Make it easier to take my blood.
August 1, 2013 9:29 AM   Subscribe

I have to have a blood test. I have a pretty severe vasovagal response, combined with abnormally tiny, difficult veins (or so I've been told by everyone who has ever taken blood from me). Help me make this easier?

The vasovagal response is something I accept and know is not going to disappear: blood pressure drops alarmingly, darkness closes in, there I am on the floor. Every single time, even with a finger prick. But: what makes everything a lot worse is the tiny vein situation. This means that getting blood taken takes a lot longer than it needs to, involves a lot of fruitless poking from a parade of phlebotomists taking their turn at attempting to tap a tiny, tiny vein while urging me to pump my fist and tying a tight rubber band around my arm.

This vein-seeking makes me feel more panicky and faint and sick than I otherwise would. This morning, I was supposed to get blood taken at the doctor's office, and four phlebotomists couldn't get a vein, and I started feeling so terrible and woozy after the 20 minutes of failed poking that I told them I had to come back another time. Now I've been instructed to go directly to the lab instead over the next few days.

My question is whether there is anything I can do to make my veins easier. Is there a time of day I should go (maybe morning is bad?). Anything I can eat or drink? How do doctors take blood from babies, who must have tinier veins than even tiny me? Should I, as a last resort, go to a pediatrician for this (seriously? I'm 31)? Also, why are my veins so tiny? I'm a small, slight person, but this seems ridiculous.

Even writing this question is making me feel faint again.

posted by millipede to Health & Fitness (34 answers total) 5 users marked this as a favorite
As for the small veins, I'm with you there. I always ask for a butterfly needle, the kind they use for babies. In fact, I *insist* on a butterfly needle even when a phlebotomist tells me they've been doing it for years and can get my vein without one. It takes longer to get the blood they need, but everyone ends up saving time in the long run because they aren't stabbing me for 10 minutes with a regular needle.
posted by mibo at 9:33 AM on August 1, 2013 [3 favorites]

Yes, ask for the butterfly needle. Also make sure you're well-hydrated, starting the day before.
posted by Johnny Wallflower at 9:35 AM on August 1, 2013 [1 favorite]

You definitely want to be well hydrated; I've been told to drink a lot of water for at least a day or two in advance.

It helps to be warm, supposedly, although I've never noticed that makes a difference. This time of year it probably doesn't matter, but if it's winter, wear long sleeves that day. I've heard some people will put a heating pad on their arm for a while before the draw.

Butterfly needle, absolutely. And if you know somewhere is an easier draw, insist on that place. For me it's back of the hand - I don't let anyone touch my arms anymore, I tell them to go straight for the hand. Most phlebotomists are very happy to skip the hard stick and glad I know where to direct them.

Are you looking at the stick? Does that freak you out a little? Personally, I have to look away - if I'm not looking, poke at me as much as you want, but if I look I get woozy.

Similarly, if the actual feeling is part of your problem, ask for a topical anesthetic. This is not at all uncommon for pediatric draws and they should have something on hand.
posted by Stacey at 9:37 AM on August 1, 2013 [1 favorite]

I don't have the small veins problem but do have the vasovagal problem and what helps me is telling the doctor about it, and having them have me lie down. Also, if it's a fasting test, I make sure I have something like juice or something that will bring my blood sugar back up, because that is my 100% first need if I'm having a vasovagal reaction.

YMMV, I do not have diabetes or similar concerns.
posted by sweetkid at 9:38 AM on August 1, 2013 [1 favorite]

Seconding the butterfly: it also helps to be clear that it's another medical professional who told you about the teeny veins and other problems. That way you don't get mistaken for someone with weird conspiracy theories about blood tests who has spent too much time on Google, which can get their backs up.
posted by Wylla at 9:39 AM on August 1, 2013 [2 favorites]

Response by poster: (I don't look at the stick, and I'm not actually afraid or freaked out--a lot of the time I will think I am fine, and sit up afterwards, then stand up, and then everything will close in and I'll be on the floor, even though I thought I was fine. This part is very unlikely to change... I just want to make my veins easier to find. Googling butterfly needle! I don't think they had that today, but they also didn't even get to a point where they kept a needle in my arm for more than a second)
posted by millipede at 9:39 AM on August 1, 2013

I'm the same way, and yes: drink water nonstop for the whole day before the test. Then tell the nurses that you would like to lie down during the blood draw, and get them to bring you water to sip afterwards as well. Give it a good 5 minutes of lying there and sipping water before you try to stand up.
posted by showbiz_liz at 9:41 AM on August 1, 2013 [4 favorites]

Speaking from experience as someone who also has the "disappearing veins" problem, hydration is probably the biggest factor.

It's not enough just to drink water that day, you have to sort of build up a "baseline" fluid reserve. Which means drinking more than you normally would (and making sure you're drinking primarily non-diuretic beverages, e.g., water, gatorade, etc., rather than coffee or caffeinated soda or beer) for a couple days before your test. At least.
posted by aecorwin at 9:42 AM on August 1, 2013 [1 favorite]

You are also absolutely allowed to ask for a phlebotomist who is extra good with kids' veins. Or the senior one, or the most expert one. It might help if you ask when you first get to the office. If it's your regular doctor's office, ask them to put a note on your chart.

And yes to the major hydration, lying down (I always lie down), and not moving for a bit afterwards. It also helps me if I have somebody's hand to hold, but that is more the freaking-out part than the actual blood draw part.
posted by Ms Vegetable at 9:44 AM on August 1, 2013

I'm a "hard stick" and it's frustrating for me because while I want to help these young phlebs-in-training who come in cheerily, they always end up calling the Expert On Call in after a number of failed sticks. This happens time after time, in the hospital and in the doc's office. I never know whether to be difficult and uncooperative and ask for the Expert On Call up front, or to let them try/train on me. It happens even when I'm hydrated and relaxed and as cooperative as I can be ... I'm just a hard stick.

What I have noticed is that if I go to a blood-draw center, like the commercial Quest centers in strip malls around, they are much much better at doing it. So maybe consider skipping the blood draw at the doc's office, where they don't actually do it that often; and just get a prescription to take to a Quest center, where they do this all day every day. That's my strategy for now, anyway, along with asking for the pediatric/butterfly needle.
posted by Dashy at 9:46 AM on August 1, 2013 [2 favorites]

Response by poster: @Dashy--that is wonderful news to hear, because the lab i'm supposed to go to is a Quest.
posted by millipede at 9:47 AM on August 1, 2013

Make sure that the person that is doing the draw knows you're a fainter. they should give you a chair to sit in untill you feel ok to get going again. they might even do it in the recliner if they have one.

I always give it a couple minutes after the draw before I get out of the chair. if that's not possible I try to stay close to a suitable seating surface before leaving the area so I can put my head between my knees.
posted by ArgentCorvid at 9:48 AM on August 1, 2013 [1 favorite]

Yes, nthing the butterfly needle. I always tell the phlebotomist up front that I have hard veins and that butterfly is usually the outcome, and if they want to try my arm I have memorized the spot on my arm that seems to have been the most successful in the past -- sadly, this spot is now scarred up, but I still point it out. The last phlembotomist I went to put a warm pack on my arm; she said it would help. I don't know if it did, but she found the vein pretty easily that time.
posted by megancita at 9:55 AM on August 1, 2013

For feeling wonky afterwards: would glucose tablets help?
posted by travelwithcats at 9:55 AM on August 1, 2013

I know you're saying you don't think anything will change the fainting, but like others have said, sitting longer and letting the doctors know will really help. Whenever I faint outright I have heightened anxiety for a few days so I try to avoid it as much as possible. Plus you increase the likelihood of head injury, etc if you're fainting so I think taking it as easy as possible and carefully getting to your feet and on your way can really help you.
posted by sweetkid at 9:59 AM on August 1, 2013

Weightlifting will promote angiogenesis and enlarge blood vessels among its other benefits. Doesn't happen fast enough to help with your upcoming test, but it could help you in the future.
posted by Thoughtcrime at 10:00 AM on August 1, 2013 [2 favorites]

Response by poster: "sitting longer and letting the doctors know will really help"

I always let them know, and now that I know it will always happen, I lie down and wait for a long time afterwards. I've got this part down. Juice and everything too. Really not looking for solutions for dealing with the fainting here--I deal with that pretty well. Looking for vein things! Anything related to time of day, anyone?
posted by millipede at 10:04 AM on August 1, 2013

Yes to being hot! After an agonising first blood donation last year, they told me to only ever come back between April and October.
posted by greenish at 10:12 AM on August 1, 2013

'hard stick' is a new term to me, thanks. Me, too. I will only go to a lab, and will tell them that I have tiny veins. Big hugs to every healthcare professional who has passed me up the chain instead of giving it a shot and failing. And that nurse in the ER who was too stubborn to get a phlebotomist - don't do that to people.

Go to a lab where that's basically all they do, and are good at it. Be hydrated. Tell them you need their best needle-pilot.

You deserve a hug.
posted by theora55 at 10:22 AM on August 1, 2013

Anything related to time of day, anyone?

I have tiny veins and do the mega-hydration thing. I find that my blood pressure is sort of low, like really low, in the mornings which can make the blood draw a little trickier both in the woozy-making and in the "is it in?" aspect. Best results for me are later in the day when I've drank and eaten an lot and when I've been up and moving around a bunch and yeah, when it's warm.
posted by jessamyn at 10:22 AM on August 1, 2013

I'm exactly the same way. They have to physically hold me down to take blood, and, even then, I will pass dead out. There really is no way past it, unless they put me under, or dope the crap out of me to where I don't care.
posted by Thorzdad at 10:24 AM on August 1, 2013

Tiny, jumpy veins run in my family. And we're great hulking hausfraus of women, not tiny creatures. :) Here are our hard-won wisdoms:
  • Hydrate like crazy. Your kidneys should be swimming. I drink water continually from when I get up until when I have a blood draw. (I usually go in the morning; haven't noticed a difference between that and afternoon.)
  • Notify the phlebotomist that you're a fainter and that you absolutely must be lying down. (I lay on the floor of an office once when there wasn't a recliner or bed.) In your case, tell them that you will often pass out after so they can let you rest afterward and give you a little juice to help you recover, and have someone to support you when you stand up to prevent you from knocking your head!
  • Warn them that you're a tough stick. Most offices have a black-belt phlebotomist who can get blood out of anybody. Usually if you say you're a tough stick, they'll fetch this person immediately. If the person drawing your blood a) doesn't seem to be this person and b) won't fetch this person immediately, tell them they get one stick, and if they are unsuccessful you want the blackbelt.
  • Ask for the butterfly needle.
  • Sometimes a warm pack (a latex glove filled with warm water and tied off, for example) laid over the target area will expand the veins and bring them to the surface.
  • Don't be afraid to explore alternate locations to draw blood from. The vein that runs between my middle and ring knuckle on the back of my hand is a champ. It's never failed, and it's almost painless for me. Phlebotomists always tell me, oh, no, it would to be too painful to draw from the back of your hand. I tell them, what's going to be painful is you fishing around in the crook of my elbow for 20 minutes before you go to the back of my hand anyway.
  • I'm told anesthesiologists are excellent vein-finders. I don't have much experience with them, though.
  • My mom was once given a Valium before a blood draw, and she said it helped immensely.
  • Remember that it's your body and you are in control. If the person trying to draw blood is not doing well, and/or if you're uncomfortable or upset, you have a right at any time to say, "STOP." You can rest, ask for a different phlebotomist, or leave and come back another day. (Of course, you have to weigh this against having to go through the whole hassle another time, but sometimes just knowing that you have an escape route makes it more bearable.)
I hope something in there is helpful!

Most phlebotomists are wonderful, caring people who know a lot about what they do, and want you to have the easiest, most painless experience possible, so communicate with them. When you find a really great one, listen to them and pick up any tricks you can from them.
posted by BrashTech at 10:24 AM on August 1, 2013 [2 favorites]

Just throwing this out there because no one else has said it: if you are stuck and need a blood draw and there is no awesome phlebotomist/very experienced person on hand, you could ask for an arterial stick.

This is not the standard, and nurses typically don't do art sticks. But if there's a respiratory therapist or a doc on hand, or anyone who does arterial blood gases, that person could do it. Art sticks aren't fun, because your artery has a thicker and more muscular vessel wall and getting stuck there will hurt a bit more (not super painful, just slightly more). But the beauty of it is that because it is done in a place where there is very little tissue overlying the vessel (your wrist), and arteries don't "roll" like veins do, and it is extremely easy to find an artery because it pulses and you can feel it, it's almost impossible to miss it, and typically it only takes one shot, even on someone who's an otherwise "tough stick".

This is my go to technique for tough sticks in the emergency dept who I need blood on (unless I need an IV line, in which case ultrasound-guided IV placement).
posted by treehorn+bunny at 10:37 AM on August 1, 2013 [2 favorites]

I too am a hard stick. the doctor at my Dad's methodone clinic had a hard time with my veins (and he got heroin addicts routinely.) nthing drink a lot of water, and no alcohol prior to giving blood.

The nurse at my docs office only uses the butterfly needle on me now. See if you can be lying down, especially if it's easier for you.

Once, they gave up and got it from fingertip sticks. It's a last resort, but it can be done.
posted by Ruthless Bunny at 10:39 AM on August 1, 2013

I know someone who had terrible trouble getting blood drawn, until she bought a folding bike and rode to the clinic, folding it and carrying it up a couple of flights of stairs to get there. The arm she carried it in was a much easier draw than the other.
posted by cromagnon at 10:58 AM on August 1, 2013

As long as you're not doing some kind of fasting test, make sure you've eaten a good meal beforehand. That will help keep you from getting lightheaded.

Hydration definitely as many have noted above. When I worked at a blood bank, we were extra careful with high schoolers (younger/smaller donors tend to have more reactions), and they had to drink a bottle of water before donating.
posted by radioamy at 11:39 AM on August 1, 2013

I am also hard to get blood from, they end up either taking it from the top of my hands or my wrists (which hurts more after). I have been asked to hold my hands under the hot tap in the lab and had them slapped about (gently) first, I think these might help a bit.

I also feel very faint afterwards, and it used to be worse, but I have found that if I read something (anything) while it is happening then its not as bad.
posted by meepmeow at 12:18 PM on August 1, 2013

When I feel like I am about to pass out I never go into the full faint. My ears start roaring, everything goes black and tunnely, My arms and legs don't work right, and there's this sweaty sick feeling like I am going to die. They tell me my face goes all pale and greenish and make me sit down until it passes. I guess my body fights that last bit where you actually hit the floor. Anyway, even that much is a TERRIBLE feeling and I'm so sorry it all happens to you.

Yeah, tiny veins are just the WORST. I know people are really hammering on this one point, but hydration is a MUST. They tried four times to draw my blood one day and then gave up (!). After a whole day drinking lots of water, they tried again--Bam! One draw, no problem, done. Such a relief!

Now I hydrate every time I know I'm having blood drawn, and even though I don't like needles I rarely have that reaction any more. I had a really bad week where they drew umpteen vials of blood, and I hydrated and did the tests late in the day, as jessamyn recommended, and other than being exhausted from blood loss, I was totally fine. So, naturally, I figured I had this thing down.

Then just recently I had a biopsy. Though it was absolutely painless, I had the passing out reaction again and I was all, 'WTF is up with that?!'

I guess no matter how fine the logical side of you is, there is a part of your lizard brain that panics sometimes and gets this adrenaline rush going for that fight or flight reflex. When you stand up suddenly your body just can't handle the overload. The word "biopsy" must have triggered that in me.

Preparation really does make a difference. Sounds like you are on top of your lizard brain, but if you want any more tips: Some people listen to music on headphones to distract themselves. Coughing and stamping your feet are supposed to help make the feeling pass, too, but when I tried that they did diddly for me. A cold, wet cloth on the back of the neck does help, though, as does more water or orange juice. Of course, as always, YMMV.

Good luck!
posted by misha at 12:50 PM on August 1, 2013

I'm a nurse and can't add much to the good advice here re: using the lab not the doctor's office, hydration, and warmth, except this: for a long term solution consider increasing your physical exercise. Over time this may make your veins somewhat more prominent. It did for mine.
posted by latkes at 1:47 PM on August 1, 2013 [1 favorite]

Adding to latkes advice: you can use a squeezy ball (technical medical term!) or one of those grip strengthener thingies. Using it immediately prior to your blood draw will help, but regular use can make a real difference.
Otherwise all,of the above tips apply: hydrate (a lot!), heat, lay down.
posted by maryrussell at 2:32 PM on August 1, 2013 [1 favorite]

I have this too! (I love this thread because it makes me feel so much less pathetic to know I'm not alone.)

Major hydration and an Ativan beforehand do the trick for me. I also remember reading somewhere that tensing up the muscles in your lower body during/after the draw can help prevent the vasovagal reaction. I haven't gotten a chance to try it yet but I plan to next time I need blood drawn.
posted by ella wren at 4:36 PM on August 1, 2013

The only thing I would add to the excellent advice above is that once you figure out what works for you, be firm about telling future blood draw-ers what you need. Tell them up front that you are a fainter and a hard stick and don't let them try to talk you out of a butterfly needle or lying down or using your non-dominant arm or whatever blood draw mojo works best for you. (I once had a phlebotomist insist that they didn't have any butterfly needles until she tried both arms unsuccessfully and then she was suddenly able to locate a butterfly. It was a Phlebotomological Miracle.) (I do not recommend this way of proving one's point if one is a fainter.)

Also, the 20 minutes hunting for a vein in a non-urgent situation is Not Okay. I have the highest respect for medical professionals but every once in a while you encounter someone who becomes so focused on Completing the Procedure that they start to lose track of you as the patient. You are completely within your rights to say that they'll have to try again another time or find someone else to do the draw or both. I have had a LOT of blood draws and I wish I had done this more often when I was newer to the game.
posted by camyram at 6:11 PM on August 1, 2013

Lousy veins here, too. Hydrate. Hydrate. Hydrate. Swinging my arms around for a minute prior seems to help a bit.

Camyram, that's great > It was a Phlebotomological Miracle.!!

Feel free to yell this if they get you on the first stick. It's fun to say.
posted by BlueHorse at 9:08 PM on August 1, 2013

Nobody's succeeded in ever getting blood out of my arm, and I'm not slight at all. I now explain when I go in that the best route is to go straight for the back of my hand - it does hurt, but I'm a little anxious about needles and havign someone prod and poke at my arm, especially when I can see it, really doesn't help. I haven't had a test for a while, but they'd usually send me to the local health centre or blood test clinic at the hospital rather than have the surgery's nurse do it for me.

It sounds like your response is considerably more severe than my tendency to faint, but I usually go in with a magazine as well, and explain to the person taking the blood that I'm not being rude but I really need to concentrate on something other than what's happening to my blood. Pro-tip: do not make this one of those magazines they have in doctor's surgeries with true life stories of people dying from getting a splinter in their finger.
posted by mippy at 3:44 AM on August 2, 2013

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