Phlebotomy Basics

August 1, 2001

Dr. Karl

As an intern, and even as a resident, house officers are expected to draw blood specimens when the phlebotomy team is unable. The experience can be time-consuming, difficult, and downright frustrating, and can provide precious little reward.

This month, Q Fever!’s I&R correspondent, Dr. Karl Newman, reveals the secrets of: Phlebotomy Basics .

When I was an intern, I hated drawing blood. Like, checking the PT/PTT every 4 hours, just 'cause my resident told me I had to. Most of those patients weren't even on heparin! But it's kind of like a wise old man once told me:

I'd rather have a frontal lobotomy
Than hafta do someone else's phlebotomy.

So, without further ado...

1. Raise Your Voice.

Huh?!?! That's right, Moe. Raise your voice. That's because the real art in phlebotomy is in finding the vein. When you're called to draw blood, it's usually 'cause someone else has already tried and failed. At that point, there's no point in checking the arms - looks like you're gonna be outta luck. But Uncle Karl knows the path to transcendent bliss:

SCREAM!

And I mean shout out loud!, and get the patient to shout too! Scream 'till you both turn red in the face! At that point a large 5mm wide vein will appear right smack in the middle of their forehead, and track straight down to the middle of the brow. This is the motherlode, boys and girls! Move quickly, or prepare to go down under. Meaning... down to the groin!

2. Get The Patient On Your Side.

You kiddin' me?!! Not a chance. 'Cause one thing you gotta prepare for is failure - and the inevitable need to do an occasional ABG or fem stick just to check a calcium. The best way to get the patient ready for these scenarios is to get them to feel your pain, so they won't notice theirs. So when you enter the room, do what I do: Shake.

Yeah, I said: Shake! Bear down and release your tension in a vagally-induced tonic-clonic seizure. Fall to the ground if you have to. Bite your tongue. Pee in your pants. That way, when you go for the vein, the patient'll already be rootin' for you.

What if you miss anyways? Do what I do. Cry! Bawl, even. Pure, unadulterated tears. The patient won't even notice that you accidentally entered their scrotum with that 16 gauge needle.

3. The Rainbow Connection.

What the...?!? You heard it here first! See, personally, I can't ever remember what tube goes with what test, and I'm way too busy to look it up. So how do I prevent the dreaded re-draws that come with, say, sending a CBC in a red top? The answer's simple, Sparky! I fill all the tubes. Every time.

And this, my friend, is where knowing a rainbow's colors come in handy. You got the red top, the orange top, the yellow top, the green top, the blue top and the purple (indigo, violet) top. You even got a striped top and a speckle top, so stick them in your rainbow too. Wheee!

Draw 'em all and send 'em all - draw two of each, in fact, because a QNS is a DOA for interns.

One last thing. Don't forget to check the box next to type-and-crossmatch. Remember what Kermie sang: Rainbows are visions, of red cell transfusions, where A/B/O antigens coincide. It ain't easy being green!

Well, that's it for now. Have a good weekend, kids, and...

“Just tell ‘em Dr. Karl sent ya!”

Remember: Quality Without The Q Is Just Uality!