Saturday, June 17, 2006

A Simple Blood Draw

It sounds like a joke: "How many people does it take to draw one tube of blood?" Answer: "Depends on where you work, I suppose."

I drew her blood a few days ago. She told me I wouldn't be able to, that no one ever did a good job, and that I was going to hurt her. She had tiny veins that were deep and the other nurses decided I should do this. I did get both tubes, and it did hurt she told me. I haven't any cure for that - I've got to use a little needle to get in through the skin to where the blood hangs out. I told her I was sorry it hurt.

Today she refused the draw. Told me it "wasn't neccessary" and that she would not be participating in anything with me involving needles. I had hurt her, and now we'd never get blood again.

I asked her a few times throughout the day. I tried to reason with her, bargain with her, and then let her know that I'd have to get the team together to hold her down and get the draw done. She continued to refuse.

I had no choice - I got the team together. Everyone put on gloves and walked down the hall to her room. I was hoping the sheer intimidation of all of those people in her room would change her mind. I really had no choice in the matter of doing the draw, but I didn't want to make it any worse for her than it already was.

She agreed. Faced with the idea of being forcibly held down or doing it on her own terms, she did what many people would do and relented. She asked if there was anyone else who could do it, because it was me that hurt her. No, no one else. She asked if we could do it another time when she was feeling better. No, no other time. "Ok, fine" she said, "but you're going to mess it up and you're not going to get any blood anyway and you're going to hurt me because you've got no skill and you're probably the worst blood-drawer I've ever seen."

Well, you know my day isn't all peaches and cream (aside from the glamorous stories I tell here). No pressure... just 5 staff and a patient watching me try to find a teeny-tiny vein to get a teeny-tiny amount of blood from. I have to say it was almost as bad as having a room full of family members looking on. I could feel the eyes on me.

I say a quick prayer to the gods of bloodletting and do my best, getting that wonderful flash of red into the butterfly and then popping the vacutainer on.

"Hmmph" she grunts. I imagine the translation was that she hardly felt it.

But there I am, hunched over, watching the blood flow so s.l.o.w.l.y into the tube. Damn. The team's still standing there, of course. Watching. It's like slow motion. I angle the tip down slightly hoping to get a better flow. It drips slightly faster.

She lets out a huge bored sigh. No translation needed.

Finally, I've got enough. After what seems like hours (but was probably more like seconds) I have completed the Miracle Draw and I'm taping a 2x2 on her.

I say "You did a good job of holding still, and I appreciate that you let me do it that way rather than having to use help. I hope it didn't hurt too much."

She gives me a deadpan look and says "You're getting better."

Posted by HypnoKitten at 9:53 PM

Anonymous may, at 8:13 AM  

you must feel good. being appreciated and all that :)

Blogger genderist, at 4:07 PM  

Yay! Those are some classy kudos to cherish!

Blogger HypnoKitten, at 9:35 PM  

Yeah, I get all the love.

Earlier I had offered her an ice-cold 7-up from the ultra-special stash in exchange for letting me do it. She should have taken it.

It was good.

Blogger Mandy, at 1:12 PM  

I had to chuckle!

Anonymous Anonymous, at 8:36 AM  

Ummm, since when can anyone "hold a patient down" against their will to draw blood?? To threaten that is called assault and to actually do it is battery. Unless the patient was deemed mentally incompetent, that's a violation of patient rights.

Blogger HypnoKitten, at 5:49 PM  

Thanks for joining in, Anonymous.

In case you haven't been reading some of my other posts, I work in an acute care (emergency) psychiatric hospital. 99% of our patients are being held there involuntarily by the courts. Certain medications CAN be forced upon them with a doctor's order, and some of those require serum levels to be drawn regularly to determine if there is enough of the medication in their blood to be therapeutic. Others require monitoring to make sure that they are working well with the patient's body. When patients are on these sorts of medications, the medical doctor or psychiatrist may choose to write an order that the patient may not refuse blood draws and may be restrained. We can also restrain patients for other medically neccesary tests when it is ordered as such. We are sent to specialized training to learn safe ways of restraining people, and ways to prevent having to restrain people. What I ended up doing to her was called a "show of force" and is a last-ditch effort to prevent having to put hands on the patient.

We know very well what our patient's rights are. Our facility is not one of the psych hospitals where patients might be restrained or put them in seclusion for any little thing. As a matter of fact, there are many times when patients have assaulted staff and (as long as they are redirectable) have merely been escorted back to their room for a time-out. For this patient I tried to be diplomatic and spent quite a bit of effort to convince her to agree to the blood draw rather than just call the team together because it was convinient for ME.

I appreciate the fact that you advocate for patients, but you are wrong in this case. Please investigate the laws regarding involuntary psychiatric detention for further information.

Anonymous Anonymous, at 5:27 AM  

Great post! The beginning of it took me back some. I used to just hate it when I worked in the ER and the first thing a patient would say is, "You'll never find a vein, no one ever can." That's not helping!

Anonymous Anonymous, at 5:33 AM  

Oh and thanks for the nurseblogs badge! I put it up this morning :)

Blogger Melissa, at 1:03 AM  

I so relate to having a room full of family members watching me start an IV. I'm sometimes tempted to tell them that for each person who watches, the odds of my being sucessful are reduced, but I never say anything.

That patient was a nasty witch. I've had way too many of them as well.

Blogger AzHaR, at 5:37 AM  

venepunture. couldn't do it well when i was a rookie medic.

but i've had a fair share of "good" patients who actually allowed me to "find" the vein with the needle or even poke them a few more times to get their blood drawn.

that's helpful. now i am pretty confident of myself.

Anonymous NPs Save Lives, at 5:27 PM  

I remember well when I couldn't hit the side of a barn right out of school. After five years of working in an acute setting, I am now called into the ICU to attempt "hard sticks". Makes me feel good! Sometimes I miss but it goes with the territory! Great post!

Blogger BotanicalGirl, at 4:13 PM  

I'm just like your patient, with one major exception: attitude. I know my veins are hard to hit, and I've learned exactly which one works well: left wrist, butterfly only. It hurts. Not the nurse's fault! I tried to donate blood three separate times, with much digging around, before I gave up.

Blogger kt, at 10:08 AM  

that was gerat!!! nothing like an audience during a stressful procedure. at least kramer and seinfield weren't there to drop junior mints all over ya. :)
thanks for stopping by my place.

Blogger Janet, at 11:02 PM  

Sometimes if you just put a slight pressure on top of the butterfly,sort of like a mild traction down and back, you will move the lumen of the needle away from the wall of the vessel and blood will flow much faster. Once you get a flashback into the butterfly, slap a piece of tape across the wings. Don't let it flop around in the vein like a lot of people do. You don't have to tape it tightly, just enough to keep it from wiggling.

Anonymous jen, at 8:03 PM  

nice job!! great stick!!

Blogger Too Fat 4 Ponies, at 11:32 AM  

Your patient reminds me of the one I had just yesterday. I did everything in my power to make her more comfortable but got nothing but complaints all night. Oh well. Guess its one of those instances where you trust your instincts and know you did a good job... despite the grumpy attitude.

Blogger unsinkablemb, at 8:09 AM  

good grief! no pressure or anything, huh? if i ever get out of the OR, i'm sure i'll have stories like this too. :) good job!

Blogger Eve C., at 7:17 AM  

This is a great post! I'm still laughing! I begin my clinicals tomorrow and although I will not be doing any blood draws (or anything invasive) but I am expecting the usual comments of not being trained or experienced, but I look forward to the humor & learning experience of the day! Thanks!!!

Blogger dog food sugar, at 8:42 AM  

I liked the post and your response to annon's comment. Well done and congrats on the Charge responsibility!

Anonymous Anonymous, at 2:23 PM  

Please come and draw my blood. I just went to one lab yesterday and today. She (same person) tried three times. The first time she got one tube and blood stopped. She tried left and tried right, I did not make a sound during the whole time until I could see that she clearly went through the vein. I got this ugly huge bruise on my arm within a hour. She never got blood in the second and third try, and sent me to another lab after the third try. I got bruised before, but they always got blood!

Anonymous Anonymous, at 5:51 PM  

my name is rick im a SEVERE NEEDLE PHOBIC! for the past 33 years i have not been touch by a needle!when i was 9 years old i was stabbed into the bone of my arm!!! i will hurt anyone who brings these f---- things around me! i warn all doctors and nurses dont even think about it!!!3 months ago i pushed a doctor on his a--- thinking i will take a shot. i have no medical insurance because no doctor will take me as patient!! i cant stand hospitals or clinics! im a severe ANGRY NEEEDLE PHOBIC. I AVOID MEDICAL CARE AT ALL COSTS!!!!!!!!!!!!!!
ITS MY WAY OF F--- OFF. no one has the right to stabbed patienst with needles!!! i read about forcing shots and i would beat the blank out of anyone thinking they could hold me down i wish that nurse tried that on me! it would be the last time she touched a patient.


Blogger HypnoKitten, at 11:21 PM  

Been off your meds long, Rick?

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