Tips For Locating Difficult Veins

DISCLAIMER: The tourniquet was not really tied on the arm. This was for visual effect and yes we are aware that it was on the arm longer than a minute but it is for locating veins. Please watch our other video on tourniquet techniques.

Preparing phlebotomy students for their state exam and training them with a correct understanding of CLEA, CLSI, OSHA, and HIPPA procedures.

[CatFromFL]

I am a retired CRNI (RN certified in IV therapy) and I suggest a few things I learned over 48 years 1. Know vein anatomy and access patient for diagnosis and hydration status. 2. Use your sense of touch more than sight. Veins bounce. 3. Allow time for vein filling after tourniquet placement. A full minute or two. Allow prep to completely dry. 4. Look at size of hand veins, all upper veins will be bigger ( just like a tree-twig to trunk)5. If patient shows signs of dehydration apply a glove filled with warm water. 6. Use dependent positioning to fill difficult veins 7. Know the potential IV use for this patient - what will be infused and how long will they need IV therapy? 8. Use good tools- cheaper IV catheters may have barbs and be less sharp- buyers should look at bevels under magnification before deciding on what to buy for your institutition. Good luck. IV therapy is a learned skill that improves with practice.

[karilynn]

Im in geriatrics and I fill a glove with REALLY warm water and place it on the vein area. It really helps! Then I clean with alcohol of course.

[mercedesrosemitchell]

I'm not a medical professional but I am a recovered IV drug user. During that time I was known for being able to hit any vein, even in people with incredibly damaged veins who often were eventually turned away when getting bloodwork because none of the phlebotomists were successful in finding a vein. For these types of patients, I have a few tips.

First off, like you said hydration is key. Addicts can be very dehydrated so getting something like Gatorade or Pedialyte in them will help a ton.

Make sure they're warm. A warm compress really doesn't provide that much heat, I recommend a heated blanket. Keep them wrapped up even if they feel hot.

If they are able, have them sit up with their arms behind them and do essentially push-ups. Ten or so should do, then put the tourniquet on right after they're done.

Another note is that many nurses, especially newer ones tend to put the tourniquet on very tight. The arm shouldn't be turning blue/purple and the patient might complain about pain or numbness. If it's too tight not enough blood is able to get to the lower part of the arm.

Another mistake I see regularly is slapping the vein. That's what they do in movies, not real life. You want to palpate with the fingers or gently rub the vain to warm it up, and promote blood flow.

Now where to hit. An addict is going to know their veins inside and out. Listen to them. Ask them where they haven't been shooting recently and which veins are damaged. If the patient is right handed, try the right arm first because they hit it less.

There's a nice fat vein that runs from the elbow to the wrist, on the outside of the arm if I'm facing you with my arms to my sides and the back of my hands facing you. This vein is very difficult for addicts to hit, especially on their dominant hand. The problem is that it rolls really badly, but I'm sure y'all know how to deal with rolling veins.

Overall though, talk to your patients and have some patience with them and odds are they'll be able to help you out more than any textbook!

[brianksigley]

Just came across your channel and I subscribed to it.
Nothing messes up your day like missing a vein...you're going along successfully drawing patient after patient and there's that one you miss and (maybe it's me...) ruins the streak and then I feel like a failure.
This is a great tip, the marking with the cap. Can't wait to watch more videos.
Never too experienced to learn something new.

[simonecrawford]

I'm a MA student and my teacher isn't the best. I want to thank you for sharing this content as it made me more confident than I ever felt during my MA enrollment. Thank you.

[cindy]

Thank you for your videos! I can't tell you how much I've learned from all of your videos. My phlebotomy teacher was the worst. When taking his class I would often double-check facts with you and he was often wrong and you were right! You were the reason why I did so well on my national exam. Keep doing what you're doing! You're videos are life savers! You have a gift!

[domski]

I’ve always been fairly good at blood draws and IV’s but this really helped me find the deep veins. Haven’t missed a stick since watching this a couple weeks ago. Thanks for the help!

[cocklet]

A couple of good tips from me working in a hospital are always have the arms below the shoulders so veins have to work against gravity, you can get blood from even the thinnest of veins with a 25 gauge needle and syringe, if patient is cold and dehydrated then get a wet paper towel with warm water (better than heating pad since water can diffuse into the veins), if you are to slap veins do it in the hand and at a slow pace (about 1 every second for about a minute), for beginners make sure your tourniquet is on tight, know decent amount about the anatomy of veins, know how much volume is needed in each tube and use pediatric tubes if needed (extremely important especially if using syringe, I can’t even count how many times I got the bare minimum of volume then would use the small volume pediatric tubes to make sure all the tests can be done (cbc and other lavender tube tests you only need to fill bottom hemisphere of tube unless esr you need more, serum and heparin tubes you really do not need as much as you think for pretty much all tests in red or green tubes (even like half an inch of blood), blue tube requires good amount obviously since you need to fill all the way which is why I liked the pediatric tube, lactic acid you don’t need crazy amount, blood cultures they tell you to get 5ml but less than that is most often accepted (what’s most important is proper technique so the right bacteria in the blood enter the blood culture), so yeah knowing the volume needed for tests will save you a lot of extra pokes), I’ve probably got more tips that I can’t think of but yeah keep practicing and have no shame in failure to get blood Bc it takes about 6-12 months to get really good if you work in a hospital that is

[raeleigh]

not a medical professional but a high school student who wants to become a phlebotomist, so your videos are informative, thanks :)

[jojofoster]

Well I been drawing blood for 8 yrs, and this is a first for me. I can't wait to try this method on my next difficult stick. Thanks

[vishybreh]

I missed a vein twice on the same patient, came back in a week to try again, missed once more and the patient doesn’t want me to do it again. So I’m here lmao

[Shayvideos]

Use heating pads..usually the kind used for pediatrics and that helps plump the veins..also ask patient to let arm hang down so gravity work with you and the blood and also feel for the vein while it's hanging down..and last but not least..take your time..sometimes you may be searching for a vein for 10-15 mins if it's really deep so don't be so hard on yourself.

[jenniferjohns]

I wish I had you as my instructor. You are fantastic!! Thank you for taking the time to upload the videos and explaining everything in depth. I would fail my phlebotomy class if it wasn't for you.. lol.

[Ravynwulf]

I've been an RN for over 10 years and now finishing my doctorate to become a nurse anesthetist. Here is a little tip that may help that I just learned, and has helped me land some 14g and 16g IV starts.

Some providers like to put a slight bend in the needle to allow for a more shallow approach to a vein. They also will lift the vein up after they enter the vein and as they make the angle of approach less. This makes it less likely to pass the needle through the other side of the vein. The bevel is flat and not a cutting edge, so there is no worry about cutting the superficial portion of the vein by doing this.

[heatherakers]

It stressed me out how long the tourniquet was on that arm.

[XxALRxX]

Thank you for these tips. I don't think I have been taught any of them this far (5th year med school). They look like good options that will not harm patients or impact the quality of the sample in a bad way unlike many supposed hacks I have been shown this far.

[sgxthach]

The cap trick is something I'll have to try on patients that I have to do ammonia tests on. To my surprise I've already been doing most of this--bending the elbow, turning the wrist ect. The only thing I haven't tried is using the cap to mark the area. I've heard some phlebotomists using their fingernail too but I always felt a little weird doing that...I'll give a shot one day, thank you!

[cierapaige]

So excited to have a new technique to try. I’ve had a few pts that I was unable fo find a vein on and had to relinquish them to another phleb. Thank you for this thorough explanation! 👏🏾

[jeremywheeler]

Thanks for the advice. I'm a new phleb and I'm not hitting all the goals I need to. I really like this job so I want to do whatever I have to to keep it.

[dotcassilles]

I've always had difficult veins, since I had severe hives as a teenager. For 20 to 30 mins before I have to get blood taken I hold a very hot wheatbag on my arm. It's the only way anyone has been able to get blood outta me besides using ultrasound to locate the vein. The ultrasound guy showed both the blood collection lady and the doctor that my veins move around alot, at least according to him. As I live in a small rural town that has ultrasound facilities once a week (it's booked a month ahead) and because I need regular blood tests, we stick to what worked best for me.