Should I complain and how? And how to avoid--bad blood draw at lab.

October 14, 2019 3:11 PM

Some people have told me I have "hard to find" veins, so I went to the lab to get bloodwork done instead of at my GP's office after the nurse seemed to be a little unsure/uncomfortable with it. At patient lab today, the person who drew my blood just stuck the needle in hard and energetically and confidently fished around in my arm (ugh) until I told her, "I don't think you're in the right place."

She then said, "You should have told me!" On the second attempt, more energetic fishing and moving the needle around under my skin until she did find the vein. She then teased me in what she seemed to think was a friendly way about how tight I was clenching my fist.

I didn't say anything in the moment, I guess influenced by the fact that it happened fast, I wasn't expecting it, and her attitude was very casual as if this was totally normal. This is the lab in a major/prestigious hospital system. Was this dangerous? Could it mess up my test results? Should I complain, and if so, how and to whom? Finally, what to say to avoid this happening in the future? (I worry that if I say, "don't do this obviously bad thing" beforehand I might get a defensive reaction--because who would do that?--and then get worse care.)

I usually go to a lab to avoid problems because I figure a phlebotomist does this all day and I'm not such a challenge to them. Usually, that is true. I didn't get the woman's name and I have no idea if she was actually a phlebotomist, nurse, or what--she was working at the front desk and I didn't see her assisting any other patients. She only brought me back after I politely inquired about how long I had been waiting (we got a number saying "please let us know if you've been waiting more than 20 minutes). Thoughts? How have you handled similar experiences?

posted by Bluebird Wine to Health & Fitness (21 answers total)

I have small veins that are hard to get into with a needle a lot of the time. It is not anything bad when the person drawing blood or starting an IV pokes around with the needle. It doesn't affect anything. I am used to it happening, so I don't think much of it anymore. The worst that can happen is the person will poke something like a nerve and you'll feel the tingle down your arm. It's uncomfortable, but eventually goes away. The blood taken is not affected by all this. If this happens again and you're bothered, don't be afraid to say something.

As for the person doing it... Was this person at least wearing scrubs or something? I have never had that experience before, but I would not let just anyone poke around unless the person looked like a lab person.
posted by Fukiyama at 3:23 PM on October 14, 2019

I've been told that j have hard to find veins as well. I usually mention that at the start in a heads up kind of way and no one has been offended.

I was asked by my provider one time if there'd been any difficulty with the blood draw because a specific test seemed a little off...maybe potassium? It was a while ago, so I can't recall if she had me redraw or not. Could be worth mentioning to your doctor at the very least to see if that could interfere with the specific tests they're running?
posted by ghost phoneme at 3:25 PM on October 14, 2019

I have to get frequent blood draws and I have terrible veins. One of the best phlebotomists, who has twenty years of experience, often works at the desk, so that’s not an indication.

I’ve rarely had people fish around, and those who have were always apologetic.

I have a previous ask on advocating for myself when I get blood draws.
posted by FencingGal at 3:40 PM on October 14, 2019 [4 favorites]

I have been told the same thing. Based on a similar experience to yours, I now tell the person drawing blood beforehand. Sometimes they use a special attachment that is supposed to make it easier, and I've had them switch to using veins in my hand instead. (I also discovered by accident that walking to the lab from home, about an hour, gets my arms pumped and ready for poking.)
posted by girlpublisher at 3:44 PM on October 14, 2019 [1 favorite]

On reading FencingGal's post, I see the special attachment I was referring to is a butterfly needle.
posted by girlpublisher at 3:46 PM on October 14, 2019

Yeahhhhh. I’ve had more blood draws and IVs than I can count. Every time is a gamble even with my VERY easy veins. Some people just aren’t good at it. Sometimes I can tell by looking at them. Since you know you have had issues with it, you can ask if their most experienced person is available.

I’m sorry. This is the sucky part of the medical system. You can get stuck with (or by) people who aren’t good at their jobs. I don’t think complaining will help anything. If you get someone next time and they aren’t doing a good job you can ask them to stop and ask for someone else or leave.

For those of us Sick People this is unfortunately a common occurrence. It’s annoying as hell. But it’s not as dramatic as say, literally not being believed about your body.

Depending on WHY this may be happening there may be things it make it easier. Like avoiding caffeine (vasoconstrictor) and being very hydrated. Talk with your doctor.
posted by Crystalinne at 3:47 PM on October 14, 2019 [3 favorites]

I’ve had the thing with potassium testing as well, it was high and my doctor said sometimes that’s an artifact of how the blood is drawn and sent me back to retest with specific instructions on how to draw it. It’s called pseudohyperkalemia and is related to how tight you clench your fist during the draw. I’m not sure if there’s anything else like that which could throw off a test, but if you see any weird results it would be worth asking your doctor if the difficult blood draw could have been a factor.

It sounds like you got a less experienced phlebotomist, which sucks, but personally isn’t something I’d complain about. It happens sometimes, unfortunately.

For future avoidance, I’d say up front that you have tricky veins, and a butterfly needle in the hand is usually the best way to go. I’ve found most phlebotomists aren’t dying to make their own lives harder and will cheerfully do that if you tell them up front it’s what works best with you. Plus, try to show up hydrated and warm.
posted by Stacey at 3:57 PM on October 14, 2019

Butterfly needles and fist clenching/pumping can make the draw easier, but can lead to inaccurate potassium values. Here's a primer on making blood drawing easier on problem veins; hope one or more of the techniques works for you. (Being well-hydrated helps me. So does holding one of those hand-warmer heating pads to the inner elbow of the drawing arm, but I'm going to try this tip from the link: Swing the arm around several times like a windmill. Centrifugal force ensures blood will enter the arm, dilating the vein, and have a harder time leaving.)
posted by Iris Gambol at 4:18 PM on October 14, 2019 [4 favorites]

A big difference that I have some control over is how hydrated I am, so make sure to hydrate as much as you are able before an appointment.

Another thing that works for me is to just... not care about the feelings of the phlebotomist. Sorry to the phlebotomists in the room, but it's true. This isn't personal; it's medical. The emotions of the person working on my body are just not something I need to spend my energy on anymore. I've had regular blood draws since I was 12, and I know when a phlebotomist is not going to be able to find my veins. Anything more than 3 minutes of fishing around causes me to just say "I would like another person to try this now, please," and let them huff and be upset. They dislike this but too bad: it's my body, and you are hurting it, and I do not need or want that.

I also have one particular location that usually works OK, and I tell them upfront: "I'm a tough stick, my veins are wiggly, hitting my vein right here (pointing to the sweet spot in the crook of my arm) works best for me." If they get huffy or annoyed about it, too bad. If they want to use another arm, too bad. If they want to start messing with trying to draw blood from my hands or feet, I just start repeating that I need a new tech or a new phlebotomist until they meet my need.

Also, I am really complimentary when they do hit it: "Thank you, that barely hurt at all" or "Wow, you're really good at this." Also, if you find a good tech, get their name, ask when they're usually on, and then call ahead of time to ask if Sandy is working that day. When you check in, say, "I usually see Sandy and am willing to wait for them to draw my blood." I do this, and having "my" tech makes things a whole lot easier.
posted by k8lin at 4:26 PM on October 14, 2019 [19 favorites]

^Oh, hell yes. I drive half an hour out of my way to go to the dinky lab where everyone's been on the job for over a decade.
posted by Iris Gambol at 4:29 PM on October 14, 2019 [2 favorites]

The lab I’ve had the best experiences with is one that does blood draws for both kids and adults - I think the people who work there have more experience finding small veins than your average phlebotomist/nurse/whoever. So if there’s a place like that near you, it might be a good option.

Do you know what vein is usually most succesful? It can be useful to point out the spot. I used to always try to have blood drawn from my left arm since I’m right handed, but I would not infrequently end up with a bruise and a draw from my right arm anyway. Now I always have them start with my right arm and it goes much more smoothly!
posted by insectosaurus at 6:01 PM on October 14, 2019

So this one time when I was 12, I had a nurse fishing for a vein (for an IV) who managed to give me permanent nerve damage. I'm not saying this to scare you. Just...please advocate for yourself. If the phlebotomist can't find a vein, ask for someone else. It's not always just a matter of 'ow, that hurts'. Fishing can do actual lasting damage to veins and nerves.

But even at 12, when I said to the nurse 'You need to stop, this hurts too much. Please get someone else to do this,' she didn't take offense and went and got someone more experienced. I think most people sticking those needles in you would rather have it go well than be egoic about it (one would hope). I have several nurse friends and they confirm this. No one wants to make someone suffer if they have any other available option.
posted by ananci at 6:04 PM on October 14, 2019 [2 favorites]

I took a phlebotomy class, and I also have hard to find veins. I would also echo the advice to say "I don't want you fishing in my veins, I want another tech". I was taught that if you can't hit a vein in your first try, take the needle out and you can try one more time. They should not be fishing in your veins and you don't deserve that.
posted by starlybri at 6:32 PM on October 14, 2019 [1 favorite]

Agree with much of the advice above - making sure you’re warm and hydrated helps with blood draws. Some blood tests are affected by bad technique on draws (and some are not affected much at all). Some of the affected tests will just be rejected by the lab (rather than returning to you a false result).

I manage a team of phlebotomists though I am not one myself. The team follow the policy that nobody does more than two (gentle) attempts on the same patient, and they ask for explicit permission before their second attempt. They would so not be offended if you asked for someone else. Also, mentioning you have been a difficult draw in the past may signal to a less experienced person that they should get an alternate. You can also straight up ask, “are you good with difficult draws? I’m nervous.”
posted by Tandem Affinity at 6:46 PM on October 14, 2019 [1 favorite]

I have small veins and continual issues when having blood drawn. I have learned to advocate for myself from the initial moment: some people are immediately understanding and find someone else who is "good with small veins", some people get offended, dig in, and find that they have to find someone more skilled in the task nonetheless. Like one of the comments above, I remember to be very gracious and grateful when it is done properly, but that is always after having made clear that I will probably need extra attention. I have found that there is usually a "star phlebotomist" or two on hand, so asking/insisting as needed should be helpful.

Good luck in the future--it is not a fun problem to have, but one gets used to it!
posted by youarenothere at 7:16 PM on October 14, 2019

I'm a hard stick and a regular blood donor. When I lived in Atlanta I found a phlebotomist at the Red Cross who had been a neurosurgeon in the Republic of Georgia. He was old enough when he emigrated that it wasn't worth the trouble to homologate his medical license so he worked drawing blood.

He never missed my vein, and once I knew who he was nobody else would do. His name was Iakob.

Find your tech and stick with them. [heh heh]
posted by workerant at 7:30 PM on October 14, 2019 [1 favorite]

I get blood drawn for tests four times a year. In my experience, there are good stickers and bad stickers and this is consistent in my experience. Unfortunately at my clinic, there's only one person on duty at a time so it is "luck of the draw." The only drawback I've had with the bad stickers (other than the drag of watching them flail around inside my arm is that about a third of the time the incompetent one will stick the needle entirely through the vein before getting it in the right place and I end up with a giant hematoma (if that in fact is the word). I am emphatically not disputing the other MFer that got nerve damage, just saying that I hope it is rare.

I would say if they didn't make you comfortable, I'd call the clinic or lab and express my unease. No one improves without feedback, and they may have thought they were "helping put you at ease" with their act. I personally wish instead of putting on a good performance they'd just concentrate on technique, since it clearly is possible to do an exceptional job all the time.
posted by Gilgamesh's Chauffeur at 8:37 PM on October 14, 2019

I give blood regularly and request an experienced tech every time to do the needlework. If the person attending.looks at all uncertain when you tell them you are a difficult draw then ask for someone else.
posted by benzenedream at 11:48 PM on October 14, 2019

No one at the Red Cross could get one of their big needles into a vein when I tried to give blood, and they told me not to come back. If someone is digging around for a vein on one side, I would tell them to get a more experienced phlebotomist to try the other side. If I felt the person did not have enough skill, and if I had a lot of bruising the next day, I might call and speak to a supervisor. And I am super-complimentary about most phlebotomists who get it in 1 stick.
posted by theora55 at 8:07 AM on October 15, 2019

Moving the needle around once it's inserted is not good practice (what ananci said - risks nerve or other blood vessel damage) although I've given up with the techs at my hospital. I usually let them try three times, then go and hydrate and try again after a while. Once the tech used the wrist - painful, but worked. You *could* try asking your doctor to do an artery draw, if nothing else works reliably... (found it more painful than normal veins but less than the wrist)
posted by ahundredjarsofsky at 6:23 AM on October 16, 2019

I always open with, "I have hard to find veins. Please use your smallest needle." My mother, who also has hard to find veins just says, "I want your best sticker," and she always gets someone really good.
Also, yes, being hydrated helps a lot.
posted by tangosnail at 9:49 AM on October 16, 2019