Successful Strategies for Difficult Draws: Introduction (02:43)

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Objectives include: collect adequate blood volumes without compromising test results and ensuring the process does not affect the outcome. Difficult veins include: ICU/CCU, geriatric, neonatal, oncology, and bariatric patients. Patient or situational challenges include: bariatric, geriatric, combative or psychiatric patients, and edema.

ICU/CCU Patients (03:26)

Venipuncture sites are limited due to multiple infusion lines, injuries or burns, and edema. Solutions include: reduce number of required tests, consider feet or ankle draws, draw below discontinued IV, draw above IV, or perform a line draw. Learn how to avoid hemolysis.

Geriatric Patients (05:56)

Veins may be hard to find due to dehydration, patency loss, and low blood pressure; may be sclerosed, rolled, or collapsed; and may be prone to hematoma. Patients also may have limited range-of-motion. Learn about solutions for each of these scenarios.

Neonates (02:31)

Challenges include: hard to find veins, stabilizing arms, and obtaining adequate volumes. Solutions include: consider hand veins, use pediatric tourniquets, pre-warm the site, consider wet palpation, recruit an assistant, use a syringe with gentle pulling pressure, use pediatric tubes, or use microcapillary tubes.

Oncology Patients (00:56)

Chemotherapy is hard on vasculature and reduces patency. Challenges include: hard to find veins, rolling veins, collapsing veins, prolonged bleeding. Solutions to these are the same as for geriatric patients; blood may be drawn by port or vascular access device.

Bariatric/Obese Patients (02:32)

Vein palpation is the most challenging aspect of drawing blood. Solutions include: pre-warming, lowering the arm, distinguishing between veins and adipose tissue, proper venous constriction, taking the required time to find the vein, and longer needles.

Bariatric/Obese Patients Situational Challenges (02:29)

Situational challenges for bariatric and obese patients include psycho-social sensitivity and seating or positioning challenges. Psycho-social solutions include the RESPECT acronym: rapport, environment/equipment, safety, privacy, encouragement, caring/compassion, and tact. Seating solutions include bariatric chairs with armrests.

Geriatric Patients Situational Challenges (01:40)

Situational challenges for geriatric patients include: disorientation or cognitive impairment; hearing loss; demanding, ornery, crabby or stubborn behavior; and long-term care. Some facilities provide lists of patient names with photographs, for identification.

Combative/Impaired/Psychiatric Patient Situational Challenges (01:11)

For safety reasons, phlebotomists may have to assess appropriateness of drawing from drug addicts, cognitively impaired patients, or Alzheimer's patients. Solutions include: recruiting assistance with restraint and being prepared to quickly release the tourniquet, conceal the needle, and apply pressure.

Pediatric Patients Situational Challenges (07:20)

"APE" stands for approach, positioning, and equipment. Approach includes: dress rehearsal, distraction, breast or bottle feeding, parental involvement, reduced procedural cues, topical anesthetics, and human touch. Learn about sitting and lying restraint methods. Equipment includes: a 23-gauge needle and butterflies.

Edema Patient Situational Challenges (00:49)

Results drawn from an edematous limb may be inaccurate. If other sites are unavailable, solutions include: deep vein palpation, post-venipuncture pressure, and vein detectors.

Venipuncture Devices (00:21)

Vein finding tools include the AccuVein AV 300, Venoscope, Veinlite, and Wee Sight.

General Tips (04:19)

View a summary of “dos” and “don’ts” for drawing blood from patients with difficult veins or in challenging patient scenarios.

Credits: Successful Strategies for Difficult Draws (01:13)

Credits: Successful Strategies for Difficult Draws