I'm Not a Pincushion: Why Am I Repeatedly Stuck at Blood Draws?

The phlebotomist tried to find a vein in my arm to place the IV. She ran her finger over my left arm and found nothing acceptable. Then she poked my right arm.

"I might have something here," she said, pointing to a thin, bluish vein near the crook of my elbow. She tied a rubber tourniquet around my arm so tight my eyes nearly popped out. And she stuck me while I held my breath, having gone through this unpleasant ritual for decades.

"Did you get it?" I asked with a hint of optimism.

"Nope," she tightened the rubber band and jabbed me in another thin blue vein. 

I've fought the battle of drawing blood most of my life, as did my mother. The nurse kept at it. I begged her to contact the phlebotomy department and have them send down their best person with difficult draws. 

"Nope," she said. Then she stuck me again, finally using a butterfly on my hand to painfully connect the IV and draw blood for the requisite colored tubes.

I am not alone. And even after a successful draw, I'm left with as many bruises as there were attempts.

As a patient, I often feel the blame for a failed attempt, which I find infinitely frustrating. Difficult blood drawings have been a part of my life since I was a skinny teenager 50-plus years ago. Live Science notes stress, dehydration and adipose tissue (obesity) can lead to a difficult draw. But there's more to the story.

"The standard technique for doing this [drawing blood] is to place a tourniquet on the upper arm around the biceps to dilate the veins in the lower arm," Mark Whiteley, M.D., told Live Science. "Once those veins are dilated or widened, blood can be drawn using a hypodermic needle inserted beneath the skin and a syringe. However, if a tourniquet is placed too tight or loose, veins may remain hidden," he said.

Other factors can also affect the success of a draw.

"Genetically, we inherit our blood vein structure," notes Randa S. Hawa, who taught in the laboratory program at Kentucky Community and Technical College in Henderson, Kentucky for nearly 30 years.

"The veins can be too small or narrow, and they can also be deep under muscle and tissue," Hawa says. "In older people, there can be a situation where the tissue around the veins doesn't hold them steady, making them hard to get into."

Dehydration can also make blood drawing difficult. Often when people come into an emergency room, dehydration may be present from an illness, making the inevitable blood draw more difficult.

As Hawa talked, I pictured my mother, in her late 40s, lying in a hospital bed before a hysterectomy. I'm a college student visiting her before surgery. I watch as a phlebotomist tries to draw her blood. Mom has "bad veins," the phlebotomist tells us. For the rest of my mother's life, and especially in the years before her 2012 death, I watched phlebotomists struggle to draw Mom's blood.

Hawa recommended ways to ensure a completed draw.

She advises patients to "make a fist to force blood into the vein. The veins may pop out, making them firmer and easier to see when the tourniquet is on."

Patients can be sure their arms are kept warm. Warm veins are fuller.

The phlebotomist can "slap" the tissue around where they will stick the patient. Hawa said a tiny slap makes the vein "fight back" and stand up more.

Hawa, who started as a technician, reminisced that sometimes patients refuse a blood test. Because venipuncture is invasive, Hawa worked with her students to approach patients calmly and respectfully.

"I also talked with my students about making sure they introduce themselves when they walk into a patient's room," she says. "They should then touch the patient's arm. That human touch makes such a difference."

"And if a patient says,' No, you can't stick me,' you can't. That would be criminal," she adds.

She remembers an older patient who threw his bedpan at the wall when she approached him to take blood. 

Hawa also recommends not calling the staff who come to draw your blood "vampires." She says,"I was called a vampire about 15 times a day." 

Technology may provide a solution for the difficult draw. Rutgers University staff have invented the Venibot, a small robot that identifies and places the needle in an appropriate vein for drawing blood or starting an IV. 

While Venibot isn't yet widely used, portable ultrasound machines are, though not every hospital or clinic has access. Portable ultrasound machines, used specifically to "map" a vein, can easily identify a 3-D image of a vein and project it on a screen. The phlebotomist can see exactly where to place the needle, thus reducing pain and potential bruising for the patient.  

I've been fortunate to have this technology available a few times. Patients like me and others who are difficult draws can benefit from this technology, which needs wider adoption. NIH estimates there are 400 million blood draws annually in the United States. There's no reason they should be painful and uncomfortable.

Amy McVay Abbott is a retired health care executive who writes about health and aging, caregiving, disability, and occasionally the arts and history. She formerly wrote “A Healthy Way,” syndicated by Senior Wire News Service. Read More