why do veins blow during a blood draw


Hi all! I am an IV nurse, seeking some advice. Earlier in the year I posted of a patient I had difficulty sticking who comes to me weekly for their IVs at our clinic. Well the issue dissipated when I found areally great vein and we\’ve been using it for the last 10 or so visits. Its a deep vein, but unlike his other ones its not a roller and its big, takes a 21g easily, a very giving vein. Well, 2 weeks ago, it infiltrated during the push. Great blood return, about half way through the pt begins c/o burning, I checked for return, nothing. That day I stuck him one more time, got a great flash (as always) and then upon pushing the fluids in (slow – bc he has a tendency to blow easily) it infiltrates, my back up – an IV certified ND came in, gave it 5 more shots and had the same issue- great flash and upond fluids, it would infiltrate. He gave his arms a rest the following week and came in today. I tried old faithful in the RAC and I would get a flash, but upon drawing back to pull some blood into the syringe I was pushing, there was no further return, we use 21/23g butterflies for pushes and blood draws. Today there were a total of SEVEN sticks (all per patients request bc I give my self a 3 stick rule). and all had GOOD flash!


I took everything slow, I treated each and every vein like a baby. and they ALL blew. Ok, if this is the only patient of mine this happens too isn\’t it safe to say its him? Ok, if it is him. why and what can he do, what can I do?? Thanks in advance everyone!
Most new nurses find that starting IVs and drawing blood can be a difficult task to perform at first. When I was a new nurse I had difficulty finding a vein to draw blood from and to start an IV in, and if I did find a vein I often missed it. This caused frustration and I actually thought I would never figure it out. I thought БWell, I must just be one of those types of nurses who arenБt talented at starting IVs and drawing bloodБ. Unfortunately, I gave up on trying for the first year and always asked a more experienced nurse to do it for me. This was a mistake because I should have not given up. Looking back at my experience with veins, I discovered that almost all new nurses have to learn how to acquire this skill (they are not БbornБ with this skill in nursing school). It is learned over time and with lots of practice. After my year of not БtryingБ, I forced myself to learn it (it became a New YearБs Resolution) and I started to have success.


I had a lot of trial and error, but once I built confidence I started to have a 95-98% success. In this article, I am going to share with you the most common reasons why people miss veins when starting an IV or drawing blood and how you can increase your success rate. Here is a video of me talking about this subject on YouTube. DonБt forget to for more videos! DonБt know how to use the IV supplies! This was a major factor for why I got so frustrated. There are 4-5 different items you need when starting an IV and if you donБt know how they work, you increase your chances of missing. You have to know, how to properly insert the IV needle, and how to flush with saline. Here is a video on that I made to help you out. You picked too small of a vein! Try to pick veins that are large (if you can) because if the vein is too small it will collapse on you when you try to insert a needle into it. DonБt know where to look for veins! There are popular places for veins (antecubital the hand are my favorite) on the human arm that almost every person has in the same place (remember we were designed the same). Here is a video I made for you on You didnБt prepare the vein properly!


You have to know how to properly engorge the veins and stabilize them before inserting the needle. It is very hard to hit a vein that may roll and is flat. If a vein is at risk for rolling, (learn ) you have to stabilize it above the insertion site before sticking the patient. The vein blew or rolled! You have to know when it is best to use a tourniquet and when it is best not to use one. If a patient (mainly young male patients who are athletic) presents with superficial, very visible, veins without a tourniquet on then you donБt want to use a tourniquet. This is because if you put extra pressure onto the already engorged vein, you will БblowБ it when the needle is stuck into it. A good analogy is to think of the vein as an inflated balloon and if the balloon is stuck with a needle it will pop (the same idea holds true for a vein that doesnБt need a tourniquet). Have no confidence! Starting IVs and drawing blood is 10% skill and 90% mental! You must gain confidence to be successful. Some patient s just don t have anything! If your patient has the following: Diabetes, Congestive heart failure, history of IV drug use, history of chemo in the past, renal failure patients, or obese etc. , you will probably have difficulty in hitting a vein due to their limited access.

They may be a candidate for a central line which will need a doctorБs order. Decide if you really need a tourniquet! If you can already see and feel the vein without a tourniquet donБt use one. Dangle the patient s arm at their side with the tourniquet on! If you are having trouble finding a vein dangle the arm. This will cause increase resistance on the vein and puff them up so you can stick them. Use heat! б Apply a warm cloth or towel to the arm to cause the veins to dilate. Pump the fists! If you are going to start an IV in the hand always have the patient pump their fist. This causes the veins to engorge and become visible. Ask the patient! Patients know their bodies better than we do. Most patients are very familiar with the best spots to get an IV or draw blood. So, always ask them before you stick. Pick a good vein! Use the popular spots as I demonstrated in the YouTube video, and make sure it is large and straight. Stabilize the vein! Learn your equipment and understand what is happening! Practice and give it time! You may be interested in:

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