If you are having difficulty drawing blood, abandon the vacutainer. The lack of a "flashback" makes it difficult to find deep-seated veins and the vacuum can collapse small veins, especially in older people.
If neither antecubital fossa yields a vein, try the forearm, the radial aspect of the wrists, the back of the hand, or even the base of the thumb. For these small veins, try a smaller needle (23-gauge, blue – but no smaller than this) or a butterfly system.
If you still have trouble, consider using the feet – this is more painful.
As a last resort, or in an emergency when the peripheral circulation is shut down, consider a femoral stab.
- Locate the femoral pulse.
- Swab the groin.
- Aim 1 cm medial to the femoral pulse, with the needle at right angles to the skin.
Use of the femoral stab is a last resort – don't make it part of your phlebotomy routine!
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