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Chronic Neuroimmune Diseases
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Last updated January 1, 2014

Blood Draws

When your veins and blood aren't cooperating

©2003 Melissa Kaplan

Do your veins submarine and disappear as soon as a needle hovers over your arm? Does your blood flow, but s l o w l y? Does it take forever to get an IV solution to run into you? Here are some things your IV nurse and phlebotomist/venipuncturist may not tell you or think of to try...

Blood thickens and blood pressure drops when you are dehydrated, and many people with chronic illness are chronically dehydrated. Being forced into long-term inactivity doesn't help matters, nor does being hypercoagulated or having orthostatic hypotension (hypovolemia). So, if you regularly challenge the folks who are sticking needles into you for reasons other than a quick injection, it's a sign you need to work on your fluid intake and, probably, your electrolytes. Skip the sweet sports drinks and go for the pediatric electrolyte solutions (such as Pedialyte®) or, if you need to do electrolytes regularly, Vitalyte is a lot less expensive, even with shipping, than the generic pediatric electrolyte solutions you find in the drugstore and grocery stores. If nothing else, on days you are scheduled to have blood drawn or get an IV, drink a quart or more of water or electrolyte solution in the hour or two before your scheduled appointment. And be sure to drink afterwards, too!

Another trick to get things flowing is to warm up. The warmer you are--or, more importantly, your arm is--the easier it is to find and use a nice juicy vein. The same goes for finding a place to plug in an IV. Next time you schedule an IV, ask the IV nurse if they have heating pads on hand so that you can come in 15 minutes or so early and get your arm warmed up. If you are going to a lab to have blood drawn, call and ask if they have any heating pads available for you to use. If they don't, stop at your local sporting goods or outdoor/camping store and pick up some heat packs you can activate when needed. You may be able to find some single use heat packs in the first aid aisle of grocery stores and drugstores. Some reusable ones just need to be reheated in the microwave or boiling water (be sure to read and follow the directions first!).

When your kidneys are sloshing and your arms feel like they are in the middle of the desert at high noon in mid summer, and the arm veins still won't cooperate, ask the phlebotomist to use an alternative site for her sticks. In my case, the veins on my hands are always easily accessible and free flowing, no matter how many unsuccessful sticks have been made in the same arm. For some reason, most phlebotomists don't think of using alternative sites for their sticks.

[In one notable case, the stubborn phlebotomist drilled into nine different sites on both arms before he finally agreed to try my hand. But at least that episode turned out better than the first time someone used my hand: the blood literally gushed out and sprayed across a 6 ft. long table and splashed on the soldier sitting at the other end...I was in Israel at the time, in 1974, working on a kibbutz on the Jordan border. The brilliant red geyser, which also liberally sprayed the white enameled table, walls, floor and the nurse's clothing, completely freaked out both the nurse and the soldier. I hasten to clarify that that was the only time my hand gushed, possibly the result my blood pressure being rather high due to the stress of the situation by that time and/or the stick being rather overly enthusiastic as the nurse decided there was nothing to lose by humoring the crazy American girl.]

Many people's blood pressure goes up just going to the doctor for a routine checkup, so it is understandable that it rises when we go to the doctor or lab because we are sick. Stress increases the blood pressure and constricts the veins, making it more difficult to draw blood. To reduce the likelihood of stress making your veins more difficult to find and draw from, learn some relaxation techniques that work for you, and put them to use as soon as you sit down in the waiting room, and keep doing them throughout the draw.

If you are in a facility where there is more than one phlebotomist, and the one working on you has poked you three or four times unsuccessfully, you can nicely ask if there is someone else who can try. Everyone can have an off day, now and then, and it may just be one for the person working on you.

If blood draws are always painful, there is a pediatric topical anesthetic agent that can be used, though it is not typically used for blood draws. EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) must be applied to the draw site 1-2 hours before the draw.

Finally, using the right sized needle is important. The needle bore (gauge) must be wide enough to allow the blood to flow in without breaking (lysing) and of the cells, but small enough to slip easily into the vein without cutting it or going right through it. One of the reasons an adult patient may be a difficult draw is because the veins are smaller than expected. In that case, the phlebotomist should be willing to try a smaller needle, say, a 21-gauge butterfly that is normally used for pediatric patients - and difficult-to-draw adults.

To reiterate:

  • Drink lots of fluids the day before and day of the blood draw.
  • Apply heat (compress, pad) to the arm and blood draw site for 10-20 minutes before the draw. Dress more warmly than you would ordinarily do for the weather that day, to keep your body surface and skin temperature elevated a bit. You can always shed the extra layer or two once your stick is over.
  • Ask the phlebotomist to try an alternate site, such as the back of your hand.
  • Relax! The more you stress about the lab visit, or anticipate a bad draw experience, or get up set while a bad draw experience is going on, the more difficult you will make things for yourself and the phlebotomist.


Additional Information and Suggestions

When the Blood is Harder to Draw

Making Lab Visits More Bearable For Children




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