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How to Draw Blood from Small Veins

Updated on September 12, 2012



If you’re a phlebotomist or nurse, you may experience the challenge of drawing blood from a patient with small veins. With several techniques to improve your success, it is possible to draw blood with minimal trauma to the patient’s skin and still obtain a viable blood specimen that is suitable for laboratory testing. If you have examined both of the patients arms, and have found tiny or small veins, first check your doctor's orders and call the lab. Ask the laboratory technician how much blood is necessary to get lab results. For example, a CBC may only need a teaspoon (4 ml) of blood to get results, for serum tests, you may need the entire vial to be filled. Find out for sure before you start the procedure.

  • Gather Your Equipment
  • Tourniquet
  • Butterfly Needles (3)
  • Alcohol Swabs
  • Cotton Balls
  • Band-Aids
  • Paper Tape
  • Several of Each Specimen Tube for Each Test
  • Vacutainer
  • Latex or Vinyl Gloves

Note: Size of the Butterfly Needle: If you are drawing a CBC, use a 22 gauge needle. Any smaller than that and you may run the risk of your blood sample resulting in hemolysis of the red blood cells. Always attempt to draw blood for a CBC with a larger sized butterfly, at least 22g. This will save you a lot of frustration if the lab calls and states your blood sample contains RBCs destroyed by the small needle, and you need to re-draw the sample.

Always explain the procedure to the Patient before application.

People with small veins may be apprehensive and may have had very bad experiences with having their blood drawn in the past. It is paramount that the phlebotomist or nurse deescalate their anxiety and put them at ease before the procedure. Reassure the patient that although they have small veins, you have special techniques to apply that will improve their experience, and you will do all you can to minimize their discomfort. Drawing blood is an invasive procedure, and the professional needs to develop the patient’s trust.

Ask Your Patient Which Vein is Usually Used for a Blood Draw

Your patient may know the best place to draw blood. Chances are they have experienced this situation before and may know what vein is more accessible.

Apply the Tourniquet

Feel the antecubital space for veins, checking medial and lateral aspects of the arm within the space, until you find a suitable vein. If none are found, remove the tourniquet and attempt the other arm. Have the patient clench and unclench their hand several times. Release the tourniquet after 30-60 seconds, or if the arm skin is changing color.

Apply a Warm Compress

If the veins are very small or you can’t locate a suitable vein, apply a warm compress to the antecubital for several minutes. Sometimes, this will bring a vein to the surface.

Note: Do not slap or smack the arm, this will only create swelling of surrounding tissues.

Hang the Arm Down at the Patient’s Side

If no vein has been found, have the patient hang their arm down at their side as your feel for signs of an accessible vein. Repeat to both arms if no veins are found.

Have the Patient do Push-Ups or Arm Curls if the Patient is Physically Able

Sometimes push-ups will force blood into the arm veins and then one can be palpated. Do not have any patient incapable of exercise performing any exertion.

When You Find a Small Vein

If you have located a suitable vein, clean the site with the circular motion of an alcohol swab. Depending on where you work, some facilities also want you to use a betadine cleanse, and let air dry. Prepare the patient for the procedure:

  • Apply the tourniquet
  • Insert the Butterfly Needle with the Hole Upward
  • Slowly Insert the Needle Until You See a Flashback of Blood
  • Insert the Vacutainer into the Test Tube
  • Draw the Correct Amount of Blood and Disconnect
  • Release the Tourniquet before Pulling Out the Needle
  • Place Firm Pressure at the Site with the Cotton Ball for 30 Seconds
  • Apply Paper Tape over a Clean Cotton Ball
  • Ask the Patient to Continue Pressure over the Puncture Site
  • Apply a Band-Aid if Necessary

Always Ask for Help

You should always have access to another qualified individual for help in these instances, even if it is just someone to verify your findings. Also, if you suspect your patient is dehydrated, report this to the physician, or supervisor, and ask if they should go home and drink enough fluids (if they are not fluid restricted) to return the next day for better results.

Take the Phlebotomy Quiz

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    • profile image

      dr.amin 2 years ago

      Thanks for expline &help

    • eHealer profile image

      Deborah 5 years ago from Las Vegas

      Hi IRC, you should be proud! You would be surprised at how few people have the knack, ability or the presence of mind! You got it or you don't, but you can develop a great ability. Good for you and remember, the few, the proud, the phlebotomists!

    • lrc7815 profile image

      Linda Crist 5 years ago from Central Virginia

      lol, I worked as a phlebotomist for 12 years and wish every phlebotomist could read this. You didn't miss a trick. Phlebotomy, like writing, requires passion, if one is to be good at it. I was and I was proud of it. Great job! Voted up.

    • eHealer profile image

      Deborah 5 years ago from Las Vegas

      Don't worry Pinappu, no one likes their blood taken, some people have an aversion to it, and maybe that's healthy. Thanks for sharing!

    • eHealer profile image

      Deborah 5 years ago from Las Vegas

      Thanks Rajan, after years and years of experience, I hope to help the newbie struggling with technique, and give the patient a few tips on how to cope with having small veins. Thanks!

    • pinappu profile image

      pinappu 5 years ago from India

      Arghh! I am afraid of such blood drawing tasks. It makes my short hairs raised.

    • pinappu profile image

      pinappu 5 years ago from India

      Arghh! I am afraid of such blood drawing tasks. It makes my short hairs raised.

    • rajan jolly profile image

      Rajan Singh Jolly 5 years ago from From Mumbai, presently in Jalandhar,INDIA.

      Excellent Deborah. Very useful tips and information for the patient.

      Voted up, useful and shared.

    • eHealer profile image

      Deborah 5 years ago from Las Vegas

      Thanks Glimmer Twin Fan, and congrats on you100%! I used some of the "old wives tales" I've heard in phlebotomy. Thanks for taking the quiz and I really appreciate you sharing your personal experiences.

    • Glimmer Twin Fan profile image

      Glimmer Twin Fan 5 years ago

      Ok - loved the quiz, especially the question about sticking the needle in blindly. I actually got 100% even though the thought of having blood drawn terrifies me. Whenever I need it done there is usually someone there who is a trainee and they always ask if I mind. If it's there first day, yes, if they have been at it a while, then I don't mind. Good hub with good instructions.

    • eHealer profile image

      Deborah 5 years ago from Las Vegas

      Mhatt! I would never "delete you!" LOL! I am so glad I got a laugh out of this one. Thanks Mhatt! You Rock!

    • Mhatter99 profile image

      Martin Kloess 5 years ago from San Francisco

      I'm sorry. I know this is supposed to be an information article. You can delete this and we'll still be friends. ...But I wanted to share the image of me and the other hubbers drawing blood.