Sr. Lab Guy
20 Years Experience
San Bernardino, CA
Male, 52
For 6 years I was a Laboratory Technician in the Air Force Reserves, working all aspects of the laboratory as well as accomplishing "blood draws" (phlebotomy) in every imaginable setting (inpatient and outpatient). I have also worked in the private sector for hospitals, doctor offices, and clinical lab sites. This was my primary field for 20 total years (which began with the Air Force training). I've been in a new career for ten years, though I recall virtually all of my lab science.
Hi Alicia,
Your question is a perennial scenario for phlebotomists. Over the years, I finally realized that the secret to "redirecting" the needle during venipuncture in an especially well-endowed arm is to be proactive BEFORE that needle even touches the skin. By this I mean, have the patient make a fist around a large object, one that fits the relative size of their hand. In the past, I've had patients use everything from a few hand towels to a few large (unused, needle-less) syringes. This creates, in effect, a larger fist, one that can exert more pressure per square inch than just a hand without this assist. Then, and this next part you need to be careful about (I'll explain that in a moment), you tell the patient that the tourniquet is going to be "really tight" so that you can "see" the vein better. Now tie that tourniquet tight, tighter than usual. But not so tight as to cut off arterial circulation (which by the way is actually fairly hard to do at the antecubital site - but not impossible). Have them open their hand momentarily to check for circulation. You should be able to see blood flow returning to the palm of the hand (turns white to red). You can also feel for a radial pulse if necessary. Finally, have them make a tight fist again around the aforementioned object, and then have them make their arm as straight as possible. You should easily be able to feel a vein. Note: I realize your question asks what to do DURING a difficult draw. My answer would be to ask a fellow phlebotomist or a nurse to re-tie the tourniquet tighter, feel for the vein above the entry site, and carefully redirect. If that's not possible, you'll need to withdraw the needle and try again, preferably at a different vein. Some text books will tell you that tourniquets that are too tight can cause hemolysis in the tubes, and also cause invalid electrolyte levels. I have to say, for the short period the tourniquet is in place, not once did I find this to be true. A tourniquet, tight or otherwise, left in place TOO LONG, will cause the above. I have seen that. But not for short periods. Hope this helps. Best of luck to you.
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Samir, this sounds like a very slow blood draw when using a multi-sample system (such as the BD Eclipse blood collection system). Most commonly this is caused by the tip of the needle not sitting well inside the vein. I'm going to presume that the tourniquet is tight enough (if it isn't, a fellow phlebotomist or a nurse can re-tighten it for you). You should gently and ever so slowly withdraw the needle a bit to allow better blood flow and if that doesn't work, ever so slowly push the needle in a tiny bit farther. Both of these methods are best done while, with your free hand, carefully pulling down on the skin (using your thumb) below the site, to help stabilize the vein. If that doesn't work, you can try redirecting the needle with caution. The risk here is the same as any "slow draw" incident: hemolysis and even blood clotting in the tube or needle before the draw is complete.
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Hi thanks for your question, Quantitative analysis, or "How much"" of a substance, is usually done on blood samples in a regular laboratory. Forensic labs may be able to quantify other samples but I don't know if that includes hair. You could Google a forensic lab or your local coroners office for more info if you like.
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Hi Justin. Go ahead and ask away. I'll do my best.
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Hi thank you for your question. This sounds like the patient may have an underlying condition that is contributing to falsely low WBC and platelet levels. Since I am not a physician I really couldn't say what those conditions are. There are ways to separate cells in the blood outside of the body. A process called "phoresis" is one I've heard of. But for a very good answer to your question call a local hospital, ask for the lab, then ask for a "Lab Tech". They could help you with this question better than I.
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Hi Umm, Sorry it took so long to answer your question, I had a family emergency near the beginning of the year. Ok, the short answer: a physician would be the one to ask this question because the over all answer would likely depend on your situation, activity levels, age, history, etc. The longer answer I will give is a generalization that could apply to anybody. Most of the tests you listed (except for "glycemia" - perhaps you meant glycohemoglobin?) would not be affected by a 16 hour fast from food and drink. In general, though, if you were severely dehydrated it is possible that your CBC could show a falsely elevated hemoglobin, meaning that if you are anemic, it could show that you are normal (as one example). Your urine could possibly show a higher myoglobin (if I remember correctly), meaning you are dehydrated. Overall, a 16 hour fast shouldn't affect lab results negatively. As for questions about your health during and after the fast, you would have to consult with a physician.
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Hi Curious, The values you list for creatinine are not what we normally see. The normal range for creatinine is around 0.6 to 1.2, so the numbers you list don't make sense. If your creatinine levels were truly 40 to 60, you'd be in serious trouble with your kidneys. Now, you might be referring to the GFR or Glomerular Filtration Rate. This is a specialized test, and my experience with it is limited to none. I did do a Google search for you, and it looks like a physician would have to interpret your results, if in fact it was a GFR. Sorry I couldn't be more helpful.
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