It's all in Vein...

[AggieMike88]

I had a blood draw today in prep for the annual doctor visit and latest status letter for my DM2 and OSA SI's.

A question for the real and armchair doc's: Why are these draws taken from the vein and not the artery?

 

[Henning]

My guess is that venous blood gives a better indication of the efficacy of the filtering organs.

 

[Gary F]

I had a blood draw today in prep for the annual doctor visit and latest status letter for my DM2 and OSA SI's.

A question for the real and armchair doc's: Why are these draws taken from the vein and not the artery?

You can get blood from an artery for most blood tests. Arterial blood is under a lot more pressure and it is more difficult to control bleeding. Unless you are checking arterial blood gas measurements there is rarely a reason to use arterial instead of venous blood.

 

[denverpilot]

Because they like digging in my arm for one.

 

[Henning]

Because they like digging in my arm for one.

Ugg, that belongs in Pet Peeves... I had one gal stick me 5 times and still couldn't get me. "I'll have to get the Dr." "No you don't, give me that" and I stuck myself. Best person I had was the guy a few weeks ago who took the blood for my Benzine card, he had it in in one swift move from the table straight into my vein, I didn't even feel it.

People are easy, cats are difficult.

 

[DaleB]

My wife does this for a living -- she's a phlebotomist. I asked her once -- Gary is right, arterial sticks will bleed like mad. And there are some tests, apparently, that require venous rather than arterial blood.

 

[denverpilot]

My wife does this for a living -- she's a phlebotomist. I asked her once -- Gary is right, arterial sticks will bleed like mad. And there are some tests, apparently, that require venous rather than arterial blood.

I always ask phlebotomists how many "lookers" vs "non-lookers" they've had that day, and then joke that I hope they're in the habit of looking.

My arms are a pain to get a draw from, and the back of my hands are easy. They always go for the arm. Sigh.

 

[bbchien]

Also liability. Say you lacerate the Artery and the guy has an anatomic abnormality for which there is no Ulnar artery. Bye bye, hand! Now if it's your dominant hand, emergency surgery to try to salvage it, get out the checkbook payable to plaintiff's attorney.

Hospitals only allow staff with licenses to do to that (so that they are the front line-liability takers).

It's all about liability.

 

[AggieMike88]

Fortunately I'm an easy stick, so no issues there.

@Bruce: Home A1c test 2 weeks ago was 7.1. Hopefully I'll be there or a smidge lower. Had to sit the penalty box again, but at least i'm out sooner this time.

 

[Rigged4Flight]

Before my last deployment we were going through the Combat Lifesaver course. When it came time for everyone to practice giving an IV, my Command Sergeant Major walked up to my station and said "stick me". I have never, ever been very good at this, and his veins were rollers, but I put on my game face and proceeded to act like I was a confident (if not competent) sticker.

A minute later he was walking away with his thumb pressed tightly over his vein, and a disgusted look on his face. I eventually got his vein to stop bobbing and weaving enough for me to stick the needle squarely... and then I blew through the back of the vein. Not one of my best pre-deployment training days.

 

[cavmedic]

Before my last deployment we were going through the Combat Lifesaver course. When it came time for everyone to practice giving an IV, my Command Sergeant Major walked up to my station and said "stick me". I have never, ever been very good at this, and his veins were rollers, but I put on my game face and proceeded to act like I was a confident (if not competent) sticker.

A minute later he was walking away with his thumb pressed tightly over his vein, and a disgusted look on his face. I eventually got his vein to stop bobbing and weaving enough for me to stick the needle squarely... and then I blew through the back of the vein. Not one of my best pre-deployment training days.

Thats the beauty of starting at the extremities. If you blew the veins , you keep moving inward.

we ( medics) would never expect the CLS to do this one , but if we couldn't get a good stick in the hand, wrist, or arm, we moved to the neck. That was always a good demonstration.


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[Velocity173]

Before my last deployment we were going through the Combat Lifesaver course. When it came time for everyone to practice giving an IV, my Command Sergeant Major walked up to my station and said "stick me". I have never, ever been very good at this, and his veins were rollers, but I put on my game face and proceeded to act like I was a confident (if not competent) sticker.

A minute later he was walking away with his thumb pressed tightly over his vein, and a disgusted look on his face. I eventually got his vein to stop bobbing and weaving enough for me to stick the needle squarely... and then I blew through the back of the vein. Not one of my best pre-deployment training days.

Ha! Ha! My last flight physical the lady went through the vein. My arm was black and blue for over 2 weeks. 20 yrs of doing flight physicals and that was the first time someone did that. Somehow I managed to get out of taking the CLS course. I hear now they don't do the IV thing anymore??

I remember in 2003 getting ready to deploy for OIF 2 we had the Small Pox shots. Those suck! I had never had it before but the docs said since I was born in the 70's most likely I did have it. I think I would have a scar to prove I had the shot but they said to be safe I needed the extra booster. Anyway, my friend was first and all he had to get was 3 sticks. He turns white as ghost and almost passes out. Now it's my turn and get stuck with I believe 13 hits. Holy crap that hurt!

 

[cavmedic]

As of 3 years ago before I got out, we trained every soldier in the squadron to be CLS. From the SCO down to the e1 cook.

We were RSTA ( Rapid Surveillance and Target Acquisition) so due to our mission , our leadership might have made that an internal policy.

I don't know how far they take the medical training in basic anymore. If they only train buddy aid or if they are CLS certing from the beginning.


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[Rigged4Flight]

we ( medics) would never expect the CLS to do this one , but if we couldn't get a good stick in the hand, wrist, or arm, we moved to the neck. That was always a good demonstration.

I love medics! (not that way)

Best medic I ever knew was on my first deployment. Guy got hurt from an IED and we were casevacing him back to base, bouncing all over the road from pothole to pothole. Doc grabbed his bicep and squeezed tight and couldn't have been more than a couple of seconds later he had the catheter taped and fluid going in. I never saw him ever hesitate on any stick he ever did, and every single time he got it on the first try. I have the honor of being the first patient he ever did stitches on.

Ha! Ha! My last flight physical the lady went through the vein. My arm was black and blue for over 2 weeks. 20 yrs of doing flight physicals and that was the first time someone did that. Somehow I managed to get out of taking the CLS course. I hear now they don't do the IV thing anymore??

Yup. During demob (FEB 2011) we heard they no longer require an IV for the CLS course. Good stuff - I freaking HATED that. I'm not good at giving them, and I REALLY don't like getting them.

As of 3 years ago before I got out, we trained every soldier in the squadron to be CLS. From the SCO down to the e1 cook.

We were RSTA ( Rapid Surveillance and Target Acquisition) so due to our mission , our leadership might have made that an internal policy.

I don't know how far they take the medical training in basic anymore. If they only train buddy aid or if they are CLS certing from the beginning.

I don't remember getting CLS in basic (2006), but we did the full course every time we deployed. Mobilizing at Fort McCoy in 2007, every time we took a break in training someone had to give/receive a practice IV. For the entire two months we were there. I felt like a junkie.

 

[DaleB]

My wife does this for a living -- she's a phlebotomist. I asked her once -- Gary is right, arterial sticks will bleed like mad. And there are some tests, apparently, that require venous rather than arterial blood.

I asked her again last night -- she said it's also because veins are shallow and arteries are deep, and an arterial stick HURTS. Most of the people she deals with are cancer patients, so unless there's a specific request for arterial blood gases they stick to the veins.

 

[cavmedic]

Nothing good can come out of removing I V therapy from the CLS course. Other than practical tourniquets , chest needle decompression and chest seals, the IV portion was a big treatment. I know there was issues with people using Hextend for heat casualties, but that was removed from the kits and replaced with NS.

Our biggest thing we pushed to our CLS was that we wanted all casualties to have a site , not necessarily fluid running, so we didn't have to screw with that during an evac.



As for the DOC who gave himself a site, he probably had lots of practice doing that. I know I NEVER had a hangover. .

The best were the drunken sticks. Thinned blood, one eye and still seeing double. The room usually looked like a murder scene after.



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[Doggtyred]

I had a blood draw today in prep for the annual doctor visit and latest status letter for my DM2 and OSA SI's.

A question for the real and armchair doc's: Why are these draws taken from the vein and not the artery?

For just about every test that would be run, venous and arterial blood are equivalent..

Electrolytes, Complete blood count, clotting times, liver function tests, drug screens, drug levels... all the same. If I have a patient with an arterial line in place for blood pressure monitoring I will use it preferentially for lab samples.. because I dont have to interrupt anything flowing into venous catheters that might dilute a specimen at the point of draw (imagine big iv's with 3 lumens all emptying within centimeters of each other - can skew results significantly).

The difference? Veins are easier to hit and hurt a lot less,... Veins have thinner walls and there are usually a large number of them fairly close to the surface of the skin.

Arteries have thicker, muscular walls due to high pressure. They typically have a nerve running RIGHT ALONGSIDE (hurts like a ***** when you hit that with a needle)... a slightly different technique for needle entry is needed, and arteries can spasm when stuck, making it difficult to get the sample. Finally when you are done, you have to hold pressure for 5 minutes or more (even more if there are blood thinners in play). Arterial sticks aren't black magic, but in general there are much much fewer people who are permitted to/expected to perform them in the course of their job than venous sticks.

The only things that MUST be run on arterial blood are Arterial Blood Gases, which give the partial pressure of CO2, O2 and bicarbonate levels in the blood in its unused state, giving a direct measure of oxygenation and ventilation (distinct from oxygenation, the blowing off of CO2), and I would venture if you are sick enough to need to check that, you wouldn't be flying....

 

[N2124v]

When I did my paramedic training the one that got me was the Intraosseous infusion into the tibia. Nothing like crunching bone. I never had to do one, saw one done, but practicing on chicken legs was enough for me. Yeah, having IV equipment and O2 sure did help get rid of hangovers.

 

[cavmedic]

Nothing beats a FAST 1


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