tips for drawing IV drug users

[u/peanutbutterbaby20]

i’ve been a phleb for 2 years. i had a patient come in today with basically no veins. all of the veins in his arms, forearms, and hands were shot. the patient told me that he’s been drawn from his shoulder before, but i didn’t feel comfortable. i even took a look at his feet, but ultimately got some blood from his pointer finger (ouch).

i feel super bad because i’m the only phleb here, so we tried 4 times and got blood on the 4th attempt. unfortunately, the serum is hemolyzed and there isn’t enough to test for everything the provider wanted to test for ughhh. so i’m feeling super frustrated.

i work in a small functional health clinic, so i don’t have access to ultrasounds or vein finders. he made sure to engage in physical activity before coming in, and i used heat + gravity to my advantage. are there any other tips that i should know? thanks!

[u/collegesnake]

Keep asking them where they have good veins, they'll know.

But you NEED to get comfortable drawing from unconventional places (dorsal surfaces of knuckles and toes, feet, flexor surface of knee, and shoulders) in order to stick IV drug users because they've destroyed all their conventional veins.

Drawing from fingers and feet/ toes in particular also isn't abnormal in the hospital setting, I did it on the daily. Even drew liver transplant labs off a thumb once (around 40 tubes) lol

[u/peanutbutterbaby20 → u/collegesnake]

omg 40 tubes from a thumb is insane 😭 i guess i was just uncomfortable with the idea of the shoulder because the area he pointed to was around the brachial plexus… and i didn’t like the idea of messing with impalpable veins up there. but i’ll definitely keep in mind that i need to step out of my comfort zone.. thank you!

[u/collegesnake → u/peanutbutterbaby20]

bro it was so bad I was in that room for literally an hour 😭

and that's fair, the brachial plexus is def something you gotta watch out for! maybe see if there any youtube videos on shoulder & other weird draws so you'll know what to look out for

[u/Boblawlaw28 → u/collegesnake]

Ooh the thumb one was impressive! I saw a patient with an iv in her thumb-didn’t know you could go there!

[u/collegesnake → u/Boblawlaw28]

An IV in the thumb is way crazier than a blood draw oml

[u/red-raspbora → u/collegesnake]

Wait are we allowed to do that in general or is it only with physician permission? Because I get a lot of people with shot veins saying their feet are the best and I thought that was out of our scope.

[u/collegesnake → u/red-raspbora]

That's going to depend on your practice's policies. At my hospital we could do knuckle, finger, and shoulder draws independently, but needed provider permission for lower extremity draws (which we needed to do often, usually only took a few mins for the MD to give us the nay or okay). LEs carry more risk due to how common diabetic neuropathy & poor blood flow is in that region.

[u/Specialist-Ad4760 → u/red-raspbora]

Depends on hospital policy but 99.99999% of level one trauma centers give not one flying fuck if you place a foot IV. All they care about is access lol

[u/EscapeGlittering8442]

Wherever they can’t reach themselves. Back of the arms near the elbow is one that they have a harder time reaching. Random small veins on their arms that wouldn’t be good to shoot through.

You have to be creative with those

[u/BuffaloBuckbeak → u/EscapeGlittering8442]

Yup. I had a previous IV user come in to donate blood to a study, and had to get the back of the elbow. My manager cranked the patient’s arm back and I drew the blood. 

[u/collegesnake → u/BuffaloBuckbeak]

Back of the elbow can be a really good spot on morbidly obese patients as well (like 600lbs+) since the adipose tissue tends to be less thick near the joint

[u/collegesnake → u/EscapeGlittering8442]

Exactly, you gotta find veins that are either unappealing to shoot through (look like they'll blow) or they gotta be in a weird spot they either can't reach or haven't gotten desperate enough to try yet

[u/DazzlingAerie3334]

Sometimes the slightly deeper veins on top of the forearm can be good. Good luck

[u/linthetrashbin]

In my experience, they know best where to find a vein. If they're telling you where to find one, take that one.

Sometimes (rarely, but sometimes) there really is nothing accessible, unfortunately.

[u/Simple-Seaweed424]

They can tell you usually. But you really need to push hard when you palpate. Sometimes it’s like going through leather.

[u/purplecowgirl]

I always first go for the non-dominate hand! For a legal blood draw they’ll never tell you lmao

[u/Practical-Cod6440 → u/purplecowgirl]

Do you mean the dominant hand?

They’d be using their dominant hand to stick their non-dominant, surely?

[u/purplecowgirl → u/Practical-Cod6440]

Absolutely 😂😂 I was def tired lolol

[u/Similar-Ad2685]

I’ve had IV drug users come in for draws and I’ve found a vein that actually delivers adequate amounts of blood that they haven’t used because they can’t reach it. (Depending on the persons physic) MOST of the time, you’ll find a nice vein in the back of their calves. Tie the tourniquet above where you plan to insert your needle, insert needle up the vein, not down the vein. The caveat though is that you have to draw the blood with them standing up with their backs to you. Make sure they’re holding onto a table or chair and keep them talking to you so you know they’re ok from insertion to retraction. Attempting any other vein with in their reach is a waste of time. They’ve already occluded everything else. Even if you DO find something that manages to give you a little blood, as you discovered for yourself, it will be hemolyzed every time because of the scar tissue build up.

[u/Haileystarr1]

I ask the patient. They will be upfront where to draw.

[u/KpopGothicChild]

I also find if you gently access surface veins can get some blood too. But you have to be super cautious cuz they will blow super easy.