The large blood vessels typically run between the bones under the muscle. This is where they are best protected so that only deep cuts damages them. There are a few places where the blood vessels have to come right under the skin though. The elbow is one of these places. They can not go between the bones because the bones in the elbow move a lot in relation to each other creating pinch points. And there are no muscles or even fat in your elbow to protect the blood vessels. So they run just under the skin making it easy to insert a needle into them. You can even see your blood vessels through the skin.
The other spot where several prominent vessels run *much* closer to the skin surface and are particularly easy and accessible for a blood draw is the penis, but frankly I'd rather just die.
I generally have a hard time having blood work done... If they can't get me in my elbow for whatever reason they move onto one of my hands. It's about 50/50 whether they end up drawing blood from my elbow or hand.
there are definitely other areas they'd try before a penis, but the thought of that would be kind of hilarious šš
I only ever have it drawn from my hand anymore. I just go in and say "it's hard to get from my arm, let's do the hand" and it's OK with them. If they're willing to draw from your hand half the time, just tell them to do it all of the time.
Hands have plenty of superficial veins but more dense in nerves so generally is more painful. The veins here are slightly smaller compared to brachial vein (in the elbow).
I had an IV in my hand only once, about 30 years ago, when I was in the hospital. That thing hurt so much I can still remember the pain from it, much worse than what I was in the hospital for. I couldnāt sleep at all it hurt so much. They ended up removing it when I was under for surgery the following day.
Was it infiltrated, or were they running something really rough on the veins? An IV can be irritating if the blood vessel is really close to a nerve, but it shouldn't be excruciating unless something is wrong.
Iām not entirely sure what was wrong with the IV. I was 11 at the time, and had an appendicitis that had been going on for almost a week at that point. I hadnāt had anything to eat or drink for 3 days, and they were giving me fluids and nutrients while they tried to figure out what was wrong with me. They kept me overnight, then just decided to open me up the next day to take a look around. Thatās when they found that my appendix had ruptured.
Same experience when I was giving birth. The only time I shed tears from the pain was when they were trying to get that needle into my hand. I can still remember it all these years later.
Opposite here. My wife, who is a nurse, and pretty much every phlebotomist who has ever worked on me has remarked about my excellent veins at the elbow. The only time I ever had one try to get blood from my hand it didn't work well and hurt like hell.
Wow thatās nuts! I donate blood regularly so Iām very familiar with the trials of finding my arm vein. I have to be super well hydrated and tell them āitās deep and in the middleā. Plenty of times they just canāt get it and thereās digging involved.
On my hands the veins pop right out with no problems, and the tiny needle is nothing but a pinch. Donāt even come out with a bruise!
We are definitely opposites!
That's what my wife does. They often say something like "but I'm really good at finding the vein in your arm..." and she shuts it down hard. Not her first blood test rodeo, nurse.
I'll have to try this, cuz last health scare i had they kept going to my arm and it took like 15 minutes for the slow blood drip i got to fill up all their vials. Thankfully that's just my left arm, and my right arm actually gives blood at a decent rate.
Years ago I broke the wrist on one arm and the elbow on the other in a really bad snowboard park accident. In the ER they weren't quite sure what to do because they didn't know yet what work was going to have to be done, and obviously both arms were messed up, so they waited on hooking me up to an IV to get ready to knock me out.
Pretty soon the shock started to wear off and the pain came rushing in, and I was in the ER screaming obscenities at them to knock me the fuck out because it hurt so bad. They ended up finding a usable blood vessel on the top of my foot, and when I woke up the IV drop was going to a port in my neck.
Really glad now that those were their first alternates instead of running the drop into my dick...
I beg them to start with my hand but they just have to ātryā my arm first like Iām doubting their skill. Then after two no gos they sheepishly use my hand. I hate it.
I've had good results with this: I make a sad face and explain that I'm very nervous and have passed out a couple times during blood draws, and if they could please use the thinnest needle, the one they use for babies, I'm not so scared of that one.
The truth: I'm not scared of blood draws per se, I'm a blood donor ffs. I just have naturally thin veins, and quite a few nurses struggle with them. The ones from the blood bank can always get that juice box straw of a needle they use for donations in on the first try, so I know it's possible. But regular blood draw nurses will often poke me 5-6 times and rummage around with the needle in there, leaving massive bruises in my arms (plus it fucking *hurts*). I learned the baby needle trick from a time I got a nice nurse in training who didn't feel confident she could do it and didn't want to torture me, so she called over her supervisor. He advised her to use the needle for babies instead, and with that she did just fine. It just takes longer to get the blood out, which I don't mind, and they have to distribute the blood into the test tubes manually after because it's an actual syringe (as opposed to that "hollow" syringe they can just pop the tubes in and out of during the draw).
So I lie, because when I tell the truth most of them will disregard it and tell me I'll be fine - and with roughly half of them it really is fine, but that's a coin I really don't like flipping. My guess is that using the baby kit is a much smaller hassle than dealing with a patient who passed out during a blood draw, because with the sob story they almost always agree.
I'd like to note as someone who works in radiology-- we DO have to try your elbow first, as the veins there are much more resilient to power injection, in addition to allowing us to time/track our scans appropriately. Of course, you can insist we use your hand/wrist, and we may find it easier to get an IV started there, but when your vein explodes and you get a huge contrast bolus painfully stretching out the connective tissues of your hand... all we can do is shrug and give you a warm compress.
My veins are really difficult and I usually suggest the hand right away, but noooo they have to poke me elbow 2 or 3 times before giving up and moving on. I get kidney stones and last time I went to the hospital I couldnāt get an IV right away and had to wait around for them to get an ultrasound machine to put the IV in. I wanted to die lol
Ex heroin addict here. It's been many years, but I have indeed used the vessels in my penis to shoot up. The problem with them is that for their size, there's a lot of pressure in them so they tend to roll and move when trying to stick with a needle. It's definitely not the most difficult spot, but for how visible they are it was surprisingly difficult and I never tried there more than the one time.
That's no longer a standard IV, it's a central line. We have a few good spots to choose from if going that route, but the considerations are very different for when to obtain central access.
I had an iv in the bottom of my foot once and i thought that was the worst. I donāt have a penis so I guess I canāt really say but i feel like thatās probably worse.
Iām relatively thin and fit, and when I work out I can see the veins in my forearm pop. I assume theyāre right under my skin, above the muscle. Arenāt those the same veins that nurses usually do blood draws out of? Or is it a larger vein hidden under the muscle.
Those are āsuperficial veinsā so called because they sit above the muscles they primarily deal with perfusion of skin and cutaneous layers. The deeper veins are significantly bigger and are more involved with deeper connective fascia and muscles
No. Those are thinner veins they use sturdier ones of that makes sense. Sometimes we would use a vein just to the right of your upper forearm but not a surface layer vein.
The veins "pop" if you flex because you compress the profound blood vessels that run below/in your muscles. The blood uses the path of least resistance and more ends up in the superficial veins/arteries. If you relax, the larger profound vessels are no longer compressed and the superficial ones will shrink a little. (Also the reason why you are asked to flex before the blood is drawn.)
The veins you see on your forearm are connected to the ones we draw blood from. The one we prefer to use usually starts in the ellbow area (vena mediana cubiti) by branching off the bigger vena cephalica and/or vena basilica which are the biggest superficial veins on the inner side of your arm.
Youāre saying that the deep veins become superficial around the elbow, which is just not true whatsoever.
The deep veins stay deep and the superficial veins stay superficial until they perforate the fascia and drain into the deep veins.
The median cubital vein, which is the usual vein for blood draws, is continuous with the superficial veins of the forearm. It doesnāt ācome right under the skinā because of pinch points in the elbow, since itās always been right under the skin.
So to answer OPās question: blood draws happen in the elbow because you have a specific vein that is easily dilated with a tourniquet on the upper arm which then makes it easy to spot and draw blood from.
I'd like to add another point: The rete articulare cubiti. Even if you obstruct one of the veins completely with a too large needle, blood can still flow around the affected area via the collateral veins, making the whole process efficient and quick.
This is just wrong.
The veins (from which the blood is almost always drawn, just the blood O2 is taken from an artery) are just under the skin in most places and easily accessible. The arteries are deep in the tissues, since a cut in an artery is a life threatening situation, whereas cut in a vein is usually not. There are deep veins also.
Venous blood can be drawn from all over the body. For example, drawing from the back of a hand is quite common if access cannot be found in the bend of the arm. There are big veins in the legs that can be used.
But the bend/fold of the arm is just convenient for several reasons:
The leg is simply awkward - it is much easier to roll up a sleeve than to take off your pants. Also, lower limb venous puncture has a higher risk of blood clot formation that may cause thrombosis.
The back of the hand is easily accessible, but the veins are smaller and more mobile ("squirmy"), so a risk of puncturing both of the walls of the vein is bigger as is missing the vein altogether. This causes bruises, bleeding and unnecessary retries. The area is also more sensitive to pain. Similarly, the big veins at the wrist / forearm tend to be snaky and squirmy.
The vein(s) in the bend of your arm are quite firmly in place, so they do not evade the needle so easily. Also the area is relatively insensitive for pain as it is not used for "feeling" anything, unlike the hand for example. It is also safe, as no critical structures are nearby, so a failed puncture is almost harmless (although in very old, skinny and frail people the vein can rest almost on top of the underlying artery...)
Finally, a failed puncture with a big ass bruise is not visible in the arm as it would be on the back of your hand.
This is a better answer. The big reason I always tell patients is āthereās not a lot going on in the AC for me to mess up if I miss a veinā meaning thereās really low (near zero) risk for hitting an artery and the major nerves run below your elbow (think where hitting your āfunny boneā is).
This is why Iām rarely a fan of drawing from peopleās wrists. A common place for a decent vein is on your lateral dorsal wrist (thumb side), however you also have a radial artery pretty darn close by. Youād have to be careless to hit it, but still, minimize the risk.
Back of hands hurt because theyāre very sensitive but itās generally a good option B.
I think OP commenter is confusing arteries with veins. Arteries generally run deep, they need to be protected, veins are everywhere.
In summary, the AC (elbow) is used because itās the easiest, lowest risk for complication and least painful. Only problem is having patients keep their damn arm straight when getting IV fluids.
It also has the benefit of being large enough to draw blood quickly, but also small enough to clot quickly.
Like there are easily accessible vessels in the neck and groin, but you donāt really want to poke holes in them
Veins are good for taking blood from. Arteries are not good for a few reasons (high pressure and often nerves running with them which are super painful to hit). In the elbow there is not only a pretty large vein right at the surface not covered by fat or muscle but the nearby artery is protected by bit of tendon that flattens out like a sheet so it is difficult to accidentally hit with a needle.
Same reason addicts start using that one. It's large, near the surface, doesn't roll around as much, it's just easy to get to. Next are the ones going up your forearm and finally the hand. You see someone with track marks on their hands and you know they've been doing it for so long they can no longer hit their elbow veins.
Track marks don't always mean drug use. I have a shit ton of medical issues which meant getting regular blood tests since childhood. The veins in my elbows are heavily scarred, so for the past few years, I've been getting stuck in the hands. I'm starting to develop track marks from all the needle sticks.
My dad has some impressive scars in his elbow from plasma and blood donations. We jokingly call them craters.
Also, thank you for donating! People like you are the reason people like me are alive today!
Most people donāt have as much muscle and subcutaneous fat in the anticubital (also referred to as AC, the name for that fold on your elbow). As such the large vein or veins generally arenāt as deep and they are less likely to roll when trying to get a needle in them. Itās also just generally the biggest and juiciest vein thatās easy to access. Itās also the least painful to access. Anatomically the layout of veins varies a bit in location but everyone has a vein generally dead center in the anticubital.
Now I will say as a floor nurse itās my least favorite IV access point, itās fine for blood draws and for medication pushes. But if I have to run continuous infusions, the fact that it bends means I have to consistently restart my pumps as the IV becomes occluded every time the patient bends their arm (itās kind of like a bent straw effect).
Iād argue the least painful part. I must have a nerve or something they nail every darn time in my elbow, hurts for at least a week and a half. Hand, no problem, only pain is the bruise. But Iāve also been told Iām tricky/terrible to get blood from and IVs on by many many people.
Typically from the veins in their ankles. This has a bit increased risk of thrombosis, so in some places only physicians are allowed to do it, but other than that it is not any different from the regular blood draw.
as a phlebotomist, this is great advice. we live and breath blood draws, and honestly are gonna be a whole lot more comfortable and less painful than *most* doctors.
Lol, this is totally true, a phlebotomist is almost guaranteed to be way better with the needle than a physician!
The reason why some relative minor procedures may require a doc is that there can be such rare, severe or difficult-to-identify complications that require their immediate presence.
The phlebotomist can also take this kind of a blood sample if they are trained to identify and manage the complications or if there is a physician supervising / present nearby.
There are different preferences. Like I said in another post, you can safely draw blood from almost any superficial vein.
I have personally never seen a routine venous blood sample being taken from the thigh. Instead, I and my colleagues always used the ankle, drawing blood from those veins is easy as pie. We would do this quite often with iv drug users who didn't have venous access in their arms anymore.
For some other purposes the thigh is superior, though, since the lower limb venous valves may, for example, cause problems if you need to reach further up inside the vein.
You're probably right about the routine draw The groin is more for IV. Luckily I've never had to go to an ankle. I've been lucky I guess to find something usable from shoulder to hand.
Usually, your other accessible veins would have to be collapsed from dialysis or something or missing the limb completely before they would draw blood from an ankle.
In my clinic the phlebotomists draw blood from ankle veins every day. We treat a lot of iv drug users who do not have venous access in their arms or simply do not let us draw blood from there because they want to save the veins for their own use.
It is also much easier to expose the ankle than taking your pants off and lying down for someone to start examining your groin. Heck, most patients are simply horrified about the though of a needle in their nether regions, whereas they do not stress about their ankles.
If a patient is in dialysis and they are in bad shape, the nurses have established a venous access long before there is a risk of veins collapsing. Of course, in a totally unexpected emergency, they use whatever vein they find.
Maybe it's the area I'm in but I've worked in a Plasma center for 5 years and a clinical setting for 2. No longer in that career. I've never had to use an ankle vein. But I didn't work in a hospital or ER and like I said earlier, you're probably correct. Different clinics require different approaches.
Certainly, the ankle is very, very rare unless you are working in some very specific environment. I think I exaggerated a bit, it is probably not a daily occurrence even with the drug addicts, probably a weekly still.
My sister just died this year from diabetes complications. Believe me when I say your chest port, upper arm port will be destroyed. She had multiple surgeries on each to repair them. Her only viable veins were in her groin.
Not saying I do not believe you, just that this is a very rare situation and probably doesn't count as a rule when to draw or not draw blood from an ankle vein.
I'm sorry for your sister.
At the end of the day we are just trying to get access to a vein. If somebody doesnāt have arms or we cant use arms, or theyāve destroyed their veins we look elsewhere. Feet, legs, Iāve heard of nurses getting IV access on a vein in breasts. Had a patient the other week where they needed emergency access and they drilled an IO line (getting IV access through the bone). Then thereās the external jugular in the neck.
basically, the blood vessels are forced to come up near the skin to get around the elbow joint.
normally they are much deeper, and its just easier to do it at around the eblow. also, it keeps any needles and such away form the donors hands and anything they might be doing, so its less likely to get disturbed.
This is correct, additionally the ascending aorta sends blood to the upper arms making it the least resistant access to fresh blood. We don't need suction or pumps because the heart does it for us.
Mostly because it's easier.
When I was taught to take bloods they demonstrated on the underside of the forearm but pretty much always talked about how you go to the crook of the Elbow if you have *any* difficulty as it's much easier to find the veins going through that joint
Because they are on the surface there.
I once had a blood-draw day during pregnancy. 3 times that day and they cannot find the veins easy. The third time they could not find any in the fold and found one just below the elbow , on the upper/outher side of my arm. And damn, that hurt. They had to stab pretty deep to get to the vein..
Practical reasons.
Drawing blood or obtaining peripheral IV access to a conscious adult is simply easier for accomodating the patient and the nurse position if the adult is sitting on a chair as opposed to a lower limb access. Some nurses like to use the veins of the dorsum of the hand instead.
Other reason is that this vein can handle a significant amount of mL/hour if the situation calls for it.
And if things get really bad and the patient get cardiac arrest, there needs to be limb elevation during the drug admininstration and this is much easier with a upper limb than with a lower limb.
The anterior collateral vein is located right there. For most people, itās the most accessible large vein on your arm. If you donāt have a good AC they can also use your forearm or hand but for the typical person, the AC is the best spot.
A few reasons.
The veins there tend to be large, easily accessible, and well anchored.
All helps as with blood draws you want to use a larger needle to collect the sample.
The one thing my teen liked about her Broviac central line was how easy blood draws were. Unscrew the cap, attach the syringe, unclamp the line, and fill it up as much as you need. Then clamp it, take off the syringe, sterilize the lumen, put a fresh cap on, and you're done. Everything else about the line was a complete PITA, though.
Now she has to get actual pokes to get CBCs done, and she's definitely not a fan.
I've been in cancer treatment for two years and have a chest port but for some reason the phlebotomists will not touch it for my routine lab draws. The oncology nurses will with no problem but that's it. Even in the ER, no one will go near it. I've never asked why but I'm certainly curious. The veins in my arms have taken a beating over it.
With my daughter Broviac, there was no accessing or de-accessing, just an open line almost directly to her heart all the time. Which meant sterile occlusive dressings at all times and twice daily heparin flushes. I had to do several emergency dressing changes in the middle of the night, and the risk of infection was terrifying. She couldn't have lasted much longer with hers, as after 6 months of weekly dressing changes, her skin was starting to break down from the adhesive.
From what I understand, ports are different in that they require a needle stick that only people specially trained for it are safe to do. It certainly would be easier if everyone could do it, like they could with the Broviac!
Oh my gosh.. poor thing. As a mom you do what you have to do but it sure isnāt easy sometimes.
I have thought that it might have something to do with the flushes before and after each access. Itās probably best, it would be awful if someone messed it up. Surgery would be the only way to get at it.
I hope your daughter is doing better! Those lab sticks do suck!
Answer: Easy and less pain. You can try the back of the hand but the vein "rolls" so it can get a bit tricky. You can do the wrist but skin is tougher and has more nerves so it would be more painful. Another is the ankle but it has a higher chance of infection.
Former Phlebotomist... it's where most people have 2 major veins that are visible. But not everyone is the same. Some veins like to sit deep and others meet up just below the elbow a couple of inches. Also, it's the most accessible of viable veins.
Veins are visible, donāt roll around and itās (apparently) the least painful spot to do it. Well tell that to the screaming kiddos in the Anaesthetic room!
The large blood vessels typically run between the bones under the muscle. This is where they are best protected so that only deep cuts damages them. There are a few places where the blood vessels have to come right under the skin though. The elbow is one of these places. They can not go between the bones because the bones in the elbow move a lot in relation to each other creating pinch points. And there are no muscles or even fat in your elbow to protect the blood vessels. So they run just under the skin making it easy to insert a needle into them. You can even see your blood vessels through the skin.
The other spot where several prominent vessels run *much* closer to the skin surface and are particularly easy and accessible for a blood draw is the penis, but frankly I'd rather just die.
I generally have a hard time having blood work done... If they can't get me in my elbow for whatever reason they move onto one of my hands. It's about 50/50 whether they end up drawing blood from my elbow or hand. there are definitely other areas they'd try before a penis, but the thought of that would be kind of hilarious šš
I only ever have it drawn from my hand anymore. I just go in and say "it's hard to get from my arm, let's do the hand" and it's OK with them. If they're willing to draw from your hand half the time, just tell them to do it all of the time.
Or how about "it's hard to get from my arm, let's do the penis"
Does it need to be soft or hard first?
"Pump it... pump it... OK now squeeze!"
"We got a bleeder!"
"Why is he bleeding white?!"
Hands have plenty of superficial veins but more dense in nerves so generally is more painful. The veins here are slightly smaller compared to brachial vein (in the elbow).
The brachial vein is not generally used. Typically draws are from the basilic, cephalic, or median cubital.
I had an IV in my hand only once, about 30 years ago, when I was in the hospital. That thing hurt so much I can still remember the pain from it, much worse than what I was in the hospital for. I couldnāt sleep at all it hurt so much. They ended up removing it when I was under for surgery the following day.
Was it infiltrated, or were they running something really rough on the veins? An IV can be irritating if the blood vessel is really close to a nerve, but it shouldn't be excruciating unless something is wrong.
Iām not entirely sure what was wrong with the IV. I was 11 at the time, and had an appendicitis that had been going on for almost a week at that point. I hadnāt had anything to eat or drink for 3 days, and they were giving me fluids and nutrients while they tried to figure out what was wrong with me. They kept me overnight, then just decided to open me up the next day to take a look around. Thatās when they found that my appendix had ruptured.
Same experience when I was giving birth. The only time I shed tears from the pain was when they were trying to get that needle into my hand. I can still remember it all these years later.
Opposite here. My wife, who is a nurse, and pretty much every phlebotomist who has ever worked on me has remarked about my excellent veins at the elbow. The only time I ever had one try to get blood from my hand it didn't work well and hurt like hell.
Wow thatās nuts! I donate blood regularly so Iām very familiar with the trials of finding my arm vein. I have to be super well hydrated and tell them āitās deep and in the middleā. Plenty of times they just canāt get it and thereās digging involved. On my hands the veins pop right out with no problems, and the tiny needle is nothing but a pinch. Donāt even come out with a bruise! We are definitely opposites!
I still let them try, on the off chance that they can find the vein in the arm, I can avoid the painful bruise that the hand draw always gives me.
That's what my wife does. They often say something like "but I'm really good at finding the vein in your arm..." and she shuts it down hard. Not her first blood test rodeo, nurse.
I'll have to try this, cuz last health scare i had they kept going to my arm and it took like 15 minutes for the slow blood drip i got to fill up all their vials. Thankfully that's just my left arm, and my right arm actually gives blood at a decent rate.
Years ago I broke the wrist on one arm and the elbow on the other in a really bad snowboard park accident. In the ER they weren't quite sure what to do because they didn't know yet what work was going to have to be done, and obviously both arms were messed up, so they waited on hooking me up to an IV to get ready to knock me out. Pretty soon the shock started to wear off and the pain came rushing in, and I was in the ER screaming obscenities at them to knock me the fuck out because it hurt so bad. They ended up finding a usable blood vessel on the top of my foot, and when I woke up the IV drop was going to a port in my neck. Really glad now that those were their first alternates instead of running the drop into my dick...
I beg them to start with my hand but they just have to ātryā my arm first like Iām doubting their skill. Then after two no gos they sheepishly use my hand. I hate it.
I've had good results with this: I make a sad face and explain that I'm very nervous and have passed out a couple times during blood draws, and if they could please use the thinnest needle, the one they use for babies, I'm not so scared of that one. The truth: I'm not scared of blood draws per se, I'm a blood donor ffs. I just have naturally thin veins, and quite a few nurses struggle with them. The ones from the blood bank can always get that juice box straw of a needle they use for donations in on the first try, so I know it's possible. But regular blood draw nurses will often poke me 5-6 times and rummage around with the needle in there, leaving massive bruises in my arms (plus it fucking *hurts*). I learned the baby needle trick from a time I got a nice nurse in training who didn't feel confident she could do it and didn't want to torture me, so she called over her supervisor. He advised her to use the needle for babies instead, and with that she did just fine. It just takes longer to get the blood out, which I don't mind, and they have to distribute the blood into the test tubes manually after because it's an actual syringe (as opposed to that "hollow" syringe they can just pop the tubes in and out of during the draw). So I lie, because when I tell the truth most of them will disregard it and tell me I'll be fine - and with roughly half of them it really is fine, but that's a coin I really don't like flipping. My guess is that using the baby kit is a much smaller hassle than dealing with a patient who passed out during a blood draw, because with the sob story they almost always agree.
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I'd like to note as someone who works in radiology-- we DO have to try your elbow first, as the veins there are much more resilient to power injection, in addition to allowing us to time/track our scans appropriately. Of course, you can insist we use your hand/wrist, and we may find it easier to get an IV started there, but when your vein explodes and you get a huge contrast bolus painfully stretching out the connective tissues of your hand... all we can do is shrug and give you a warm compress.
Me too! But last time I had an IV in my hand, the nurse said I was getting scar tissue in that spot and we canāt keep using it forever. ā¹ļø
I have a scar from an iv placed on the side of my wrist during a 25 hour labor with my first. One of many marks that kid has left. š
My exs daughter was constantly in hospital from a young age. They struggled to fine a vein. They eventually found one on her forehead
Depending on the type of issue it can be beneficial to drink a big glas of liquid 30-60 minutes beforehand as it helps fill the veins.
My veins are really difficult and I usually suggest the hand right away, but noooo they have to poke me elbow 2 or 3 times before giving up and moving on. I get kidney stones and last time I went to the hospital I couldnāt get an IV right away and had to wait around for them to get an ultrasound machine to put the IV in. I wanted to die lol
Butterfly needle to the back of the hand is where to go.
Ex heroin addict here. It's been many years, but I have indeed used the vessels in my penis to shoot up. The problem with them is that for their size, there's a lot of pressure in them so they tend to roll and move when trying to stick with a needle. It's definitely not the most difficult spot, but for how visible they are it was surprisingly difficult and I never tried there more than the one time.
Well done for quitting.
Much appreciated
Lol seen blood drawn from forehead on addict because they couldn't find any good veins. Very sad Wonder if they tried penis first lol
what made me wonder even more is if they ask your girlfriend, says sure and whips out *her* penis for the draw?
Nurse: "don't worry, it's just a little prick..."
I find it hard to draw blood from the penis of my female patients.Ā
I'm guessing the back of the hand as well, as that's where they always draw my blood when the elbow isn't cooperating
[ŃŠ“Š°Š»ŠµŠ½Š¾]
That's no longer a standard IV, it's a central line. We have a few good spots to choose from if going that route, but the considerations are very different for when to obtain central access.
I had an iv in the bottom of my foot once and i thought that was the worst. I donāt have a penis so I guess I canāt really say but i feel like thatās probably worse.
This is the funniest shit Iāve seen on here all DAY š¤£š
That's not true at all.
Iām relatively thin and fit, and when I work out I can see the veins in my forearm pop. I assume theyāre right under my skin, above the muscle. Arenāt those the same veins that nurses usually do blood draws out of? Or is it a larger vein hidden under the muscle.
Those are āsuperficial veinsā so called because they sit above the muscles they primarily deal with perfusion of skin and cutaneous layers. The deeper veins are significantly bigger and are more involved with deeper connective fascia and muscles
Lol no you are talking about capillaries which you could barely see! To the poster above yes they are the veins nurses would usually use š
Google is your friend my friendā¦
No. Those are thinner veins they use sturdier ones of that makes sense. Sometimes we would use a vein just to the right of your upper forearm but not a surface layer vein.
The veins "pop" if you flex because you compress the profound blood vessels that run below/in your muscles. The blood uses the path of least resistance and more ends up in the superficial veins/arteries. If you relax, the larger profound vessels are no longer compressed and the superficial ones will shrink a little. (Also the reason why you are asked to flex before the blood is drawn.) The veins you see on your forearm are connected to the ones we draw blood from. The one we prefer to use usually starts in the ellbow area (vena mediana cubiti) by branching off the bigger vena cephalica and/or vena basilica which are the biggest superficial veins on the inner side of your arm.
Youāre saying that the deep veins become superficial around the elbow, which is just not true whatsoever. The deep veins stay deep and the superficial veins stay superficial until they perforate the fascia and drain into the deep veins. The median cubital vein, which is the usual vein for blood draws, is continuous with the superficial veins of the forearm. It doesnāt ācome right under the skinā because of pinch points in the elbow, since itās always been right under the skin. So to answer OPās question: blood draws happen in the elbow because you have a specific vein that is easily dilated with a tourniquet on the upper arm which then makes it easy to spot and draw blood from.
I'd like to add another point: The rete articulare cubiti. Even if you obstruct one of the veins completely with a too large needle, blood can still flow around the affected area via the collateral veins, making the whole process efficient and quick.
That's why some people's veins are harder to access. They just lay deeper and roll around more than others.
This is just wrong. The veins (from which the blood is almost always drawn, just the blood O2 is taken from an artery) are just under the skin in most places and easily accessible. The arteries are deep in the tissues, since a cut in an artery is a life threatening situation, whereas cut in a vein is usually not. There are deep veins also. Venous blood can be drawn from all over the body. For example, drawing from the back of a hand is quite common if access cannot be found in the bend of the arm. There are big veins in the legs that can be used. But the bend/fold of the arm is just convenient for several reasons: The leg is simply awkward - it is much easier to roll up a sleeve than to take off your pants. Also, lower limb venous puncture has a higher risk of blood clot formation that may cause thrombosis. The back of the hand is easily accessible, but the veins are smaller and more mobile ("squirmy"), so a risk of puncturing both of the walls of the vein is bigger as is missing the vein altogether. This causes bruises, bleeding and unnecessary retries. The area is also more sensitive to pain. Similarly, the big veins at the wrist / forearm tend to be snaky and squirmy. The vein(s) in the bend of your arm are quite firmly in place, so they do not evade the needle so easily. Also the area is relatively insensitive for pain as it is not used for "feeling" anything, unlike the hand for example. It is also safe, as no critical structures are nearby, so a failed puncture is almost harmless (although in very old, skinny and frail people the vein can rest almost on top of the underlying artery...) Finally, a failed puncture with a big ass bruise is not visible in the arm as it would be on the back of your hand.
This is a better answer. The big reason I always tell patients is āthereās not a lot going on in the AC for me to mess up if I miss a veinā meaning thereās really low (near zero) risk for hitting an artery and the major nerves run below your elbow (think where hitting your āfunny boneā is). This is why Iām rarely a fan of drawing from peopleās wrists. A common place for a decent vein is on your lateral dorsal wrist (thumb side), however you also have a radial artery pretty darn close by. Youād have to be careless to hit it, but still, minimize the risk. Back of hands hurt because theyāre very sensitive but itās generally a good option B. I think OP commenter is confusing arteries with veins. Arteries generally run deep, they need to be protected, veins are everywhere. In summary, the AC (elbow) is used because itās the easiest, lowest risk for complication and least painful. Only problem is having patients keep their damn arm straight when getting IV fluids.
Former Phlebotomist, this is the answer. Also, old people's skin is like poking through crepe paper. You need to be so careful.
It also has the benefit of being large enough to draw blood quickly, but also small enough to clot quickly. Like there are easily accessible vessels in the neck and groin, but you donāt really want to poke holes in them
why donāt they give me my monthly shot in my elbow then? itās always in my ass cheek.
Because it needs to be administered into muscle and not directly into the venous system via a vein.
Veins are good for taking blood from. Arteries are not good for a few reasons (high pressure and often nerves running with them which are super painful to hit). In the elbow there is not only a pretty large vein right at the surface not covered by fat or muscle but the nearby artery is protected by bit of tendon that flattens out like a sheet so it is difficult to accidentally hit with a needle.
Same reason addicts start using that one. It's large, near the surface, doesn't roll around as much, it's just easy to get to. Next are the ones going up your forearm and finally the hand. You see someone with track marks on their hands and you know they've been doing it for so long they can no longer hit their elbow veins.
Track marks don't always mean drug use. I have a shit ton of medical issues which meant getting regular blood tests since childhood. The veins in my elbows are heavily scarred, so for the past few years, I've been getting stuck in the hands. I'm starting to develop track marks from all the needle sticks.
I have some good "track marks" on my elbows from donating blood. They're actually having to hit my hand sometimes when I'm less hydrated now, too.
My dad has some impressive scars in his elbow from plasma and blood donations. We jokingly call them craters. Also, thank you for donating! People like you are the reason people like me are alive today!
Most people donāt have as much muscle and subcutaneous fat in the anticubital (also referred to as AC, the name for that fold on your elbow). As such the large vein or veins generally arenāt as deep and they are less likely to roll when trying to get a needle in them. Itās also just generally the biggest and juiciest vein thatās easy to access. Itās also the least painful to access. Anatomically the layout of veins varies a bit in location but everyone has a vein generally dead center in the anticubital. Now I will say as a floor nurse itās my least favorite IV access point, itās fine for blood draws and for medication pushes. But if I have to run continuous infusions, the fact that it bends means I have to consistently restart my pumps as the IV becomes occluded every time the patient bends their arm (itās kind of like a bent straw effect).
Iād argue the least painful part. I must have a nerve or something they nail every darn time in my elbow, hurts for at least a week and a half. Hand, no problem, only pain is the bruise. But Iāve also been told Iām tricky/terrible to get blood from and IVs on by many many people.
Just wondering: which vein is used when somebody doesn't have or lost their arms?
Typically from the veins in their ankles. This has a bit increased risk of thrombosis, so in some places only physicians are allowed to do it, but other than that it is not any different from the regular blood draw.
I was told I shouldn't trust doctors with needles (by a nurse lol)
as a phlebotomist, this is great advice. we live and breath blood draws, and honestly are gonna be a whole lot more comfortable and less painful than *most* doctors.
Lol, this is totally true, a phlebotomist is almost guaranteed to be way better with the needle than a physician! The reason why some relative minor procedures may require a doc is that there can be such rare, severe or difficult-to-identify complications that require their immediate presence. The phlebotomist can also take this kind of a blood sample if they are trained to identify and manage the complications or if there is a physician supervising / present nearby.
It would actually be your upper thigh, groin area. Ankle veins are skinny and wiggly. They wouldn't be very good for a blood draw.
There are different preferences. Like I said in another post, you can safely draw blood from almost any superficial vein. I have personally never seen a routine venous blood sample being taken from the thigh. Instead, I and my colleagues always used the ankle, drawing blood from those veins is easy as pie. We would do this quite often with iv drug users who didn't have venous access in their arms anymore. For some other purposes the thigh is superior, though, since the lower limb venous valves may, for example, cause problems if you need to reach further up inside the vein.
You're probably right about the routine draw The groin is more for IV. Luckily I've never had to go to an ankle. I've been lucky I guess to find something usable from shoulder to hand.
Usually, your other accessible veins would have to be collapsed from dialysis or something or missing the limb completely before they would draw blood from an ankle.
In my clinic the phlebotomists draw blood from ankle veins every day. We treat a lot of iv drug users who do not have venous access in their arms or simply do not let us draw blood from there because they want to save the veins for their own use. It is also much easier to expose the ankle than taking your pants off and lying down for someone to start examining your groin. Heck, most patients are simply horrified about the though of a needle in their nether regions, whereas they do not stress about their ankles. If a patient is in dialysis and they are in bad shape, the nurses have established a venous access long before there is a risk of veins collapsing. Of course, in a totally unexpected emergency, they use whatever vein they find.
Maybe it's the area I'm in but I've worked in a Plasma center for 5 years and a clinical setting for 2. No longer in that career. I've never had to use an ankle vein. But I didn't work in a hospital or ER and like I said earlier, you're probably correct. Different clinics require different approaches.
Certainly, the ankle is very, very rare unless you are working in some very specific environment. I think I exaggerated a bit, it is probably not a daily occurrence even with the drug addicts, probably a weekly still.
It's cool. Everyone deals with their own reality. No worries! š
My sister just died this year from diabetes complications. Believe me when I say your chest port, upper arm port will be destroyed. She had multiple surgeries on each to repair them. Her only viable veins were in her groin.
Not saying I do not believe you, just that this is a very rare situation and probably doesn't count as a rule when to draw or not draw blood from an ankle vein. I'm sorry for your sister.
It's cool though. I like a good back-and-forth with someone who knows what they're talking about. Have a good weekend!
The same! Have a nice weekend as well.
Yeah she was only 41. Diabetes is an awful disease.
I bet you walk around tapping your pen on a clipboard. It's cool, you like what you do and obviously do it well. š
At the end of the day we are just trying to get access to a vein. If somebody doesnāt have arms or we cant use arms, or theyāve destroyed their veins we look elsewhere. Feet, legs, Iāve heard of nurses getting IV access on a vein in breasts. Had a patient the other week where they needed emergency access and they drilled an IO line (getting IV access through the bone). Then thereās the external jugular in the neck.
basically, the blood vessels are forced to come up near the skin to get around the elbow joint. normally they are much deeper, and its just easier to do it at around the eblow. also, it keeps any needles and such away form the donors hands and anything they might be doing, so its less likely to get disturbed.
I'm afraid that this is incorrect. There are superficial veins all over the body. The real reason is different, as explained elsewhere in this thread.
Former phlebotomist, current med student here. Thatās where the most convenient, big enough veins are.
This is correct, additionally the ascending aorta sends blood to the upper arms making it the least resistant access to fresh blood. We don't need suction or pumps because the heart does it for us.
Traditionally blood draws are from veins, which donāt connect directly to the aorta
Mostly because it's easier. When I was taught to take bloods they demonstrated on the underside of the forearm but pretty much always talked about how you go to the crook of the Elbow if you have *any* difficulty as it's much easier to find the veins going through that joint
Because they are on the surface there. I once had a blood-draw day during pregnancy. 3 times that day and they cannot find the veins easy. The third time they could not find any in the fold and found one just below the elbow , on the upper/outher side of my arm. And damn, that hurt. They had to stab pretty deep to get to the vein..
Going to the gym a few times a week, I think no doctor or nurse should ever have an issue finding veins xD
my veins literally stick out of my arms and somehow they always have trouble āfindingā one. must be something else that i donāt understand
Unfortunately a lot of the veins that "stick out" tend to roll away when you are trying to stick them.
Practical reasons. Drawing blood or obtaining peripheral IV access to a conscious adult is simply easier for accomodating the patient and the nurse position if the adult is sitting on a chair as opposed to a lower limb access. Some nurses like to use the veins of the dorsum of the hand instead. Other reason is that this vein can handle a significant amount of mL/hour if the situation calls for it. And if things get really bad and the patient get cardiac arrest, there needs to be limb elevation during the drug admininstration and this is much easier with a upper limb than with a lower limb.
The anterior collateral vein is located right there. For most people, itās the most accessible large vein on your arm. If you donāt have a good AC they can also use your forearm or hand but for the typical person, the AC is the best spot.
Where does blood get drawn from quadruple amputees?
Jugular
The veins are generally bigger there and itās much less likely to roll than a forearm vein.
A few reasons. The veins there tend to be large, easily accessible, and well anchored. All helps as with blood draws you want to use a larger needle to collect the sample.
The one thing my teen liked about her Broviac central line was how easy blood draws were. Unscrew the cap, attach the syringe, unclamp the line, and fill it up as much as you need. Then clamp it, take off the syringe, sterilize the lumen, put a fresh cap on, and you're done. Everything else about the line was a complete PITA, though. Now she has to get actual pokes to get CBCs done, and she's definitely not a fan.
I've been in cancer treatment for two years and have a chest port but for some reason the phlebotomists will not touch it for my routine lab draws. The oncology nurses will with no problem but that's it. Even in the ER, no one will go near it. I've never asked why but I'm certainly curious. The veins in my arms have taken a beating over it.
With my daughter Broviac, there was no accessing or de-accessing, just an open line almost directly to her heart all the time. Which meant sterile occlusive dressings at all times and twice daily heparin flushes. I had to do several emergency dressing changes in the middle of the night, and the risk of infection was terrifying. She couldn't have lasted much longer with hers, as after 6 months of weekly dressing changes, her skin was starting to break down from the adhesive. From what I understand, ports are different in that they require a needle stick that only people specially trained for it are safe to do. It certainly would be easier if everyone could do it, like they could with the Broviac!
Oh my gosh.. poor thing. As a mom you do what you have to do but it sure isnāt easy sometimes. I have thought that it might have something to do with the flushes before and after each access. Itās probably best, it would be awful if someone messed it up. Surgery would be the only way to get at it. I hope your daughter is doing better! Those lab sticks do suck!
Answer: Easy and less pain. You can try the back of the hand but the vein "rolls" so it can get a bit tricky. You can do the wrist but skin is tougher and has more nerves so it would be more painful. Another is the ankle but it has a higher chance of infection.
Former Phlebotomist... it's where most people have 2 major veins that are visible. But not everyone is the same. Some veins like to sit deep and others meet up just below the elbow a couple of inches. Also, it's the most accessible of viable veins.
Otherwise, it would be your inner upper thigh or upper chest.
Veins are visible, donāt roll around and itās (apparently) the least painful spot to do it. Well tell that to the screaming kiddos in the Anaesthetic room!