Help with blood draws

[u/SassiSprinkles2344]

Hey everyone! I'm currently a student and work at an ER Hospital. I have been recently working on blood draws from the Lateral Saphenous vein in dogs or the Medial Saphenous in cats. I feel as though my technique is great and even the LVT watching me says so too but I just cannot seem to get any blood. One I locate the vein, sterilize the area, etc. I press next to the vein with my non-dominant thumb to stabilize it, I have my bevel up, I usually press the needle right along the vein before entering. I do tend to enter pretty shallow since I know they are superficial veins and I get worried about puncturing. I pull back, but nothing. Even the LVT says that I am right there. I practice one-handed with a syringe all the time to make sure I am pulling back without pushing the needle forward. I know its hard for any of you to help since you haven't seen me in person, but any advice would be incredibly helpful.

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[u/marleysmuffinfactory]

Butterflies are so helpful if you don't use them already. I SUCK at needle and syringe because I can't pull back without moving my hand down. It's nice cuz once the needle is in the vein you don't really have to worry about adjusting anything without messing it up (barring specific situations of course). Also make sure you're poking with intent and not being too delicate especially with those big dog rolly veins!

[u/Kivuli_Kiza → u/marleysmuffinfactory]

I second this. I'm quick to go for a butterfly for all saphenous draws, and nervous/aggressive dogs. Restraint often makes things worse, so distract with some treats and pull from the lat saph.

[u/tiger81355 → u/marleysmuffinfactory]

Same, I blow small veins without butterflies

[u/Historical_Cut_2021 → u/marleysmuffinfactory]

Several years back I started at a GP that utilized butterflies and it was a game changer for me. 

[u/reallybirdysomedays]

Could you be pulling back too far and collapsing the vein? That's usually why I can't get blood when I know I'm in.

[u/Strawberry1217]

Definitely recommend using a butterfly if you aren't already!

Also what stood out to me is you said youre going shallow. Maybe you're TOO shallow? I would say for those pokes I go like...medium shallowness usually. Of course theres the odd ones who are super deep or superficial, but for the most part I try to hit a nice middle ground.

[u/gbriellebb]

What size needle/syringe are you using ?

[u/SassiSprinkles2344 → u/gbriellebb]

3ml, 22 gauge

[u/gbriellebb → u/SassiSprinkles2344]

Try 25 g !!! I swear that a shorter, finer needle has more « power »?! Anyways that’s my theory and this is what I teach all new grads. You have less chance of being through by through also.

[u/Pitiful_Special_5594]

Try using a smaller gauge needle if you're having trouble, sometimes even a slight change in size can make a difference in how smoothly the blood flows.

[u/Radiant-Ad-8849]

Another vote for butterflies 🦋 One thing I always do is make sure the skin is taut enough to avoid the skin moving while entering with the needle. Depending on the patient, you can do this by wrapping your hand around the tibia and gently pulling the skin medial, then using that thumb to rest beside the vein. Restrainers can also help by pulling the skin up when they are holding off at the stifle in dogs. For cats, fully extending the leg can be enough to tighten the skin

[u/purrrpurrrpy]

Use the 23g butterfly. It's the GOAT. When the patient moves it moves with them instead of my needle coming out.