Saturday, October 18, 2008

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* =)


  1. The sight of syringe scare the shit out of me. I hardly go for blood test due to that. I think till now, I only go to 4 blood test.

    Alcohol swab is an effective cleaning tools. Use alcohol to clean some of my computer equipment and it work like wonders.

  2. i posted another post, on how to allay pain, at the receiving end.. hopefully, you can try that the next time you go for blood test :)

    haha! maybe,i should try using alcohol swabs for that too!

  3. the syringe is pretty big... but i would say the lady might be immuned to blood taking. i sometimes have to have my blood taken 4 times and now i'm pretty immune to the pain.

  4. >renaye>> wow! self-claimed immune to pain!! good to hear that! why did you had to have your blood taken 4 times a day? the only thing i could think of now is Dengue Fever...

  5. thanks for sharing!! i'l keep that in mind! btw...can i link you into my blog?

  6. ooh luckily i didn't know u reply my comment on ur post... hmm.

    anyway... yea i do some quite a number of blood test. one is body check up and other tests for my gastric and yea dengue fever.

    feel free to leave ur footprint on my blog!

  7. >chiiliyeow>> no problem! i have linked you too ^^

    >renaye>> bingo! usually dengue fever take blood QID (4 times a day).. you have gastritis huh? need to have regular meals on time ooo~ take care of the stomach..
    p/s: *left footprints*.. you read a lot of books! i thought life of pi is a good one!

  8. >renaye>> i tried commenting but there was this error :

    The baboons do not approve of your robotic tendencies.

    Error matching blog to blogger entry. If you are the owner of this blog, please check that there is no typo in your blog address and that you have pasted the code from the Add Ads page correctly.

    how? :(

  9. hello! first time commenting here! ^^ came from darren's blog..

    anyway just wanna say thanks for this post! provided lots of helpful tips for me.. since i'm just starting out in clinicals.. =)

  10. welcome, zzzyun! =)
    i'm so happy that you find this post helpful... clinical are the best times.. you get the hands on experience, rather than just reading.. enjoy your clinicals ya!

  11. i taking off the torniquet after the blood taking should be bear in's uncomfortable to have it on the arm for long time :P
    btw, this my 2nd time here, n 1st time leaving commen..ur blog is great,u did a great job~

  12. >sine nomine> thanks for visiting :) i agree, the tourniquet can be painful when left long, had added that to the list :)


dear friends, firstly, thanks for leaving your comments.. they are very much valued :)

secondly, do remember to leave your name =)
i'll like to know how can i address you ^^ thx

oh yes, if you do not have a blog/URL, just select open ID and leave the URL section blank :)

Author's Note

Dear friends and readers, Thank you for dropping by and leaving comments/ shoutouts. More importantly, thank you for being there... please accept my apology that, lately, i may be busy with work and not have time to reply youir messages/comments, but rest assured, each and everyone is read, and highly appreciated :) have a nice day! ^^

of love

Today, i heard a story which was not a story of falling...
of living in the dark end of winter turmoil..
instead, it was a love story..
of a couple who did not live happily ever after...
but they live, loving each other..