Although blood draws are not for the faint-hearted, my experiences have taught me how to draw blood successfully. But, I did not learn everything in my phlebotomy course. During my first three weeks as a phlebotomist, each blood draw was unexpected, ranging from simple to difficult blood draws and some, spontaneous. These experience, of course, have allowed me to reconsider my career.
This was all learned when my friend Patrick Jahries decided to take a nationally certified phlebotomy technician course. This phlebotomy course was held three days a week for two weeks, where a small group of people learned how to draw blood by learning different techniques, vials, location of veins, and practicing on one another.
After tagging along with my friend Patrick, we began a phlebotomy course to obtain our national certified phlebotomy certificates. In the classroom, we learned different methods of drawing blood. In the course, some students were lucky, and they perfected their drawing skills, while others did not. At practice, one of the students drew blood on me and made it slightly painful by applying pressure to a cotton ball when removing the needle from my arm. Not all phlebotomist did this. Yet, Patrick seemed to have nailed drawing blood. His blood draws were more accurate than mine. At this point, my aim was to become a great phlebotomist.
Then before the course ended, we took our last blood draw test and the national certification exam. We studied for days, and without much surprise, we both passed the course and exams.
After three months, I accepted a job offer with a 2-week paid internship at a clinician’s office. These first weeks were difficult. The day passed by incredibly fast. I drew 5–10 patients per day. I used the cotton ball experience to make my patient’s experience best, and they seemed to favor this technique. But this was not enough. Not all blood draws were lucky.
To start, veins were deceptive. These veins are not visible from the skin, while others appear to be visible from the skin and disappear after the insertion of the needle. In one patient, he pointed out that the vein I attempted to draw from was nitrous for rolling when it certainly disappeared. In another patient, my attempts were all unsuccessful, leading other experienced and higher qualified staff having complications and difficulties. These types of patients always forewarned me and that lead them to blame their veins.
Additionally, patient’s veins roll. In the insertion of the needle, certain types of veins move. When this happens, the needle needs to be repositioned. This is commonly referred as fishing, and it is painful. As an example, during my second week, an elderly patient’s blood draw consisted of some fishing and with success, a small bead of blood flashed into the tubing, and that contrasted the green butterfly shaped gripper with the color of blood. This is typical and is known as being within the vein. In spite of the flash and the delight from the patient, blood did not flow past the bead of blood. Once more, the patient was poked, the flash was seen and this time the vials were filled. Patients began to prefer other staff for their blood draws. The difficulties of drawing blood did not end here.
Furthermore, the blood stopped flowing. It seemed that every fourth blood draw would stop after filling two or three vials of blood. The preferred drawing technique consisted of a butterfly needle. This needle has a plastic gripper that looked similar to a butterfly shape and attached a 12-inch tubing that feeds blood into a hub that holds the vials. In one of these blood draws, a patient’s test order consisted of 15 vials. The patient was surprised as the needle did not hurt, as much as she anticipated. Despite this, the blood stopped and a second needle was used. The patient presumed once more the outcome but the second attempt was successful. In this blood draw, drawing more than once further distanced her confidence.
Then, before the last week ended my employer asked me to think whether the job fit me, but not answer until a few days passed. That day my biggest fear of hurting people began to manifest. This lingered during my drive to work, school and my weekend. My thoughts then began to fill with my experiences of the past blood draws. When faced with significant challenges, my greatest ideas randomly strike in my thoughts or even dreams. This was one of those problems that becoming a great phlebotomist was not enough to place my mind at ease. Despite this, helping patients was significant enough, and after talking with my employer, my internship was extended for an additional three more months.
What was thought to be my last drive to work, that was the drive my problem was solved.
After arriving, these thoughts were kept to myself. These ideas consisted of evaluating and creating hypothesizes of the most common errors in blood draws, categorized from symptoms. The following day consisted of research on my spear time and connecting possible ideas on creating a successful blood draw.
The last few days consisted of testing new techniques and perfecting others. These techniques were learned by chance or by observation. The first major technique involved different pressures of the tourniquet. That revealed hidden veins with palpating and lower pressures decreased veins from collapsing. A different brand of butterfly needles was mistakenly ordered. This needle dramatically decreased blood clotting in the tubing. Later, I learned that drawing faster also helped. By the end of the week, there were no failed blood draws. This was noted by patients and receptionists.
Finally, the end of the week arrived. Without a surprise, my blood draws success rate shifted. I know that with time my patient’s confidence will heal and simultaneously, my drawing skills and confidence will too. After all the internship has taught me three valuable lessons. Continue to help people, make a great experience for patients and aim to become a great phlebotomist with the addition of using the scientific method.
