really nicely "Can we try someone else? I know you're good at this, but I am too tired for you to try this much today."

Basically remembering that my phlebotomists are people at work who aren't always thinking about me helps. I mean, no one likes to be told how to do their job, so since this is a situation where you have to do that it really pays to be extra nice and understanding, while at the same time not getting stuck with a needle 17 times.
posted by k8lin at 8:47 AM on September 10, 2012

Go in very well hydrated, and let them know right away that you're a tough stick. Let them look you over, and consider places like hands and feet. They bruise more and hurt more for most people - but they hurt a lot less than digging around in your forearm for five minutes! Also, if you ever have someone who manages to stick you fairly quickly, ask lots of questions so you can repeat the process!
posted by a hat out of hell at 8:51 AM on September 10, 2012

Nthing the suggestions about being upfront about being hard to stick, and sharing your expertise about where has been most successful historically.

I had this problem for many years. What finally seems to have solved it is losing a bunch of weight. I recognize that this isn't a practical suggestion for next weeks draw, and that mileage will vary drastically on this one, but since it is a solution to the problem I thought I'd throw it out there.

Good luck--I know just how awful that pincushion feeling is...
posted by Sublimity at 9:09 AM on September 10, 2012

If you're not required to fast before the blood draw, it might help to have some breakfast in you. I evidently have no blood before I eat, no matter how much water I drink.
posted by Quietgal at 9:12 AM on September 10, 2012

Response by poster: The consensus seems to be:

- stay hydrated
- stay warm/apply heat
- be upfront about how difficult it has been in the past
- try to get the star phlebotomist, if possible
- point out where blood has been most easily drawn from in the past

The inside of my right arm has generally not given me too much trouble, but the best vein got blown last Wednesday, unfortunately, so they've been avoiding it. How long does a blown vein normally take to heal (in other words, even if the faded bruise is still visible this Wednesday, could they get some blood from it)?
posted by catch as catch can at 9:25 AM on September 10, 2012

Pro tip: whenever you get blood drawn or an injection, breathe out as the needle goes in. It does help relax your tense muscles, etc.
posted by Lynsey at 9:49 AM on September 10, 2012

I had some fun hematology/phlebotomy adventures a few weeks ago and learned about the "intern's vein", so-called because it's "easy enough for an intern to hit it". You might ask about this. Generally, the nurses/phlebotomists avoided areas where I had existing punctures (all were about 2-7 days old).
posted by judith at 9:50 AM on September 10, 2012

All the points you have are great (the heat one is something I see nurses use a lot). Stay *really* well hydrated, like well in advance of this needle stick.

Only other point is that, if you're having a ton of anxiety (which really will make your little veins clam right up - and it sounds like your prior experience validates anxiety), a nurse can use lidocaine to numb the area she'll stick you. If you're feeling really nervous, that should be an option you can take.
posted by circle_b at 10:34 AM on September 10, 2012

Do you lift weights at all? I used to have very difficult veins and would suffer through multiple sticks every time. Then I started weight lifting and everything changed, now it's never an issue. I suggest doing bicep curls a few times a week (even if just that!) as a more long-term approach. Best wishes, I feel for you. I don't have a fear of needles either, but having someone "dig around" looking for a vein isn't fun.
posted by palegirl at 11:11 AM on September 10, 2012 [1 favorite]

I came to suggest what circle_b said - you can request a local anesthetic at the site of the draw. If they're going to stick you multiple times, at least you can be numb during the process.
posted by medusa at 1:48 PM on September 10, 2012

Ask for a 23 gauge needle. This can be a "butterfly" or just a regular needle, but it's much finer --used for babies. Works so much better for me. Insist on it, and insist they use your best vein. Good luck!
posted by ravioli at 5:32 PM on September 10, 2012

I would imagine running around the block or doing some pushups right before might get the juices flowing, but I have nothing to back that up.
posted by gjc at 8:11 PM on September 10, 2012

Where are you going to get your blood drawn? I recently did a clinical rotation in phlebotomy, and most of the people who came in with stories of getting stuck more than a few times were getting drawn in doctor's offices by MAs who only do a couple draws a day. The phlebotomists at the outpatient lab were usually able to get these people on the first try.

If you're not already, I would suggest trying a lab that has dedicated phlebotomists. As someone above said, a lot of being a good phlebotomist is experience, and dedicated phlebotomists do MANY more than a couple sticks a day. The people I was working with were really great at knowing how to find the right vein because all they did was find veins.
posted by sherber at 12:21 AM on September 11, 2012

If you can get a pediatric phlebotomist, definitely do that. I talked my way into getting blood drawn at a children's hospital long after I'd aged out.

I ask them to let me lie down which makes me a lot more relaxed, and I find that being relaxed makes a huge difference. Would listening to music help so you're not paying attention? I bet they'd let you do that.
posted by (Over) Thinking at 6:36 PM on September 11, 2012

Best answer: You sound like you've got some good ideas but let me re-iterate some and mention a few new ones. To give you some context: I was on a drug which required major blood draws, and at one point I was going in every two-three days for weeks at a time. I'm a VERY bad stick.

-You might try hydrating yourself the day before the appointment as well as the day of. This is what I was told on my last go-round. So I drank about 70oz of water the day before and a full 100-120oz of water (that's between 12-15 glasses of water) the day of. It worked. That's the level of hydration I'm thinking of when people above are talking about hydration. I realize that having to pee every fifteen minutes basically every day for a few weeks isn't your idea of a fun time, but it's truly helpful.

-If you can eat beforehand, do so. It will help. If you can't do so, try very hard to have something to eat on hand immediately afterward. Otherwise, you may get faint and they'll have to give you a juice box before you can leave (don't ask me how I know).

-Potentially a good way to check if you're hydrated enough is to see if your major vein sticks out a bit from the top of your hand. A little hard to explain, but I've had good luck getting blood drawn when the vein on top of my hand has been fuller and more visible.

-Absolutely point out what spots have worked before. As for blowouts, I've never had them blow out a vein because I stopped them the one time it almost got to that point, but the bruising from almost getting to blow-out lasted about three days or so. I would strongly suggest avoiding blood draws from your blown spot for now.

-Don't let them go for something truly exotic (for me, they tried to get blood out of the space between my fourth and fifth knuckle. that's not really a vein. that's more like a capillary) if you're not comfortable with the idea. If you for some reason haven't tried the backs of your hands, though, have them try each one; this is potentially much less painful than your inner arms.

-If you've not tried a butterfly needle, may I suggest it? They are smaller and puncture smaller veins more easily. When I was getting my blood drawn every two-three days, this was huge for me.

-The rockstar phlebotomist needs to be at a place which draws blood frequently. Ideally, that's all they do and they do it multiple times an hour. If you're going to a doctor's office, I'd suggest a lab and if you're going to a small lab, I'd suggest a big one.

-If you're not relaxed while you're sitting upright and they're rooting around your veins (which, frankly, would not surprise me), request to lie down. It's amazing how much the comfy padded chair relaxes you.

-Also look far away from the place they're sticking and request that they talk to you while the actual sticking is going on (a competent phlebotomist should have no problems multi-tasking). You being even a little panicky won't help the blood flow and it's better to have them do what's necessary to relax you a bit.

Don't let this lead to phobia--for me, I'm perilously close and need to concentrate on managing my anxiety while getting blood drawn. You don't want to get to that stage!
posted by librarylis at 8:25 PM on September 11, 2012

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