Working in the medical field comes with many challenges, new and old. One of these challenges for phlebotomists is drawing blood when the veins are difficult to locate or palpate. There are several reliable and trusted tips and techniques that could help provide usable veins without damaging the patient’s arm. Here, we discuss some best practices for working with tough veins and how to overcome these challenges.

A Look at the Most Commonly Used Veins

A phlebotomist uses four primary veins to perform blood draws. Each is generally available at the visit, but sometimes, finding them or capturing the necessary blood volumes is challenging. It’s essential to understand these primary veins to gain awareness regarding where to focus the drawing methods and know any potential risks associated with each one.

Median Antecubital Vein

This vein is the most used option that people often associate with blood draws. The median antecubital vein sits in the elbow joint of the patient’s anterior-positioned arm. This location is the least painful draw site and provides ample supply when anchored appropriately.

Cephalic Vein

The cephalic vein sits on the lateral area of the arm and is generally the second choice for professionals. This vein is a safer alternative when the median antecubital vein is not viable at the draw time.

Basilic Vein

The basilic vein has an increased risk of collapse because of how challenging anchoring can be. It also sits closer to the nerve and artery, creating increased difficulty.

Dorsal Hand Vein

The last resort vein, the dorsal vein, sits on the top of the patient’s hand or by the thumb and wrist. This area is generally a successful blood draw location, but most phlebotomists use this vein as a last resort after the other three prove too challenging.

Tips for Locating a Vein To Draw From

You can sense the ideal location and viable veins when palpating the patient’s arm. Unfortunately, most veins are not readily available or noticeable by sight alone. Because of this, a phlebotomist must master the art of palpations to seek out suitable vein locations. Applying a gentle but firm pressure can help distinguish between an artery and a vein.

Once the vein becomes available, it’s paramount to use a tourniquet for anchoring. This step will help centralize the necessary vein and create an easier draw. However, the firmness of the tourniquet can create issues. Should the wrap be too tight, the professional risks losing plasma. But if the wrap is too loose, the vein may not centralize enough.

In the unlikely event the tourniquet, entryway, and draw are unsuccessful, various factors could be preventing your success. Removing the needle and locating a new point of entry or an entirely new draw site is essential. When these steps fail, phlebotomists can refer to these six tips and techniques to gain access to difficult veins.

Warm the Body

By placing a heating pad or warm cloth on the desired draw site, you are enhancing the overall visibility of the veins by increasing blood supply and flow.

Rely on Gravity

Never underestimate the power of gravity. Having the patient stand up with their arms at their sides can help pull the blood supply downward. Another option is having the patient perform a series of windmills with their arms to circulate the blood and help gravity along. This movement often creates vein dilation.

Increase Hydration

Advising your patient before their scheduled blood draw to increase their hydration efforts can help streamline the process on the day of the drawing. Hydration can create a supple vein site by dilating the veins. Adequate hydration is also beneficial for ensuring their overall well-being during the draw.

Relaxation Techniques

Some people have a great fear of needles, which can cause their bodies to respond in unfavorable ways at the time of draw. Try to coach your patient through relaxation techniques, approach them in a gentle manner, and play soothing music in the office.

Another option is to assist them in a meditation leading up to the draw if they express concern. While their feelings are valid, it’s vital to their safety that the draw is successful.

Deep Breaths

Coaching your patient through deep, intentional breathing can be more efficient in soothing the patient. Try practicing inhaling deeply through the nose and exhaling through the mouth for several rounds to bring the patient back to optimal blood circulation.

Numbing Agents

Numbing agents come with risks but can work depending on circumstances. Sometimes, numbing creams or other topicals constrict the veins and counteract the process. Another thing to be mindful of is how long the agent may take to work.

The upside is these agents create a more pain-free experience for the patient, and this may serve as a mental aid to help them relax. It’s advantageous to evaluate the severity of the situation and understand the patient’s source of fear before applying a numbing agent or topical solution.

How To Navigate Difficult Veins

When a phlebotomist experiences trouble locating or using a vein in any location, consider asking the patient for their input. Ask them about common draw sites from the past and how professionals managed to succeed before.

Also, factor in the time of day for the scheduled draw. If the patient has a history of challenging draws, leave this in their chart so future appointments can coincide with optimal drawing windows. Afternoon blood draws typically result in success because circulatory movements made throughout the day will dilate the veins. You can recommend a later appointment time to mitigate issues.

Why Some Veins Are Tricky

There is a wide range of reasons one vein is more challenging to locate than others. Sometimes, a patient’s physical age causes the veins to be smaller in size, while other times, patients are genetically predisposed to problematic veins.

All genetics aside, one particularly common issue is the hydration levels of the patient. That’s why suggesting or advising your patients to increase their water intake before their appointment is advantageous.

Equip your medical practice with the necessary supplies and blood draw tools to ensure even the toughest of veins are reliable. Cascade Health Care features a professional collection of butterfly needles for sale. Regardless of preferred techniques, drawing blood from difficult veins can be detrimental to a patient without the necessary devices. Partner with us today to learn more!