Why can't people start IVs in my veins and can I help them somehow?
September 27, 2016 11:12 AM   Subscribe

This is the third time I've gone to get a contrast IV for either an MRI or CT scan and the tech was unable to start the IV. What, if anything, can I do to fix this?

I've had many IVs successfully started by EMTs and one started by the roaming IV folks at the hospital for surgical prep. The EMTs never seem to have any issues, but the roving IV person managed to cause me to spurt copious amounts of blood from the top of my hand for 45 minutes and the anesthesiologist was called in to fix it. She claimed to have been doing this for 15 years and never saw such a thing.

When I went for two different contrast MRIs they stuck me repeatedly and never got an IV to start. The first time they claimed I was dehydrated, so we rescheduled. I hydrated and went through the same thing--multiple sticks, no joy. After they started prodding around my ankles I said "Yeah, no, goodbye" and never managed to get the test done. Yesterday, for the CT contrast, the tech squeezed and tapped both of my arms and muttered about not being able to trace the vein. After holding fists for more than half an hour with the tourniquet on I finally just said, "OK, I'm done now, thanks for trying."

Here's what I don't get. I am so pale that my skin is practically translucent. I can see veins all over the place. I know I tend to get dehydrated, so I've made an effort to drink extra water the day before IV starts. It doesn't seem to help.

So is there anything I can do to make this easier on myself and the techs? The longer it takes and the more they prod the more my anxiety ramps up, mostly because I start to lose confidence in the tech's ability to do it correctly. I do my relaxation techniques, but two techs have complained that my slow and deep breathing makes them "more nervous." I just want to get this stupid test done. If it's of any consequence, I'm not diabetic and I'm not a drug user, iv or otherwise. I did have to get a ton of blood testing done when I was lithium and I've donated a massive quantity of blood, so I'm not sure if this has anything to do with it.
posted by xyzzy to Health & Fitness (22 answers total) 4 users marked this as a favorite
I have had a lot of trouble with this. Apparently I have "side veins" - meaning that the ones in the crooks of my elbows are difficult to access because instead of being right in the middle, they're at the sides of my arm. Not being a phlebotomist I'm not sure exactly why this makes it so difficult, but the last time I donated blood, the woman working with me used a lightly inflated blood pressure cuff to squeeze things in order to get the blood flowing. I do not know whether this is good science, but it made giving blood about 3x faster than the time before and a LOT less painful (the time previous, they had to pretty much squeeze me like an orange). Perhaps worth experimenting?
posted by wellred at 11:27 AM on September 27, 2016 [1 favorite]

Some medical professionals are better at sticking an IV than others. You might have deep veins. I have this problem. My dad has it too. We figure it's probably genetic. I can't tell you the number of times they've had to go get someone who's really good at it in order to get IVs in me.

Your best bet is to warn them up front: "hey, I'm hard to IV for some reason.. if you can't get it is there someone else who's known to be a wizard at it?"
posted by INFJ at 11:29 AM on September 27, 2016 [6 favorites]

Every hospital or test center has that person who's a ninja at sticking veins, that everyone else calls when they get a 'hard stick' (I'm surprised they didn't before, and let you go).

You should get in the habit of asking for that person right away -- it's absolutely your right to do so. Just say, I'm a hard stick and this usually goes badly, please call the vein ninja.
posted by Dashy at 11:29 AM on September 27, 2016 [16 favorites]

I am also a "hard stick" and have needed the vein ninja often. I typically tell them up front that I've had difficulty in the past; after I tell them, they try once or twice, and then tend to go get the vein ninja.

It was discovered somewhat by accident once that my veins are quite a lot easier to get into if I'm laying down, so now I suggest that if I'm already sitting on an exam table.
posted by telepanda at 11:38 AM on September 27, 2016

I'm a "hard stick" as well and I've learned that all they're going to achieve at the crook of my elbow is a massive bruise. I've started drinking lots of water the day before and the day I know I'm getting blood drawn, warning them as I sit down that I'm hard to draw blood from, and suggesting they go straight for a butterfly on the back of my hand, as that almost always works.
posted by angelchrys at 11:42 AM on September 27, 2016 [4 favorites]

Agreed that the skill levels of techs vary drastically - when people have average veins it doesn't matter, but if you have difficult veins it does. I find that phlebotomists and techs who draw blood and start IVs all day are significantly more likely to easily find a good vein and avoid bruising me than nurses and others who do regularly draw blood but only as a minor part of their job.

Being able to see a vein doesn't mean that it's a good candidate to draw blood or start an IV. I've had a couple techs explain more to me, but I don't really remember. I do find it helpful to remember the locations where techs have been most successful so I can direct people to try those areas first - for me, that's inside my right elbow. I used to have them try my left elbow first (since I'm right handed), but often ended up needing to switch and with bruises to boot. Now I just go for right side to start.
posted by insectosaurus at 11:59 AM on September 27, 2016

Answered as asked:
- drink plenty of water throughout the day
- stay warm! it's much easier to find a plump vein on a nice, warm arm than a cold one
- dangle your arms off the sides of the bed/chair/stretcher/whatever to decrease blood return to the heart

Frankly, given the fact that people in the past haven't had trouble sticking you, I think you've just hit a run of bad luck. I'm an INCREDIBLY easy stick (I have plump, big veins) and the nurse who placed my IV when I went to have my son had to fish and fish. It happens.

FWIW, I'm a trauma ICU nurse and stick lots of people. I have off days, too. It's a technical skill and sometimes the person performing it screws up. It happens. I'm sorry it happened to you.
posted by pecanpies at 12:05 PM on September 27, 2016 [8 favorites]

I've got this problem too, plus extreme needle phobia (caused by traumatic experiences, heh.)

I drink (water, juice, etc.) for two days prior, I warn them I'm a hard stick, I suggest an ultrasound wand, and I lie down. I also avoid doing things that might lower my blood pressure (no anti-anxiety meds, sigh.)

It's still agonizing and takes too long, but I rarely need more than two techs and have way less bruising and bleeding than I used to.

Bonus: I almost always get free orange juice and candy by the end of it, and insisting on lying down has basically eliminated fainting spells. The staff really appreciate getting warned in advance that you may be difficult, and they really hate unexpected drama.
posted by SMPA at 12:05 PM on September 27, 2016

I have weird veins. You can see them, but they're too deep or small to get a good stick in my elbows. Instead, I've learned to ask for my hand/wrist. Most phlebotomists are cool with that, though so will fight me. I've hand a bunch of IVs (anesthesia, MRI contrasts, chemo) and blood draws this way.

I've also learned that the tricks about abstaining from caffeine before a blood draw and being super hydrated really does help.
posted by kendrak at 12:28 PM on September 27, 2016 [1 favorite]

Hydration is one thing you definitely can do. I'm a hard stick if I'm dehydrated, but pretty easy if I've had a lot of water in the last day.
posted by bonehead at 12:40 PM on September 27, 2016

I have rolling veins that are also tiny. Along with the conventional wisdom of hydration and abstaining from caffeinated beverages, some long-term habits help. My veins got easier to find after I had been weightlifting for a while. I don't know why. Just regular exercise didn't do anything, I'd been bicycling for years before with no vein changes. I would also like to note that my body fat percentage hasn't changed, and I am a woman who has never taken any kind of performance drug. Not even protein powder these days.

Take this with a big grain of salt. I don't know if your health will allow you to do so, and you should check with your doctor before adopting any fitness regimen.
posted by domo at 12:42 PM on September 27, 2016 [2 favorites]

Ha, I'm writing this just after restocking an IV pouch to put back in my ambulance.

You're already hydrating, which is great. Next best thing after that is to get things warm. If you are physically able, do 10 minutes of moderate arm exercises about 30 minutes before you will need to give blood--curl a small weight or something similar. Then wear an easily removable cardigan or sweatshirt over your arms until it is time for the IV or phlebotomy. If you aren't able to exercise for medical reasons, maybe a warm pack over a sweatshirt on your preferred start site?

Ask the next person who has success with an IV whether your veins are particularly deep and shallow. Pay attention to where they stick you and also what position they hold your arm in. Try to express these things to the person who attempts to stick you next. Phrase it as "I've been having some trouble with IV starts and this is what has helped recently" rather than "I'm a horrible stick, you'll have to do xyz". Lots of extraordinarily stickable people say they have bad veins so the latter sentiment is often ignored.

"I do my relaxation techniques, but two techs have complained that my slow and deep breathing makes them more nervous." This is such bullshit that it makes me furious. This is the first sign that you should find someone else to do your IV start. Ugh. Don't let anyone bully you into letting them try unless you are comfortable with them. If you need an ER nurse or someone else with vein ninja skills to come up to the radiology floor to start a line, then that's what you need. Don't let anyone give you crap about it.
posted by skyl1n3 at 12:54 PM on September 27, 2016 [10 favorites]

I have this problem as well. I always tell them I'm a hard stick, and sometimes they don't believe me until they try. I have had luck asking for people with pediatric or nursing home experience. Also, I discovered quite by accident that the hospital I go to has what they call an "IV team" that consists entirely of ninjas. Only one member of the IV team has ever had to try more than once and she got me on the second try. I don't know how unusual that is, but there's no harm in asking.
posted by FencingGal at 2:33 PM on September 27, 2016 [3 favorites]

"vein ninja" is my new favorite phrase. good advice here!
posted by acm at 3:29 PM on September 27, 2016

Ask them to numb your arm too. It'll hurt a lot less and be less stressful for everyone. Or use emla cream or something similar.
posted by fshgrl at 3:32 PM on September 27, 2016

Lift weights! Start doing bicep curls -- even at low weights -- and you're find yourself becoming very veiny.
posted by gramcracker at 4:40 PM on September 27, 2016

There are two types of needles that can be used to start IVs, a straight needle and a 'butterfly' or 'winged' needle. The winged needle is smaller, is attached to flexible tubing, and is most frequently used for children or the elderly. Insist that they use a butterfly needle on you.

Your run-of-the-mill phlebotomist may not want to use it because they may be less familiar with it and they are more expensive or they may just not believe you when you say you need it.* There is also a misconception that because of the attached tubing the butterfly needle results in a less 'clean' sample, but this is not true.

If you advocate for yourself strongly you can usually get them to use one. It can be helpful to have someone else with you to stand up for you.

*Or they may decide that you're an IV drug user and start treating you like shit
posted by bq at 7:32 PM on September 27, 2016

Yes, ask for a pediatric needle!
posted by BlueHorse at 10:02 PM on September 27, 2016

I have small, deep veins in fat arms, which means I'm virtually impossible to stick. Most folks end up using the back of my hand. It happened often enough that now I just TELL nurses to start there. It saves so much pain and frustration. A butterfly needle helps, too.

Just be glad no one's ever filled a vial from a finger stick. One nurse did that to me. She squeezed it out drop by drop, into a tiny vial, despite my protests. My finger was sore for days!
posted by jhope71 at 6:10 AM on September 28, 2016

Start working out more, drink lots of water the day of the needle stick, and tell them right off that you're a 'hard stick'. Insist that they call the best phlebotomist in the house right away - don't let the first person practice on you unless they are the designated bad-ass.
posted by latkes at 7:48 AM on September 28, 2016

(In my experience - nurse - everyone knows what butterfly needles are. Phlebotomists will be most skilled with the tools they are personally most comfortable with, so while I do think it's helpful to share what part of your body is usually the easiest to get blood from, I don't think it's helpful to tell the operator what tool to use.)
posted by latkes at 7:50 AM on September 28, 2016 [1 favorite]

Drink about a pint of water an hour before your appointment.

A phlebotomist told me about that when I complained about how inconsistent my blood draws were (sometimes they were super easy, sometimes they had to go exploring with the syringe). Being habitually hydrated throughout the day isn't enough. You need to drink water immediately beforehand too.

I was like, "JESUS! Why don't you guys tell people that? I would've started front-loading on water beforehand years ago."
posted by Autumnheart at 7:26 PM on September 28, 2016

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