Hard Veins?? Raynaud's difficult blood draws or IV's

I'm sure most of you, just like me have had a lot of experience getting blood drawn and maybe even IV's inserted. Do the phlebotomists and nurses have trouble? Well I have learned over the years that it really is a marvelous skill and some can draw my blood with a butterfly and I tell you I don't even feel it while others can torture me with the needle -- poking, prodding digging around and leave me bruised. I had one experience in a doctor's office where the nurse stuck me 8 times and then called for the Dr. I knew I was in trouble then because the Dr. I'm sure has less experience than the nurse but somehow he was able to get a vein in my hand to give him some blood.
I've also had experiences in the hospital where they had to call for the expert in because no one could get my IV started. But I've also had times where they have no trouble at all. I'm trying to figure out what makes the difference. I am always careful to be well hydrated first, I know that is important and usually make sure I'm thoroughly drowned if I know ahead of time. I know a lot of it is the skill of the person doing it but I wonder if there is some difference in my veins at some times. I've been told I have small veins, rollover veins, veins that hop, Etc.....
But yesterday I was told a new one -- the nurse said I have hard veins?
As an aside I have no skin symptoms except hard and splitting cuticles and scleroderma pattern on capillaroscopy no hard skin anywhere.
I had to go for 2 iron infusions. Last week I had my first one and the nurse doing the IV brought a hot damp towel and wrapped my arm and I was also given a warm blanket. When she came back after a while to do the IV she noticed my hands were still cold, then I told her I had Raynaud's and she proceeded to warm my hand with her hands before she would begin the IV. She got the IV in the first time with no incident.
This week I went for my second infusion and a different nurse -- this one used no hot towel and just began trying to get the IV in -- she also noticed I was cold and commented she had seen in my chart that I had Raynaud's, but still didn't bother to try to warm my arm at all. Well needless to say today I am bruised and sore because it took several attempts a lot of digging and twisting of the needle and lots of apologies from her(why she didn't stop and warm my arm I never had the courage to ask, I just put up with the pain). Well as she was having difficulty she kept tapping the veins in my arm looking puzzled and looked at me and commented -- it's almost like your veins are hard. Has anyone ever had a comment like that from a nurse or phlebotomist when you don't have hard skin? I'm thinking it has a lot more to do with the Raynaud's and the cold, and that the nurse I had last week had the right idea. I'm going to pay more attention now to see if things go easier getting blood drawn when I am warmer. A lot of the time even when the needle will go in, it seems they have a hard time getting the blood to flow on me. One phlebotomist told me it is because of my small veins it closes it off or something. But I'm wondering if it has to do with being cold. Any nurses out there have any ideas?

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I have one arm that seems to be easier than the other. I used to think that one person who drew the blood was better at it than others. Then one day it dawned on me that he always used my right arm. Could it be something like that for you?

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Well this time it did happen that way, each nurse did use a different arm. But that has not been my experience in the past. For
blood draws they almost always use my right arm and sometimes they have trouble and sometimes they don't. Thank you for the help though, in the future I will pay more attention to which arm and see if there is a difference.

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When you are cold, your veins constrict (vasoconstriction). Meaning that your veins literally tighten up, and become smaller. causing the lumen of the vein (the space where blood flows through) to become smaller. They will have a hard feeling to them when they constrict. When you warm up, your veins dilate (vasodilation). Meaning, they get bigger, the lumen opens up so blood can flow through the veins easily.

Having raynauds, your vessels constrict, making it hard for blood to flow. That's why your toes and fingers go blue when you are cold, because not enough blood is getting to them. And then, once you warm up, you notice they turn red, because blood flow is restored.

I am 1 semester short of my R.N. , I have systemic lupus, and pretty bad raynauds because of it.

I hope this helps you, and I hope your poor arm feels better! Ouch!

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My story is the same as yours! I worked out that for it to work I would always wear long sleeves and take my hot water bottle myself! It worked every time. And a butterfly must be used. Also being hydrated too helps.

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My daughter is a pediatric patient and has the same problem. For IVs, they have her lay down, and warm her entire body for 10 minutes with heated blankets. They know ahead of time that she is a "hard poke" and have been able to get her on the first try with this approach. We also make sure she is hydrated. Before we used this method, it would take 7-8 times, even with a vein finder. Try to lay down if that is an option, combined with warming your entire body. The nurse also recommended wearing gloves to warm the body before a blood draw, even in the summer. Hope this helps.

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My daughter has scleroderma and she has to do IVs 3xs a month and have blood draws and her veins ended us not good any more heating up her body drinking extra fluids , using the hulk (view finder)and ECT. Her doctor ended putting a port in her since she will always need her infusions.

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I sympathise with your pain on the second infusion! I've come to dread having blood taken because it can be so painful.

I didn't think I had significant skin thickening because my arms looked the same to me, but the skin is fairly tight when you feel it, and you can't see my veins very well at my elbow anymore, so I think there is more thickening under the surface than I realised. So you possibly could have more skin thickening than you realise? I'm a bit unclear on whether scleroderma causes thickening/hardening to the vein walls - something implied by some nurses, but I'm not sure if this is correct. I guess it would make sense if it can do that to the skin and internal organs.

I do think it's easier to get blood when I'm warmer and hydrated, as you said, and I've also found the following things to help:
-My GP has prescribed me a local anaesthetic cream to numb the skin over the veins where I will be having blood taken from - I apply this about 20 minutes before a blood draw, and it really does take the edge off. I can still sometimes feel the blood draw, especially if they have to dig around a bit, but it stops it being so painful, as I used to find them really painful. I think it also helps in that I'm more relaxed knowing it will be less painful, so I don't tense up so much.
-The nurses seem to find it easier to locate a vein if I don't have my arm completely straight, as this tends to pull the skin tight over the crease of my elbow. If my arm is slightly bent they can feel the veins beneath the skin better.
-I get blood taken at our city hospital blood department where the nurses are more experienced, and not at my local GP surgery. This has made a difference in that they are now normally able to get blood the first or second time, whereas it has taken up to 12 times in the past!

It's ironic really that before I had scleroderma I found blood draws a doddle, and now that I need them every 3-4 weeks they are a real hassle!

I hope you find some tricks to help in the future - it's certainly no fun having them digging around!

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I use hand warmers. I have a tiny, surface vein in one hand that often works, and so when I'm on my way to the blood draw I stick a hand warmer in my glove and the surface of my hand is usually pretty warmed up by the time I get there. I'm sure they would work if placed on the arm with tape or something as well. That plus hydration has increased the likelihood of a successful draw for me. The other thing that has helped me is advocacy- I state that I'm a tough draw and show the vein that is most often drawn from. Good luck to you.

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Thank you so much for the replies and advice. You are all such a great support!
To: Momscleroadvocate and Poobird, I am so sorry that your daughters suffer through this terrible illness and the treatments for it. I am a Mom and I can't imagine what you must go through. I'm sending up prayers for your girls and your families. Thank you for reaching out to give me advice when you are going through so much.
I will try these ideas to keep warm before future blood draws and IV's - I must admit that since I've never had an ulcer I tend to not be as careful as I should about my Raynaud's. But it would be great if keeping warm will help with the needles.
Moms -- I am glad your daughters have you for advocates.
I must admit I am not always a good advocate for myself. I do usually comment to the tech or nurse that I am a tough draw but don't go much further. I don't like to be pushy or difficult and just put up with it-- it's just pain,-- right? I did comment to the nurse that my one of my fingertips was a little blue and she agreed, but she didn't want to stop shoving the needle in. Interestingly enough after she finally got the IV started she offered to bring hot packs to warm my hand -- a little late -- well it still helped the Raynauds but too late to help with the IV insertion. I was too timid to insist that she warm my hand and arm first. Next time I'll take the advice to wear gloves and bring hand warmers and do the warming myself ahead of time. Thanks again, everyone!

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I have the same problem, I even fainted the time before last because they couldn't find a vein and kept poking around. There is one nurse that seems to be able to find the right vein so I always ask for her and from now on I ask if I can lie down. They also use a butterfly or baby needle which takes longer but at least it works better for me.

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My arm veins are pretty awful at this point. They've been resorting to taking it from the back of my hand.

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They always have trouble taking blood from me. I have also had a mastectomy so they can only use one are and I am on blood thinners so I have to have my blood taken weekly. This summer as well I had a PIC line in so they could only take blood from my foot. I often wonder what will happen when they can no longer get blood. When I go to the clinic they all dread getting me. Sometimes I've had to go through more than one technician because they can only try three times. It's extremely frustrating but I don't think there is anything I can do about it.

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When your cold/Raynauds vessels constrict. This can make the vein seem "hard" , which equates to difficult. Since you have had numerous difficult experiences, speak up! Let the staff know that a warm towel/blanket helps with the situation and makes it easier for both of you. Also a "butterfly" needle, which is used on infants and small children, works well on folks like us. This is usually drawn from the hand. Some staff are better skilled then others, and if it possible request one who was successful in the past, or at the least give the quick hopefully helpful solutions before you begin. Some patients are difficult to draw, for a variety of reasons. Speak up. And nicely suggest that this info be put in your file for future punctures. It will help you and the staff. Usually they are grateful for the heads up.

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I don't let anyone try more than twice anymore . I only have one arm to draw from, since I had a lymph node dissection on the other side, so the challenge is worse. You're right, the skill varies from practitioner to practitioner. I needed a scan with contrast done recently. Two technicians each tried three times, then they called in the attending, who tried three times more. That was nine sticks with an 18g needle. At that point I said enough. My daughter, who is an ER physician, was in the waiting room. I begged the attending to let her try. Although "It's against regulations" they let her in the scan room and she got it on the first try. The doctor responded, " well, they do it all the time," and that is indeed one key advantage. A warm room is another (good luck with that one) and so is being hydrated. I've also noticed that if you wear an ace wrap, the veins tend to bulge under the wrap, so when you remove it, the veins are visible... but the effect is short lived, so the tech has to be quick. The wrap probably keeps body heat in so the veins dilate.
Also, Tricia54, I'm on a blood thinner too and do home monitoring. It requires a finger stick only, I can do it when I want, it's simple and the cost is covered by insurance. The company is Alere and your physician can write the order for it. It just takes a few times to check your results with the blood draw lab, they may differ by a tenth or two but you and your physician can work that out.

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I have the same problem for years with every comment you could imagine . My sclero specialist eventually had a port put in me. Problem solved . The port is a power port. Never again will I be poked and prodded and bruised or having to wait hours for a specialist to do an IV who also is troubled with my veins. However those warm blankets were wonderful!!!

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I also have had problems with blood samples and inserting ivs and I also have experience from the other side as a nurse taking bloods and inserting ivs. I personally think a lot of it is down to the individual carrying out the procedures and I'm usually sent to the phlebotomist who is the best skilled. I think again from both sides that time needs to be taken looking and palpating a vein before going anywhere near with a needle to save you from the multiple prods and digging about . I also have one arm better than the other , always ensure you're warm and well hydrated as it does help .

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