Anyone have trouble with blood draws?

@DokaGirl I've performed over 100,000, yes that's one hundred thousand blood draws, and a good number of difficult ones. My advice to you is to stick to your guns and INSIST that lab personnel use a small needle and heat. It's your body. When they balk just keep saying "Nope, that's not going to work, nope, nope..."

(My own example: I've learned that medical personnel can't get an accurate blood pressure measurement with the big automated machines or a wrist cuff. I INSIST on a manual reading, which is very close to what I get my home OMRON unit. I also insist that BP and heart rate are measured after I've been sitting down for at least five minutes. I just keep repeating what I need/want.)

For the sickest of patients a site for an IV may be needed in an emergency. I recall being at the bedside of an oncology patient whose veins were hard to find. Eventually I found a good one on his/her foot and was about to proceed with the blood draw using a butterfly when my actions were halted by a nurse who said "Stop, we need to use that for an IV" which in the way it was said I inferred they had been looking with no luck until I came along . So that meant I had to spend a few more minutes looking for ANOTHER spot.

Everything everyone has been mentioning here to help you have been good suggestions. I don't recall seeing these:

• If drawing from a hand vein, lower your hand as much as possible. Try with or without resting it on something to help with stability for the blood draw.
• If drawing from a hand vein, don't try for a spot where a vein forks and forms a "Y." Try a half-inch (1cm) above that, "above" being toward your elbow.
• To stabilize ANY vein, use the thumb below the spot and a forefinger above the spot where the draw is planned. A lot of phlebotomists just use their thumb below the spot.
• If you need to go back for more blood tests and it's been less than a week since your latest draw, wait until a week is up and then go back. It's very hard to get blood from veins that are healing, swollen or bruised.
• Ask for the phlebotomist who has done the best job. See if you can learn when they are scheduled to work.
  
• This is last resort: If the lab is part of a hospital, find out if there is a dedicated team of IV nurses who do nothing but start IVs. You can find out by calling Nursing Administration. If they have such a team, ask if one of the IV nurses could be called to the lab when you arrive, not after you've been poked several times. You'd have to clear this with the lab manager also. They will be just as good if not better than your best phlebotomist.

 

Thank you @CFS_for_19_years.

Good and detailed advice for next time. Insist, insist, insist. Interesting, I encounter much less resistance from the staff at a privately owned lab I go to, than my recent visits to a hospital lab.

Thank you for your experienced suggestions!

 

Good advice about the BP measures too, @CFS_for_19_years

 

"It's my body". Thank you @CFS_for_19_years. For me, this brings up the underlying belief that our bodies are not our own. Neither are our minds considered our own by some - e.g. the BPSers.

In medicine, as well as other areas, our own knowledge of our own bodies is sometimes, or frequently denied.

So while I plan to INSIST more strongly next time with blood draws, I know that
beneath these little scenarios rests the strongly held view that as a lay person where medical things are concerned, I am often considered clueless, even though in
reality I'm not!

 

@DokaGirl, I don't know if there is a spot on your lab requests where your doctor could give special instructions. If there is a spot, have them write "Patient needs heat applied and 23-gauge butterfly needle."

• If it's a paper requisition, that's easy. They just need to write it anywhere there's an empty box.
  
• Your doctor could also write it on a prescription pad that you keep for each time you visit the lab.
  
• If it's a digital request ask the doctor to get creative and find any empty box somewhere to add notes.

 

Thank you @CFS_for_19_years ! That's a very good.

 

I was going to say that my blood runs out, but the problem is technically the opposite - it's a struggle to fill a tube. Especially difficult if more than one tube full is needed.

 

@fossil, mine too. Filling one tube can be a problem; more than one is even more difficult, despite the prep I do. Heat where the blood draw will be done does help.

Overall, it would be interesting to know if a significant percentage of pwME have trouble with blood draws, and why.

 

When blood enters a tube (as opposed to a syringe) it does so by vacuum - tubes are called Vacutainers. The vacuum is sufficient to collapse small veins or as sometimes happens, the needle is not in the center of the vein. Sometimes the needle can be moved just ever so slightly to gain a full stream into the tube. Sometimes when tubes are switched, jostling will displace the needle so that blood doesn't flow. At this point it is hard to recover a good filling speed or sometimes any filling at all. (Typical needle size is 21-gauge.)

In these cases it would have been easier to get flow going with a smaller gauge needle, such as are used with butterflies (23-gauge) and a syringe, since a syringe on its own will not create a vacuum. The best way to be sure the butterfly needle is in the center of the vein is to insert it into the vein and see if the blood flows freely into the tubing connected to the butterly. Once that is accomplished then the syringe can be attached. (It helps to have one person placing the needle and another person attaching the syringe.) The person operating the syringe needs to pull slowly.

I could tell when the butterfly was in the right spot by pulling back on the attached syringe - I worked alone so there were no spare hands to assist in the placement.

Rare causes of impeded flow can be a high hematocrit, which is a higher than normal percentage of red blood cells in the blood, normal being 38-45%. I would assume that if anyone had this condition it would have been discovered in previous basic tests known as a CBC or Complete Blood Count.

 

@CFS_for_19_years, could you explain what a hard draw is, and what causes it to be rejected for testing? I have a general idea, but am interested in a more specific explanation. Thank you very much for your reply.

 

A hard draw means it was hard getting blood from the patient, i.e. small veins, multiple sticks. There are two main reasons for rejection.

1. Coagulation (clotting): For Complete Blood Counts that measure the numbers of red and white blood cells and platelets, the blood flows into a lavender-topped tube that has a small amount of an anticoagulant called EDTA. In order for the EDTA to be effective, the tube needs to be inverted several times with the EDTA within 20-60 seconds from the time blood started flowing in, otherwise it will start to coagulate.
Coagulation can also happen if blood is drawn into a syringe and not transferred quickly enough into an EDTA tube.
Usually the person doing the blood draw is unaware that the blood has started to clot. It's only discovered when the tube arrives at the bench of a technologist who checks the blood for small clots before testing it. This is done by taking two wooden sticks and ringing them around in the tube of blood, removing then and observing them for anything that sticks to them. If anything sticks it will look like a glob or some threads between the sticks. This small clot makes the blood sample unsuitable for any blood cell counts or ESR (erythrocyte sedimentation rate).

2. Hemolysis: If there is mechanical trauma to the red cells from a difficult draw, the red cells will break open and cause the clear part of blood (serum or plasma) to turn red. Since the potassium inside red cells is much higher than it is in serum or plasma, the hemolyzed serum or plasma can't be used for potassium determinations. There are probably other tests that can't used hemolyzed samples but potassium is the most frequent one.

 

Thank you very much @CFS_for_19_years, for your detailed and interesting replies.

Cheers!

 

I just heard today of a young ME sufferer where it took ages to fill up the glasses when drawing blood. This was not the first time this had happened and I think they just had to in the end give up drawing as much as was intended.

When searching on the forum, there are a few threads on this topic, so it seems to be a problem for several with ME. But the discussions are a bit old.

Does anyone know if there's any recent knowledge/possible explanations for this phenomena in connection with ME?