Sweat formed on my forehead and
axillaries as I palpated the area for one final time. In my mind, I reviewed
the steps needed to pull off this deceptively simple task. Is the tourniquet on
correctly? Check. Is the area sterilized with isopropyl alcohol? Check. Are the
veins being anchored properly? Check. Then in one slow, but precise movement I
pierced the butterfly needle through the skin. For a terrifying second, there
was nothing. Then after inching the needle forward, there was a sudden flash of
red blood in the tube. I slide forth the serum separator tube into the BD
vacutainer and watched as the blood poured in. The sweat evaporated off my body
as I breathed a sigh of relief. The rest of the procedure went smoothly as I could
now switch over to talking to the patient about their healthcare concerns and
day-to-day life. This incident was my first successful attempt at drawing blood
from a morbidly obese patient. My success with the phlebotomy procedure highlighted
three vital aspects of healthcare: technique, communication, and luck.
Just a few weeks earlier I was a
new student fresh from a phlebotomy-training course. It was my first time I
came across such a large variety of body types with different vein placements.
The result was a chain of ugly hematomas, incomplete blood draws, and multiple
sticks attempts. One situation in particular still leaves me reeling every time
I remember it. A wheelchair-bound
elderly lady needed a whole batch of blood tests for a preoperative evaluation.
Her skin was almost translucent and her veins rolled around as the skin
stretched. To my complete shock, I manage to access the vein on my first try.
Yet it was during the tube insertion that things went awry. Blood slowed to a
dribble and the area surrounding the needle started to swelling. In a panic, I
quickly withdrew the needle and began applying pressure to the area. However,
out of the corner of my eye, I noticed the blue tourniquet was still on! My hand
shot forward and pulled the tourniquet loose, but the damage had already been
done. The elderly lady was crying out in pain and her daughter right next to
her was equally distraught. The senior medical assistant came to the rescue and
took over and performed the blood draw seamlessly while I collected the pieces
of my shattered confidence.
As luck would have it would be this
same Ukrainian medical assistant who served as my mentor. She provided the vital
onsite training so lacking from the certificate course. such as setting up the
blood drawing apparatus first before anything else and that I should try to
draw blood within the first five minutes of meeting a patient. Anything over
that time puts added pressure on phlebotomist because all the extra time spent
looking for a solid vein increases the patient’s expectation that that first
draw will be done right. Always look for veins that rebound, as the ones that
do not are often too small for blood draws. Keep calm when switching tubes as
once the needle is in and drawing blood it will not usually fall out unless it
is accidentally pulled out.
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