Wednesday, September 04, 2013

Patients with "Bad" Veins Can Prepare in Advance for IV Starts or Blood Draws

          Frequently I have cared for patients with challenging veins.  I prefer to call them "challenging," rather than "bad."  No one wants to be poked and prodded to have their blood drawn or have their IV therapy initiated.  It can be both painful and scary, as a patient, being advised that your veins are "bad" can actually be taken as an insult.  The patient may just feel that the nurse is "bad" at doing the sticking.  To  me, psychologically, it's better to begin with the right terminology to put the patient at ease.

          I have some techniques that have allowed me to have an extremely high rate of IV start success with challenging patients, but as a patient--there are some things that you can also do.  Here is my advice . . .

1.  Push fluids 24 hours prior to your blood draw or IV therapy.  Of course this is not always possible.  But many patients DO know that they will be needing a blood draw or a scheduled infusion on a regular basis. In such cases, really pushing oral fluids the day prior to the IV stick will make a difference.  UNLESS you are on fluid restriction, for some reason, try to take in at least three full glasses of water the day prior.  That extra fluid can make a wonderful difference in plumping up challenging veins.

2.  "Dangle" your hand or arm prior to the IV stick.  Gravity is your friend when it comes to dangling your hand or arm.  Instead of sitting with your hand or arm on the armrest or your lap, if you lower your arm straight down at the side of your chair while waiting for the nurse or technician to assemble the equipment, your veins in that extremity will be a bit plumper, due to gravity pooling some of your blood there.  This can really help.

3.  Apply heat to your veins. Nurses and phlebotomists know that heat applied to the skin above the vein will dilate the vein, making it plump up with blood and helping you have an easier stick.  However, you can't rely on a heating pad or any such helpful device actually being available to the staff.  (I have seen some really creative ways of trying to "make" some applied heat--not always a safe thing to do).  What you can do as a patient is use a hot water bottle that you have prefilled at home--keep it applied to your typically "best" veins to encourage a successful experience.  As an infusion nurse, I always had a heating pad tucked away for a particular patient--or on a day when the weather was so cold that "everyone" seemed to have hiding veins.  Again, that is not something you as a patient can depend on . . . Do ask if there is a blanket warmer available wherever you happen to be (ER usually has those)--wrap a pre-warmed blanket around the arm, and you can get some very good results.

4.  Suggest a vein, but allow your nurse to give a professional opinion.   When I get blood drawn, I usually point and say, "Right there."  But I have great veins, so no problem.  When an experienced provider starts looking at your veins, they make pretty quick judgments about where to go for the IV stick.  I have had situations where I've made my decision and have my needle poised, only to have the patient pipe up with, "You'll never get it there, no one ever does."  Well, actually I may well get it there, but I want every patient to have the right to tell me what works for them--but I'd prefer they tell me right up front.  

5.  Just breathe.  Some patients are better than others about relaxing during their venipuncture.  Some patients go so stiff and tense when the needle touches their skin, that it feels as if their arm has turned to stone.  When very anxious, doing some deep cleansing breaths (getting oxygen to the brain) can only help.  The easiest way to to this is breathe slowly and steadily IN through the nose for a count of 5 and then slowly releasing the breath--on another count of 5.  

6.  Be cautious with the IV.   It seems ridiculous to have to recommend caution, but I have seem some patients who have a hard time with the IV start, soon after start rummaging through their purse and dislodge the catheter!!  Please, don't be that person.  I'm not suggesting you sit completely still--just suggesting that you are extra careful for the duration of your infusion.

Later I'll post some of my favorite tips for the nurse starting an IV on a patient with challenging veins.

If you have a tip to share for patients with difficult veins--please feel free to share that in the comments section below.


Terri said...

Thank you for posting these tips/ideas to improve weak/challenging veins. I am already needle-phobic from a horrible experience near my 17th birthday. 19 unsucsessful attempts 1 right after another by several hospital staff was my trigger.
I am currently in treatment requiring IV and as they continue, the IV insertion attempts become increasingly painful to the point of screaming. We tried 14 times this last treatment each time the intended vein collapses leaving gnarly bruises from wrist and back of hand up, including the final stick, up where arm meets my body just in front of the arm pit. Both arms bruised top to bottom, top & bottom (if you get me). I will be most definitely trying at least a few of these before my appt Wednesday. I will try and post another comment after I have given these a good run and let you know how they worked for me if you'd like.
Thanks again, so much

Carolyn Cooper, MPH, RN said...

HI, Terri!! I am so sorry to hear about your current situation and the difficulty you are having. If you are having treatment requiring frequent IV starts, and your veins are really suffering, a temporary line is always worthwhile for your doctor to consider. A PICC line (peripherally inserted central catheter) is helpful when the treatment goes on for a period of weeks. An infuse-a-port, port-a-cath, can be used for months to years.

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