I just have to rant a little.

I had my pre-op testing done this morning. The nurse was very nice and competent. Until it came time for the blood draw.

I was a Paramedic. I used to start IV's bouncing down the road in the back of an ambulance with poor lighting. I was an ICU and ER nurse. I have worked with patients who are VERY difficult sticks with teen-einey little fragile veins. I wasn't a vein whisperer like some of the people I've worked with, but I was pretty darned good. Co-workers would ask me to take a look if they'd already tried a couple of times and hadn't come up with anything.

It's a skill, yes. But it is not rocket science. I hadn't started an IV in 20+ years when I went back to nursing school, and didn't get much opportunity to practice in school. But it wasn't very long on the new job before I got my groove back. Like riding a bike so to speak.

Basically, I have a lot of experience to back up this rant.

I have good veins. I was the one everyone wanted to practice on in Paramedic school (by the time I went to Nursing school, they'd stopped allowing practice on fellow students). They aren't all that visible, which is a little surprising considering my skin is incredibly light. But they palpate (finding by feel) VERY easily.

Drawing blood isn't nearly as difficult as IV sticks, for a bunch of technical reasons I'll spare you. If anyone misses my veins, either I'm dehydrated, or they need more practice. Blowing the vein, or going through it, that happens a lot. So I know exactly what the bruise pattern looks like for each. Blowing it can't always be predicted. Going through (transecting) it, that is usually sloppy technique with normal sized veins.

Lady COMPLETELY missed the vein in the bend of my elbow. That vein is a HUGE pipe, it's the go-to spot for most emergency medicine providers because it's a gimme. Mine is not overly large, but it's a good solid vein. She had the tourniquet on my arm a good 3 minutes trying to FIND the vein. She even admitted that she wasn't any good at feeling veins, that she needed to see them. (Gotta say, more times than not for whatever reason - skin color, scars, tattoos, hair, etc, you CAN'T see the vein. Anyone worth their salt doing IV's or blood draws needs to learn to feel them.)

THEN she managed to get the blood draw on the second stick in my forearm, but she went through the vein. I knew watching her she'd done it, but I wanted the draw over so I didn't say anything. The bruise tells the story though. And it'll still be there next week when I go in for surgery, since I bruise like fruit.

She's been a nurse for a long while, so it's not a newbie error. She just hasn't had the opportunity (or taken the time) to get trained in good technique and practice. But she does this many many times a day as a pre-op intake nurse. There are videos on YouTube teaching how to have better draw/IV technique, and tips and tricks all over the internet. I even have a half dozen on my Pinterest board.

Sticks, especially with the little needles for blood draws, don't hurt me very much at all. I didn't care that she took two sticks on me, it's an eh kinda thing for me. But the whole drive back to the office, I thought about all the patients who don't have good veins that she's sticking over and over. She did say she won't stick anyone more than twice (most hospitals have a policy of two or three sticks, then find someone else), so that's good. But some people find needles traumatizing and incredibly painful.

There is even technology that illuminates the veins for more accurate sticks, but it hasn't become widespread. Heck, I can go on Amazon and by a cheap-o vein illuminator for $30... won't be as good as some of the ones made for hospitals, but if I were as bad at it as she is, I'd do anything to get an edge.

I don't know what the purpose of this rant is... people who want to get better at blood draw/IV sticks generally can. She apparently doesn't. Which saddens me as a nurse and as a patient.

After they blew my hand, they made the switch to piggyback. But, I had to drink one dose as I didn't have IV access for a few hours between those forearm sticks...I'd rather blow every IV site on my entire body than drink another dose of that foul stuff. It was like drinking salty, weird, thick blood. I shudder to even think about it.

Gag. Yeah, when I was a rookie nurse, I gave that crap to a patient to drink, and she puked it right back up. Another nurse taught me to mix it in orange juice. Apparently it cuts down on the burning and makes it a little easier to get down and keep down, but I don't even want to know that that tastes like. Even the pills for K+ are awful because they are HUGE. And of course they take longer to take effect, and if your K+ is really messed up they need to correct it fast.

Hugs for having to go through that.

FOr the most part I have not had any issues with blood draws or giving blood. They have always found my veins on at most the 2nd stick. When I had my surgery, they kept giving me lidocaine or whatever to dull the pain of the stick for the IV. I had never had surgery before so I didn't know what to tell them. They'd give me a shot of pain killer and then try to stick me and my vein would shrink up! They stuck me 8 times to get me into surgery (the eighth time they didn't give me painkiller) and then I got out of surgery and my site had blown so they had to stick me again. (They didn't notice that my site had blown until I complained about the huge lump on my arm!) I told them not to give me the pain killer and it went in on the first try. The sticks weren't that painful to begin with so I would have been fine without the pain killer, I was more frustrated with the 9 bruises on my arms! I looked like I had been in a fight!

pam

But someone who only knows how to put IV's in AC's will mess up a forearm because it's less forgiving.

Yes, our radiographers are usually only placing needles into the AC - and most of them need to see the vein to place the needle. Most of them also fear the hand and the bigger needles that are needed for higher flows and would never use the forearm.

I always shake my head when they get one of the radiologists because the patient said "I'm getting chemotherapy", I get there and I see veins in which you could throw a needle into while still standing at the door of the room. They assume that all patients getting chemotherapy automatically have bad veins without even looking. Ugh.

FOr the most part I have not had any issues with blood draws or giving blood. They have always found my veins on at most the 2nd stick. When I had my surgery, they kept giving me lidocaine or whatever to dull the pain of the stick for the IV. I had never had surgery before so I didn't know what to tell them. They'd give me a shot of pain killer and then try to stick me and my vein would shrink up! They stuck me 8 times to get me into surgery (the eighth time they didn't give me painkiller) and then I got out of surgery and my site had blown so they had to stick me again. (They didn't notice that my site had blown until I complained about the huge lump on my arm!) I told them not to give me the pain killer and it went in on the first try. The sticks weren't that painful to begin with so I would have been fine without the pain killer, I was more frustrated with the 9 bruises on my arms! I looked like I had been in a fight!

pam

I refuse lidocaine for IV starts. My experience is that it makes the veins more liable to blow. I don't think it hurts bad enough to mess with it. I had an anesthesiologist ask one time "what, do you LIKE pain??". LOL.

But someone who only knows how to put IV's in AC's will mess up a forearm because it's less forgiving.

Yes, our radiographers are usually only placing needles into the AC - and most of them need to see the vein to place the needle. Most of them also fear the hand and the bigger needles that are needed for higher flows and would never use the forearm.

I always shake my head when they get one of the radiologists because the patient said "I'm getting chemotherapy", I get there and I see veins in which you could throw a needle into while still standing at the door of the room. They assume that all patients getting chemotherapy automatically have bad veins without even looking. Ugh.

Yeah, I understand that you need a big pipe for dye because of the pressure injector. Interestingly enough, I had a chance to chat with a rad tech one night in the ER and he said that his preference is actually high on the forearm, because the AC's are positional enough that sometimes a slight bend in the arm will cause the pressure injector to blow it, or push it off the hub which makes a HUGE mess. I started going down onto the forearm if I could find a vein that would take an 18ga or 20ga (our rads said min 20ga) and having fewer restarts on the CT table. Heck, I've had patients that I could put a 16ga in their hand.... not that I'd do that to anyone unless they'd bit me or peed on me already. Ah, good times, good times. LOL.

FOr the most part I have not had any issues with blood draws or giving blood. They have always found my veins on at most the 2nd stick. When I had my surgery, they kept giving me lidocaine or whatever to dull the pain of the stick for the IV. I had never had surgery before so I didn't know what to tell them. They'd give me a shot of pain killer and then try to stick me and my vein would shrink up! They stuck me 8 times to get me into surgery (the eighth time they didn't give me painkiller) and then I got out of surgery and my site had blown so they had to stick me again. (They didn't notice that my site had blown until I complained about the huge lump on my arm!) I told them not to give me the pain killer and it went in on the first try. The sticks weren't that painful to begin with so I would have been fine without the pain killer, I was more frustrated with the 9 bruises on my arms! I looked like I had been in a fight!

pam

I refuse lidocaine for IV starts. My experience is that it makes the veins more liable to blow. I don't think it hurts bad enough to mess with it. I had an anesthesiologist ask one time "what, do you LIKE pain??". LOL.

Now I know better, but at the time I was like, whatever you want to do. I have no idea!

@@theantichick

Reading your post about veins rolling and hitting valves really ticks me off. Everytime they miss, that is what I am told. My vein rolled or they hit a valve.

To be stuck 6 to 8 times to get an IV in is ridiculous. I know when I was fat, I was a difficult stick but now? I am half of what my body weight was and I can see my veins so if they really have technique to stop the rolling veins why don't they use it?

I am always very gracious about it but honestly after the 3rd or 4th time I start to get really frustrated. It's not like I don't warn them.

I mean really, during my one blood draw for adrenal testing, they had to go get some guy who had a vein finder that lit up my whole arm.

During that, I was absolutely NOT dehydrated like for surgery.

@@mngreeneyes

I definately learned to tell them not to use lidocaine because every single time they do my veins simply shrink away and they miss.

Unfortunately it took me to major surgeries to figure that one out.

Now I just tell them to go for it and instead of getting nailed 6,7,8 times, it only took 2 tries.

@@theantichick

This was a great post and I have learned a lot listening to you guys talk about this. I know when I have my 2nd plastics I will be making sure we don't use lidocaine and I will give them one shot at it before asking for someone else.

When I had my cervical fusion surgeries. There were 3 people on me at one time. They had stuck me 7 times and still did not have a vein. My surgeon walked in to do his check in and could not believe what was going on in there. He told them to go get the anesthesia nurse so we could move it along. I was seriously thinking they would never get a vein.

3 weeks ago when I had my Brachioplasty, they stuck me twice and finally got a small one going enough to knock me out. While I was out, they put one in my foot. That was weird but I am thankful I was put to sleep for it only because anyone touching my feet makes me jump. LOL!

@@theantichick

Reading your post about veins rolling and hitting valves really ticks me off. Everytime they miss, that is what I am told. My vein rolled or they hit a valve.

To be stuck 6 to 8 times to get an IV in is ridiculous. I know when I was fat, I was a difficult stick but now? I am half of what my body weight was and I can see my veins so if they really have technique to stop the rolling veins why don't they use it?

I am always very gracious about it but honestly after the 3rd or 4th time I start to get really frustrated. It's not like I don't warn them.

I mean really, during my one blood draw for adrenal testing, they had to go get some guy who had a vein finder that lit up my whole arm.

During that, I was absolutely NOT dehydrated like for surgery.

Some people's veins are truly harder than others. You may have something going on that makes you truly a hard stick. I've run across a couple of people in my career as a Paramedic and ER nurse who I just COULD NOT trap their vein. I'd have to feel your arm to be able to judge.

It also ticks me off, because there are nurses and techs that are just flat out bad at the skill, but instead of learning how to get better, they tell the patient that it's [fill in the blank] of the patient that's causing the problem. So there's lots of patients out there who are NOT hard sticks who think they are. When they go in, they tell the nurse "I'm a hard stick" and it actually sets the nurse up with the expectation that they're hard and like many other delicate skills, confidence is everything. So it becomes a self-fulfilling prophecy, and it harms patients. Anything that harms my patients, frankly ticks me off.

Try not telling them next time. Don't say anything other than if you have a place you don't like being stuck like your hand. If they specifically ask, shrug and say "I'm about average, probably." See if it changes the dynamics.

And if you truly are a hard stick, you can request that they use a vein finder or a sono site right off the bat. Sono sites are only for IV's, so it won't help with blood draws. If they only have one nurse trained for sono site (for us it was the shift supervisors who were trained), it may increase your wait significantly, and in an urgent situation you may not be able to wait. Cheap-o vein finders are about $30 on Amazon. If I was a particularly hard stick, I'd bring my own.

If you have a chronic condition where you have to get blood draws all the time, find out who's the best tech they have and specifically request him/her. We had frequent flyers at the ERs where I worked who had 2 or 3 preferred nurses or techs who had a history of good results, and they'd ask for them by name. If we could, we'd try to accommodate.

I refuse lidocaine for IV starts. My experience is that it makes the veins more liable to blow. I don't think it hurts bad enough to mess with it. I had an anesthesiologist ask one time "what, do you LIKE pain??". LOL.

Ok, I'm dumb and clueless here - what's this about lidocaine and IV starts?

I refuse lidocaine for IV starts. My experience is that it makes the veins more liable to blow. I don't think it hurts bad enough to mess with it. I had an anesthesiologist ask one time "what, do you LIKE pain??". LOL.

Ok, I'm dumb and clueless here - what's this about lidocaine and IV starts?

Some places will offer you lidocaine to theoretically make the IV start hurt less. They take a teeny teeny needle and inject lidocaine (which is a topical anesthetic, deadens the nerves) under the skin into the tissue around the vein. It's basically the same thing they do before putting in sutures for a deep cut. Then they start the IV. Anesthesiologists in particular love this, I'm not really sure why. We never used it in the ER.

I don't have any studies to back it up, but in my observations when I was doing surgical rotations, as well as my own surgeries in the past, lidocaine tends to make the veins easier to blow. I also heard this from a number of Paramedics back in the day.

Also, I personally feel that the lidocaine burns worse than the IV start itself. So I'd just as soon do without it. Though you have to watch them... I had one start at me with the little needle, and if I hadn't been a medical person I wouldn't have known what he was about to do. They are supposed to tell you before they do it, but sometimes they miss it.

Now, they also have a new thing that they spray on the top of the skin. That started in pediatric hospitals and has become more common. I had them try it on me with my EGD a few weeks ago, and I didn't see much difference in pain with the IV start, but there's nothing with that which would mess the IV start up, that I can see. So if they offer that, you may want to try it.

I had a chance to chat with a rad tech one night in the ER and he said that his preference is actually high on the forearm, because the AC's are positional enough that sometimes a slight bend in the arm will cause the pressure injector to blow it, or push it off the hub which makes a HUGE mess.

Yes, I don't like the AC myself that much when it comes to injections. The veins do (usually) not blow but the automatic injector regulates down the pressure rate and flow rate when the needle doesn't work properly. However, for cardio scans and PE scans the AC is a good place. The patient mustn't bend the arm though.

In my experience the veins on the soft inside of the forearm seem to be more prone to blowing when it comes to higher flow rates but maybe I'm making things up in my mind, lol. In general I have to take what veins are left anyway. Usually the patients have already been sticked multiple times (several IV lines over the course of the hospital stay, multiple blood drawing).

Some places will offer you lidocaine to theoretically make the IV start hurt less. They take a teeny teeny needle and inject lidocaine (which is a topical anesthetic, deadens the nerves) under the skin into the tissue around the vein. It's basically the same thing they do before putting in sutures for a deep cut. Then they start the IV. Anesthesiologists in particular love this, I'm not really sure why. We never used it in the ER.

Never have seen this. I mean like - never. We use Xylocain before we insert sheaths of course but not IV sticks to administer contrast agents. I also never seen it at another hospital so far.

Sometimes when it comes to little children they put a kind of cream on the skin that is supposed to dull the pain a bit. Don't know how good that works.

But if I had a nickel for every patient who told me they were such a hard stick, and I had zero trouble getting it on the first try, I'd be able to buy a car.

Me, too.

@@summerset

I lived in Minnesota and now live in Wisconsin. I swear with the exception of my Brachioplasty 3 weeks ago, every single time I have had to have an IV for surgery specifically, they use a small injection of lidocaine. It NEVER goes well for me. It always blows the vein so now I tell them not to bother. I would rather get stuck once or twice rather than 6 or 8 times when they tried it.

I have never had anyone try it when in an emergency situation with me in an ER or an ambulance. They always go right for the vein and can usually hit it in just a couple of times. I can handle a couple......it's the many that come with surgery and most of the time it is because I am so severely dehydrated.

When one drinks a minimum of 64 oz and day and then you cannot have anything for at least 12 hours, you get dehydrated.

Recently my last few surgeries they requested nothing to drink 4 hours before and that has seemed to help.

@@theantichick

I am going to take your advice and say nothing and see what happens. I will tell hubby to keep quite too. He is usually the one to say anything because he hates seeing them stick me so much and would rather they got the anesthesia nurse right away.

It is funny because when they do get that person whoever it is, they can usually get me on the first try.