By David Tignor and Rob Carter, RN
I can’t imagine there are many people who actually enjoy having their blood drawn; however, to maintain good health, routine blood draws are often necessary. This article reviews ways to help ensure blood draws are as easy and trouble free as possible.
As a person with severe hemophilia A, routine labs and blood draws are a part of my care routine. On a few occasions, I have experienced bleeds in the antecubital vein (the area in the bend of the arm) as a result of having the venipuncture. These bleeds were most likely due to one or more factors: the gauge of the blood draw needle, the unavoidable movement of the needle in the vein when collection tubes are placed and removed, how the needle is withdrawn from the vein, or even from the post-draw bending of the elbow, rather than keeping it straight, to place pressure after the needle is removed. If you live with a bleeding disorder you may have experienced similar issues. Luckily there are steps you can take to minimize negative effects from an infusion or blood draw.
If you have a bleeding disorder, chances are your veins are accessed on a more frequent basis than most individuals’. As such, it’s important to keep your veins happy and healthy. One great way to start well before an infusion is needed is through diet and exercise! Regular exercise will help your veins grow larger and stronger.
Additionally, following a healthy diet will ensure your veins recover quickly from frequent pokes and prods. Dietary suggestions include food rich in bioflavonoids (natural antioxidant compounds typically found in fruit), vitamin C, antioxidants, and fiber. This will help the elasticity and strength of the vein walls and valves. A healthy diet, plenty of exercise, and staying properly hydrated will have a positive impact on your veins and overall health.
We all know that our annual HTC visit will typically require labs to be drawn. Many hospitals and clinics will have a phlebotomist available to administer the blood draw. A phlebotomist is an individual who is trained and certified to draw blood. Typically, phlebotomists will use vacuum-sealed collection tubes in conjunction with an adapter/holder and a hypodermic needle. The size of a needle is determined by gauge numbers, which refer to the diameter, technically known as the “bore” of the needle. A larger gauge number indicates a smaller needle diameter or bore. For example, the bore of a 23-gauge needle is smaller than a 16-gauge needle (often used for blood donations). For adults, the most common blood draw needle size used to draw blood is a 21-gauge.
There can be a higher risk for those living with a bleeding disorder to have bruising, hematomas, or even a bleed at the venipuncture site when blood draw systems use a larger needle.
An alternative for preventing trauma to your vein is to use a butterfly needle. I have found that requesting a smaller gauge butterfly needle for blood draws has made a huge difference for me. A 23-gauge is the size typically used on children. Anything smaller, the needle would need to be in the vein too long and can cause hemolysis, which is the breaking down of red blood cells causing the release of hemoglobin into the surrounding fluid and may result in a ruined blood sample.
Your phlebotomist can be asked to use a 23-gauge butterfly needle and most of the time they will comply without any issues. However, sometimes they have to follow a certain protocol when drawing blood and are allowed to use the smaller 23-gauge butterfly needles for children, or to control stress placed on small or fragile or rolling veins. If you are an adult and would prefer a smaller needle for your blood draw, talk to your hematologist or doctor and ask them to write, “Please use 23-gauge butterfly needle” on your blood draw orders. This will let the phlebotomist know there is a valid reason an adult with seemingly typical veins requires a 23-gauge butterfly needle for the venipuncture.
Especially for children, a numbing cream can be applied to the venipuncture site to help alleviate the pain of the needle stick. This will require time for the cream to work. Also, an excessively tight tourniquet is not needed and may cause bruising on tender skin. Placing the tourniquet over the sleeve instead of on bare skin can help with this.
It is important to educate your phlebotomist about your bleeding disorder as it relates to the draw and advocate for your specific needs. In my case, I have pretty good veins and some phlebotomists do not understand why I am requesting a 23-gauge needle. I found it helps to have a quick conversation before the blood draw. Educating them about your condition and the steps that can be taken to minimize any issues is a great way to ensure a positive outcome. If you are not comfortable with their level of experience, you have the right to ask for another phlebotomist.
Phlebotomists have a demanding job and are sometimes rushed to get patients in and out of the lab. Sometimes being in a hurry can result in human error when extracting the needle, such as applying pressure while the needle is still in your arm instead of applying pressure after the needle is completely removed. This can cause unnecessary trauma in the vein. Remind the phlebotomist to remove the needle completely. Once gauze and a bandage are placed over the injection site, place gentle pressure for at least 5 minutes while keeping your arm straight. Bending your arm can cause the blood to pool resulting in a bruise. If certain adhesives cause skin irritation, be sure to remove the tape within 20 minutes. A Coban wrap instead of tape may also be requested.
Healthy veins are important for everyone, but for those living with a bleeding disorder, taking additional steps is key to preserving the access sites we depend on. By eating healthy, staying well hydrated, exercising, and working closely with your physician and the phlebotomist conducting blood draws, you can greatly improve your experience when it comes time to do labs or receive an infusion.
Tips for a Successful Blood Draw
Hydrate – Most important for a successful blood draw is to be hydrated. Drink plenty of water before your appointment to help dilate the veins. Avoid nicotine (cigarettes, vapes, chewing tobacco) and caffeine (sodas, coffee, energy drinks). These will constrict the veins making the draw more difficult.
Warm up – Being warm increases the blood flow and makes the veins easier to find. Take a warm shower before your appointment and keep yourself warm in cold temperatures. Do a few jumping jacks or rotate your arms around to get blood flowing. Hold a warm compress over the injection site for 15 minutes.
Use gravity – Let your arm hang down to increase blood flow. Make a fist or squeeze a stress ball. No need to pump your hand since doing so does not increase blood flow, especially once the tourniquet is on.
Relax and breathe normally - Being tense can lead veins to constrict. Don’t watch the venipuncture if it bothers you or makes you feel dizzy.
Sit still – Try to avoid making it more challenging! Hold a small child in your lap, and use distraction.
Speak up – If you’re prone to feeling dizzy when having your blood drawn, let your nurse or phlebotomist know before starting.
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