As a new nurse or even an experienced one, phlebotomy may be a challenging and intimidating new skill to learn. While there are phlebotomy techniques taught in school, it can be very different doing it yourself in the hospital setting on real patients. Let’s look at some phlebotomy tips for nurses so you can feel prepared and step up your game.
Some hospitals will have their phlebotomy team draw all labs, while others will have nurses do all of them, and some hospitals have only certain units draw their own labs (critical care, for example).
Phlebotomy is the technique of using needles to draw and collect blood from a patient. Though many people dread it, blood samples can provide the medical team with important information about the patient’s health. These blood specimens from phlebotomy can be used to monitor things such as coagulation levels, electrolyte levels, platelet counts, and even to diagnose illnesses.
Since these blood tests are so important you want to take special care to make sure your patient feels as comfortable as they can during the process. Because people have different pain and anxiety levels, as well as differing anatomy, it can be a bit tricky to draw blood. Here we give you some important tips to make phlebotomy less scary for you and your patient.
Phlebotomy Tips for Nurses
Phlebotomy vs. Venipuncture
To give you a better idea about the process of drawing blood, first, we define two important terms. Many people mistakenly use the terms “phlebotomy” and “venipuncture” interchangeably, but in fact, they are different.
Both processes use needles to puncture the skin, but the main difference between the two is the purpose. As we know, phlebotomy uses a needle to draw blood, specifically to study the blood sample. While venipuncture also uses the needle to puncture the vein, it is a broader term that can be used for different purposes. Venipuncture can not only be used to draw samples of blood from a patient but also can be used to insert an IV tube, also known as intravenous therapy. Another notable difference between the two is that in phlebotomy, every sample that is taken must be done with a new needle, whereas in venipuncture that may not always be necessary. Even though the two terms are similar to each other, it is important to distinguish between the two to help you provide the best care to your patient.
Phlebotomy Tips for Nurses: Best Places to Draw Blood
After defining the process of phlebotomy we go through some of the best places to draw blood. Since people are so different, there may be certain areas with greater blood flow or a more apparent vein. The last thing you want is to be stabbing your patient multiple times during the blood tests since you are not able to find an adequate vein to draw from. The best veins to draw from include:
1. Elbow veins. These are also known as antecubital veins, medial cubital veins, or cephalic veins. These are the most commonly used veins that are located where the arm bends at the elbow. These are commonly used because the veins are located close to the skin’s surface, making it easier to see. It is also easy to puncture and does not roll easily. It is also fairly low risk compared to puncturing veins in other areas of the body that can damage other veins more easily.
2. Hand veins. This network of veins is also known as the cephalic or basilic vein. These are found on the backside of a patient’s hand and are also found close to the skin’s surface. This is typically not the first choice, since a person’s hand can be very sensitive. It is also close to other veins, nerves, and arteries, making it a slightly higher risk.
3. Wrist veins or forearm veins. The veins in this area include the basilic vein, axillary vein, and median cubital vein. The veins are typically larger in this area, so they may be more visible. For others, this area may be tricky since the veins run deeper than in the elbow or hand area. This area is also not the first choice for many phlebotomists due to the risk of hitting nerves. The radial, ulnar nerve, and artery are located in the wrist area, making it a bit tricky to draw here.
Phlebotomy Tips for Nurses: Tips for Drawing Blood
Now to the most important part- tips for drawing blood. You may have a lot of knowledge of vein selection, but you won’t know what it feels like until you do it. We have compiled the tips of experienced phlebotomists and nurses to bring you useful tips for blood specimen collection.
1. Vein of choice. To begin the process, you will first need to know how to select the vein to draw blood from. We recommend instead of just looking for a visible vein, to feel around for one as well. For some people, their veins are simply less visible. A perfect vein may not always be a prominent vein. A sufficient vein to draw blood from feels bouncy and springy. You may want to practice on yourself or other healthcare professionals to get a better idea of what this feels like. Knowing what a vein feels like helps you locate it quickly and effectively. This decreases the chance of missing a vein during puncture.
2. Pressure. The blood flow pressure is important in the visibility of the vein as well as helps the blood drawing process end quickly. If your patient’s veins are not as visible, you may want to use a tourniquet and ask your patient to lower their arm for a greater angle. This helps to add pressure to the vein and make it more visible. One thing to note is that if the vein is visible on the skin do not use a tourniquet since this can easily add too much pressure and cause the vein to collapse. With so many different scenarios, time and practice are the best ways to feel more comfortable with the process.
3. Rolling veins. Knowing how to spot one can help avoid complications and let you take the necessary steps to ensure a smooth blood drawing process. Rolling veins often look like they are not flowing in a straight line, and may have to do with the angle and how tight the skin is. If you suspect a rolling vein make sure to have your patient extend their arm to help stabilize the vein.
You want to keep the skin taut in order to puncture the center of the vein. If you are working on the hand area, have your patient put their hand in a fist to help stabilize the vein and keep the skin tight.
4. Make sure you are familiar with the equipment. This helps you feel more comfortable with blood tests as well as help your patient feel more confident in your abilities. Could you imagine going into a process you are scared of just to have the expert look confused? The blood collection essentials you will need include alcohol prep pads, blood sample tubes, gauges, gauze, tourniquet, and medical tape.
The size of the gauge will depend on a couple of different factors. This can be the size of the vein and also the number of tubes you need to draw. For those that need more than one sample of blood, we recommend a larger gauge to help the blood flow quicker into the tubes. For a multiple tube draw, also make sure to choose a vein large enough to decrease the chances of clotting or blowing veins.
5. Make sure your patient feels comfortable. For most people drawing blood can be a nerve-racking process. For patients that are unsure or nervous about the process need a nurse that can stay calm and professional to ease their anxiousness or discomfort. A great way to help the patient stay calm is to ask them to count to three and take a deep breath.
Since there are risks of damaging other nerves or veins in the process, you want to make sure they stay still and do not freak out. While you patient takes a deep breath, you can then take the sample during the time. This gives them something else to focus on instead of you sticking the needle into their arm. A deep breath is also proven to calm and reduce nervousness which can help keep them steady while you draw the proper volume of blood. Some nursing programs have certain steps to take, however, this all depends on your patient. You want to provide them with the best experience and this can include things such as sounding professional, engaging in conversation, and giving them absolutely no reasons for concern.
Phlebotomy Tips for Nurses: Final Thoughts
While there are phlebotomy teams, as a nurse you will most likely be drawing blood or completing venipuncture for an IV. While nursing schools and books try to describe the phlebotomy process and experience as best they can, it can be very different doing it in person. Phlebotomy is a critical nursing skill that can be improved over time and practice.