How to Hit a Vein When Drawing Blood

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Physician-backed tricks to hit a vein every time
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Drawing blood quickly and cleanly is an important skill for doctors, nurses, lab personnel, or phlebotomists. Many venipunctures are routine, but you may occasionally encounter difficult veins that require more assistance. Fortunately, with the proper technique, you can hit those veins easily and make the process more manageable. For more information on locating specific veins, drawing blood from “hard to stick” patients, and other troubleshooting tips, read on. [1]

Drawing Blood From a Difficult Vein: Top Tricks

  1. Apply a warm compress over the draw site for 2-3 minutes.
  2. Massage the draw site gently and feel for a vein with your index finger.
  3. Ask the patient to swing their arm lightly.
  4. Tell the patient to take deep breaths and drink water before the appointment.
Method 1
Method 1 of 3:

Tricks to Make the Vein More Visible

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  1. Warmth causes the veins to dilate, making them easier to spot and stick. To heat up the veins, apply a warm compress over the draw site for 2-3 minutes, and be sure to disinfect the area with 70% alcohol afterwards (before you draw blood). [2]
    • Alternatively, soak the arm in warm water or place it under a running faucet.
  2. Difficult veins aren’t visible to the naked eye, but you can locate them by touch. Gently massage the draw site to make the vein more visible, then use your index finger to find one that feels spongy yet firm. [3]
    • Nurses in movies and TV shows often slap the arm to find difficult veins, but this is actually a poor technique that can result in a hematoma. [4]
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  3. When you increase blood flow to the arm, it can increase the veins and make them more visible. Tell the patient to gently swing their arm in a clockwise direction, or have them perform a light exercise like jumping jacks or bicep curls. [5]
    • If you’re drawing blood from a regular patient, tell them to avoid strenuous exercise the day before the blood test to ensure their results are accurate. [6]
  4. If the patient is nervous or has a needle phobia (trypanophobia), it becomes more difficult to draw their blood. Stress can compress their veins and negatively affect the results of their test, especially for biochemistry panels. Reassure the patient that the pain is very brief and minor, and have them breathe deeply to calm down. [7]
    • You could also help them feel at ease by chatting about their day or turning on some relaxing music (if possible). [8]
    • If you think the patient might faint, have them lie down on their back to improve blood flow to their head. This also reduces their chances of falling and injuring themselves if they do pass out. [9]
  5. Most blood tests don’t require fasting, so the patient can eat or drink before coming in. If that’s the case, ask the patient to drink lots of water to hydrate their veins and make them more accessible. [10]
    • You may want to advise the patient to avoid caffeinated drinks 24 hours before their test to prevent dehydration. [11]
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Method 2
Method 2 of 3:

Taking Blood from the Forearm

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  1. To set up for the blood draw , confirm the ordered blood tests, and ensure that the forms and labels are accurate. Check the patient’s first and last name, file number, date of birth, and the reason for the blood draw. Then, ask if the patient has any allergies, phobias, or if they have ever fainted during previous injections. [12]
    • After confirming this information, assemble your supplies, wash your hands, and wear appropriate personal protective equipment (PPE). [13]
  2. A tourniquet increases the amount of blood in the vein to make it stand out more. To apply a tourniquet, place it approximately 3 inches (7.6 cm) to 4 inches (10 cm) above the draw site, and make sure that you do not tie it too tight or for more than 2 minutes. If the tourniquet is tied properly, the vein will feel resilient or slightly bouncy when you palpate it. [14]
    • A tourniquet also helps anchor the vein so it doesn’t roll around as much, making blood draw less painful for the patient and injection easier for the phlebotomist. [15]
    • Alternatively, you can use a blood pressure cuff that is inflated to 40–60 mm Hg. [16]
  3. In general, the inside of the elbow is the preferred draw site because the median cubital vein is usually visible. This vein runs between the muscles and often looks like a blue bulge in the inside of your elbow. It’s also relatively easy to access because the tissue around the vein prevents it from rolling away from the needle. [17]
    • If you can’t see the median cubital vein, gently massage the area to feel for it.
    • Do not draw blood from a place where the veins divide or join together—doing so increases the risk of a hematoma. [18]
  4. Before drawing blood, clean the area with a 70% alcohol swab for at least 30 seconds, and make sure to cover at least 2 centimetres (20 mm) downward and outward from the center of the site. Let the skin dry completely for another 30 seconds before inserting the needle. [19]
    • Alcohol is a better disinfectant than iodine because if iodine gets into the blood, it can alter the test results. If you decide to use iodine, follow it with a 70% alcohol swab. [20]
    • Do not blow on or fan the entry site with your hand as it will contaminate the area, and repeat the disinfection process if you accidentally touch the site. [21]
  5. To prevent the vein from rolling, hold the patient’s lower arm and pull the skin below the vein taut. Ask the patient to form a fist so the vein becomes more visible, then swiftly insert the needle at a 15 to 30 degree angle. Hold still while collecting blood, and attach the necessary tubes or syringes to remove the proper volume (as specified by your laboratory). Release the tourniquet after 1 minute before removing the needle. [22]
    • Leaving the tourniquet on for longer than a minute will affect the concentration of red blood cells, possibly altering the test.
    • Withdrawing the needle while the tourniquet is still on will result in pain.
  6. After removing the needle, take clean gauze and place it over the draw site. Ask the patient to hold the material in place with their arm straight and extended, and make sure they do not bend their arm during this time to avoid a hematoma. [23]
  7. Activate the needle’s safety feature before throwing it away, and dispose of the needle, syringe, and blood sampling device in a puncture-resistant sharps container. [24]
    • You can discard any items that do not release blood if squeezed (such as gloves) in the general waste, unless your local regulations or hospital states otherwise.
  8. Mislabeling could lead to delays in processing the sample or more serious issues like misdiagnosis, so be sure to recheck the labels on the tubes and forms before dispatching the blood samples. [25]
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Method 3
Method 3 of 3:

Troubleshooting Strategies

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  1. If you cannot find the vein in the inside of the elbow in either arm, move down the forearm to search for the basilic or cephalic vein. These veins are usually visible through the skin, and you can ask the patient to lower their arm and make a fist to make them more prominent: [26]
    • The cephalic vein runs along the radial side of the forearm, and it is the second most common draw site after the median cubital vein.
    • The basilic vein runs along the ulnar side. The basilic vein is less frequently used than the cephalic, and it is more likely to roll away from the needle than the cephalic vein because it is not held as tightly in place by the tissues around it.
    • If you can’t access those veins, find the metacarpal veins on the back of the hands. They are usually visible and can be palpated. However, do not use them for elderly patients because the skin is not as supple and does not support the veins as well.
  2. Some entry sites are more difficult to access and have a higher probability of complications. When choosing a site, avoid drawing blood from the following areas: [27]
    • Sites that are near an infection
    • Have extensive scarring
    • Have a healed burn
    • Are on an arm that is on the same side as where the patient had a mastectomy or fistula placed
    • Are bruised
    • Are above an IV line
    • Are on an arm where the patient has a cannula, fistula, or vascular graft
  3. Occasionally, you may encounter problems with the needle, such as going too far into the tissues or inserting it at too low of an angle (so the bevel is against the wall of the vein and impedes blood flow). To fix this, pull the needle back a little bit without removing it from the skin, and change the angle of the needle while it is still under the skin so that it can be inserted into the vein. [28]
  4. Protocol in many laboratories and hospitals dictates that phlebotomists may attempt a venipuncture 2 times before having someone else try. If both of your attempts are unsuccessful, ask a colleague to locate the patient’s vein. [29]
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Expert Q&A

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  • Question
    Phlebotomists- How do you approach a difficult vein? I am still new and not comfortable with them yet.
    Shari Forschen, NP, MA
    Family Nurse Practitioner
    Shari Forschen is a Registered Nurse at Sanford Health in North Dakota. Shari has worked in healthcare since 1996 and her expertise lies in acute care bedside nursing on a medical oncology floor. She received her degree from Medcenter one College of Nursing in 2003 and her Family Nurse Practitioner Masters from the University of North Dakota in 2014. Shari is a member of the American Nurses Association.
    Shari Forschen, NP, MA
    Family Nurse Practitioner
    Expert Answer
    The best way to get used to approaching difficult veins is with lots of practice.
    Thanks! We're glad this was helpful.
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    Not Helpful 29 Helpful 56
  • Question
    I have small veins and have had problems with blood withdrawals. Is there some kind of exercise to help improve your veins or make them bigger and more visible?
    Shari Forschen, NP, MA
    Family Nurse Practitioner
    Shari Forschen is a Registered Nurse at Sanford Health in North Dakota. Shari has worked in healthcare since 1996 and her expertise lies in acute care bedside nursing on a medical oncology floor. She received her degree from Medcenter one College of Nursing in 2003 and her Family Nurse Practitioner Masters from the University of North Dakota in 2014. Shari is a member of the American Nurses Association.
    Shari Forschen, NP, MA
    Family Nurse Practitioner
    Expert Answer
    Make sure you are well-hydrated and take in a good diet so you are as healthy as you can be.
    Thanks! We're glad this was helpful.
    Thank you for your feedback.
    If wikiHow has helped you, please consider a small contribution to support us in helping more readers like you. We’re committed to providing the world with free how-to resources, and even $1 helps us in our mission. Support wikiHow
    Yes No
    Not Helpful 16 Helpful 43
  • Question
    What if the veins are nearly finished in your arm or hand? Where do I go then?
    Shari Forschen, NP, MA
    Family Nurse Practitioner
    Shari Forschen is a Registered Nurse at Sanford Health in North Dakota. Shari has worked in healthcare since 1996 and her expertise lies in acute care bedside nursing on a medical oncology floor. She received her degree from Medcenter one College of Nursing in 2003 and her Family Nurse Practitioner Masters from the University of North Dakota in 2014. Shari is a member of the American Nurses Association.
    Shari Forschen, NP, MA
    Family Nurse Practitioner
    Expert Answer
    Any vein will do, legs, feet, etc. If you are truly out of options, a PICC line can be temporarily placed.
    Thanks! We're glad this was helpful.
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      References

      1. ↑ https://www.unitekcollege.edu/blog/stick-like-a-pro-tips-for-mastering-the-art-of-venipuncture
      2. ↑ https://supportgroupsfornurses.org/resources/phlebotomy-tips-for-hard-sticks
      3. ↑ https://www.unitekcollege.edu/blog/stick-like-a-pro-tips-for-mastering-the-art-of-venipuncture
      4. ↑ https://webpath.med.utah.edu/TUTORIAL/PHLEB/PHLEB.html
      5. ↑ https://my.clevelandclinic.org/health/diagnostics/24508-blood-tests
      6. ↑ https://medlineplus.gov/lab-tests/how-to-prepare-for-a-lab-test
      7. ↑ https://my.clevelandclinic.org/health/diagnostics/24508-blood-tests
      8. ↑ https://kidshealth.org/en/teens/blood-draw.html
      9. ↑ https://my.clevelandclinic.org/health/diseases/17536-syncope
      1. ↑ https://my.clevelandclinic.org/health/diagnostics/24508-blood-tests
      2. ↑ https://supportgroupsfornurses.org/resources/phlebotomy-tips-for-hard-sticks
      3. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665
      4. ↑ https://www.unitekcollege.edu/blog/stick-like-a-pro-tips-for-mastering-the-art-of-venipuncture
      5. ↑ https://www.unitekcollege.edu/blog/stick-like-a-pro-tips-for-mastering-the-art-of-venipuncture
      6. ↑ https://harmreductionwa.org/wp-content/uploads/2019/05/PBHRWA-Tourniquets-a-users-guide.pdf
      7. ↑ https://www.sciencedirect.com/topics/nursing-and-health-professions/tourniquet
      8. ↑ https://webpath.med.utah.edu/TUTORIAL/PHLEB/PHLEB.html
      9. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665
      10. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      11. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      12. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      13. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      14. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      15. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      16. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      17. ↑ https://www.unitekcollege.edu/blog/stick-like-a-pro-tips-for-mastering-the-art-of-venipuncture/
      18. ↑ https://www.akronchildrens.org/lab_test_specimen_procedures/PERFORMING_A_VENIPUNCTURE.html
      19. ↑ https://www.arizonacollege.edu/blog/needle-positioning-the-key-to-a-successful-blood-draw
      20. ↑ https://www.akronchildrens.org/lab_test_specimen_procedures/PERFORMING_A_VENIPUNCTURE.html
      21. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/
      22. ↑ https://www.ncbi.nlm.nih.gov/books/NBK138665/

      About This Article

      Article Summary X

      If you’re trying to draw blood from a hard-to-hit vein, first, tie a tourniquet about 4 inches above where you want to insert the needle. Then, put a warm pack or warm water bottle over the area, since heat makes veins dilate and expand. Next, palpate the arm rather than slap at it, since slapping can give your patient a hematoma. When you’ve targeted a vein, try to get your patient to relax by having them lie down or do some deep breathing exercises, since stress can make veins harder to hit. For tips from our Nurse Practitioner on how to find another vein if the median cubital vein isn’t visible, scroll down!

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