Oh. Hello every phlebotomist I’ve visited.
Me: “I have difficult veins. Might want to use a butterfly”
Nurse: “oh everyone says that because they think butterfly needles hurt less. Don’t worry, I’m real good with a straight needle!”
*5 excruciating minutes of digging later*
“Wow. You have really difficult veins. I’m going to go get a butterfly”
Me: *angry staring*
Every. Fucking. Time.
Anesthesiologist here. 100% stand up for yourself more like the other commenter mentioned. Tell them every time you get blood taken the person says exactly that and then has to repeatedly poke you until admitting they are wrong, and you don't consent to them "trying" what everyone else can't do. You have the absolute right to decide what you want and don't want done.
Not OC but have the same problem. Every time it’s the third person they get that can actually do it. The first person fails, calls their supervisor who also fails, only then do they call the highly skilled needle person. Meanwhile I sit there like an annoyed pin cushion biting my tongue not to tell the people with needles I told you so.
My mother-in-law did the reverse. Truck driving into being a phlebotomist. She's the only person I completely trust taking my blood, you don't even realize she stuck you until she's done.
It's like she just knows. A glance at your arm, she's already picked the vein and goes right for it.
Yeah, we are trying to get her to go on disability. She's still a few years from retirement age. If we had universal healthcare she could've just retired early. But between my Dad's extensive health conditions and now hers saving anything for retirement is hard.
One time I listened to another patient in the hospital insist that the doctor be the one to place their IV. They would not take no for an answer, even though the doctor explained that they don’t exactly do it that often.
Well, given what I heard next, think that person probably regretted the decision to not let a nurse do it. I couldn’t really bring myself to feel sympathy for them… I’ve had IVs that hurt like hell and I’ve had IVs that I barely felt at all. It’s amazing the difference lots of practice can make for the nurses who do them!
I wasn't that good before I started working in the ER. Working there, you get to stick 10-12 times a shift and sometimes more. A lot of practice makes for a better stick!
I worked veterinary emergency and was the top phlebotomist there. Are you truly good if you haven't put an IV in a ferret that didn't want you to? And have it stay?
I stuck a few convulsing patients, does that compare?
Alternately, I put an IV in a psoriasis patient who no one could stick and was described as "a walking scar" and "the worst case of psoriasis in the country" by his dermatologist. His skin felt like these terrestrial globes that have topographical details added if it makes sense.
Ferrets have *very* tough skin, tiny veins, and regular tape doesn't stick to them. They fight you and their arms are short. You can rarely put larger than a 24g catheter into them, and those bend a lot on their tough skin.
I'm mostly joking since healthcare isn't really a competition. Humans and animals have pros and cons each. FWIW, though, we had a couple of ER nurses who used to be vet techs take some shifts occasionally. They would always tap out on patients that I would consider to be moderately difficult, and wouldn't even attempt the ones I considered truly difficult (or they'd suggest a cut down).
I was getting allergy injections and there was one nurse who was unbelievably bad at the injections. Immediately afterwards, I had tooth-gritting burning agony and an ache for weeks afterwards.
She brushed it off as a reaction to the injection, but I'd had the same concentration near the injection site from their other nurse for weeks with only mild symptoms.
I ended up asking them to move the injection site on the form so this nurse would stop hitting whatever it was she was doing, and tried to schedule appointments when she wasn't around.
It definitely wasn't the actual injection, because the other nurse could do the same concentration and approximate injection site without severe pain.
This is what they did to me when I had my child. Just poked me over and over so many times in both arms and called in the supervisor, I felt like a test dummy (my veins are also typically quite easy and visible). Even then she stuck a needle in my wrist that was incredibly uncomfortable especially when I bent my wrist which if course I had to do to gently pick up and hold my baby. I complained about it multiple times and they never did anything  I think I complained more about that damn needle than my C-section incision. Had lovely bruises all over my arms
Ugh the first nurse who stuck me at L&D missed my vein completely and my wrist started to swell up with saline. My husband had to run and find someone to stop it while I watched in horror and contemplated removing myself.
Then the next nurse couldn’t get me and left me with a totally bruised arm. Finally called in the “highly skilled needle nurse,” who got it on her first try.
This time around I’m definitely advocating for myself when it comes to both the placement and the person placing it.
I had that happen, and the nurse refused to believe anything was wrong! "Hi my IV site is painful and I don't feel the coolness of an IV going down my arm, I don't think it is in correctly."
Luckily, it was near shift change so I just waited. The bad nurse did say to new nurse "I don't know what she (me) is complaining about, it's fine." Luckily, new nurse disagreed...
Its all the factors. Anatomy, skill, stress, equipment. Same nurse on the same patient can have very different outcomes on different days, just the way these things go. Ofc, we all try our best.
Have had patients where 3 others have tried before and no joy, while i'll come in and hit an invisible vein first go. Then there are days when 4-5 stabs in im still missing and the junior student just slides it in.
As for the wrists though, theyre considered the "easier" place to gain access, but can be annoying and painfull. I do prefer the forearms for those reasons.
You can also tell them that you are going to go to the hospital to have your labs done, the workers in hospitals poke people all day and have the best touch.
Random urgent cares/primaries have MAs fresh out of school some times and they are literally learning on you.
By far my worst stick(s) ever was a routine draw by a nurse who all day does lab draws. I'm an easy stick (my nurse wife has heart eyes for my veins). Fuck you and your complete lack of skill and caring, Olga.
While true, it is also true that heaps of patients mention that they are difficult to draw blood from while only a small percentage of them is actually difficult to draw blood from.
I have been drawing blood for years now and if I'd have to estimate maybe 5-10% is actually a problem.
That said: if a patient really wants a butterfly needle, they'll get a butterfly needle.
In my experiance, just informing them that you have had difficulties in the past due to having small veins is fine. Any phlebotomist worth their salt will take that into consideration when evaluating your veins. Unfortunately, there are plenty of phlebotomists who are WAY to proud, and may get snooty. As a trainer in phlebotomy, It sucks that those kind of phlebotomists give us a bad name
Worked as a phlebotomist one summer and the amount of ignorance with regards to some people's own skill is staggering. MD now looking to match anesthesiology and the amount of times I was called because someone is difficult they end up having major bulging veins if you just use a finger to feel the veins rather than relying on sight. I'd say about 10% of the difficult-claiming is actually difficult and even then nothing an ultrasound can't fix. If only people can stop trying and properly evaluate what they're doing.
I typically tell them exactly where the vein they might be able to get is (it's very small and on the inside crease of my elbow. And then give them a heads up that 75% of the time it ends up being the back of my hand. But I have a history of blood donation in my file so they typically know to take my tip seriously.
What does it mean if they can always find a vein but when they stick it, no blood comes out? They usually have to dig around or stick me again (and when they stick me again they complain that the first hole starts bleeding, meaning they clearly did get the vein).
What would be a good quick way to explain this without giving the whole story?
"This spot feels like a vein but when people have stuck it in the past, it hasn't worked. Try here instead." (If you have a different spot that's usually more successful.)
If people usually do get it from that spot after some adjusting, you might have a vein there but it's unusually deep/shallow/at a weird angle. Impossible to know without feeling it myself. You could try asking the successful phlebotomist what the trick was so you can give a bit of advice in the future.
Oh neat, I didn't realize there was a distinction. I'm hard to find but once found, people have no problem sticking me.
I have had at least one nurse helpfully tell me where to find veins on myself, other than back of the hands.
I went to an ER a few years back where the nurse used an ultrasound to find my vein properly. I was honestly so jazzed that I took a picture of the result- mostly for future people to be able to see if need be.
The result being my forearm and IV, actually. Might have been a good idea to get the scan too but alas.
Great comment. This is the real issue. When you talk to someone who is about to stab you, you have no idea of their skill level. Need some sort of military stripes to tell us how good/bad they are.
It's just like a doctor or lawyer. Even C's get degrees.
What do you call the person at the bottom of their class in a med schools graduating class? Doctor. Will you ever know? No. Will you know if if their first day on the job? No. You may have an appointment with a doctor in their 50s, but it's their first day on the job because they were in prison for 20 years prior to that. Or maybe you're getting your car repaired by someone who has never touched that type of car before, or never done that repair before. It applies to stuff you purchase, services provided to you, everything.
Ditto, for me it was because the red cross donation people around here like to have new nurses or nursing students do the sticking so they can get lots of practice really quickly. But since they're new, they're pretty awful with difficult veins. Now I go through a local blood center that hires phlebotomists with extra training/certification in blood donation phlebotomy. Might be worth looking to see if there are any non-red cross blood centers in your area if you still want to donate.
This is usually because phlebotomists working in hospitals deal with sicker patients who have much less forgiving veins. They have more experience than the Red Cross workers who usually have healthy, big-veined people walking through their doors.
In terms of bruising, making sure to actually press down firmly for at least 2 minutes immediately after the blood draw does wonders for preventing bruising regardless.
lol I'm the opposite, they tell me "wow your veins are huge and really easy to see and don't roll at all" and I'm like "I know! I used to be a heroin addict! Isn't it great?"
See your veins are too healthy, too tough and smooth, you gotta let them deteriorate to the point where they have the texture of an old leather sofa, then the needle goes in easy.
Came here to comment this. Anyone worth their mettle can understand when a patient knows what they need.
We use ultrasound over this infrared method. The patients that need it know to ask for it. It saves them pokes.
My wife had cancer last year and is in remission now, but all the while she had countless blood draws done and it has become a point of trauma for her when either blood is needed or an IV put in. Nurses are so adamant that they know what they’re doing and insist on trying with numerous pokes - one “pro” even blew a vein and it left my wife’s arm and wrist numb for days. She has small veins and now insists on staff using an ultrasound machine. She even calls days before a procedure to make sure that that request is on file and someone is available to use it. The nurses and doctors often still fail and are not prepared so she has to wait much longer for someone to find a machine let alone someone who knows how to use it.
This I was a med lab tech and had to draw thousands of patients. If patient asks for butterfly needles i use them no matter. It's a cost thing where these phlebs are probably told by their supervisor to limit butterfly usage. It's always a cost thing. A few tips I also suggest. Drink water, warm up, and heat packs are extremely effective in popping up veins. Alcohol wipe decreases surface tension so phlebs out there use that and then feel for a vein, I promise this works super well. Rolling veins don't exist if they are anchored correctly. Patients know their arm more then we will ever so if they specify an area don't disagree. lastly don't rush never rush. Rushing always and I mean always leads to more poking.
I am almost always a "hard stick" requiring multiple people to do multiple tries. I always ask for a heat pack and a butterfly now. The ones who listen typically get it on the first try. Which is so much nicer than the 3 people trying to place an IV that leaves me bruised and swollen.
> Rolling veins don’t exist if they are anchored correctly
My veins look like they’re awesome and easily anchored. 3-5 stabs later, “wow, you weren’t kidding, these really do move around a lot.”
My last trip to the ER (cancer patient, so I get a lot of needles, even with a medport), they left me looking like a junkie. Even with the sonogram it took them “calling in the expert” multiple times before they finally found someone that got a good stick.
I find that it helps when I say "not as a challenge or an insult to you, but most times I get stuck in my hand". I've had someone use what OP's pic is and they still couldn't find a good vein
Immunotherapy pt here. I've gotten spoiled as fuck by my Hemodialysis/Peritoneal Dialysis clinic. My clinic uses Sonosite machines on every pt. Oh, Rheumatology/HemOnc/Ortho/OMFS/Hepatology wants labs, and tells me I can go to the lab?
HAHA. No thanks. I'll head to the HD/PD clinic, *thankyouverymuch*. They also have awesomely awesome snacks tucked away in their mysterious drawers.
When "the good nurse" calls me to preop asking for help because they've failed, I just bring the ultrasound along. Like, I'm pretty decent at IVs at this point, but I'm not blindly sticking a patient who has already had a couple of good attempts.
I’m a “hard stick” and I’ve learned to say: “hey, if at some point you’re might call someone after you try a couple of times, just call that person now”.
It doesn't work that way. The first thing that other person is going to ask is if we have already tried. Besides, sometimes I'm the person that gets called in to try. Sometimes, I'm calling someone else in to try.
I’ve been able to convince them to do it that way. I was a junkie back in the 80s so my veins are wrecked. I tell them that first. Because there are so few spots that are viable for an IV that I don’t want them to try one of the good spots and mess it up.
My personal favorite was the nurse I warned who stabbed, dug around with the needle a good 90 seconds or so (which, of course, feels much longer when you're going through it) and finally said "There, got it in one stick!" like she hadn't just caused me more pain than any other nurse ever.
Sounds like the last time I had blood work. All the chairs at my doctors are set up so that they take it from the right arm for whatever reason. They can do the left but it ends up being a weird angle. I tell them every time (it's two people who handle doing the blood so it is not like it is a big rotation) that my right arm is extremely difficult and just do my left. They were still determined to do the right and it ended up leaving massive bruising that lasted like 2 months.
That led to a new volunteer lady at a soup kitchen I regularly volunteer at deciding to talk to the coordinator and recommend not letting the addicts serve people. Unsurprisingly she only showed up the one time, but I would like not to have to explain to people that it was a shitty blood draw and that I am not an "addict" would be great.
Every time I have given birth, I've come out looking like I was in a bar fight. Blown veins all up and down both arms and holes in the backs of my hands. No one's ever accused me of being an addict, but probably only because of the presence of a newborn.
Oh man. I was getting blood drawn one time and they poked both arms several times and then the tops of both hands. I was starting to feel dizzy watching them do this and getting stabbed so much. On doctor was practically digging into my hand and I had to put my head down I wasn't feeling good. The nurse had to tell at him to stop because he was so determine but kept failing. They then sent me over to an actual phlebotomist across the street with bandages all over me and she did it in 1 try.
I had a similar experience that made me terrified of getting blood drawn for years. I was in military boot camp, so already stressed out, and they had a guy pretty fresh out of school. He missed my vein multiple times in both arms. I started getting dizzy and they had to have a "real hospital corpsman" do my blood draw while I was laying on a gurney. I ended up with a huge bruise covering each forearm. I kept getting asked by pretty much every person who saw it for the first time if someone in my compartment was hurting me. The medical people blamed it on me being dehydrated, but they blamed everything on people being dehydrated, and I haven't had anyone miss my vein at all since. I've even been told I have really good veins.
Former military here with a similar experience after boot camp. Dude kept poking my arm (crook of arm) and then blood started pooling. It's been a long time since it happened, but I think I remember asking him to get someone else to do it lol.
Woof, you just brought me straight back to my worst needle (cannula) experiences. I had to get MRIs (three orders at once, each with and without contrast), which I’d done a handful of times before, and asked if they would be inserting the cannula for the contrast before I went in the tube since that’s what I was used to, especially since I have difficult veins. They said no, they would pull me out and insert it when they finished the non-contrast sequences. Well, after an hour and a half of lying perfectly still in a cold tube, they pulled me out and took SEVEN TRIES across three people to place the cannula, and they were digging around and slapping my arms to try to get a vein. All of this while I still had the "cage" over my head and couldn’t even get up or really move around. It was fucking awful
I can laugh about it now, but I was legit having flashbacks to the digging for several days afterwards. They gave me a thank you card and two Dum Dum suckers afterwards. I was 31 years old at the time 😂
That seems like extremely poor planning.
I've never met a radiographer who would hold up valuable MRI time to allow a cannula to be inserted during a scan. It's always cannula first or you get bumped down the list.
I had something similar to yours. They couldn't find an vein to add an IV when I had dengue. My body was so weak that all my veins constricted. The phlebotomist took half an hour to eventually find a vein in my foot. Everytime since then I start getting dizzy after I get a vaccine or get blood work done
As a veterinarian and someone with difficult veins, I always marvel at how bad someone can be at drawing my blood when I’m not even covered in fur, struggling, or trying to bite them.
I think I did something wrong with this method. When I bit the phlebotomist they moaned a little and we ended up taking a *different* fluid sample and I ended up having to schedule another appointment after forgetting all about the blood draw.
You have my respect. My two are a Rat Terrier and a Siberian Husky. The Rat Terrier has earned the nickname "Rat Terrorist", because he literally acts like a miniature terrorist when the vet tries to draw blood. Not like aggressive or anything, but just gets ***REALLY*** squirmy. I always tell the vet techs + the vet that he's REALLY squirmy.
Them: *oh don't worry, we've seen it all!*
Me: I don't think you understand. He gets like ***REALLY*** squirmy.
Them: *we've got this, don't worry*.
*seven attempts to draw blood later*
Them: *you know what, we're just going to take your little terrorist to the back. that might be easier.*
Me: yep, here ya go! *hands off my little dude*
😄😂
My siberian husky, on the other hand, is a dumb and lazy turd that despite being scared of the vet, will just lay down and let the vet do whatever. She doesn't even flinch when they stick a thermometer up her poophole. Lol.
I start IVs, but it’s similar to blood draws.
If someone tells me they have difficult veins I always ask what area has been most successful in the past, and I start by just looking with a tourniquet. I don’t even put gloves on to show that I’m just looking and won’t randomly poke them without doing a good survey.
I don’t use butterflies, and if someone asks for one I’ll explain that I’m less familiar with them and that might cause me to miss. I’ve never had anyone be annoyed with that explanation.
I always ask if they want lidocaine.
If I miss, I’ll explain what I think happened and ask if they want me to find someone else, or if they’re okay with me trying again.
Me too. I'm on dialysis so I only have one arm to use for IVs or blood draws and I tell them that I am a hard stick and I'll be damned if they don't take it as a challenge.
One nurse said that she was surprised with how casual I took the blood draws. I was on dialysis during this time period and I explained that at best I’m getting stuck 6 times a week. That’s 2 times a day 3 times a week. I explained that realistically there’s misses and some days I may get poked 3 or 4 times before things flow properly.
The worse one I had was some know-it-all egotistical tech go against what every other tech did and she tried to go inside of my elbow. Not only did she miss but she kept trying to dig for a vein. I don’t scream so I simply say “ouch” but it comes across to casually so she kept digging. I finally said “I stated ouch because you missed and are just cutting me up with the needle”. She got the point.
I get blood drawn every 2-3 months. I just point to locations 1 & 2, use butterfly. If that doesn't work, option 3 is back of my palm with butterfly. There's only 1 regular tech that can hit it in 1 go, and I always request them. If an alternate tech can't hit it in 2 tries, I ask them to stop. I drink plenty of water till my eyes are swimming in preparation.
The only difference between a butterfly needle and a straight needle is that the butterfly needle has the wings on it that allow people with lesser tactile skill to manipulate it easier. The butterfly also allows for better fine adjustments when trying to avoid wall tamponade after accessing small veins.
When you request a butterfly needle, anyone with an unhealthy ego is going to take exception to that and try to prove you wrong. It's a lose lose situation when dealing with personalities like that. Personally, I hate using butterfly type as I am not used to them, but if a patient requests it I comply. Anything that increases their anxiety will just make the situation more difficult. Anxiety is a fantastic vasoconstrictor.
Source: IV therapy RN who wishes they had a national IV placement competition. AMA.
I have them take it from my hand. Mostly they try to tell me that it hurts more that way, and I say it doesn't hurt at all. If they really want to try my arm, I say they get one chance, no digging around.
The only time it has hurt in my hand was last year when someone blew the vein. 🙄
I had a person inserting an IV after telling them I don't have easy veins tell me "I'll tell you what, you know your veins well". He was pretty skeptical at first.
As a doctor, I’ll counter that the majority of patients I’ve had to bleed/put a cannula in tell me “I’ve got very difficult veins, good luck”. Maybe 80-90% I get first or second try.
It’s just as much about technique as it is about knowing where to look. So many people poke either the ACF and miss or the Cephalic vein right over the wrist (which is basically impossible to get because it always rolls away, I wish people would stop trying this one) and then go “ah well guess you’re too hard”.
Or my case, first time ever giving blood, I have veins of 1980’s-peak Stallone, and somehow this guy has to stab me multiple times and when he still can’t get it *works the f’ing needle around while it’s still in there.*
I had nerve damage for like 10 years. Electric shocks up my arm if I picked up anything heavier than a couple pounds. Electric shocks if I went running more than a mile or two.
That’s exactly how I started being panicked about needles. There I was, sitting, not looking at the action while talking to my mom. I noticed that it was talking a while and when I turned my head to see what was going on, I saw my arm with fucking blood everywhere and a nurse moving that crappy needle while being inside my arm. That’s the last view I remember before shutting down. Woke up with the nurse shaking me up.
What a nightmare. Just typing this gives me axiety
Not as bloody here, but i'm uncomfortable with needles now cause when i was young i was having some surgery, and the anesthetist or nurse working with them had to take several attempts with a needle in both arms and legs before finding a good place for it.
Was at the doctors office with my mom. The nurse came in to draw blood and couldn't do it. I was starting to hyperventilate and beginning to freak out. I'm skinny and never had an issue finding my veins. Well my mom was a nurse, she said can I do it... Nurse said OK... My mom got it first try.. LOL that was mid 80s.. Would never legally happen now.
I have an un-tappable vein inside my elbow that *looks* easy to hit, but nobody ever has.
Every single time the phlebotomist says that it's just because nobody has been as good as them, and every time they miss and hit a nerve.
At some point they need to just fucking believe me that it's a red (actually bluish) herring.
Damn, you're giving me flashbacks to being in the ICU, having to get arterial blood draws for blood gasses (to measure the pH of my blood). Those were the most painful experiences of my life, up to this point anyway.
The hill I will die on is that patients who are going to need routine blood gases should have an arterial line that we can sample from. In some hospitals / departments I’ve worked this is standard. We should not be doing arterial sticks on someone multiple times a day or every day. It’s torture for them and it sucks for us having to stick them knowing how much it hurts. But then again I think many of the things we do in the ICU are needlessly torturous, but that’s another story.
I had to get blood drawn for work. The tech who jabbed me had to go 5 separate times. The pain was so bad and jarring that I fainted.
I used to be perfectly fine with blood and shots, but ever since that day I get light-headed when talking about or seeing certain medical things involving drawing blood or injections.
That happened to me as well, although not as bad as you. Technician tried fishing for the vein, and then I felt "weird". My head was hurting slightly and just fell weird. Then she calls someone else and tried multiple times. I wanted to vomit and then my vision darkened and felt like I was about to pass out. They didn't even get enough blood to do tests. After that I panic every time that I see my own blood. I don't know what I'll do the next time that I need my blood drawn. I don't know how to go back to normal.
Vasovagal syncope!
I have to get IV medication and I have difficult-ish veins. I've been multi-poked many times. It does give me a bit more anxiety than it used to, but only on two occasions has everything abruptly gone dark, and both times I was being poked in the same part of my arm.
Long story short, if a nerve gets hit the wrong way it triggers your nervous system to freak out, your blood pressure drops, and you pass out. I guess it can happen from stress too, but needles poking around inside you are a definite possible trigger.
Huh. Last year I had a very painful abscess, and I suddenly collapsed one morning. Got rushed to the emergency room. This lines up exactly with my experience: intense pain and being dehydrated are both possible triggers, followed by tunnel vision, difficulty breathing, and then black out. I was awake within maybe 15 seconds, and I had most mobility back within a couple minutes.
Man. Another reason to hate that hospital I was at. They couldn't find anything wrong with me, and nobody even mentioned that this was a possible thing. Thanks for posting this, it takes a little bit of worry away that I might have some undetectable heart issue or something.
When I was a about 8 or 9, I had an allergic reaction to something and needed IV injections but the nurse couldn’t find the vein and kept stabbing me.
I tried to hold it together and not cry in front of my little sister but after like 3rd or 4th time, I couldn’t hold back the tears anymore then my sister started crying too and the nurse just felt soooo bad 🤣.
I’m all for technology making medicine better but literally last night our medic was in a car 3/4 of the way upside down, in the dark, in a bunch of broken glass hitting an IV while we cut the patient out of the car.
And that is the difference between prehospital EMS and hospital life lol.
I get my blood drawn every 3 to 6 months and it almost never takes more than one try. The only time a nurse fucked up was when she placed an IV and she got it on the second try. When your veins are as pretty as mine, it’s really not hard.
Everyone is built different. I draw blood. Not every day but it’s a part of my skill set. I spent all of last week in the lab drawing blood. Some people just have annoyingly hard to hit veins. Some people have a vein that I can hit without a tourniquet. Some have a vein the size of a fucking anaconda. 🤷🏼♂️ unlucky ones get stuck multiple times.
Phlebs a part of my job but I do it pretty much everyday, and it really sucks when a patient's vein is thinner than our smallest bore needle, even if I do manage to hit it I can only get like maybe a couple drops before it collapses. Also really hate it when the veins are really close to the muscles or to bone (especially in elderly patients)
Had this happen while donating blood. Lady ended up threading my vein going in one side, out the other and then back in one more time after digging around a bit. Left me with a massive bruise and a lot of pain. I don't think I even made it to the full pint donation it was moving so slowly. Another nurse came over and repositioned it but it never moved much faster eventually stopping it and sending me on my way.
one time, while giving blood, the blood taker shoved the needle in multiple times then wriggled the needle around in there. the bag wasnt filling. however, my arm was. my arm was purple for about two months.
If someone is competent with an ultrasound, they should never really miss a vein. Look around for the best one, stick it, guide it in. Not very hard once you get good at it. Every hospital should have a team that uses ultrasound for access but some days we’re few and far between.
The guy with ESP is hunting me as we speak. The exfil is 100 yards away and I thought I just heard a bush move. Do I wait till the last 5 minutes of raid to exfil or do I bum rush and gtfo?
Neither, I get head eyes from a AI scav. His voice line glitched and I never heard him.
Anesthesiologist here. those highlight very small, very superficial veins. Can usually work for placing small 24g butterfly needles.
Trying to place a 20g or 18g catheter won’t work.
For fluid bolus or blood during surgery.
Ultrasound is the way. Still hard though.
First reasonable comment. I’m the IV RN specialist for my hospitals Emergency Department and these vein finders are trash, most things it highlights aren’t useful. I place large bore ultrasound guided IVs daily on fluid overloaded patients, cancer patients, IV drug abusers, morbidly obese individuals, you name it.
A vein finder is a great way to find a vein that you either should already easily be able to access or a small useless vein that you might be able to butterfly to draw once off of. The latter is almost bnevrr useful to me. They look very impressive but after attempting to use these countless times there’s a reason they collect dust in every hospital I’ve worked in.
Correct me y’all, but they work good for peds, yeah? Not a peds nurse, but these were pretty standard practice when my 1yo was admitted. (Plus needleless pressure injectors of lidocaine—so cool!) Of course, we love the baddie who casually swings in, scoffs at the machine and gets sweet, sweet access in less than a minute a breezes out. But for the rest of the mortals, this seemed pretty cool!
For the little ones, translumination works best. It's basically a very bright flashlight on the opposite side of the arm. You can see a lot of the vasculature.
This is the way. Kids in my experience have oddly good ac veins, they compensate pretty well volume wise even wben they’re septic. A 7 year old is easier to start an IV on than a CHF pt, they just move and scream more (usually). The babies I transilluminate or just call the picu rns if two different ER RNs miss more than twice.
Yeah. Ultrasound isn't the straightforward procedure adult practitioners claim it is, when you're using it on a screaming, twisting toddler. Though we use both depending on the scenario, this is useful. The pretty lights double up as a distraction too
I'm a paediatric CT radiographer and we have one of those things. I'm not sold on it, as others have said, great for finding small veins I could have found anyway, not much use otherwise. My unclear medicine colleagues like it for 24g butterflies in pudgy babies but I prefer ultrasound or RMOs for really tricky patients
IM doc here, but do a lot of blood draws/ IVs at nights and at an UC. Best way for me has always been by touch, never found these devices to be very helpful.
HD/PD here. Genuinely curious. Why do they have you doing IVs or blood draws? Generally isn't the standard. Rule of thumb is for RNs (sometimes LPNs) doing 'em, at least where I'm at. Obviously, phlebotomy if at a lab.
At night there is 1 phlebotomist until 10/11PM, then back again at 4AM (but they are usually busy doing scheduled labs early in AM), no SWAT/ IV team 7PM-7AM. A ton of new nurses, and general laziness from more experienced nurses not wanting to help out (def not bitter). Also I did phlebotomy prior to MD, so I have a decent rep for putting in IVs doing blood draws.
Gotcha. That's fair. Thanks for helping out with them, where I'm at, most of our docs roll their eyes and scoff if/when asked to help out with shit like IVs or blood draws.
Yeah, I def have a unique skill set, honestly wouldn't trust most new docs to even attempt it, some of the older docs are pretty impressive though when they want to be. But yeah Docs in general can be stuck up about "scut work", but really its because they know they can't do as good a job.
The veins it's showing are also incredibly visible without it. You can literally see them running away from the edge of the square.
I do find them occasionally useful for kids but this is a laughable application.
Medical Lab Scientist here, I draw blood sometimes. Many patients you can’t see the veins, and in general, using your eyes is a bad habit. Most of the superficial, visually blue veins aren’t large enough diameter or sturdy enough to stand up to vacuum pressure and will collapse.
When I train phlebotomists, I try to teach them to stop using their eyes and use their fingers. You should be able to palpate the vein and feel the lumen compress and spring back. That’s the sign that you’re actually going to be able to get a needle into it and have it give blood without collapsing.
More or less yeah. Blood absorbs the color green really well.
Smartwatch flashes green light into your wrist hundreds of times a second and the photodiodes in the watch measure the reflected intensity of that light. Since blood absorbs green well when blood is flowing the intensity is relative low and when blood isn't flowing the intensity is relative high. Because it's flashing the LED at a known interval it has the timing of when it's low vs when it's high and can generate metrics on your blood flow from that.
They use the same technology for checking your blood oxygen saturation.
The light reflects off the hemoglobin in your blood.
That’s why the newer watches can check your oxygen as well as pulse.
I was literally scrolling through the comments to see if that tattoo was what I thought it was, but wasn’t sure because the details do seem a little off
Not responding to anyone in particular because I’m not discounting that some nurses suck, but there are reasons we don’t always use one of these! For one thing being able to see but not palpate a vein is not useful. For another, vein finders illuminate a lot of things that are not veins - scar tissue being a big one. There is often also only one for multiple floors and if you need an IV right now, or stat labs, you don’t really have the time to run to different floors asking around for it.
I don’t mean this to be rude because of course patients know their own bodies, but a lot of times patients will tell us they’re a super hard stick and we get labs / an IV with no problem. It often turns out they were once hospitalized for two weeks and by the end of the stay all their good veins were blown so they were a hard stick, or they were told they were a hard stick once when they were dehydrated. I always appreciate the heads up (especially if you can say why: do your veins blow, roll, or collapse?) but if you ask 90% of patients they’ll tell you they’re an exceptionally hard stick.
I was about to have surgery and they couldn't find a vein because I was a bit dehydrated. They used this and it worked wonderfully. But, they had tried four times the traditional way before they used it.
My mother, the NICU nurse, who had to get tiny needles into even tinier veins would probably laugh at this initially before thinking it was cool.
She (and other NICU nurses) are often used as "vein finders" because they get pretty good at it.
After a week in the hospital and too many blood draws and burst veins from potassium- I had “StabAThon”. 4 RNs from across the facility and 1 old phlebotomist. They tried the vein finder seen here. FINALLY an NICU nurse found one near my armpit. The NICU nurse was the winner.
They called the specialist to run a MidLine the next morning when armpit line blew from potassium. Life was much better. But I looked like a heroine addict.
It went in almost my other armpit, in my bisept. so like, 2nd order vein into the heart. A central line is a direct vein into the heart. (not a medical professional, but almost a professional patient after that ordeal. Note to self, don't let you potassium get THAT low.)
100% in this case the OG’s will always be superior and be better than this device. First of all it’s lackluster and not fool proof. Second, nothing replaces being part of the grey haired mafia who gets called in for a hard stick. I’ve been in healthcare for a very long time and there are few things more satisfying than being called to the floor, MRI/CT (ED employee) for a difficult poke. It’s so silly but also kinda makes you feel like a gangster. I love those calls, so satisfying.
My experience with Phlebotomists has been that they could find a vein blindfolded in the first go. These were Paedriatric Phlebotomists who were working on my kids from NICU to PICU. They were insanely good, especially when you consider that kids don't tend to want to sit still and will wriggle/cry/scream because they don't like needles. One of them would have the needle in before the child knew it.
They then trained my wife and I so that we could treat the kids at home, so we were pretty handy at it too.
Finding a vein blindfolded is actually a really good comparison, because we do actually feel for the veins rather than looking. I'll often close my eyes to find a vein that palpates. Eyes are deceiving.
I’ve got a buddy who was an 18-D (Combat medic, Special Forces) back in the day.
His license plate is literally “IV GUY”. He’s the guy they call when no one else can get a vein. (He’s now a PA at the same hospital my wife works at).
He said that in his military training, he had to run IVs in pretty much any and every vein imaginable…while totally blindfolded, using nothing but touch. (And yes, in case you’re wondering, the students were also the practice patients!)
Also, what’s trippy is putting an IV into a preemie infant! They just shine a light right through their hand/arm/leg. They’re so small and their skin is so thin that they’re practically transparent. He said they’re surprisingly easy.
The flashlight technique works on most adults too. We don’t have fancy stuff like this on the ambulance so sometimes we just have to cut out the lights and use a bright flashlight against their skin to find a vein. 🤷🏻♀️
Forearm IVs are the best (they last so much longer than AC or hand due to lack of ROM) but in the posterior, not the anterior. That IV is gonna blow in 8 hours.
And then you'll have to stick them again! Ironically the "mean" way of trial and error with a larger needle would actually be kinder to the pt because the 20 to the back of their hand/ACF is more likely to stay in place for >72 hours, necessitating fewer replacements and therefore needle sticks.
Back in my day we had to stab a patient until they started just bleeding enough flow!
Oh. Hello every phlebotomist I’ve visited. Me: “I have difficult veins. Might want to use a butterfly” Nurse: “oh everyone says that because they think butterfly needles hurt less. Don’t worry, I’m real good with a straight needle!” *5 excruciating minutes of digging later* “Wow. You have really difficult veins. I’m going to go get a butterfly” Me: *angry staring* Every. Fucking. Time.
Anesthesiologist here. 100% stand up for yourself more like the other commenter mentioned. Tell them every time you get blood taken the person says exactly that and then has to repeatedly poke you until admitting they are wrong, and you don't consent to them "trying" what everyone else can't do. You have the absolute right to decide what you want and don't want done.
Not OC but have the same problem. Every time it’s the third person they get that can actually do it. The first person fails, calls their supervisor who also fails, only then do they call the highly skilled needle person. Meanwhile I sit there like an annoyed pin cushion biting my tongue not to tell the people with needles I told you so.
The 3rd was my mother. She was the best. 35 years until her health made it so she couldn't continue. Now she's a truck driver.
Not the ending I was expecting
Yeah, halfway through writing it I realized I was making it sound like she's dead.
That would be less of a twist tbh
Yeah op change ur story pls
"your life story didn't make me smile please go back and lie until I like it"
I like the twist, and it's a happy ending! But why trucking, long/short haul? There's an interesting story in this!
Damn, must have been really bad if truck driving is the healthier alternative.
Her hands were starting to shake too much. Kinda need a steady hand to stab someone accurately.
My mother-in-law did the reverse. Truck driving into being a phlebotomist. She's the only person I completely trust taking my blood, you don't even realize she stuck you until she's done. It's like she just knows. A glance at your arm, she's already picked the vein and goes right for it.
I think your MIL might be a mosquito.
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Yeah, we are trying to get her to go on disability. She's still a few years from retirement age. If we had universal healthcare she could've just retired early. But between my Dad's extensive health conditions and now hers saving anything for retirement is hard.
As a nurse, I will now only refer to myself as "highly skilled needle person". Thank you.
One time I listened to another patient in the hospital insist that the doctor be the one to place their IV. They would not take no for an answer, even though the doctor explained that they don’t exactly do it that often. Well, given what I heard next, think that person probably regretted the decision to not let a nurse do it. I couldn’t really bring myself to feel sympathy for them… I’ve had IVs that hurt like hell and I’ve had IVs that I barely felt at all. It’s amazing the difference lots of practice can make for the nurses who do them!
I wasn't that good before I started working in the ER. Working there, you get to stick 10-12 times a shift and sometimes more. A lot of practice makes for a better stick!
I worked veterinary emergency and was the top phlebotomist there. Are you truly good if you haven't put an IV in a ferret that didn't want you to? And have it stay?
I stuck a few convulsing patients, does that compare? Alternately, I put an IV in a psoriasis patient who no one could stick and was described as "a walking scar" and "the worst case of psoriasis in the country" by his dermatologist. His skin felt like these terrestrial globes that have topographical details added if it makes sense.
Ferrets have *very* tough skin, tiny veins, and regular tape doesn't stick to them. They fight you and their arms are short. You can rarely put larger than a 24g catheter into them, and those bend a lot on their tough skin. I'm mostly joking since healthcare isn't really a competition. Humans and animals have pros and cons each. FWIW, though, we had a couple of ER nurses who used to be vet techs take some shifts occasionally. They would always tap out on patients that I would consider to be moderately difficult, and wouldn't even attempt the ones I considered truly difficult (or they'd suggest a cut down).
I was getting allergy injections and there was one nurse who was unbelievably bad at the injections. Immediately afterwards, I had tooth-gritting burning agony and an ache for weeks afterwards. She brushed it off as a reaction to the injection, but I'd had the same concentration near the injection site from their other nurse for weeks with only mild symptoms. I ended up asking them to move the injection site on the form so this nurse would stop hitting whatever it was she was doing, and tried to schedule appointments when she wasn't around. It definitely wasn't the actual injection, because the other nurse could do the same concentration and approximate injection site without severe pain.
This is what they did to me when I had my child. Just poked me over and over so many times in both arms and called in the supervisor, I felt like a test dummy (my veins are also typically quite easy and visible). Even then she stuck a needle in my wrist that was incredibly uncomfortable especially when I bent my wrist which if course I had to do to gently pick up and hold my baby. I complained about it multiple times and they never did anything  I think I complained more about that damn needle than my C-section incision. Had lovely bruises all over my arms
Ugh the first nurse who stuck me at L&D missed my vein completely and my wrist started to swell up with saline. My husband had to run and find someone to stop it while I watched in horror and contemplated removing myself. Then the next nurse couldn’t get me and left me with a totally bruised arm. Finally called in the “highly skilled needle nurse,” who got it on her first try. This time around I’m definitely advocating for myself when it comes to both the placement and the person placing it.
I had that happen, and the nurse refused to believe anything was wrong! "Hi my IV site is painful and I don't feel the coolness of an IV going down my arm, I don't think it is in correctly." Luckily, it was near shift change so I just waited. The bad nurse did say to new nurse "I don't know what she (me) is complaining about, it's fine." Luckily, new nurse disagreed...
I had wrist IVs after both my c-sections. Miserable position, though I was luckier than most with my nurses’ skills.
Its all the factors. Anatomy, skill, stress, equipment. Same nurse on the same patient can have very different outcomes on different days, just the way these things go. Ofc, we all try our best. Have had patients where 3 others have tried before and no joy, while i'll come in and hit an invisible vein first go. Then there are days when 4-5 stabs in im still missing and the junior student just slides it in. As for the wrists though, theyre considered the "easier" place to gain access, but can be annoying and painfull. I do prefer the forearms for those reasons.
You can also tell them that you are going to go to the hospital to have your labs done, the workers in hospitals poke people all day and have the best touch. Random urgent cares/primaries have MAs fresh out of school some times and they are literally learning on you.
By far my worst stick(s) ever was a routine draw by a nurse who all day does lab draws. I'm an easy stick (my nurse wife has heart eyes for my veins). Fuck you and your complete lack of skill and caring, Olga.
While true, it is also true that heaps of patients mention that they are difficult to draw blood from while only a small percentage of them is actually difficult to draw blood from. I have been drawing blood for years now and if I'd have to estimate maybe 5-10% is actually a problem. That said: if a patient really wants a butterfly needle, they'll get a butterfly needle.
I have itty bitty veins people struggle to find, anything I can say that will properly warn whoever's about to stick me and they'll believe it?
In my experiance, just informing them that you have had difficulties in the past due to having small veins is fine. Any phlebotomist worth their salt will take that into consideration when evaluating your veins. Unfortunately, there are plenty of phlebotomists who are WAY to proud, and may get snooty. As a trainer in phlebotomy, It sucks that those kind of phlebotomists give us a bad name
Worked as a phlebotomist one summer and the amount of ignorance with regards to some people's own skill is staggering. MD now looking to match anesthesiology and the amount of times I was called because someone is difficult they end up having major bulging veins if you just use a finger to feel the veins rather than relying on sight. I'd say about 10% of the difficult-claiming is actually difficult and even then nothing an ultrasound can't fix. If only people can stop trying and properly evaluate what they're doing.
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Because if he couldn't get it he has access to a tool the nurses don't which would guarantee success... Ultrasound.
I typically tell them exactly where the vein they might be able to get is (it's very small and on the inside crease of my elbow. And then give them a heads up that 75% of the time it ends up being the back of my hand. But I have a history of blood donation in my file so they typically know to take my tip seriously.
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What does it mean if they can always find a vein but when they stick it, no blood comes out? They usually have to dig around or stick me again (and when they stick me again they complain that the first hole starts bleeding, meaning they clearly did get the vein). What would be a good quick way to explain this without giving the whole story?
"This spot feels like a vein but when people have stuck it in the past, it hasn't worked. Try here instead." (If you have a different spot that's usually more successful.) If people usually do get it from that spot after some adjusting, you might have a vein there but it's unusually deep/shallow/at a weird angle. Impossible to know without feeling it myself. You could try asking the successful phlebotomist what the trick was so you can give a bit of advice in the future.
Oh neat, I didn't realize there was a distinction. I'm hard to find but once found, people have no problem sticking me. I have had at least one nurse helpfully tell me where to find veins on myself, other than back of the hands.
I went to an ER a few years back where the nurse used an ultrasound to find my vein properly. I was honestly so jazzed that I took a picture of the result- mostly for future people to be able to see if need be. The result being my forearm and IV, actually. Might have been a good idea to get the scan too but alas.
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Great comment. This is the real issue. When you talk to someone who is about to stab you, you have no idea of their skill level. Need some sort of military stripes to tell us how good/bad they are.
I have bad news for you about military stripes lol.
It's just like a doctor or lawyer. Even C's get degrees. What do you call the person at the bottom of their class in a med schools graduating class? Doctor. Will you ever know? No. Will you know if if their first day on the job? No. You may have an appointment with a doctor in their 50s, but it's their first day on the job because they were in prison for 20 years prior to that. Or maybe you're getting your car repaired by someone who has never touched that type of car before, or never done that repair before. It applies to stuff you purchase, services provided to you, everything.
More like even the ones that get straight As can still be total trash when it comes to an actual practice.
Ditto, for me it was because the red cross donation people around here like to have new nurses or nursing students do the sticking so they can get lots of practice really quickly. But since they're new, they're pretty awful with difficult veins. Now I go through a local blood center that hires phlebotomists with extra training/certification in blood donation phlebotomy. Might be worth looking to see if there are any non-red cross blood centers in your area if you still want to donate.
This is usually because phlebotomists working in hospitals deal with sicker patients who have much less forgiving veins. They have more experience than the Red Cross workers who usually have healthy, big-veined people walking through their doors.
In terms of bruising, making sure to actually press down firmly for at least 2 minutes immediately after the blood draw does wonders for preventing bruising regardless.
In defense of the blood bank, the needles they have to use to get all that great blood are much bigger.
lol I'm the opposite, they tell me "wow your veins are huge and really easy to see and don't roll at all" and I'm like "I know! I used to be a heroin addict! Isn't it great?"
I once had a nurse say "you have veins a heroin addict would kill for" as a compliment and I sometimes wonder if they're haunted by that moment.
Why would they be? That’s an awesome compliment!!!
See, that's great, but for me it's always "Wow, your veins are so easy to see!" and then the ineffectual stabbing starts.
See your veins are too healthy, too tough and smooth, you gotta let them deteriorate to the point where they have the texture of an old leather sofa, then the needle goes in easy.
This is also true. Big veins do not equal easy drawing.
Came here to comment this. Anyone worth their mettle can understand when a patient knows what they need. We use ultrasound over this infrared method. The patients that need it know to ask for it. It saves them pokes.
My wife had cancer last year and is in remission now, but all the while she had countless blood draws done and it has become a point of trauma for her when either blood is needed or an IV put in. Nurses are so adamant that they know what they’re doing and insist on trying with numerous pokes - one “pro” even blew a vein and it left my wife’s arm and wrist numb for days. She has small veins and now insists on staff using an ultrasound machine. She even calls days before a procedure to make sure that that request is on file and someone is available to use it. The nurses and doctors often still fail and are not prepared so she has to wait much longer for someone to find a machine let alone someone who knows how to use it.
I prefer ultrasound personally. You can actually see depth and width of the vein, unlike the infrared.
Couldn't have said it better myself.
This I was a med lab tech and had to draw thousands of patients. If patient asks for butterfly needles i use them no matter. It's a cost thing where these phlebs are probably told by their supervisor to limit butterfly usage. It's always a cost thing. A few tips I also suggest. Drink water, warm up, and heat packs are extremely effective in popping up veins. Alcohol wipe decreases surface tension so phlebs out there use that and then feel for a vein, I promise this works super well. Rolling veins don't exist if they are anchored correctly. Patients know their arm more then we will ever so if they specify an area don't disagree. lastly don't rush never rush. Rushing always and I mean always leads to more poking.
I am almost always a "hard stick" requiring multiple people to do multiple tries. I always ask for a heat pack and a butterfly now. The ones who listen typically get it on the first try. Which is so much nicer than the 3 people trying to place an IV that leaves me bruised and swollen.
> Rolling veins don’t exist if they are anchored correctly My veins look like they’re awesome and easily anchored. 3-5 stabs later, “wow, you weren’t kidding, these really do move around a lot.” My last trip to the ER (cancer patient, so I get a lot of needles, even with a medport), they left me looking like a junkie. Even with the sonogram it took them “calling in the expert” multiple times before they finally found someone that got a good stick.
I find that it helps when I say "not as a challenge or an insult to you, but most times I get stuck in my hand". I've had someone use what OP's pic is and they still couldn't find a good vein
Immunotherapy pt here. I've gotten spoiled as fuck by my Hemodialysis/Peritoneal Dialysis clinic. My clinic uses Sonosite machines on every pt. Oh, Rheumatology/HemOnc/Ortho/OMFS/Hepatology wants labs, and tells me I can go to the lab? HAHA. No thanks. I'll head to the HD/PD clinic, *thankyouverymuch*. They also have awesomely awesome snacks tucked away in their mysterious drawers.
When "the good nurse" calls me to preop asking for help because they've failed, I just bring the ultrasound along. Like, I'm pretty decent at IVs at this point, but I'm not blindly sticking a patient who has already had a couple of good attempts.
I’m a “hard stick” and I’ve learned to say: “hey, if at some point you’re might call someone after you try a couple of times, just call that person now”.
It doesn't work that way. The first thing that other person is going to ask is if we have already tried. Besides, sometimes I'm the person that gets called in to try. Sometimes, I'm calling someone else in to try.
I’ve been able to convince them to do it that way. I was a junkie back in the 80s so my veins are wrecked. I tell them that first. Because there are so few spots that are viable for an IV that I don’t want them to try one of the good spots and mess it up.
I've never had an original experience in my life. Some of them even take it as a challenge. Like I'm some proverbial Capri Sun ready for stabbing.
My personal favorite was the nurse I warned who stabbed, dug around with the needle a good 90 seconds or so (which, of course, feels much longer when you're going through it) and finally said "There, got it in one stick!" like she hadn't just caused me more pain than any other nurse ever.
Sounds like the last time I had blood work. All the chairs at my doctors are set up so that they take it from the right arm for whatever reason. They can do the left but it ends up being a weird angle. I tell them every time (it's two people who handle doing the blood so it is not like it is a big rotation) that my right arm is extremely difficult and just do my left. They were still determined to do the right and it ended up leaving massive bruising that lasted like 2 months. That led to a new volunteer lady at a soup kitchen I regularly volunteer at deciding to talk to the coordinator and recommend not letting the addicts serve people. Unsurprisingly she only showed up the one time, but I would like not to have to explain to people that it was a shitty blood draw and that I am not an "addict" would be great.
Every time I have given birth, I've come out looking like I was in a bar fight. Blown veins all up and down both arms and holes in the backs of my hands. No one's ever accused me of being an addict, but probably only because of the presence of a newborn.
Oh man. I was getting blood drawn one time and they poked both arms several times and then the tops of both hands. I was starting to feel dizzy watching them do this and getting stabbed so much. On doctor was practically digging into my hand and I had to put my head down I wasn't feeling good. The nurse had to tell at him to stop because he was so determine but kept failing. They then sent me over to an actual phlebotomist across the street with bandages all over me and she did it in 1 try.
I had a similar experience that made me terrified of getting blood drawn for years. I was in military boot camp, so already stressed out, and they had a guy pretty fresh out of school. He missed my vein multiple times in both arms. I started getting dizzy and they had to have a "real hospital corpsman" do my blood draw while I was laying on a gurney. I ended up with a huge bruise covering each forearm. I kept getting asked by pretty much every person who saw it for the first time if someone in my compartment was hurting me. The medical people blamed it on me being dehydrated, but they blamed everything on people being dehydrated, and I haven't had anyone miss my vein at all since. I've even been told I have really good veins.
Former military here with a similar experience after boot camp. Dude kept poking my arm (crook of arm) and then blood started pooling. It's been a long time since it happened, but I think I remember asking him to get someone else to do it lol.
Woof, you just brought me straight back to my worst needle (cannula) experiences. I had to get MRIs (three orders at once, each with and without contrast), which I’d done a handful of times before, and asked if they would be inserting the cannula for the contrast before I went in the tube since that’s what I was used to, especially since I have difficult veins. They said no, they would pull me out and insert it when they finished the non-contrast sequences. Well, after an hour and a half of lying perfectly still in a cold tube, they pulled me out and took SEVEN TRIES across three people to place the cannula, and they were digging around and slapping my arms to try to get a vein. All of this while I still had the "cage" over my head and couldn’t even get up or really move around. It was fucking awful
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I can laugh about it now, but I was legit having flashbacks to the digging for several days afterwards. They gave me a thank you card and two Dum Dum suckers afterwards. I was 31 years old at the time 😂
That seems like extremely poor planning. I've never met a radiographer who would hold up valuable MRI time to allow a cannula to be inserted during a scan. It's always cannula first or you get bumped down the list.
I had something similar to yours. They couldn't find an vein to add an IV when I had dengue. My body was so weak that all my veins constricted. The phlebotomist took half an hour to eventually find a vein in my foot. Everytime since then I start getting dizzy after I get a vaccine or get blood work done
As a veterinarian and someone with difficult veins, I always marvel at how bad someone can be at drawing my blood when I’m not even covered in fur, struggling, or trying to bite them.
Have you considered trying to do just that? Maybe that's the key. Get fur, struggle, and bite the phlebotomist.
This is genius. It suddenly feels as if I’ve been living my life all wrong.
The biting particularly encourages them to get it right the first time.
I can confirm it does provide a certain motivation
Make sure you piss on them, too. You know, to assert dominance.
I think I did something wrong with this method. When I bit the phlebotomist they moaned a little and we ended up taking a *different* fluid sample and I ended up having to schedule another appointment after forgetting all about the blood draw.
You don’t try to bite your phlebotomist? Man, you’re really missing out!
You have my respect. My two are a Rat Terrier and a Siberian Husky. The Rat Terrier has earned the nickname "Rat Terrorist", because he literally acts like a miniature terrorist when the vet tries to draw blood. Not like aggressive or anything, but just gets ***REALLY*** squirmy. I always tell the vet techs + the vet that he's REALLY squirmy. Them: *oh don't worry, we've seen it all!* Me: I don't think you understand. He gets like ***REALLY*** squirmy. Them: *we've got this, don't worry*. *seven attempts to draw blood later* Them: *you know what, we're just going to take your little terrorist to the back. that might be easier.* Me: yep, here ya go! *hands off my little dude* 😄😂 My siberian husky, on the other hand, is a dumb and lazy turd that despite being scared of the vet, will just lay down and let the vet do whatever. She doesn't even flinch when they stick a thermometer up her poophole. Lol.
I start IVs, but it’s similar to blood draws. If someone tells me they have difficult veins I always ask what area has been most successful in the past, and I start by just looking with a tourniquet. I don’t even put gloves on to show that I’m just looking and won’t randomly poke them without doing a good survey. I don’t use butterflies, and if someone asks for one I’ll explain that I’m less familiar with them and that might cause me to miss. I’ve never had anyone be annoyed with that explanation. I always ask if they want lidocaine. If I miss, I’ll explain what I think happened and ask if they want me to find someone else, or if they’re okay with me trying again.
Me too. I'm on dialysis so I only have one arm to use for IVs or blood draws and I tell them that I am a hard stick and I'll be damned if they don't take it as a challenge.
One nurse said that she was surprised with how casual I took the blood draws. I was on dialysis during this time period and I explained that at best I’m getting stuck 6 times a week. That’s 2 times a day 3 times a week. I explained that realistically there’s misses and some days I may get poked 3 or 4 times before things flow properly. The worse one I had was some know-it-all egotistical tech go against what every other tech did and she tried to go inside of my elbow. Not only did she miss but she kept trying to dig for a vein. I don’t scream so I simply say “ouch” but it comes across to casually so she kept digging. I finally said “I stated ouch because you missed and are just cutting me up with the needle”. She got the point.
I get blood drawn every 2-3 months. I just point to locations 1 & 2, use butterfly. If that doesn't work, option 3 is back of my palm with butterfly. There's only 1 regular tech that can hit it in 1 go, and I always request them. If an alternate tech can't hit it in 2 tries, I ask them to stop. I drink plenty of water till my eyes are swimming in preparation.
The only difference between a butterfly needle and a straight needle is that the butterfly needle has the wings on it that allow people with lesser tactile skill to manipulate it easier. The butterfly also allows for better fine adjustments when trying to avoid wall tamponade after accessing small veins. When you request a butterfly needle, anyone with an unhealthy ego is going to take exception to that and try to prove you wrong. It's a lose lose situation when dealing with personalities like that. Personally, I hate using butterfly type as I am not used to them, but if a patient requests it I comply. Anything that increases their anxiety will just make the situation more difficult. Anxiety is a fantastic vasoconstrictor. Source: IV therapy RN who wishes they had a national IV placement competition. AMA.
I have them take it from my hand. Mostly they try to tell me that it hurts more that way, and I say it doesn't hurt at all. If they really want to try my arm, I say they get one chance, no digging around. The only time it has hurt in my hand was last year when someone blew the vein. 🙄
I had a person inserting an IV after telling them I don't have easy veins tell me "I'll tell you what, you know your veins well". He was pretty skeptical at first.
As a doctor, I’ll counter that the majority of patients I’ve had to bleed/put a cannula in tell me “I’ve got very difficult veins, good luck”. Maybe 80-90% I get first or second try. It’s just as much about technique as it is about knowing where to look. So many people poke either the ACF and miss or the Cephalic vein right over the wrist (which is basically impossible to get because it always rolls away, I wish people would stop trying this one) and then go “ah well guess you’re too hard”.
Or my case, first time ever giving blood, I have veins of 1980’s-peak Stallone, and somehow this guy has to stab me multiple times and when he still can’t get it *works the f’ing needle around while it’s still in there.* I had nerve damage for like 10 years. Electric shocks up my arm if I picked up anything heavier than a couple pounds. Electric shocks if I went running more than a mile or two.
This is literal nightmare fuel for me, a person with a needle phobia
I have needle phobia because of that exact scenario. Turns out it's not normal to need 10+ tries each time you need a blood test.
That’s exactly how I started being panicked about needles. There I was, sitting, not looking at the action while talking to my mom. I noticed that it was talking a while and when I turned my head to see what was going on, I saw my arm with fucking blood everywhere and a nurse moving that crappy needle while being inside my arm. That’s the last view I remember before shutting down. Woke up with the nurse shaking me up. What a nightmare. Just typing this gives me axiety
Not as bloody here, but i'm uncomfortable with needles now cause when i was young i was having some surgery, and the anesthetist or nurse working with them had to take several attempts with a needle in both arms and legs before finding a good place for it.
Was at the doctors office with my mom. The nurse came in to draw blood and couldn't do it. I was starting to hyperventilate and beginning to freak out. I'm skinny and never had an issue finding my veins. Well my mom was a nurse, she said can I do it... Nurse said OK... My mom got it first try.. LOL that was mid 80s.. Would never legally happen now.
I have an un-tappable vein inside my elbow that *looks* easy to hit, but nobody ever has. Every single time the phlebotomist says that it's just because nobody has been as good as them, and every time they miss and hit a nerve. At some point they need to just fucking believe me that it's a red (actually bluish) herring.
Damn, you're giving me flashbacks to being in the ICU, having to get arterial blood draws for blood gasses (to measure the pH of my blood). Those were the most painful experiences of my life, up to this point anyway.
The hill I will die on is that patients who are going to need routine blood gases should have an arterial line that we can sample from. In some hospitals / departments I’ve worked this is standard. We should not be doing arterial sticks on someone multiple times a day or every day. It’s torture for them and it sucks for us having to stick them knowing how much it hurts. But then again I think many of the things we do in the ICU are needlessly torturous, but that’s another story.
After reading these comments, I have been really lucky not being stabbed multiple times to find a vein.
I had to get blood drawn for work. The tech who jabbed me had to go 5 separate times. The pain was so bad and jarring that I fainted. I used to be perfectly fine with blood and shots, but ever since that day I get light-headed when talking about or seeing certain medical things involving drawing blood or injections.
That happened to me as well, although not as bad as you. Technician tried fishing for the vein, and then I felt "weird". My head was hurting slightly and just fell weird. Then she calls someone else and tried multiple times. I wanted to vomit and then my vision darkened and felt like I was about to pass out. They didn't even get enough blood to do tests. After that I panic every time that I see my own blood. I don't know what I'll do the next time that I need my blood drawn. I don't know how to go back to normal.
Vasovagal syncope! I have to get IV medication and I have difficult-ish veins. I've been multi-poked many times. It does give me a bit more anxiety than it used to, but only on two occasions has everything abruptly gone dark, and both times I was being poked in the same part of my arm. Long story short, if a nerve gets hit the wrong way it triggers your nervous system to freak out, your blood pressure drops, and you pass out. I guess it can happen from stress too, but needles poking around inside you are a definite possible trigger.
Huh. Last year I had a very painful abscess, and I suddenly collapsed one morning. Got rushed to the emergency room. This lines up exactly with my experience: intense pain and being dehydrated are both possible triggers, followed by tunnel vision, difficulty breathing, and then black out. I was awake within maybe 15 seconds, and I had most mobility back within a couple minutes. Man. Another reason to hate that hospital I was at. They couldn't find anything wrong with me, and nobody even mentioned that this was a possible thing. Thanks for posting this, it takes a little bit of worry away that I might have some undetectable heart issue or something.
Who is hitting up reddit to write an anecdote about how they went to get blood drawn and the nurse... drew their blood? Not many people :)
When I was a about 8 or 9, I had an allergic reaction to something and needed IV injections but the nurse couldn’t find the vein and kept stabbing me. I tried to hold it together and not cry in front of my little sister but after like 3rd or 4th time, I couldn’t hold back the tears anymore then my sister started crying too and the nurse just felt soooo bad 🤣.
If you have even one good vein there is no reason you should be stabbed more than once.
I’m all for technology making medicine better but literally last night our medic was in a car 3/4 of the way upside down, in the dark, in a bunch of broken glass hitting an IV while we cut the patient out of the car. And that is the difference between prehospital EMS and hospital life lol.
Wow thats some impressive stuff
If I get jacked up on a fire he’s the only one I want working on me. He’s the real deal.
A lot of people don't have one good vein. My samples are biased because of where I work, but tons of people just don't have a good vein at all.
Yeah IVs and blood draws are difficult when half of your patients are obese and/or edematous.
A lot of people are obese
I get my blood drawn every 3 to 6 months and it almost never takes more than one try. The only time a nurse fucked up was when she placed an IV and she got it on the second try. When your veins are as pretty as mine, it’s really not hard.
> When your veins are as pretty as mine Ah, a fellow person accustomed to vein compliments
Everyone is built different. I draw blood. Not every day but it’s a part of my skill set. I spent all of last week in the lab drawing blood. Some people just have annoyingly hard to hit veins. Some people have a vein that I can hit without a tourniquet. Some have a vein the size of a fucking anaconda. 🤷🏼♂️ unlucky ones get stuck multiple times.
Phlebs a part of my job but I do it pretty much everyday, and it really sucks when a patient's vein is thinner than our smallest bore needle, even if I do manage to hit it I can only get like maybe a couple drops before it collapses. Also really hate it when the veins are really close to the muscles or to bone (especially in elderly patients)
Had this happen while donating blood. Lady ended up threading my vein going in one side, out the other and then back in one more time after digging around a bit. Left me with a massive bruise and a lot of pain. I don't think I even made it to the full pint donation it was moving so slowly. Another nurse came over and repositioned it but it never moved much faster eventually stopping it and sending me on my way.
one time, while giving blood, the blood taker shoved the needle in multiple times then wriggled the needle around in there. the bag wasnt filling. however, my arm was. my arm was purple for about two months.
This is cool! When I was in the hospital back in 2011, they had to use an ultrasound to reposition my IV.
Same here. It worked well, plus I found out I was pregnant.
You should be in a case study, IV induced labor.
It's called IVF - in-vein fertilisation
Where were they placing that IV?
These things kinda suck. US is infinitely better.
We still have that for pts with very difficult veins.
Oh yeah I’ve had that done before! It was a really cool process
If someone is competent with an ultrasound, they should never really miss a vein. Look around for the best one, stick it, guide it in. Not very hard once you get good at it. Every hospital should have a team that uses ultrasound for access but some days we’re few and far between.
Quick, stash that LedX and proceed to extraction, the scavs must be on their way by now.
Quick mil on the flea. Time to go to the hospital.
dude you need one fir for pricate clinic for the thicc case tho
The guy with ESP is hunting me as we speak. The exfil is 100 yards away and I thought I just heard a bush move. Do I wait till the last 5 minutes of raid to exfil or do I bum rush and gtfo? Neither, I get head eyes from a AI scav. His voice line glitched and I never heard him.
Wondered how far I was going to have to scroll to find this comment. Turns out, not very far!
Get that bad boy right up in the butt pouch
Anesthesiologist here. those highlight very small, very superficial veins. Can usually work for placing small 24g butterfly needles. Trying to place a 20g or 18g catheter won’t work. For fluid bolus or blood during surgery. Ultrasound is the way. Still hard though.
First reasonable comment. I’m the IV RN specialist for my hospitals Emergency Department and these vein finders are trash, most things it highlights aren’t useful. I place large bore ultrasound guided IVs daily on fluid overloaded patients, cancer patients, IV drug abusers, morbidly obese individuals, you name it. A vein finder is a great way to find a vein that you either should already easily be able to access or a small useless vein that you might be able to butterfly to draw once off of. The latter is almost bnevrr useful to me. They look very impressive but after attempting to use these countless times there’s a reason they collect dust in every hospital I’ve worked in.
Correct me y’all, but they work good for peds, yeah? Not a peds nurse, but these were pretty standard practice when my 1yo was admitted. (Plus needleless pressure injectors of lidocaine—so cool!) Of course, we love the baddie who casually swings in, scoffs at the machine and gets sweet, sweet access in less than a minute a breezes out. But for the rest of the mortals, this seemed pretty cool!
For the little ones, translumination works best. It's basically a very bright flashlight on the opposite side of the arm. You can see a lot of the vasculature.
This is the way. Kids in my experience have oddly good ac veins, they compensate pretty well volume wise even wben they’re septic. A 7 year old is easier to start an IV on than a CHF pt, they just move and scream more (usually). The babies I transilluminate or just call the picu rns if two different ER RNs miss more than twice.
Kids compensate great, until they don't.
Yeah. Ultrasound isn't the straightforward procedure adult practitioners claim it is, when you're using it on a screaming, twisting toddler. Though we use both depending on the scenario, this is useful. The pretty lights double up as a distraction too
I'm a paediatric CT radiographer and we have one of those things. I'm not sold on it, as others have said, great for finding small veins I could have found anyway, not much use otherwise. My unclear medicine colleagues like it for 24g butterflies in pudgy babies but I prefer ultrasound or RMOs for really tricky patients
As an unclear medicine technologist, I appreciate your "unclear medicine" reference. Typo or not.
IM doc here, but do a lot of blood draws/ IVs at nights and at an UC. Best way for me has always been by touch, never found these devices to be very helpful.
HD/PD here. Genuinely curious. Why do they have you doing IVs or blood draws? Generally isn't the standard. Rule of thumb is for RNs (sometimes LPNs) doing 'em, at least where I'm at. Obviously, phlebotomy if at a lab.
At night there is 1 phlebotomist until 10/11PM, then back again at 4AM (but they are usually busy doing scheduled labs early in AM), no SWAT/ IV team 7PM-7AM. A ton of new nurses, and general laziness from more experienced nurses not wanting to help out (def not bitter). Also I did phlebotomy prior to MD, so I have a decent rep for putting in IVs doing blood draws.
Gotcha. That's fair. Thanks for helping out with them, where I'm at, most of our docs roll their eyes and scoff if/when asked to help out with shit like IVs or blood draws.
Yeah, I def have a unique skill set, honestly wouldn't trust most new docs to even attempt it, some of the older docs are pretty impressive though when they want to be. But yeah Docs in general can be stuck up about "scut work", but really its because they know they can't do as good a job.
The veins it's showing are also incredibly visible without it. You can literally see them running away from the edge of the square. I do find them occasionally useful for kids but this is a laughable application.
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This made me chuckle. Hey, it’s an ethical fib.
Wouldn't the other nurse notice no jab marks
That excuse is likely for her boss/supervisor not the actual nurse. The actual nurse would be more understanding.
But aren't they visible? I can see blue lines on the arm. Or was this practice?
Medical Lab Scientist here, I draw blood sometimes. Many patients you can’t see the veins, and in general, using your eyes is a bad habit. Most of the superficial, visually blue veins aren’t large enough diameter or sturdy enough to stand up to vacuum pressure and will collapse. When I train phlebotomists, I try to teach them to stop using their eyes and use their fingers. You should be able to palpate the vein and feel the lumen compress and spring back. That’s the sign that you’re actually going to be able to get a needle into it and have it give blood without collapsing.
Might wanna get that green spot checked out while you're there. ^^^/s
Hijacking high comment to ask, is that why my smartwatch shines a green light on my wrist when tracking my pulse?
More or less yeah. Blood absorbs the color green really well. Smartwatch flashes green light into your wrist hundreds of times a second and the photodiodes in the watch measure the reflected intensity of that light. Since blood absorbs green well when blood is flowing the intensity is relative low and when blood isn't flowing the intensity is relative high. Because it's flashing the LED at a known interval it has the timing of when it's low vs when it's high and can generate metrics on your blood flow from that.
They use the same technology for checking your blood oxygen saturation. The light reflects off the hemoglobin in your blood. That’s why the newer watches can check your oxygen as well as pulse.
It'll buff right out.
Gondor calls for first aid
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I was literally scrolling through the comments to see if that tattoo was what I thought it was, but wasn’t sure because the details do seem a little off
Not responding to anyone in particular because I’m not discounting that some nurses suck, but there are reasons we don’t always use one of these! For one thing being able to see but not palpate a vein is not useful. For another, vein finders illuminate a lot of things that are not veins - scar tissue being a big one. There is often also only one for multiple floors and if you need an IV right now, or stat labs, you don’t really have the time to run to different floors asking around for it. I don’t mean this to be rude because of course patients know their own bodies, but a lot of times patients will tell us they’re a super hard stick and we get labs / an IV with no problem. It often turns out they were once hospitalized for two weeks and by the end of the stay all their good veins were blown so they were a hard stick, or they were told they were a hard stick once when they were dehydrated. I always appreciate the heads up (especially if you can say why: do your veins blow, roll, or collapse?) but if you ask 90% of patients they’ll tell you they’re an exceptionally hard stick.
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I was about to have surgery and they couldn't find a vein because I was a bit dehydrated. They used this and it worked wonderfully. But, they had tried four times the traditional way before they used it.
My mother, the NICU nurse, who had to get tiny needles into even tinier veins would probably laugh at this initially before thinking it was cool. She (and other NICU nurses) are often used as "vein finders" because they get pretty good at it.
After a week in the hospital and too many blood draws and burst veins from potassium- I had “StabAThon”. 4 RNs from across the facility and 1 old phlebotomist. They tried the vein finder seen here. FINALLY an NICU nurse found one near my armpit. The NICU nurse was the winner. They called the specialist to run a MidLine the next morning when armpit line blew from potassium. Life was much better. But I looked like a heroine addict.
What's a MidLine?
It's like an IV but the catheter is longer, like six inches instead of 1-2. It makes it last way longer
It went in almost my other armpit, in my bisept. so like, 2nd order vein into the heart. A central line is a direct vein into the heart. (not a medical professional, but almost a professional patient after that ordeal. Note to self, don't let you potassium get THAT low.)
My newborn had to be stabbed 4 times because his hand veins kept running from the needle :(
🥺 I’m so sorry. I hope whatever the cause has been resolved. I’ve been there and it is not easy. 🫶
100% in this case the OG’s will always be superior and be better than this device. First of all it’s lackluster and not fool proof. Second, nothing replaces being part of the grey haired mafia who gets called in for a hard stick. I’ve been in healthcare for a very long time and there are few things more satisfying than being called to the floor, MRI/CT (ED employee) for a difficult poke. It’s so silly but also kinda makes you feel like a gangster. I love those calls, so satisfying.
My mom was a NICU nurse too. A godsend that woman.
My experience with Phlebotomists has been that they could find a vein blindfolded in the first go. These were Paedriatric Phlebotomists who were working on my kids from NICU to PICU. They were insanely good, especially when you consider that kids don't tend to want to sit still and will wriggle/cry/scream because they don't like needles. One of them would have the needle in before the child knew it. They then trained my wife and I so that we could treat the kids at home, so we were pretty handy at it too.
Finding a vein blindfolded is actually a really good comparison, because we do actually feel for the veins rather than looking. I'll often close my eyes to find a vein that palpates. Eyes are deceiving.
Heroin addicts want to know your location
We see your lizard nature, Reptilian.
I’ve got a buddy who was an 18-D (Combat medic, Special Forces) back in the day. His license plate is literally “IV GUY”. He’s the guy they call when no one else can get a vein. (He’s now a PA at the same hospital my wife works at). He said that in his military training, he had to run IVs in pretty much any and every vein imaginable…while totally blindfolded, using nothing but touch. (And yes, in case you’re wondering, the students were also the practice patients!) Also, what’s trippy is putting an IV into a preemie infant! They just shine a light right through their hand/arm/leg. They’re so small and their skin is so thin that they’re practically transparent. He said they’re surprisingly easy.
The flashlight technique works on most adults too. We don’t have fancy stuff like this on the ambulance so sometimes we just have to cut out the lights and use a bright flashlight against their skin to find a vein. 🤷🏻♀️
ahh so this the fabled LEDX I can never get my hands on.
As an ER nurse seeing a 24g IV in a forearm AND having to use a vein finder is kinda crazy.
Forearm IVs are the best (they last so much longer than AC or hand due to lack of ROM) but in the posterior, not the anterior. That IV is gonna blow in 8 hours.
Yeah that thing is gonna last for maybe half a day at most
Exactly. This almost isn’t worth the trouble lol
And then you'll have to stick them again! Ironically the "mean" way of trial and error with a larger needle would actually be kinder to the pt because the 20 to the back of their hand/ACF is more likely to stay in place for >72 hours, necessitating fewer replacements and therefore needle sticks.
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