Blown veins

AuntPeggy

AuntPeggy

Final Approach
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I was hospitalized a few months ago and was on an IV drip of fluids. As well, I had a CT scan with contrast administered by IV. Now, nurses have had problems with getting a good vein for about 25 years (I'm 75 now) and more and more frequently they cannot get a good flow from my elbow and resort to drawing from the back of my hand. In the instance mentioned, the fluid IV was into my hand and the CT contrast was into a vein inside my upper arm, nearly in my armpit.

Fast forward to last week. I was back in the hospital lab for another CT scan. As usual, I warned the technician that she might have a problem finding a good vein. She tried the back of my left hand and "blew" the vein when she cleared the line with saline. She then tried 2 places in my arm and was unable to pierce a good vein. Another technician appeared and tried again in the back of my right hand. In this case, the pain was excruciating when that vein "blew" and both technicians gave up and took me to another floor for a more skillful technician.

This third technician spent quite some time massaging and tapping up and down my right arm and hand before finally inserting a needle just under the last joint of my little finger. "Don't move around, it's placed in a very fragile location," I was told. In all, it took 3 people and an hour to get one needle in place.

Here's my question: I don't want to be a pin cushion the next time. What is the appropriate request to make that will ensure that the more skilled and artful technician is the ONLY one who starts poking around my veins? I have tried telling people that my veins roll and they are fragile. I still have to let the less skilled one (or two) give up before the expert is called. How can I skip directly to go?
 
Third time's the charm, right? ;) For what it's worth, I work in a clinical medical laboratory, and have done so in three different states and five different hospitals. There are not any lab techs anywhere that are allowed to inject saline into you during a phlebotomy procedure. Those were very likely nurses or possibly medical assistants. (I'll plead ignorance to many states' laws.) All veins "roll" as you put it. None of them are anchored by unyielding tissue. They all move. Anyone who draws blood knows this. It's kind of like telling the dentist that you use your teeth for chewing. These boots were made for walking, etc. ;) Next time you need blood drawn at that facility, just ask to have the IV nurse insert your catheter and you'll be all set. If something was placed and remained in your arm/hand/foot/chest for peripheral access then it was not placed by a lab tech. It was placed by a nurse, NP, PA, or physician. Make the person drawing your blood aware of this and that should be a good place to start to get the right professional working on you. Hope this helps.
 
Maybe ask the lead tech to write you a letter or put a note in your records/file. Guessing leadership doesn’t want the hassle any more than you do...for some of the lower techs it’s probably just a fun challenge at your expense.

Edit: see post above. I have the same issue as I’m getting older and did not know how to approach this.
 
If you say "my veins are so bad they usually need an ultrasound to find a good one; all the ones you can see will blow" you might have a fighting chance. They might decide to try anyway, but it's worth a shot. (Also will be super awkward if you try this approach in a place that doesn't have an ultrasound available for starting IVs...)
 
Peggy, talk to the doctor ordering the tests and tell him/her what happened. Don't put up with this again. If you know the vein that works then insist on that vein. Give them one shot to get it right then tell them to bring their best in. I've had similar happen to me, never again but you have to speak up. You don't have to worry about these people's feelings, tell them up front that you have had issues in the past and want their best person. If they start fishing for the vein with the needle tell them they are done and next up. In my case after 4 tries they finally had the anesthesiologist come in and do the IV. I was dehydrated by design, come to find out the person who normally did the ivs was on vacation and they had 2 nurses try who normally didn't do ivs. What you went through is borderline abuse, don't stand for it.
 
Peggy, Mrs. Steingar has the exact same problem. She tells them upfront and very forcefully that they're going to have problems, and if I'm around I tell them in my OUTSIDE VOICE to skip the JV team and go right for the pros. Sometimes it works for her, always works for me.
 
I have always had a hard time with IV's to the elbow, and veins "collapsing" or "rolling". Once that cycle starts, I can start to feel faint, and once did actually faint. Its a really horrible feeling, with abdominal cramping and nausea and sweating. I have much better luck when they use my hand.

One thing that really helped me: For a long time, I would try to relax - imagine myself on a beach with the sun on my face, breathing deeply, that sort of thing. Never helped at all once the faintness started.

But I read online the key was to keep blood pressure up, and the way to do that was to intentionally tense up, by tightening abdominal and leg muscles. The exact opposite of relaxing! I tried that and it works! I do it every time now and have had far, far fewer problems.

Just what works for me - I know everyone is different.
 
I always ask the following question. "When you cannot get the IV to work, who do you call?" They always give an answer, I then say, call them now and skip the painful steps of me saying I told you so repeatedly.

Tim
 
  • Schedule your appointments for normal weekday working hours to get the best chance of having the most skilled person available to start your IV.
  • Make sure you are well hydrated prior to the appointment. Reschedule if you are sick.
  • Make sure your technologist is a certified CT technologist.
  • Ask that your IV be placed by a nurse trained to place difficult IVs.
    Tell the technologist you do not want a trainee to place your IV.
  • Explain in detail, and with great feeling, how painful past attempts to start peripheral IVs have been for you.
  • And, if you don't like how its going, refuse to continue, go back and explain to the doctor who ordered the exam just how painful this is for you. Make the provider work for you.
 
AuntPeggy said:
I was hospitalized a few months ago and was on an IV drip of fluids. As well, I had a CT scan with contrast administered by IV. Now, nurses have had problems with getting a good vein for about 25 years (I'm 75 now) and more and more frequently they cannot get a good flow from my elbow and resort to drawing from the back of my hand. In the instance mentioned, the fluid IV was into my hand and the CT contrast was into a vein inside my upper arm, nearly in my armpit.

Fast forward to last week. I was back in the hospital lab for another CT scan. As usual, I warned the technician that she might have a problem finding a good vein. She tried the back of my left hand and "blew" the vein when she cleared the line with saline. She then tried 2 places in my arm and was unable to pierce a good vein. Another technician appeared and tried again in the back of my right hand. In this case, the pain was excruciating when that vein "blew" and both technicians gave up and took me to another floor for a more skillful technician.

This third technician spent quite some time massaging and tapping up and down my right arm and hand before finally inserting a needle just under the last joint of my little finger. "Don't move around, it's placed in a very fragile location," I was told. In all, it took 3 people and an hour to get one needle in place.

Here's my question: I don't want to be a pin cushion the next time. What is the appropriate request to make that will ensure that the more skilled and artful technician is the ONLY one who starts poking around my veins? I have tried telling people that my veins roll and they are fragile. I still have to let the less skilled one (or two) give up before the expert is called. How can I skip directly to go?
Click to expand...
Refuse, keep refusing, insist on speaking with the head phlebotomist (?), then the medical director if need be. Keep refusing. Time to become the Wicked Witch of the West. Explain they might be great technicians bunyou've lived with you body for 75 years and you want to make it easier on them as well as you.

Keep refusing. Have another friend or relative or hubby there to make sure they attempt no procedure without your permission.

BTDT. Have similar problem with blood draws. I refuse any blood work in my hand, regardless of the reason.

Just keep refusing and insist on speaking with TPTB to explain the issues.
 
Are you getting this done at a hospital or an outpatient center? Typically outpatient ct techs don’t start enough Iv to be super proficient for a “hard stick”. When I have a patient that is a hard stick I will send to the hospital and have them do there with instructions that I called a head of time when I placed the order that an ER nurse has to come over or someone from the interventional radiology team or anesthesiology team come over- those cats are the pros.
Ct scan iv imaging requires a larger bore line to power that in.
 
benyflyguy said:
Are you getting this done at a hospital or an outpatient center? Typically outpatient ct techs don’t start enough Iv to be super proficient for a “hard stick”. When I have a patient that is a hard stick I will send to the hospital and have them do there with instructions that I called a head of time when I placed the order that an ER nurse has to come over or someone from the interventional radiology team or anesthesiology team come over- those cats are the pro
Ct scan iv imaging requires a larger bore line to power that in.
Click to expand...

Almost all the IVs I start have been outpatients. CT techs that get the most practice starting IVs are doing outpatients. Because, in the hospital they come to us with an IV already started. ER patients get their IVs started by ER nurses. Inpatients have a good IV when they come to us. If they don't, I may try to start an IV on them. But, if its a hard stick, or I have a lot of STAT exams to do, I'll send them back to the nurse that sent the patient down without an IV.

If I'm not scanning, I have people breathing down my neck, wanting to know why not. Difficult stick, send them back because EVERY EXAM is STAT. (God, I wish I could make a living fixing airplanes!)
 
Ask if they have any phlebotomists that used to be a veterinary technician. Vet techs are used to hitting veins the size of angel hair pasta.

Vet Techs know more than most nurses and have finer skills (and yet are paid about a quarter of what a nurse makes).
:popcorn:
 
I haven’t had that problem personally, but I had to watch them repeatedly stick my 2 week old son until they had exhausted almost every vein in his body. I learned a couple things very quickly:

1. Enough is enough. We are in charge and we need to say when to stop

2. When someone was good, we learned that persons name and schedule. In the outpatient scenario, if he took a day off, we’d come back.

3. When the PICU and NICU nurses fail, they call the LifeFlight folks. They don’t fail.
 
455 Bravo Uniform said:
Maybe ask the lead tech to write you a letter or put a note in your records/file. Guessing leadership doesn’t want the hassle any more than you do...for some of the lower techs it’s probably just a fun challenge at your expense.

Edit: see post above. I have the same issue as I’m getting older and did not know how to approach this.
Click to expand...
I get my lab work done at several different hospitals. I'm always seen by someone new. The best are at the Cancer Institute, but my insurance won't pay to have the CTs or procedures done there. I'll see my doctor at the Cancer Center tomorrow and tell him about the problems.

BTW, I don't have cancer.
 
mcmanigle said:
If you say "my veins are so bad they usually need an ultrasound to find a good one; all the ones you can see will blow" you might have a fighting chance. They might decide to try anyway, but it's worth a shot. (Also will be super awkward if you try this approach in a place that doesn't have an ultrasound available for starting IVs...)
Click to expand...
Good idea, but I hate ultrasound, too. The places I go always have ultrasound available.
 
PaulS said:
Peggy, talk to the doctor ordering the tests and tell him/her what happened. Don't put up with this again. If you know the vein that works then insist on that vein. Give them one shot to get it right then tell them to bring their best in. I've had similar happen to me, never again but you have to speak up. You don't have to worry about these people's feelings, tell them up front that you have had issues in the past and want their best person. If they start fishing for the vein with the needle tell them they are done and next up. In my case after 4 tries they finally had the anesthesiologist come in and do the IV. I was dehydrated by design, come to find out the person who normally did the ivs was on vacation and they had 2 nurses try who normally didn't do ivs. What you went through is borderline abuse, don't stand for it.
Click to expand...
I like this idea the best. To be honest, I've shown a huge bruise from a blood draw to my doctor in the past and he said it is unacceptable. But then, it has happened again. I'll be sure to bring it up again tomorrow when I see him.
So, I'll tell the doctor to order their best person to start the IV and then when they are doing it, I'll ask for their best person again.
Yes, I was dehydrated, too. No, food, medicines before the scan. So, I'll ask the doctor if I can have plenty of water beforehand. That does help.
 
JOhnH said:
Ask if they have any phlebotomists that used to be a veterinary technician. Vet techs are used to hitting veins the size of angel hair pasta.

Vet Techs know more than most nurses and have finer skills (and yet are paid about a quarter of what a nurse makes).
:popcorn:
Click to expand...
Or a pediatric or neonatal nurse who is expert at IVs. They're used to tiny & difficult veins.
 
steingar said:
Peggy, Mrs. Steingar has the exact same problem. She tells them upfront and very forcefully that they're going to have problems, and if I'm around I tell them in my OUTSIDE VOICE to skip the JV team and go right for the pros. Sometimes it works for her, always works for me.
Click to expand...
Hubby was there, but they told him to sit in the waiting room wondering why an IV was taking an hour. Now I know to have him be more proactive if it takes more than a few minutes.
 
FastEddieB said:
I have always had a hard time with IV's to the elbow, and veins "collapsing" or "rolling". Once that cycle starts, I can start to feel faint, and once did actually faint. Its a really horrible feeling, with abdominal cramping and nausea and sweating. I have much better luck when they use my hand.

One thing that really helped me: For a long time, I would try to relax - imagine myself on a beach with the sun on my face, breathing deeply, that sort of thing. Never helped at all once the faintness started.

But I read online the key was to keep blood pressure up, and the way to do that was to intentionally tense up, by tightening abdominal and leg muscles. The exact opposite of relaxing! I tried that and it works! I do it every time now and have had far, far fewer problems.

Just what works for me - I know everyone is different.
Click to expand...
I try to relax, too. OK, next time I'll use tension. Thanks.
 
tspear said:
I always ask the following question. "When you cannot get the IV to work, who do you call?" They always give an answer, I then say, call them now and skip the painful steps of me saying I told you so repeatedly.

Tim
Click to expand...
I like that.
 
wilkersk said:
  • Schedule your appointments for normal weekday working hours to get the best chance of having the most skilled person available to start your IV.
  • Make sure you are well hydrated prior to the appointment. Reschedule if you are sick.
  • Make sure your technologist is a certified CT technologist.
  • Ask that your IV be placed by a nurse trained to place difficult IVs.
    Tell the technologist you do not want a trainee to place your IV.
  • Explain in detail, and with great feeling, how painful past attempts to start peripheral IVs have been for you.
  • And, if you don't like how its going, refuse to continue, go back and explain to the doctor who ordered the exam just how painful this is for you. Make the provider work for you.
Click to expand...
How do you have the mental power to be so assertive after you've gone without food all morning and then downed a couple of bottles of contrast that causes your bowels to move every few minutes? I'm not trying to be flip, just remembering about the state I was in at the time.
 
murphey said:
Refuse, keep refusing, insist on speaking with the head phlebotomist (?), then the medical director if need be. Keep refusing. Time to become the Wicked Witch of the West. Explain they might be great technicians bunyou've lived with you body for 75 years and you want to make it easier on them as well as you.

Keep refusing. Have another friend or relative or hubby there to make sure they attempt no procedure without your permission.

BTDT. Have similar problem with blood draws. I refuse any blood work in my hand, regardless of the reason.

Just keep refusing and insist on speaking with TPTB to explain the issues.
Click to expand...
They tell me that I must have the contrast. For a while I was able to avoid the contrast because of poor kidney function, but now they are insisting on it and then telling me to drink lots of water after the test. I feel so sick for a couple of days afterward just because of the contrast.
 
benyflyguy said:
Are you getting this done at a hospital or an outpatient center? Typically outpatient ct techs don’t start enough Iv to be super proficient for a “hard stick”. When I have a patient that is a hard stick I will send to the hospital and have them do there with instructions that I called a head of time when I placed the order that an ER nurse has to come over or someone from the interventional radiology team or anesthesiology team come over- those cats are the pros.
Ct scan iv imaging requires a larger bore line to power that in.
Click to expand...
This is done in a lab at the hospital or the lab associated with the Cancer Center. As I mentioned, there is never a problem with the Cancer Center. Cancer has been ruled out as a problem and my insurance won't pay for them to do the tests any more. But, the cancer center doctor is still working with me.
I'll see him tomorrow and discuss this with him.
 
wilkersk said:
Almost all the IVs I start have been outpatients. CT techs that get the most practice starting IVs are doing outpatients. Because, in the hospital they come to us with an IV already started. ER patients get their IVs started by ER nurses. Inpatients have a good IV when they come to us. If they don't, I may try to start an IV on them. But, if its a hard stick, or I have a lot of STAT exams to do, I'll send them back to the nurse that sent the patient down without an IV.

If I'm not scanning, I have people breathing down my neck, wanting to know why not. Difficult stick, send them back because EVERY EXAM is STAT. (God, I wish I could make a living fixing airplanes!)
Click to expand...
The technician who finally got the IV started, in the back of my hand, was the CT technician. Two others were unable to get it started and they couldn't get an RN to come do it. That CT technician spent at least 20 minutes looking for a good vein before sticking me. He said he'd get an anesthesiologist if it didn't work for him first time. I wonder what the insurance company would think about that.

PS. They keep asking if I have a "port" at the Cancer Center. I absolutely hate that idea. (+I don't have cancer.)
 
JOhnH said:
Ask if they have any phlebotomists that used to be a veterinary technician. Vet techs are used to hitting veins the size of angel hair pasta.

Vet Techs know more than most nurses and have finer skills (and yet are paid about a quarter of what a nurse makes).
:popcorn:
Click to expand...
Chuckle. Next stop, the animal hospital. :eek::(
 
bluesky74656 said:
I haven’t had that problem personally, but I had to watch them repeatedly stick my 2 week old son until they had exhausted almost every vein in his body. I learned a couple things very quickly:

1. Enough is enough. We are in charge and we need to say when to stop

2. When someone was good, we learned that persons name and schedule. In the outpatient scenario, if he took a day off, we’d come back.

3. When the PICU and NICU nurses fail, they call the LifeFlight folks. They don’t fail.
Click to expand...
How horrible for you. Is he OK now?
 
AuntPeggy said:
How do you have the mental power to be so assertive after you've gone without food all morning and then downed a couple of bottles of contrast that causes your bowels to move every few minutes? I'm not trying to be flip, just remembering about the state I was in at the time.
Click to expand...

I'm so sorry you have to go through that. I see this quite regularly with my Saturday morning outpatients. I've complained to supervisors about this very topic multiple times.

My suggestion is try to have someone go with you who can advocate for you during the exam. They need to be up on whats happening. And, you need to specifically tell the technologist that this person has your permission to be present during the exam.
 
This has been done to death so I'll give my highly respected expertise. Well worth the price you pay for it....

Usually when they start looking for a place for the needle, I hear, "Oh, you will be an easy stick." I reply, "No, looks are deceiving. Everyone says I look like an easy stick but I am not. So at this time I need to inform you, if I feel pain so will you."

Most take that as a good reason to bring in the first team.

However, my last trip to the emergency room, they stuck me 3 times including a port. I never felt a thing.
 
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