How to reduce pain in a patient when taking blood /inserting cannula? (for medical students)

I syringed 20cc blood from a patient last thursday. I did not realized how scary it was, until my friends stared at the size of the 20cc blood-filled syringe in shock. Thank God, the blood did not clot. The thing is, the patient, she just lie there like normal, relaxed... I wonder whether she was accustomed to blood taking, or did she not noticed the huge syringe, or was it really that painless?




*syringe sizes for comparison - 20cc is the most right*
p/s: mind you there are of course syringes even bigger in sizes, some even up to 50cc!

So, I figure, today i shall talk about a few tips on: How to reduce pain in a patient when taking blood/ inserting cannula (branula)? (for the benefit of the medical students)

1. Choose the site. Unless the patient has already a line/ has a AVF/etc, which you indefinitely need to take blood from the other hand, take time to choose the site.

2. If both hands have good veins, ask whether patient is a right-hander or left-hander. Use the non-dominant hand whenever possible.

3. Appear CONFIDENT. It is very important to maintain a professional outlook. Know what you are doing. Do NOT use words like : ‘I THINK I can take from here’ or ‘this is my first time’ or ‘my last line got bunked’ or ‘ I am a medical student’ etc...
I often introduced myself as a 'Trainee Doctor/ Doktor Pelatih', rather than ' Medical Student/Pelajar Perubatan'. I am not lying about myself... but words like that DO make a difference... patients would have more confidence in us... seriously, trust me...

4. Explain to the patient why this needs to be done. Start with a professional smile and a 'how are you today?'

5. Be prepared. Have everything readied in a kidney dish before doing it. (gloves, the alcohol swab, cotton, syringe+needle/ branula, the torniquet, etc) There was a study though, which concluded that using the alcohol swab does not offer any added benefits in terms of killing organism on the surface of the skin. We still practice it anyway, it is more hygiene, i suppose, it cleans the surface, and sort of 'shines' the skin, making the veins easier to be seen.

6. TALK to the patient. I have this habit of talking to patients whenever I do procedures or examine them. Usually demography data, like where do you live, how are your kids, how's your job, etc… somehow, distracting them makes it less pain.. it also helps allays anxiety..
(I do get into trouble when I do short cases in exams, though, and my supervisor/ examiner would comment: no talking to the patient in short cases. I find the silence when examining the patient being rather uncomfortable and tense)

7. Do it swiftly and smooth. Time does matter. But do not appear in a hurried manner.

8. Remember to take off the tourniquet as soon as blood is taken as it's uncomfortable to have it on the arm for long time (suggested by sine nomine)

9. Get help when necessary. I only allow myself a max of 2 attempts. Whenever failed, I get help. (don't fail too much also lar.... that's why it's important to practice, practice, practice!! you do not want to wait until you are the HO on-call and you'll have so much work to do, just trapped at a cannula insertion and there's noone to back you up... )

10. Last but not least, i would like to emphasize: WEAR gloves EVERYTIME you take blood/insert branula. BE EXTRA CAREFUL. DO NOT RECAP! The risk of needle-prick injury, it never worth it!

11. (will add on to the list if think of any, open for other tips/ suggestions)

One of the most frustrating words, in the wards, I guess was: line bunked!

*all the best in blood taking/ cannula insertion* =)