lesV Venipuncture
by M.W.
 


[Disclaimer: The information provided here is for educational purposes only and is purely the opinion of the author. This site disclaims all responsibility for reliability or veracity of its content. Should you choose to undertake Any of these practices discussed here you do so entirely at your own risk. Neither the author nor editors advocate any of these practices nor guarantee their safety nor do they promote support or encourage the breach of any applicable laws. This is dangerous and not to be undertaken without proper medical training.]



Iím a registered nurse and have a lot of experience with phlebotomy. Iíve also taught it to quite a few vamps. Donors can do this too if theyíre so inclined. Most phlebotomists arenít licensed, itís a skill theyíve been taught and improved by experience. Everybody starts somewhere.

Some donors prefer venipuncture because itís something theyíve experienced before and they know what to expect in terms of pain and/or because it can be easier to conceal than a cut. However, also be aware there are people who are very squeamish about needles. Find a good diagram of veins and arteries and study it thoroughly, although it probably wonít show all the smaller veins in the hand and lower arm, and there are always individual variations.

If someone has little or no experience with venipuncture, I usually recommend they start with a butterfly needle setup. A 23-gauge needle is a good one to learn with. The larger the number the smaller the needle. A butterfly needle has little plastic wings on it and itís easier to guide. It also has a length of tubing on it that can either be attached to a syringe or used like a straw by the vamp.

Make sure your donor is warm and comfortable, as veins just disappear in cold nervous people, and itís also a nice thing to do for your donor.

The technique: Most venipunctures are done in the arms, although hands are acceptable. Most people have a large vein in the inner aspect of the elbow called the antecubital vein. Youíll need to feel it as it runs to the side in some people rather than the center. To tap a vein, place the tourniquet just above the elbow. Cross ends of the tourniquet once , then tuck the upper piece back under the lower piece to make like a half bow, so the tourniquet can be released easily with one hand. If youíre going to use a vein below the elbow, you can either put the tourniquet above or below the elbow. Sometimes below makes the lower veins stand out better. You want the tourniquet to be snug but not painful. Also be aware some people have a latex allergy so be sure to ask your donor. There are latex-free tourniquets available.

When youíre starting out, itís usually good to use a vein that you can both see and feel. After youíve applied the tourniquet, use either a cotton ball or small gauze pad soaked with alcohol or hydrogen peroxide and stroke the veins as you look. Stroking makes them stand out better. You can also lightly slap the area with the tips of your fingers. When youíre picking a vein, see if it Ďrollsí easily from side to side. If so have the donor make a loose or tight fist, whichever works. Stay away from anything that pulses. Those are arteries not veins, so donít mess with them. Also be sure youíre feeling a vein and not a tendon, as sticking a tendon just downright hurts and you wonít get any blood either. Rotating the donor's wrist gently in either direction, while feeling for the vein with your finger, can move the vein away from a close-by tendon or bone, reducing the risk of hitting something other than the intended vein. Once youíve chosen a vein, clean the area with alcohol or hydrogen peroxide. If you prefer to use betadine, be sure to clean it off, as itís irritating to the skin if left on. Hydrogen peroxide is my personal favorite because if thereís any sucking involved, it has the least taste to it.

butterfly

Uncap the needle and look at the tip and turn it bevel up (like a scoop, longest pointy part on bottom). Donít touch the needle itself, it needs to stay sterile. For Ďrollingí veins, you need to pull back on the skin a little behind where youíre going to pierce, to keep the vein steady as you pierce. Pierce the skin at about a 45 degree angle directly on top of the vein, then lower the needle closer to the skin as you go into the vein (a few people prefer to pierce on one side of the vein and then go into the vein, itís a personal preference). You need to pierce the vein in the direction towards the body (just keep in mind, veins are flowing back to the heart). Donít be too slow about it but donít jab either. Just do it in one steady move. If your hand shakes, donít freak out; after 15 years I still have times when my hand shakes too. Just donít scare the donor. If youíre shaking too much, best to wait until you settle down a little.

If youíre in the vein, youíll see a blood return in the needle hub or the tubing. Once you see blood you donít have to advance very far, just far enough so it wonít fall out, a little under half an inch. You donít want to take the chance of going through the vein. If you going to be drawing the blood into a syringe or sipping from the tubing, you need to leave the tourniquet on for as long as youíre drawing. You can also put a small piece of tape across the needle or wings to hold it in place. When youíre done, release the tourniquet first, then withdraw the needle as you get ready to apply pressure with another cottonball or piece of gauze. Now weíre talking vampires here, not laboratories, so the vampire may want to suck directly from the site once the needleís been removed. If so, the tourniquet can be left on for a short time, or the vamp may just prefer to use pressure from his or her hand like a tourniquet.

blood draw

Another newsflash: For years we were taught to apply the cotton ball and bend the personís arm up, to hold pressure. Now the standard is just to apply the cottonball or gauze and hold pressure a few minutes. Iím told bending actually causes more bruising and breaks up the platelet clot thatís forming. After youíve released the pressure, check to see if itís bleeding through the gauze/cotton/bandaid and if so, continue to hold pressure a little longer. Change it if necessary. You can apply a bandaid or a piece of tape over it, but sometimes bandaids cause more bruising when left on. They do on me and then I have a bruise to cover up instead just a small needle mark.

Now what if you make an oops? Donít feel too bad, everyone does, even the most experienced people now and then. If you just donít get any blood back, but you donít see any swelling at the site, then pull the needle back a little, but not out. Feel the vein again, then move forward again in the direction where you feel the vein. If you canít get it after a few tries or itís hurting the donor, then take it out and do aftercare. If you remove the needle completely from the skin, donít reinsert it. You can however, use the same hole again with a new needle, if you just missed and didnít Ďblowí the vein. Or depending on the state of your donor, you can try in another spot. Release the tourniquet between tries so the donorís arm can get some circulation. If you canít see or feel any veins, you can try a warm wet compress around the arm for 10 or 15 minutes and again be sure your donor is warm and comfortable. Something warm to drink like tea may help too or a glass of wine is also a good vasodilator. If you put the needle in and you see blood come back but the area starts to swell, pull the tourniquet immediately, withdraw the needle and do aftercare. Whatís happened is that the vein has Ďblowní. You either went through the vein, or scraped the side of it and itís bleeding under the skin. Or a few people just have very fragile veins. Itís not dangerous, but be nice to your donor because it will leave a nasty bruise. Warm wet compresses for awhile can give some relief and help the swelling go down. They can take an over-the-counter pain reliever if they need it. If you accidently hit an artery, which is highly unlikely if youíve stayed away from anything that pulses and studied your veins and arteries, youíll know because it will be bright red and the blood will fill the tubing or syringe quickly. Release the tourniquet, withdraw the needle and apply firm pressure with a gauze pad or cottonball for at least 5 minutes. Then tape it snugly and check it to be sure itís not bleeding through. If so, hold pressure longer.

Syringes: If youíre going to draw blood into a syringe, I would recommend a 10cc syringe. Thatís the equivalent of 2 teaspoons of blood. You can use a 20cc syringe, but if you do, be sure youíre using a 21 or 19 gauge needle, or itís just too hard to draw. Pull gently back on the plunger while you hold the needle in place at the hub (or tape a butterfly needle). If the bloodís not coming easily, ask the donor to take some slow deep breaths and relax. When you see the blood coming just give it time with slow steady gentle pulling until itís full. Too much suction can cause the vein to collapse. Some vamps draw more than one syringe, if theyíre experienced enough to switch out syringes and not move the needle. Itís easier with a butterfly setup to do multiple syringes.

Needles: Once youíre prolific with a 23 gauge (I donít recommend anything smaller or it will be hard to draw the blood), then you can increase the gauge size if you wish to 19g or 21g. An 18g will give a lot of blood quickly, but it does have a bite to it and I recommend it only after the donor (and the vamp) are experienced. And for heavenís sake, donít harpoon someone with a 16g or 14g, itís not recommended unless youíre very experienced and your donor doesnít complain. You can also use a plain hypodermic needle either with a syringe or just let the blood freeflow down the arm or into a preferred vessel. Try to get your hypodermic needles in the 1 inch length. Anything longer than that is sometimes unwieldy. When ordering needles, for example, a 21g x 1Ē is a 21 gauge needle that is one inch long. The butterfly sets come in gauges with different lengths of tubing usually 6 or 12 inches. You really shouldnít ever reuse needles, even the butterfly ones. Use a new sterile one each time. And if you have to pull the needle completely out of the skin, donít reinsert the same needle. And please dispose of needles safely in something like an empty plastic soft drink or water bottle with a screw-on cap.

Where do you find supplies? Asking around is usually your best source. Most items can be purchased online. More on supplies will be found on the Needful Things page.

Lancets: Iíll mention lancets here as they are a way of drawing blood. Lancets may be found at any store that carries diabetic supplies. You can use them on the tips of the fingers (I like to call it fingerfood), the forearms or other areas. For the purposes of bloodletting, it will usually take more than one puncture. There are some new lancets on the market that slice rather than puncture and yield up more blood with one application; however, they are considered a specialty medical product and may be harder to find.

 

~Be Safe and Feed Well~

thing
Back
Home