Can you take the blood from my hand, please?
March 23, 2021 2:07 PM   Subscribe

I have small veins in my arms which “roll” and having blood drawn is typically a long and painful process with many attempts which ends in a draw from the veins in my hand. Is there a reason we can’t just start with the hand?

I always explain this situation to lab techs and nurses the moment I sit down, with as much humor as possible about how they drew the short straw today. I tell them from the beginning that this process almost always ends with blood being drawn from my hand. Only once in my whole life has anyone just accepted this at face value and said “you know your body, if you say hand, we go for the hand.” She was a great lab tech.

Good lab techs will say “I’m going to have a look at your arms first” and then do the tourniquet, press on my veins with their fingers, and ultimately go for the hand. Bad lab techs, like the one I had today, will say “I can do it, no problem,” and proceed to stick me three or four times in the arm, rooting the needled around, leaving me with a golf ball size bruise in the crook of my arm and ultimately going for the hand to finish the job anyway. Note that this was at a lab where they do this all day long, and I was well-hydrated but obviously not super relaxed once the poking and re-poking and needle twisting started.

Is there a medical reason that I should avoid having blood drawn from my hand as much as possible? Will my vein collapse? Are those veins more fragile, generally? There must be some reason for lab techs'/nurses' resistance.

If there is no medical reason not to go straight for the hand, what can I say to medical staff to convince them that it is not worth their time nor my suffering to try for the arm? My simple explanations, citing of past experience, and right to bodily autonomy is clearly not sufficient for most people.

I’ve seen the previous questions on blood draws which make me more confident that I have the right to advocate for myself, but I would like to know if the specific remedy I’m requesting (proceed directly to the hand) is inadvisable for some medical reason I’m unaware of.
posted by philotes to Health & Fitness (15 answers total) 1 user marked this as a favorite
 
I have a similar issue. A nurse told me that they normally don't like to draw blood from there, because repeatedly drawing blood from those locations makes it harder to use them if you end up in hospital.
posted by pipeski at 2:19 PM on March 23, 2021 [1 favorite]


Just to be clear: are you actually asking them to draw from your hand or are you telling them that your arms are tricky and you usually need to have blood drawn from your hand?
posted by mskyle at 2:22 PM on March 23, 2021


You have the right to refuse. Tell them you don’t want them to use your arm, period, and stick to that. Be nice but firm.
There is no reason, other than their own egos and comfort levels and experience, for them to be persnickety about it. And your experience trumps their experience.
posted by SLC Mom at 2:29 PM on March 23, 2021 [1 favorite]


Response by poster: Just to be clear: are you actually asking them to draw from your hand or are you telling them that your arms are tricky and you usually need to have blood drawn from your hand?

Maybe, indeed, I'm not being forceful enough, because I believe that if they want to override my experience then it must be with good reason. I tend to say "I have difficult veins and this almost always ends with drawing blood from my hand," assuming that should be enough information for them to go for my hand unless there's a compelling reason not to.


A nurse told me that they normally don't like to draw blood from there, because repeatedly drawing blood from those locations makes it harder to use them if you end up in hospital.

Ok, interesting. Does anyone know with what frequency this would become an issue? I'm looking at a stretch of a year or so of semi-frequent blood draws, approximately every few weeks. If we alternated hands, would having blood drawn from the vein on a hand about once a month present a problem if I needed hospitalization?
posted by philotes at 2:42 PM on March 23, 2021 [1 favorite]


I'm also a 'hard stick' and usually, but not always, end up having the blood drawn from my hands. When I was doing IVF I needed to have my blood drawn every 2 days or so and it was a nightmare in the beginning, so I totally feel your pain.

I have learned to say to them right away that my veins are uncooperative and to please use their smallest needle (usually a butterfly). They usually don't like to use them because it takes longer, but that's a small price to pay to avoid all the pain and bruising. I too absolutely love the great techs who take me at my word and get it done - I try to learn their names so I can ask for them specifically next time. I can also live with the techs who try everything else first but then go for my hand. But ever since I specifically started asking for a butterfly needle, I haven't had a problem with the bad techs. I think they accept that if I know enough to ask for a particular needle, I've been down this road at least once before and maybe do know what I'm talking about. Good luck!!
posted by widdershins at 3:21 PM on March 23, 2021 [6 favorites]


I have this same issue and found if I tell the phlebotomist that "Previous phlebotomists over the past several years have had to use a 21 or 23 gauge butterfly needle on my hand because my arms are too difficult to stick," 9 times out of 10, they skip the arm and go right for the hand. For the 1 outlier, I politely decline until they agree to go for the hand.
posted by jamaro at 3:25 PM on March 23, 2021 [7 favorites]


No, no reason. The technician may be afraid of being blamed for the fact that it's a bit more painful than taking blood from the arm.
posted by JimN2TAW at 3:29 PM on March 23, 2021


I had my left hand used repeatedly for IVs and blood draws and it did end up developing a scar on the vein which hurt like heck when they poked through it. Left it alone for over a year and then it was ok to use again but I prefer they try to rotate spots if possible.
posted by CarolynG at 3:52 PM on March 23, 2021 [1 favorite]


I'm a 'hard stick', too. Ask for a phlebotomist. Most nurses and other health care folks are pretty good at drawing blood, but I've still ended up with blown veins, painful bruising and feeling like a pincushion when I'm already stressed. Now, I ask Are you a phlebotomist? I have crappy veins. If the answer is no, and they're an experienced nurse, I'll still say okay. But after 1 unsuccessful stick, I ask for a phlebotomist. I don't say so ahead of time, too much pressure, but that's my personal boundary. And if they get it, my praise is effusive. I don't think any experienced phlebotomist has ever taken more than once. Letting them know my veins are tiny, and being a bit proactive makes some more likely to use the butterfly; good.

If you know you're going to have to give blood, drink a lot of water, it helps a little.
posted by theora55 at 4:56 PM on March 23, 2021 [1 favorite]


I'm also a hard stick, I warn phlebotomists that my hand almost always ends up being the best option, and I would say nine times out of ten they say sure and go straight for the hand. Once in a while someone wants to try the arm and I don't mind letting them, it's not worth it to me to fuss about. But I think I'd feel differently if I were getting regular draws. It's okay to advocate for what you need!

If you do find someone you work well with, I wonder if you could ask them to put a note in your record and/or ask them what the magic words are you convince other techs at that site?
posted by Stacey at 5:33 PM on March 23, 2021 [1 favorite]


FWIW my relative has similarly difficult veins in her arms, based on previous experience, literally no one can hit them. She tells everyone things with some success.

Anyway, the one way they can get a needle in her arm is with an ultrasound. So that is one thing you could ask for. If that works for you then it would be one way to avoid sticking in your hand. If that does work for your, then in the future if they can't manage that at the facility you are at maybe you need to go over to a different location that does have that available.

Regardless, absolutely do not allow them to fish around in your arms when they have a 0% chance of success. It's not good for anyone.
posted by flug at 5:34 PM on March 23, 2021 [1 favorite]


Best answer: Nurse and blood-drawer here. There are also technical reasons the hands are not where we start. Starting at the hand is something I tried to avoid, less because of the risks of vein damage and more because if I wasn't able to access a vein in the hand I'd have to use a tourniquet higher on the arm to try an antecubital vein (inside elbow) and the tourniquet would cause the hand to bleed again and leave bruises. This is why phlebotomists prefer to start higher up on the arm - you can move the tourniquet further down the arm for the wrist or hand veins without risking antecubital vein bleeding.

It's also true that the veins in the hand are smaller and more delicate, and usually more painful to access. They also scar where stuck and this increases "rolling" because the vein wall is thicker in that spot and resistant to puncture. Your really want to preserve your hand veins if you can, and they are not suitable for certain purposes, like blood transfusion, where you need at least an 18 gauge needle - this is probably not going to be possible in your hand unless you are a big skinny guy with prominent veins. We called them pipes - where even a tourniquet seemed overkill.

Also, the smaller the needle the more turbulent the blood flow into an evacuation tube. This is physics - the more turbulent the blood draw the more likely the blood cells will be hemolyzed, tearing open the blood cell walls, which interferes with some lab tests. If the cells rupture the contents spill into the plasma and can falsely elevate some tests, particularly electrolytes. All reasons to try to access a larger vein first.

Also agree with the ultrasound suggestion, though I haven't really seen them often outside of Emergency Departments. It's certainly worth asking about.
posted by citygirl at 7:53 PM on March 23, 2021 [13 favorites]


Don't ask, tell. Give them a hand and say, "take it out of this hand".
posted by a humble nudibranch at 12:30 AM on March 24, 2021


I'm a hard stick if I'm anxious and the room is cold. It's been less problematic giving blood over the past 12 months but I still warn people. One boundary I've started to set upfront though: you get ONE shot on each stick, no fishing around. If my veins roll, no one has ever gotten them by trying to move a needle around once it's already missed. I'm friendly but firm about this.
posted by deludingmyself at 3:51 AM on March 24, 2021 [2 favorites]


Is there a medical reason that I should avoid having blood drawn from my hand as much as possible?

Mr. Meat says no. "Any vein you go for repeatedly will eventually scar down."
posted by Ms Vegetable at 6:18 AM on March 27, 2021


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