Difficult veins
Approaches for patients whose veins are hard to find, feel or access.
Why veins are difficult
Veins may be deep, small, fragile, mobile or scarred. Dehydration, body habitus, long-term illness, repeated venepuncture and normal anatomical variation all contribute.
Preparation
Warming the arm helps veins fill. Position the arm supported and extended, make sure the light is good, and give an anxious patient time to settle.
Feel, do not just look
Palpation tells you more than sight. A vein you can feel but not see is usually a better target than one you can see but not feel. Check both arms before choosing.
Technique
Anchor a mobile vein by applying traction below the site. A butterfly set can give more control for small or fragile veins. Consider forearm and hand veins when the antecubital fossa is not suitable.
Knowing when to stop
Follow your employer’s policy on the number of attempts before handing over to a more experienced colleague. Repeated attempts cause pain and bruising. Record what happened so the next person is forewarned.
General information only. It is not accredited CPD and does not replace your training, your employer's procedures or the receiving laboratory's requirements.
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