SYRINGE VS. EVACUATED TUBE SYSTEM: Pros and Cons

Just before I get blood from my patients, I always ask myself on what method should I use to ensure a successful venipuncture. It's after vein assessment that I decide what to use and based from my experience, I've come to realize that both the syringe method and ETS (evacuated tube system) have their own advantages and drawbacks. Check this out!

I've always loved using syringes. I feel safe when using them. This is when I hear compliments such as "It's not painful' or 'I didn't feel anything..Thank you'..

SYRINGE

Registered trademark of Terumo Corporation

1. PROS

• with backflow
• less painful
• you can change the needle gauge for smaller/thinner veins
• can be maneuvered

    2. CONS

• limited amount of blood 
• time consuming in transfering blood from one tube to another
• 10cc plungers are hard to pull and agent for short draws
• needle pricks
• cause for platelet clumps if blood is not transferred immediately

On the other hand, when times are busy, I use ETS! I realize you have to be sure when doing ETS method or else YOU'LL BE SORRY it didn't turn out so well.

EVACUATED TUBE SYSTEM

Registered trademark of Becton-Dickinson Company

1. PROS

• faster way of collecting blood
• with safety feature included
• recommended for multi-sample draws
• suitable for tests requiring closed system method of venipuncture (eg Ammonia, Carbon dioxide)
• reduces the risk of hemolysis

    2. CONS

• proper order of draw should be strictly observed
• not recommended for newborn or pedia patients
• not suitable for easily collapsed veins
• might not get the appropriate amount if vacuum tubes are expired or opened already
• would mostly leave hematoma on the skin

It's all in your hands what to use during your shift but one must consider convenience both for you and to the patient, It's always been like that from the start. So think and use these weapons wisely :-)

Phlebotomy 101: How to extract difficult veins? Must-see tips!

I think none of us phlebotomists would want to stick a needle twice. If only the patient knows how we tried our best to get his blood once. BUT...We can't avoid having patients with difficult veins and because of this, we might fail to extract some of them. As a result, patients will get angry and all we have to do is to sigh and act like we never heard them.

But then, we're just humans. We're not perfect thus we make mistakes. Letting go might be hard but just like in getting blood where you think it's hopeless and it's hurting, maybe it's best to just pull it out. Well, if you want to know how I deal my patients in situations like these, then this might be of help for you. I tell you a secret: All extractions starts with setting the patient in a good mood before we stick the needle in them.

TRICKS TO ASSURE THE PATIENT...

I think one of the things to keep a patient comfortable is to show to them that you really know what you're doing, Make an impression that you can be trusted. Sometimes, a patient might ask: Are you a sharpshooter? Are you the senior phleb? To gain trust, you must be confident and set a positive attitude that you can do it. Always act like you're an expert. VEIN ASSESSMENT IS VERY IMPORTANT. Do not haste and take your time in finding the right vein. Just with that manner, the patient will understand that you are really taking time and didn't take him for granted. If must, communicate to them but not to the extent of being talkative (I usually ask them if their lab tests are on a monthly or weekly basis and later they do the talking).

WHAT IF IT REALLY FAILED...

Based on my experience, patients tend to understand why the extraction went wrong when you explain to them what happened and also the mood that you set for them can be helpful. So, the next thing you gonna do is to convince him/her to extract again.

If the patient is already angry, it is best to keep calm. Don't contest the patient's high temper. Deal them in a professional way. Don't argue. Why not try these options for yourself?

Option 1: See if there's a basilic or cephalic vein in that arm.

- Although median cubital vein is ideal but sometimes you need to consider other veins as well such as the cephalic vein in which obese ones have more palpable cephalic vein.

Option 2: Find vein in the other arm.
- Go try palpate the patient's other arm. You may find a vein there. As what I've said, take your time. Mostly, palpable veins are located in the dominant arm so it is helpful to ask if the patient is right-handed or left-handed.

Option 3: Look for a vein in the dorsal hand of the patient

- If there's no hope to find a vein in both arms, we can get blood in patient's dorsal hand if they allow it. Sometimes, I'm surprised how some people have palpable veins on their hands while they're having deep and thin veins in the arm.

Option 4: Use small-gauge needle or a butterfly

- An assessment of what to use when extracting blood can help you achieve a one-stick only goal. Take note that thin veins can't stand bigger gauge needles as the vein will collapse upon insertion. Butterfly method is advisable if the veins are thin and superficial or if you're going to extract in the dorsal hand.

Option 5: Ask help from a senior phlebotomist
- Only and only if the patient insisted..but if not, why not try your best? It's not always your senior will come and rescue you. Show to your senior that you made an effort and at least you've tried. If it still failed for the second time, allow the senior to do the job.

PLEASE STAY TUNED FOR AN UPDATE OF MY PHLEBO TIPS