Bad veins- a rant

I'm a nurse, and I've started a lot of difficult IVs.  Sometimes patients aren't aware of "good" veins that I can find with a hot pack, a couple of tourniquets, and different positioning of the hand/arm.  Here are some suggestions:

1.  Always go an appointment well hydrated.  Drink a couple of huge glasses of water before having blood drawn.  It truly makes a difference.

2.  Carry a doctor's note ordering the technician to use a small butterfly.

3.  Suggest they wrap your hand and arm with a hot towel for a few minutes before searching for a vein.  It makes the good veins pop out better.

4.  Suggest your "good" vein, but don't be 100% closed to the idea that there might be others.  There's a big vein on the back of your arm, between the elbow and wrist, that most people (and nurses) aren't aware of.

5.  Tell the technician they get ONE stick.  If they miss the first one, they don't get another try.  Someone else, preferably higher up the food chain, gets the next stick.

Good luck...

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Sorry this happened....luckily I have great veins, but I'm not a pin cushion....if they can't get it on the first try, maybe they get a 2nd try, then find someone else....

I used to have fabulous veins.  Before chemo.  Gosh..now they are as tough as garden hoses.  I point out the vein that seems to be the winner all the time and will give them 2 (or 3 if they are being nice) sticks.  

I have been going to the same chemo infusion center for over 13 years now.  After 2 different primary breast cancers, both which required chemotherapy, the nursing staff became very familiar with my hard to find, easy to blow, fragile veins.  They also are the most adept and knowledgeable blood drawers in my experience, compared to the often less experienced staff found in physician offices, clinics or radiology departments.

This is by no means a condemnation of the many excellent staff who are talented blood drawers in those other areas, but I have found that there can be a disturbing inconsistency in the expertise of those staff as a whole.  If you can request a specific person who you have had good experiences with, then great!  But otherwise it is often a gamble in areas where starting IVs or blood drawing is not the main job of that individual.

After a few bad experiences in hospital labs and doctor's offices, I many years ago began to get all my required blood draws or IV starts for annual scans done at my chemo center by the nurses there.  Since I see my oncologist every 6 months, I always schedule my annual physical with my PMD at a time close to one of my oncology visits.  I contact my PMD's office and ask them to send a script for any requested labwork to the chemo center office.  The day of my oncology visit I get all bloodwork drawn by the nurses in the chemo center for both my oncologist and PMD.  Everybody gets copies of the lab results, I get one stick for multiple labs and feel that at least I am minimizing my risks by limiting the number of sticks I get each year, plus utilizing the staff I feel are most likely to protect my veins.

When it comes to my annual CT scans, I schedule an appointment with the chemo center to have my Hep Lock inserted one hour before I am due to report to radiology for the scan.  The radiology staff is always thrilled to see me show up with a line already in place for the contrast media.  After the scan is completed, the radiology staff remove the Hep Lock, apply a pressure bandage and send me on my way.  I generally, remove the pressure bandage myself 10 minutes later, check the site to be sure it no longer needs a pressure bandage, then apply Neosporin and a standard bandaid which I wear for the rest of the day to protect the area.

Obviously, these steps I take are for pre-scheduled, non-emergency events where I know in advance that I will need labwork or an IV stick.  In a medical emergency situation, about all we can do is communicate to staff our significant medical history and precautions for at-risk limbs in whatever method we have available.  Certainly, having informed family members who can inform staff when we cannot ourselves, is a big help.  Also having a document in your purse or on your person, with your full medical history, including all surgeries, medications, allergies and instructions for avoiding blood draws, blood pressures etc. in at-risk limbs etc. is very important.

I have found a great website that has a number of free downloadable forms that you can fill out and keep copies for your family members and yourself to have on hand when needed.  I use the Emergency Form to keep all my most important medical information handy and update it as needed each year.  I always keep a copy in my purse.  My husband and I also keep copies of each other's emergency form in the event we need to have their information readily available. 

Here are the links to the downloadable forms.  You will be asked to provide your email address but after that you can download all the free forms if you choose.  These are Adobe forms that allow you to fill them out using your computer. You are able to save both a blank version of the form and also a completed version with your information entered:

http://www.americanmedical-id.com/about_us/med_form_intro.php

Emergency Medical Information Form

ihopeg - for using EMLA cream put a dab on the are and then cover with some Saran wrap _a square a bit larger than the area will just 'sit there' kepping it from being wiped off by clothes/etc.  It is supposed to help it work quicker also.  Diferent people are different - for me it works in as little as 20 mins or for as long as 90 mins - At least those are the 2 extremes I've done - usually 30 - 60 mins.