Challenges

Situation

 Difficulties

Recommendations

Patients with difficult to locate veins e.g. geriatric patients

Dif​ficult to locate veins,

decreased vein elasticity, rolling, collapsing or fragile veins, dehydration and low blood pressure make locating

veins difficult.

Warming the site increases blood flow as much as seven times. Options include:

• Commercially available pre-warming devices. To avoid burning the patient, the device provides a uniform temperature that does not exceed 42C.
• A towel or diaper dampened with warm tap water used to wrap a hand or foot before skin puncture. However, care must be taken not to get the water so hot that it scalds the patient.
• Massaging the area gently to help locate a vein and increase blood flow.

Obese patients

Deep veins, challenging palpation and locating a vein. Rolling veins may be present.

• Use bariatric chairs, if available, in an out-patient setting to prevent discomfort and embarrassment.
• Consider longer needles to help access deeper veins.
• Warming the site (see row above) or using a Vein Viewer may enhance vein location.
  
  
  
  

Oncology patients

Chemotherapy can alter

vasculature and affect vein patency and palpability.

Rolling veins may be present.

See under ‘Patients with difficult to locate veins’ above.

Needle-Phobic

patients

Fear of needles. This is usually a result of a prior negative encounter with sharps

• Present yourself calmly and confidently.
• Make sure the patient is reclined comfortably.
• Explain the procedure without showing any collection items
• Built trust by engaging in conversation to distract the patient e.g. We are going to work together to make this as quick and gentle as possible
• Complete the procedure as quickly as possible
• Exercising an abundance of patience and compassion

Cognitively

impaired and/or combative patients

Unpredictable and sudden motions and behaviors.

• Assistance should be sought from another staff member e.g. another phlebotomist and/or appropriate patient relative to help keep the patient stable and minimize sudden motions
• If the phlebotomist/collector feels that the procedure cannot be performed safely, the physician should be notified that the procedure cannot safely be undertaken.
• Do NOT place equipment within reach of the patient.
• A clean gauze should be ready to use in case the needle is violently removed if the procedure is undertaken.