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View Full Version : Why are some people's veins easy to stick and others nearly impossible?


aceplace57
12-16-2011, 09:59 PM
I'm one of the unlucky people with veins that are hard to stick. IV's sometimes takes three or four tries by an experienced blood technician. A regular nurse could stick me ten times and never hit a vein. :( I even have trouble getting blood drawn unless it's a really, really experienced blood tech.

My cousin was the same way. She developed ovarian cancer and got a pic port in her chest. That was the only way she could get chemo. But, they still wanted to draw blood from her arm because the blood drawn from the port wasn't as clean. I've seen her take six or more sticks before they got blood.

Is there a medical reason the lucky ones have nice, juicy veins that are easy to stick?

Elendil's Heir
12-16-2011, 10:02 PM
Low blood pressure and just the inherent physiological variations of different people's veins are the main reasons, aren't they?

Ambivalid
12-16-2011, 10:06 PM
Heredity and genetic history play a role.

nivlac
12-16-2011, 10:33 PM
I don't think blood pressure has anything to do with it. People are just different. For some the veins are closer to the surface and more visible, for others the veins are deeper under muscle for instance. I know when I get blood drawn the tech sometimes has problems finding the vein, so I'd point out to them the exact spots where I'm usually poked. That usually leads to success in one poke.

Nunavut Boy
12-16-2011, 10:44 PM
Hi. I've been a lab tech for the last 10 years (holy shit 10 years?) and these are my reasons why:

1) Some people just have small veins that are hard to feel for and hard to get a needle into
2) Fatter people tend to have their veins buried deeper and are thus harder to find
3) Being dehydrated (and more people are more dehydrated than they realize) means that even if I get a needle in, the vein will just collapse a lot of the time
4) Chemo patients' veins turn to rubber. Seriously, it's like trying to poke through a tiny garden hose that wiggles around all higgely-piggely.
5) Older people's collagen has collapsed meaning their veins flop all over and are hard to keep still when you're poking them even if you're anchoring them with your non needle hand.
6) Some people get nervous and jerk involuntarily making the job at least twice as hard.

The most important factor is number 1, but many people have multiple factors and some have almost all of the above making them extremely hard to get.

If get phlebotomized often and know what areas are better than others or which arm is better, PLEASE tell the tech.

Ambivalid
12-16-2011, 11:43 PM
I don't think blood pressure has anything to do with it. People are just different. For some the veins are closer to the surface and more visible, for others the veins are deeper under muscle for instance. I know when I get blood drawn the tech sometimes has problems finding the vein, so I'd point out to them the exact spots where I'm usually poked. That usually leads to success in one poke.

http://google.com/url?sa=t&rct=j&q=vascularity&source=web&cd=1&sqi=2&ved=0CDMQFjAA&url=http%3A%2F%2Fen.wikipedia.org%2Fwiki%2FVascularity&ei=Hx3sTq-9JYn30gHhwe3GCQ&usg=AFQjCNFfay0SxT7sLmuTx9NwWlmPYNDQzA

Blood pressure is involved in the prominence of a person's veins, as well as genetic factors and body fat levels.

jayjay
12-17-2011, 12:43 AM
If get phlebotomized often and know what areas are better than others or which arm is better, PLEASE tell the tech.

Yeah, assuming the tech doesn't take "I can be hard to stick, so I usually get a butterfly on the top of my hand" as a challenge. I'm diabetic, so I'm getting blood drawn for an A1C usually twice a year, at least, and I can't count the number of times that explanation was met with "Oh, I'm sure I can get a good vein in your arm!" followed by five minutes of stick-pull-dig around-pull-dig around some more-pull out-stick in a new spot-rinse-repeat. And usually ending, after five minutes of annoyance and pain, with them using the damn butterfly on the top of my hand.

nivlac
12-17-2011, 04:51 AM
http://google.com/url?sa=t&rct=j&q=vascularity&source=web&cd=1&sqi=2&ved=0CDMQFjAA&url=http%3A%2F%2Fen.wikipedia.org%2Fwiki%2FVascularity&ei=Hx3sTq-9JYn30gHhwe3GCQ&usg=AFQjCNFfay0SxT7sLmuTx9NwWlmPYNDQzA

Blood pressure is involved in the prominence of a person's veins, as well as genetic factors and body fat levels.
That cite had to do with with bodybuilders. For more typical people I don't think there's much correlation between the variations in blood pressure and the ease at which veins can be found for drawing blood. Show me a scientific cite that says otherwise. In my experience I've known people who have very prominent veins with normal bp and others who have high bp with barely visible veins. What Nunavut Boy posted sounds like the voice of experience and the definitive answer to me.

Nava
12-17-2011, 09:55 AM
If get phlebotomized often and know what areas are better than others or which arm is better, PLEASE tell the tech.

I tell, but they don't believe me! :(

The worst time, I ended up with large bruises inside both elbows... for a week, I pretty much couldn't do anything without mentally cursing the ancestry of the iron-shoe-wearing pseudo-blood-tech who'd got paid to treat me like a voodoo doll.

gotpasswords
12-17-2011, 09:59 AM
If get phlebotomized often and know what areas are better than others or which arm is better, PLEASE tell the tech.
When they ignore us, do we have permission to stab them? I was at the hospital last week for a pre-op exam, and I told them that my right arm usually works best. Naturally, she dives into my left arm, only to find a dry well. :smack:

Bloodless Turnip
12-17-2011, 10:23 AM
I've noticed a trend, healthcare workers assume the patient is an idiot.

Why? I have also given them the information that need to draw blood quickly and painlessly. In the last few years they have ignored me every time.

Nunavut Boy
12-17-2011, 11:21 AM
BP generally doesn't matter. We have tourniquets to bring up peoples' veins. The only time BP matters is if the patient is bleeding out or otherwise lost a lot of blood. In fact, there's been a few times that during my morning rounds I am the one to discover that a patient in hospital for a minor routine thing has bled internally overnight due to fact that they are hard to rouse and their giant veins will not come up at all due to extremely low BP.

Re: techs not listening to the patient as to where to get blood. I always listen as there is very little downside. I can generally get blood on anyone and if someone prefers I stick them in a more painful location even when I think I can get it somewhere else, well, I don't want to get in a pissing contest with them and they may just be right. People who routinely get their blood taken generally know where blood can be collected; on the other hand, we get a lot of people who come in with perfectly fine veins whose last blood collection was in 1986 and who are convinced that they are a hard stick due to a bad experience probably due to an inexperienced tech. It can be a judgement call, but like I said there is very little downside to doing like they want.

Elendil's Heir
12-17-2011, 02:55 PM
If I had had blood techs disregard me several times and it had hurt, I would say very calmly to the next, "Please draw the blood from [favored site or arm]. I have learned, unfortunately, that drawing it from anywhere else almost never works, and is very painful to me. If you will not draw from [favored site or arm], I would like to speak to your supervisor. I respectfully refuse to give my consent for you to draw from anywhere else."

Ambivalid
12-17-2011, 03:07 PM
That cite had to do with with bodybuilders. For more typical people I don't think there's much correlation between the variations in blood pressure and the ease at which veins can be found for drawing blood. Show me a scientific cite that says otherwise. In my experience I've known people who have very prominent veins with normal bp and others who have high bp with barely visible veins. What Nunavut Boy posted sounds like the voice of experience and the definitive answer to me.
..

The Lovely Margo Lane
12-17-2011, 07:36 PM
I have a really obvious juicy-loking vein in my left arm, and nothing visible in the right. I have never had a successful draw of even a vial out of that pretty left-arm vein - it rolls and jumps, and in the rare event of a stick it gives a little and peters out. The one in the right is a little hard to find, but it sticks smoothly and gives actual blood. Of course new techs want to try the left and bash the skills of previous techs who failed. I haven't needed blood drawn in 5 years or so, and I'm hoping that now that I'm in my late 20s I'll be able to keep my wits about me and insist on the right stick spot the next time it has to happen.

Cub Mistress
12-17-2011, 09:54 PM
I draw blood on a occasional basis (once or twice a week) almost always on elderly patients. I ask them where previous blood draws have been successful, because I need all the help I can get! I have had my share of big, fat, pretty veins give a half a milliliter of blood and refuse to put out any more. I have woken up in the middle of the night thinking about the difficult blood draw I have scheduled for the next day, because I hate sticking my patients more than once. Really.


Tell me where others have gotten blood easily before, I promise I will listen. Also please be sure to drink an extra glass of water to be sure you aren't dehydrated. Plump veins are happy veins (and happy nurses.)

KarlGauss
12-17-2011, 10:40 PM
I think the two reasons most applicable to most people are:

1. the more muscular someone's arms are, the more the blood is needed by them (duh). So, with time, and repeated muscle use and demand for blood, the blood vessels gradually enlarge (hypertrophy), in the same way that the muscles hypertrophy.

2. when it's hot, or more accurately, when a person is hot, their body tries to give off the excess heat. One way of doing so is by dilating the veins. That causes them to have more surface area and, thus, more area to give off heat. So, on a hot, sticky summer day, getting blood from most people is a breeze (and that's why blood techs will sometimes wrap a warm, moist towel around the forearm of the person they're trying to get blood from). Conversely, when someone's cold, their veins constrict (and you know, it really is impossible to get blood from a frail, sedentary old person when you're in a cold room!).

constanze
12-18-2011, 11:47 AM
If I had had blood techs disregard me several times and it had hurt, I would say very calmly to the next, "Please draw the blood from [favored site or arm]. I have learned, unfortunately, that drawing it from anywhere else almost never works, and is very painful to me. If you will not draw from [favored site or arm], I would like to speak to your supervisor. I respectfully refuse to give my consent for you to draw from anywhere else."

Question to the nurses, doctors and blood techs in this thread (who do listen anyway):
1. Do you think that would work?

2. Can you imagine why some techs, nurses etc. don't want to listen? Is it power trip? Bad training leading to insecurity? Do you know other nurses or techs who you would consider less than competent or less willing to listen?

Antigen
12-18-2011, 12:29 PM
Question to the nurses, doctors and blood techs in this thread (who do listen anyway):
1. Do you think that would work?

2. Can you imagine why some techs, nurses etc. don't want to listen? Is it power trip? Bad training leading to insecurity? Do you know other nurses or techs who you would consider less than competent or less willing to listen?

1. It should work, in general. As long as you're not being a rude dick about it, telling me your left arm is better will simplify the process for both of us.

2. Sometimes, the patient doesn't know better. The best place to stick a person, in general, is in the arm. A needle to the hand hurts more, is more likely to bruise, and the butterfly needle is harder to keep in place through the blood draw. So, someone who is scared of needles and asks for the butterfly because it's a smaller needle - they may be asking out of ignorance and fear. Obviously, some people do need to be drawn from the hand, and people who have a lot of blood work done will know how to direct a phlebotomist. It's sometimes hard to know which is which, unfortunately.

The real issue is when a tech tries to prove the patient wrong by going after an impossible vein. I've known a couple with a bad attitude who will try to do it their way first to prove a point, and that really pisses me off. That said, if a patient asks me for a butterfly to the hand, I will ask why, and I will ask if I am allowed to check their arms for good veins first, promising I will not stick unless I find a good vein there. I try to explain why I'm doing that, and I describe the process as I go, showing them how I'm looking for only the best veins. If they freak out, sure, I'll get them in the hand with the butterfly, but I make sure they know it's more likely to sting and they may bruise. I hate hearing "the tech was so bad, look at the big bruise on my hand", because in general it's almost impossible to avoid some bruising when you're sticking a needle into that area.

Some places won't go straight to the butterfly until the arms have been checked for good veins accessible by a straight needle, because butterflies are so much more expensive and also increase the risk of unacceptable draws due to the dead space in the tubing.

KneadToKnow
12-18-2011, 12:39 PM
2) Fatter people tend to have their veins buried deeper and are thus harder to find

This what I've often suspected my problem is, although the technicians are always kind to suggest that

3) Being dehydrated

was to blame. :)

WhyNot
12-18-2011, 12:58 PM
Hi. I've been a lab tech for the last 10 years (holy shit 10 years?) and these are my reasons why:

1) Some people just have small veins that are hard to feel for and hard to get a needle into
2) Fatter people tend to have their veins buried deeper and are thus harder to find
3) Being dehydrated (and more people are more dehydrated than they realize) means that even if I get a needle in, the vein will just collapse a lot of the time
4) Chemo patients' veins turn to rubber. Seriously, it's like trying to poke through a tiny garden hose that wiggles around all higgely-piggely.
5) Older people's collagen has collapsed meaning their veins flop all over and are hard to keep still when you're poking them even if you're anchoring them with your non needle hand.
6) Some people get nervous and jerk involuntarily making the job at least twice as hard.

The most important factor is number 1, but many people have multiple factors and some have almost all of the above making them extremely hard to get.

If get phlebotomized often and know what areas are better than others or which arm is better, PLEASE tell the tech.
Excellent post! I'd add that some people like to go for the juicy looking vein, instead of feeling for a good vein. I have a lovely juicy looking vein in my left AC that's utterly useless for actually drawing blood or holding an IV. There's a ginormous strong valve just past the nice blue visible part, and it blocks the catheter every time. If people know what they're doing, they feel it and notice the valve. If they're new or ill-trained, they believe their eyes instead of their fingers.

I'll add the dirty little secret of nursing education: they don't teach us blood draws or IV placement in school. They teach us about blood draws and IV placement, and they have a few plastic models in lab, but we are absolutely forbidden to draw blood on a patient, or even on another student, to learn the actual physical skill. That means that almost every nurse's first blood draw is on a living, breathing patient. So you might think you're a "hard stick" because you were, unknowingly, the very first or second person that nurse ever tried to stick. It's absolutely ridiculous, in my opinion. Thank you, school liability lawyers. :rolleyes:

I tell, but they don't believe me! :(
This doesn't excuse it, but perhaps it explains it...EVERYONE says they're a "hard stick" with "bad veins". Literally everyone I've ever handled, including the big bodybuilder with bulging veins I could toss a 16 gauge into from across the room, like a human dartboard. Unfortunately, all these chicken littles desensitize many techs and nurses, and we don't believe you until we see it for ourselves. I'm trying hard not to fall into that trap, myself.

So, on a hot, sticky summer day, getting blood from most people is a breeze (and that's why blood techs will sometimes wrap a warm, moist towel around the forearm of the person they're trying to get blood from).
Ooh! *frantically scribbles down notes* Makes sense, I'll keep that trick in mind. Thanks!

aux203
12-18-2011, 01:02 PM
Question to the nurses, doctors and blood techs in this thread (who do listen anyway):
1. Do you think that would work?

2. Can you imagine why some techs, nurses etc. don't want to listen? Is it power trip? Bad training leading to insecurity? Do you know other nurses or techs who you would consider less than competent or less willing to listen?

1. Sure. They might think you're a PITA if you phrase it that way but they'd probably do it. But that leads into point 2...

2. Most people will take a whatever tips they can get on a tough stick. However, if they don't listen, it's probably because most fo the time, they're right and the patient is wrong. Mostly might mean only 70-80%, but it's still high enough they rely on their own judgement over yours. There's recall bias on both sides, I suspect. There's also an absolutely huge variation in technical skill when it comes to this sort of thing. There are also some good reasons to try for the arm first, though that's a whole discussion it and of itself.

Arterial BP has nothing to do with the prominence of your veins.

constanze
12-18-2011, 01:04 PM
I'll add the dirty little secret of nursing education: they don't teach us blood draws or IV placement in school. They teach us about blood draws and IV placement, and they have a few plastic models in lab, but we are absolutely forbidden to draw blood on a patient, or even on another student, to learn the actual physical skill. That means that almost every nurse's first blood draw is on a living, breathing patient. So you might think you're a "hard stick" because you were, unknowingly, the very first or second person that nurse ever tried to stick. It's absolutely ridiculous, in my opinion. Thank you, school liability lawyers. :rolleyes:

That surprises me - I remember reading about people who volunteer for nursing and doctors schools so that people can learn exams and putting needles on living persons. It's less risk/ trouble than pharma experiments, and earns a little money.

Have these been discontinued due to liability?

constanze
12-18-2011, 01:06 PM
2 Conversely, when someone's cold, their veins constrict (and you know, it really is impossible to get blood from a frail, sedentary old person when you're in a cold room!).

I can see why many women with low blood pressure, sitting in an AC room, will then have small veins from being cold!

Elendil's Heir
12-18-2011, 01:11 PM
If I had had blood techs disregard me several times and it had hurt, I would say very calmly to the next, "Please draw the blood from [favored site or arm]. I have learned, unfortunately, that drawing it from anywhere else almost never works, and is very painful to me. If you will not draw from [favored site or arm], I would like to speak to your supervisor. I respectfully refuse to give my consent for you to draw from anywhere else."

Emphasis added. I guess I should have added "and politely."

Nunavut Boy
12-18-2011, 01:31 PM
That surprises me - I remember reading about people who volunteer for nursing and doctors schools so that people can learn exams and putting needles on living persons. It's less risk/ trouble than pharma experiments, and earns a little money.

Have these been discontinued due to liability?

When I trained, we poked our classmates. I have also helped organize and supervise phlebotomy training sessions for first year medical students (who also poked their classmates) when I was in university. This was in Canada though, maybe things are different in the US

Lynn Bodoni
12-18-2011, 01:55 PM
I've found that if I make sure to drink lots of water on the day before I go to the doctor, the inevitable stick is a lot easier. I've also gotten into the habit of telling the phlebotomist that there's a very nice vein in my left elbow, but it's deep, and s/he's going to have to pull that tourniquet rather tight. It's not that I ENJOY tight tourniquets, it's just that I'd rather have the stick done as quickly and smoothly as possible.

What I really hate is when the tech can't get red, then pulls the needle out most of the way and sticks it in in another direction.

WhyNot
12-18-2011, 02:30 PM
That surprises me - I remember reading about people who volunteer for nursing and doctors schools so that people can learn exams and putting needles on living persons. It's less risk/ trouble than pharma experiments, and earns a little money.

Have these been discontinued due to liability?

We were told by our instructors that it was a liability issue, yes. Whether they were telling me the truth, I couldn't say. I've had four friends from different nursing schools - some two year programs, some four year programs - also report the same. So it seems widespread in my area, if not state, if not country.

My friend in the RN/Midwifery program at UIC has volunteer "patients" to practice PAP smears and pelvic/cervical checks on, but they're not allowed to do blood draws or IVs in that program, either.

I assume, but don't actually know, that phlebotomy students actually get some practice on real people who aren't patients, but not nursing students.

ETA: I know nursing students used to practice on each other with the knowledge and approval of their school, because veteran nurses have told me so. I don't know when that ended, but I can narrow it down to sometime between 1990 and 2005, based on graduation dates.

Ambivalid
12-18-2011, 02:43 PM
That cite had to do with with bodybuilders. For more typical people I don't think there's much correlation between the variations in blood pressure and the ease at which veins can be found for drawing blood. Show me a scientific cite that says otherwise. In my experience I've known people who have very prominent veins with normal bp and others who have high bp with barely visible veins. What Nunavut Boy posted sounds like the voice of experience and the definitive answer to me.

http://google.com/url?sa=t&rct=j&q=arterial%20blood%20pressure%20and%20vein%20prominence&source=web&cd=16&ved=0CE4QFjAFOAo&url=http%3A%2F%2Fehow.com%2Ffacts_5837863_meaning-prominent-blood-veins_.html&ei=vkDuTu7uA-jy0gHvnZSrCQ&usg=AFQjCNHhnWwiIkPlJum5fg2rr_l6SMsHkQ

"According to Dr. Kirksey, prominent veins can have roots in heart problems such as heart failure and high blood pressure."-quote from link (bolding mine)

KarlGauss
12-18-2011, 03:00 PM
http://google.com/url?sa=t&rct=j&q=arterial%20blood%20pressure%20and%20vein%20prominence&source=web&cd=16&ved=0CE4QFjAFOAo&url=http%3A%2F%2Fehow.com%2Ffacts_5837863_meaning-prominent-blood-veins_.html&ei=vkDuTu7uA-jy0gHvnZSrCQ&usg=AFQjCNHhnWwiIkPlJum5fg2rr_l6SMsHkQ

"According to Dr. Kirksey, prominent veins can have roots in heart problems such as heart failure and high blood pressure."-quote from link (bolding mine)

Actually, if you go to the source of his quote (http://medhelp.org/posts/Peripheral-Arterial-Disease-PAD-/Prominent-Veins/show/595181), it states that pulmonary hypertension may lead to distended veins. That is a very different entity than the usual hypertension we hear about so often and refers to high pressures within the blood vessels of the lungs (which may be transmitted out and back into the veins). There is no relationship between the 'common' hypertension (i.e. arterial or systemic hypertension) and distended veins.

WhyNot
12-18-2011, 03:06 PM
http://google.com/url?sa=t&rct=j&q=arterial%20blood%20pressure%20and%20vein%20prominence&source=web&cd=16&ved=0CE4QFjAFOAo&url=http%3A%2F%2Fehow.com%2Ffacts_5837863_meaning-prominent-blood-veins_.html&ei=vkDuTu7uA-jy0gHvnZSrCQ&usg=AFQjCNHhnWwiIkPlJum5fg2rr_l6SMsHkQ

"According to Dr. Kirksey, prominent veins can have roots in heart problems such as heart failure and high blood pressure."-quote from link (bolding mine)
Right, but there is little correlation between prominent veins and easy-to-stick veins. There is some, yeah. Bodybuilders, being comprised mainly of mesomorphs, tend to have both prominent and easy to stick veins. But plenty of old people with high blood pressure have prominent, easy to see but hard to stick "rolling" veins, or veins with lots of scarring or annoyingly placed valves.

Low blood pressure is related to a hard stick in extreme situations like hemorrhage, but a BP of 110/70 instead of 160/90 isn't going to make a difference. Hydration status makes much more of a difference.

Digital is the new Analog
12-18-2011, 05:37 PM
I assume, but don't actually know, that phlebotomy students actually get some practice on real people who aren't patients, but not nursing students.

When my sister took a course to become certified as a phlebotomist, they stuck each other. They did it enough to be decent at it, with the understanding that if they actually wanted to be GOOD they should spend some time working at a hospital doing phlebotomy. There's nothing like experience.


-D/a

aux203
12-18-2011, 06:13 PM
Right, but there is little correlation between prominent veins and easy-to-stick veins. There is some, yeah. Bodybuilders, being comprised mainly of mesomorphs, tend to have both prominent and easy to stick veins. But plenty of old people with high blood pressure have prominent, easy to see but hard to stick "rolling" veins, or veins with lots of scarring or annoyingly placed valves.

Low blood pressure is related to a hard stick in extreme situations like hemorrhage, but a BP of 110/70 instead of 160/90 isn't going to make a difference. Hydration status makes much more of a difference.

To echo KarlGauss, the difference between a systolic of 110 or 160 isn't going to mean jack as far as the prominence of your veins. Under normal conditions in a healthy person, the pressure of the arterial system is almost entirely dissipated as it crosses the high resistance capillary system. The veins have a high capacitance and will dialate in response to increased blood volume limiting changes in venous pressure. In the setting of blood loss you can maintain a normal blood pressure through vasoconstriction. Your veins will start to constrict long before your blood pressure drops significantly in a healthy young person.

Venous distension as a result of increased venous pressure is generally associated with a significant disease state. It can be associated with primary pulmonary hypertension (extremely rare) or pulmonary hypertension due to various other cardiac and pulmonary conditions i.e COPD, CHF, etc. That's not what anyone means when they use the terms high blood pressure or hypertension, however.

Others can chime in but getting proficient at IVs and blood draws, to say nothing of expertise, takes dozens or even hundreds of reps. Considering how many people need to at least be minimally proficient in that skill, it's not something easily accomodated by most training programs. They have other things to worry about.

Just for the record, I'll take skinny old woman veins over obese veins any day...

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