Question regarding drawing blood. Hello, my name is Nirut. I am a phlebotomist in training and I am planning to attend the nursing school, but right now I am having a hard time to keep my hand from shaking when drawing blood and I afraid that if this continue to goes on I won’t be fit for medical field.
Please feel free to offer any suggestions and advice.
Sincerely,
Nirut
This question was asked in the nursing forum section.
Sarah says
Hello!
I wanted to give my opinion on this since I suffered from the same thing and I am now a registered nurse (I know longer struggle from it by the way).
Drawing blood, giving shots, or starting IVs is 90% mental and 10% skill. I noticed that when I was confident in myself I did not shake when I was holding the needle and trying to stick a vein. However, if I was nervous or thinking “there is no way I am going to get this vein” I would shake and I of course I would miss the vein (because I wasn’t confident).
You said you are a phlebotomist in training so that means you are just starting out. Once you get practice and start to feel confident (this comes over time) you will no longer shake. Don’t be hard on yourself because almost everyone suffers from this.
I would not let this hold you back from going to nursing school. I wish you much success, Nirut.
Sarah
Nirut says
Thank you very much for the promptly reply,Sarah . I never realize the important of being confident before. I used to missed a lot and I afraid that i will hurt the the patient when I was traning in school. I also have a trouble using the butterfly needle to draw from top of the hand where we trained to tied the tourniquet slightly above the wrist. I missed a lot and since the training over I chose to believe that will never be able to draw blood again. I will start believing in myself from now on instead of telling myself not to shake which make shake even more.
Sincerely
Nirut
Sarah says
You’re very welcome! So glad I could help you out. Practice makes perfect with needle type skills. I have been a nurse for almost a decade and still miss veins…it just happens. I wish you much success 🙂
Sarah
Veatriz says
Hi Nirut I am also a registered nurse and I agree 100% with Sarah advise. It’s perfectly normal to feel that way at the beginning. Once you get more practice you will start feeling confident and the more you practice the better you will get. Now is the time to learn.
My advice don’t hold yourself back and try to get all the practice you can this means even pediatrics. I work in the ER and since I started I always want the challenging cases that experience that I got helps me each day drawing blood, starting IV’s and performing all txs to renal patient, CA pts, Newborns, patients in a code, in general I’m ready for any patient that comes in to the ER.
When ever you don’t feel confident, while you preparing the tools you need take a deep breath make a small prayer for guidance “The Lord will never let you down “.
GOD BLESS YOU Nirut! !!
Veatriz
Sarah says
Great advice Veatriz! I totally agree with you. It is all about being confident 🙂 God is always there to provide strength.
Veatriz says
Amen!
Nirut says
Sorry for the late reply, I got a little cold this week. Thank you very much Sarah and Veatriz, I wish the training would be more than just one week. I am actually done with the training last week, but I decided to go back and in because my classmate still have not finish her hours and I want to be there in case she might need extra help. Plus, i can use a few more practice. My questions to both of you is that, does the way we steady the hand, prevent ones from shaking when holding the needle. I recalled that when I was in school If I used the thumb and the index to how the adapter and lay the other four finger down on the arm and put the weight down on those four finger on the arm then that will prevent my hands from shaking. I have also learned that my common mistake was going in too deep and a couple of time i have to back out the needle slowly and gently to get the blood flow again. I know that one swift motion and short motion is good. But i saw someone went in slowly. What is the best way to do it ? Does fast and gentle mean no pain? I am taking your advice and pray in my mind before I draw blood even when i shake a little I try to loosen up and think that I am helping people and i know that God has chosen this path for me
Sincerely
Nirut
Sarah says
Hey Nirut!
I hope you are feeling better 🙂 Yes I think that holding the needle the way you specified can definitely help with shaking. Are you using a butterfly or straight needle? I always try to make sure I have a good grip on the needle so I don’t fumble it and drop it…this would probably make the patient freak out. Also, when I am just about to stick the patient I gently rest the side of my hand against them to also help steady my hand.
Regarding patient pain….I think that it really depends on the patients awareness of you sticking them (are they squeezing their eyes close and waiting for the poke or are they talking with you keeping their mind occupied). I have done both techniques you described and sometime the patient feels it and other times they don’t. A lot of people are very afraid of getting stuck with a needle and will complain of pain no matter what you do. However, others will say “oh I didn’t feel anything”. I suggest that you keep a conversation going with them so they have their mind occupied.
What are your suggestions Veatriz?
Veatriz says
Hi Nirut and Sarah. Sorry to respond so late. I’ve been very busy.
Again I agree with Sarah and like her I gently rest the side of my had against patients arm when I’m about to stick the needle. One thing to have in mind is that at the beginning many times the patient is as scared as you. It’s normal for them to be scared or just nervous, if they see you insecure it will make them get more nervous and they may get more tense and they could feel more pain. Now it’s important to always project your self secure. Talking to the patient helps them relax. With practice and having passion for what you do, makes the difference. God Bless both of you.
Nirut says
To Sarah and Veatriz, sorry for the reply. I was preparing for the nurse entrance exam. By the way, I tried all the techniques that I could think off. I missed less often, now but often times I could not get enough blood to fill the tubes because I either went in too far or i either withdraw the needle out way too far. I am done with my externship as a phleobotomist last week, but I volunteer to help out so that I can keep practicing and get more experience. I feel l ashamed of myself though, because I am new to the clinic many patients will not let me draw blood from them. Of course i do understand that they have the right to ask for someone else and they know that someone new to the clinic might hurt them.. Sarah and Veatriz, i often use the multi-draw adapter when i draw from patients who have big bouncy veins or male patients(I use the 23 or 22 guage needle on the multi-draw adaptor). I only use the butterfly if i draw from a female patients or when I draw with a multi draw adapter with Male patients and I missed and i have to draw from a different arm. I did some research in the internet and it said that shaky hands can be the lack of vitamin b12,so I am taking B12 right now. My question to you both is how do you make a decision whether to use the butterfly or 23 or 21 needle to draw from the patients.. Also how can I prevent myself from going too deep? There is one last tenchnique that I have not try to though which asking patients to make a fist and put in under the elbow of the arm that I am going draw from. i leaned that in school and I think it might give me a better ankle for both the patient and for me to position my hand steady without shaking too much. I am scare but I know that this is the field for me.
Sincerely
Nirut
Sarah says
Hey Nirut!
Great questions! I hope you did well on your entrance exam 🙂 I had the same problems starting out. Sometimes it is just hard to prevent going through the vein or not getting enough blood to fill the vials. Usually if you are not getting enough blood to fill the vials, your needle has clotted off. It is best to use the biggest size needle if you are drawing multiple tubes. I use a 20 (pink) or 18 (green) (I try to avoid an 18 cause it is so big and can cause increased pain) but the larger the needle gauge the less chances of it clotting off while you are drawing. If I’m drawing a couple of tubes I use a 22 gauge which is the blue one. Do you use a vacutainer?
Another reason you aren’t getting enough blood is that your needle is against a valve in the vein. If you move the needle out a bit (this removes it from the valve) you may notice that you start getting blood again. This might be something you want to keep in mind.
I always use a butterfly needle when drawing blood because I like how I can grip the “wings” for support…but when I start IV I use a straight needle. I think it is how the person was taught…I don’t think it really makes a difference on if you use a butterfly or other device type. It is really the person’s technique.
As going through the vein, this is just something that you will learn over time. If the vein is large and superficial I know that I will have to barely go in (superficially). But if the vein is not superficial and it has some tissue over it I know I will have to go a smidge deeper. A tip I could say is that once you get that first flash of blood return in your needle (butterfly needles are the best for showing the flash of blood return when you have hit the vein) I would stop advancing and put on the tube to start collecting blood.
Hope that helps…that is my two cents lol
Sarah
Veatriz says
Hi Nirut
I had a friend that used the butterfly more often that the needle because she felt more confident. Depending on how she felt she will give it a try with the needle till she finally stopped using the butterfly often. The butterfly help her with the problem you are talking about. She did not know how deep to go with the needle, the butterfly help her get the idea of how deep to go. I use the fist technique at the beginning and it help a lot. Don’t give up. By taking bit B12 you are showing that you are willing to do everything you can to get better that means a lot. Nursing is a sacrificed job to me is worth I will never trade what I do. I love my job. Good luck.