Blood test vein issues

[Honeybun]

Pathologists find it difficult to get a good vein on me. There is one good one at the hospital who can get it in one shot but others including path centers have to use my arms or hand as pin cushions and I come out very bruised and the bruises take several weeks to go away. I don't mind the digging around discomfort, but my arms can look like a drug users. One young female pathologist had 6 attempts and was nearly in tears, she asked me to come back when there was someone else on.

Anyone else have similar problems?

Is the needle size used in transfusions similar to the size of the needle when you donate blood? I used to have a local because of my fine veins. Can you have one for a transfusion?

Honey

[Whizbang]

I don't know if this would work, but you might consider doing some curls with a 1.25 or 2.5Kg (3-5lbs.) weights daily, not a lot maybe 2 - 3 sets of 10 repetitions per day on eacch arm... It may help with your vascularity...

It might not help right now, but down the road it may make a difference...

Just my experience, as I have no issues with vascularity, as I've lifted weight since I was 16, and even though I don't do so much any more, it's made a difference for me...

[sbk007]

A nurse told me if you don't drink enough water, its harder to find veins.

[Sally C]

Hi Honey,
I am someone who has very small veins - I am a small person anyway - don't know if there is a connection. They always have to use a child's needle when I get my blood checked.
But after veins are poked enough they get scar tissue which makes it harder and harder to find a good vein.
I hope you don't anticipate having many transfusions or alot of bloodwork but if you do I highly recommend asking for a port. It's placed just under the skin and accesses the main vein into the heart. My husband has had over 125 transfusions along with the many CBC's, etc. since Dec., 2008. I can't imagine how he would have fared had he not had his port.
God Bless,
Sally

[Chirley]

Honey I used to take blood from people as part of my job. It's not policy in Oz to use small needles for blood tests because as the blood travels through a finer needle it can break the blood cells and cause false results. The smallest gauge should be a 22, ideally larger. (The higher the number, the smaller the needle)

There are things you can do to help. Drink some water (not a lot, it effects the results), keep warm (wear a coat and take it off at the last minute), walk briskly or jog to the collection centre (exercise dilates your veins), while waiting for your turn, hang your arm down and let gravity help pool the blood in your arm, take a heat pack with you and while you are waiting, place it over the area where they can usually find a vein. Sometimes lying down works.

I have a port and I love it but it doesn't give blood for tests but that doesn't really matter because generally blood collection centres are not permitted to access your port for a blood test anyway. Only Registered Nurses can take blood from your port and phlebotomists are not Registered Nurses.

There are little tricks that blood collectors can use to dilate veins but it depends entirely on the amount of experience, education and skill. When you find a good collector stick to them.

Chirley

[Glenda H]

Very interesting posts esp about drinking more water. Chirley I'll have to remember all your tips.
One "Collector" told me that my veins are starting to scar over so now I don't have any unnecessary blood tests. I always try and alternate the arms. I only had one time where the girl couldn't get any blood but luckily someone else was there who could.

[Sally C]

Hi Chirley,
Thank you for correcting the misinformation in my post. I didn't realize there were things you could do to avoid scarring of veins. I'm surprised health care providers here don't inform patients or use these methods to keep the veins from scarring as I know of situations where a Picc line has had to be put in due to scarring - my sister-in-law the most recent - last month.
I wasn't aware of how ports are handled in Australia. Here in the US my husband has had blood drawn many times through his port but as you said - only a nurse can access it. That has never been a problem though as there are always nurses available when his port needs to be accessed or flushed.
I hate to think that my blood work results are skewed because of small needles being used but that's the only way they have been able to draw blood from my small veins. What do you do when a larger needle can't be used?
Thanks again for the information.
Best wishes,
Sally

[Chirley]

I've had times when the patient has had to go to radiology and have blood taken under ultrasound guidance but that was rare. Occasionally I would do an arterial puncture but I avoided that as much as I could.

Generally, there are ways and means of getting the veins to distend but some of them required the patient to be a hospitalised patient and I didn't deal with outpatients much at all.

A GTN patch or paste over the vein, GTN sublingual spray, ventolin nebulisers, waiting for the patient to just finish a physio session (that worked a treat, patients get a good workout). Then there is the tried and true blood pressure cuff method.....NOT TO BE USED WITHOUT MEDICAL APPROVAL..place the cuff on the upper arm, using a manual BP machine, inflate until it increases to above the systolic pressure (highest number), this cuts off the arterial blood supply to the arm (see why you need medical approval) leave the cuff inflated for at least 45-60 seconds, deflate the cuff entirely, wait a few seconds for the blood to flood back into the arm then inflate the cuff again to just above the diastolic pressure (lowest reading), this cuts off the venous return, effectively trapping the tide of blood in the lower arm and distending the veins. I repeat....THIS IS NOT ADVISABLE FOR SOME PEOPLE.

When I'm an inpatient the nurses try to take blood through my port but 90% of the time it just won't bleed and they send for a phlebotomist to take my blood from my arm but I have good ante cubital veins so its not a problem. In the collection centres within the hospital they can't take blood from a port anyway and neither can the private Pathology companies in the community.

My port has been playing up lately and it has an increased back pressure which sends the IV pump alarm going. It's also getting harder for the nurses to manually flush. I've had this port for 5 years now and I'm wondering if its near its end.

Chirley

[Honeybun]

Hello

Are the ports like the ones they put into your arms? Are they uncomfortable and how do you care for them? How do you not knock them?

Sorry if these seem silly questions?

Honey

[Chirley]

Honey, the lines in your arms are usually PICC lines (peripherally inserted central catheter). They protrude from the skin and require weekly, if not more often, dressings. You have to be conscious of them all the time and wrap them up with waterproof plastic when showering. They are also prone to infections and blocking (clots etc).

Portocaths are inserted surgically either in radiology or theatre. They have a reservoir that lies under the skin of the chest wall with a line that feeds through the subclavian vein to the large vein at the entrance of the heart, the superior vena cava. (that's why it's called central). When you require treatment they insert a needle through the skin and into the port reservoir. Generally it's pretty painless but some nurses place an ice cube on the skin first to numb it and some use a cream called EMLA, that is a topical anaesthetic. But, generally you really don't need anything for the pain. It hurts less then a blood test or IV. The needle can stay in for a week at a time if you need it and its so comfortable that you forget it's even there. When you're not having treatment, the needle comes out and the only maintenance is a monthly or two monthly flush to keep it from blocking. Because it lies completely under the skin it has a lower infection rate than a PICC line.

Here is a picture of my port after having it for 5 years. Note the slight bruise where I had the needle in last week. It's placed just under the right collar bone.

[Honeybun]

Thanks for the explanation Chirley, especially the picture.

Honey

[Cheryl C]

I think it depends on what you are having transfused/infused as to how small a needle they can use. My veins look good but they "roll" easily. After a few nasty experiences one of the nurses in WA told me to ask for the yellow (child's) catheter, which is OK for Intragam (from plasma) but it might be different for red blood or chemo delivery? Some nurses are just better than others at inserting catheters too. In Australia there seems to be a policy that if a nurse doesn't get it in in 2 tries, someone else has to take over.

[Chirley]

Yeah, you're right Cheryl. IV cannulas can be smaller for different types of infusions. It's taking blood that requires a certain size needle.

My hospital had a policy that we could have three attempts at blood taking or cannulation but I never had more than two attempts.

I figured after two attempts that the patient had lost confidence in me and would probably prefer someone else to try and why would I want to put myself through the trauma of having a third attempt when I was obviously having difficulties through either difficult veins or just me having a bad hair day.

Chirley

[Cheryl C]

In one of the Melbourne hospitals my veins played up badly and they brought some kind of scanning machine, which shows the cannula going into the vein and this resulted in a successful insertion.

[slip up 2]

one thing we used to do....made a cotton bag about 12 " long 4" wide & sewed it down the middle....left an opening & put rice on both sides & sewed it up....into the microwave most clinics have them & place it on hand with a towel underneath for about 10 min before the blood draw.....worked for us....as others have said lots of water....

[Lulu]

I have hard-to-find veins and used to bruise very easily, it got so bad that sometimes bruises would pop up without having touched the skin, especially on my hands and feet.

Have responded very well to vitamin K supplements (check out the thread in Alternative treatments) - blood counts are almost normal and the spontaneous bruising has stopped.

My mother has a similar tendency (although does not have MDS) so in my case I think there is a genetic factor.

[Cheryl C]

You are right about the use of heat over the site before cannula insertion Slip Up 2. In my experience it really helps.