Friday, June 18, 2010

A question for my fellow vampires:

I have a blood draw coming up in the next week. Normally, I have veins you could hit with a harpoon from a door three blocks down. This, however, will be a fasting blood draw, and my veins disappear when I fast, no matter how much water I drink.

Would it be a breach of manners to show the phlebotomy guy my left radial vein and say, "This one, right here, with an eighteen-gauge butterfly"? It's at my wrist, which is an odd place, but then, I have odd anatomy (thanks, Mom!). Or is that considered sub-fusc?

Comments welcome. Last time, he had to stick me six times before getting enough blood for two vials.

22 comments:

Anonymous said...

I say tell him. I have a deathly fear of needles so the fewer pokes the better. I always ask my kids at work where to poke or not poke. It just makes things easier for everyone.

A NURSE said...

As someone who freakin' hates the sight of a needle coming at me....I would definitely go for pointing at the vein you want drawn from.(wrap it in a hot towel the whole way there too) I have worked in a prison and I never minded even the inmates pointing out the best vein (please don't draw any parallels here...I am only making the point that it's ok to indicate the best vein!!) You would know YOUR veins better than anyone! And who the Flip wants 6 pokes? I'd be on the floor. =^@

Luis said...

I am a firm believer in telling them where to stick it -- and not just during a phlebotomy. Yes, by all means. Keeping silent and allowing a botched phlebotomy to happen doesn't do either side any favors.

Maha said...

I say go for it! I love it when patients tell me which veins work for them so that I don't have to work too hard.

And I love that your veins can be accessed with a harpoon! I thought I was the only one - my arms are a lesson in vascular anatomy unto themselves.

me said...

I have absolutely crappy veins... right now, the only place they can draw is my L hand dorsum...
And I make NO bones about telling them they need a butterfly and a hot pack...
Go for it...
I pity my future nurses!

Anonymous said...

Whenver I have to have blood drawn the tech takes one look at my veins and asks me if I know of the best place to stick me, of course I do.

No tech has ever gotten angry or out of sorts when I have told them where to stick me.

You know your body best...I would just tell him/her, it will be easier for the both of you.

Good Luck
Mary

Christine said...

Oof, 6 times? I'd request someone else!

I was a phleb in a previous life. I'd listen to recommendations from people about which vein to use, but I wouldn't always follow them. Sometimes people knew what they were talking about, and sometimes they had crazy misconceptions due to previous people missing their veins and making up excuses. The fact that you're a nurse would give you more authority. But an 18 gauge in the wrist? I'd probably use a 21-22 gauge butterfly, I'd be too afraid to blow your vein with a needle that large in that delicate of an area. (also, I'm assuming other tricks of the trade have been used on you - like warming up the a/c area, turning your wrist, etc)

Anonymous said...

I'm being trained in phlebotomy and I'm told that we should always at least use the tourniquet and look for an arm vein first, but not necessarily stick the person if it's not going to work.
With you being a nurse I think they'd listen to you. I say you might as well ask. I hear weird requests all the time, I don't think they'll find you rude for just asking.

PurpleRN said...

I tend to have shy veins as well, and I've noticed that the lab people actually appreciate when I give them hints.

I'll warn them ahead of time that I'm a fainter, and that they'll probably need a heel-warmer, and that if they can get one of my hand veins I'm less likely to pass out than if they have to go for my AC.

Ever since I started speaking up, blood draws have gone so much better!

Jo said...

In answer to a couple of questions: Yes, six sticks. And I didn't request somebody else, because frankly, it would not have done a bit of good. My veins go into hiding when I don't eat, except for the hose on my wrist.

And yep, that's a hose on my wrist. An 18-gauge will go in easy as pie without fear of blowing it.

Thanks, too, for the recommendation of the hot pack on the way. Will do!

Sassenach said...

Are you kidding? Of course it's ok. If the lab tech gets offended, ask for someone else. I'm a hard stick and I've learned which places are best. I'm not willing to be a silent pincushion; it's my experience, too, that if they get offended over your input it's because they're insecure about their own skills.

For fasting blood work, I put a hot water bottle over my arm and keep it on from home to lab. I've found that the frigid temps in labs cause my veins to disappear.

Becca said...

Definitely tell them. They're not exactly going to object to having their job made quicker and easier.

I'm a hard stick too. Good luck!

AtYourCervix said...

As a nurse who does very frequent IV starts and phlebotomy sticks, if I have a "difficult stick" patient, I appreciate them telling me where their good sites are. I usually ask if they have a preference of where I start their IV too. Believe me, I am NOT offended by a patient telling me to "use a butterfly" and "stick me in this spot". They know their bodies better than I do.

A NURSE said...

best way to do the hot pack: hot wet hand towel(if you have a very small hot pack that u can microwave-you can add that in as well, but moist heat works best) - wrap around wrist - get a plastic bag and tape it firmly in place and don't remove until the Tech is ready to draw... ;)
(no need to ok this: just delete, thks) :)

Scrub Ninja said...

Sticking you a half-dozen times is no fun for him either. Show him the right place and you can both get on with your day.

tottergirl said...

I do it all the time. The vein in my elbow is difficult to get so I start out by telling them, "Use my hand." I can't handle multiple sticks. Also, the heat pack is great, when I was being constantly tested while on warfarin, I'd put a heat pack on my hand and they could just pop right in.

Brad said...

I always tell them where to stick me. They usually argue with me, saying "the vein is crooked," etc. But after letting phlebotomists talk me out of it too many times, and end up sticking me twice or more, now I just insist they go for the spot I picked and they always get it bang on the first time. Me being an RN/ARNP carries no weight with phlebotomists by the way.

Anonymous said...

Hi Jo,

Having worked as a phlebotomist off and on for the past 11 years, I can tell you that it's all in your approach. I do appreciate it when patients point out their best spot - you live with your veins, and therefore know them better than I do!

That said, I've had patients who were whiny SOBs and firmly instructed me "you can only take my blood here with a 25 gauge butterfly, and only at 17 minutes past the hour. Oh, and if you miss the first time you're out of chances, but my doctor desperately needs all of these labs completed by 21 minutes past the hour."

It's all in the approach :)

good luck!
-nurse8

brad rn said...

I second that most recent comment by anonymous, by the way. Long time ago I used to always tell phlebotomists "If you can't find it, please don't dig around, just start over." That would always make them nervous I think, because it always ended with 2+ pokes. Once I left that part out, it went smoother.

Anonymous said...

As a Phleb and MedTech I always appreciated a patient's perspective, but reserved the final authority on performing the stick. Usually, medical professionals would know how best to proceed, but sometimes I could see something they couldn't because of the different sight lines.
If your phleb isn't sensitive to what you say about yourself or argues without reason, ask for a different one. [djs]

Dawn said...

Whoever let out the statement that butterfly's are the magic needle, really needs to be smacked! Here's a clue, a needle is a needle. It's all in how you use it, not whether it has wings!

Anonymous said...

had phlebotomy and saline drip, total mess. baseball bulge after saline bag was half emptied. 15" long and 4" wide bruise on arm. It has been 5 days bruise is a little less and swelling mostly gone. acute pain and stiffness in skin at puncture. On Plavix aspirin and Berlinta because I am a clotter.