Vein attempts

Jeanie Finnegan's congenital heart defect means her veins are tiny, even for a 1-year-old. During the child's frequent hospital stays, her mother braces herself every time Jeanie needs blood drawn or an IV inserted.

"Sometimes she would have to get blood drawn twice a day," said Dorie Finnegan of Niles. "It's a lot of little pricks here and there."

Not all of the pricks find a vein on the first try. After a few failed attempts, sometimes Jeanie isn't the only one crying.

So Finnegan was thrilled when nurses at Advocate Lutheran General Hospital in Park Ridge rolled out a new device that uses infrared light to map a patient's vein structure on the surface of the skin. By highlighting the best vein, the VeinViewer can save a lot of tears, said Michele Habich, pediatric clinical nurse specialist at Lutheran General.

The VeinViewer is just one of the ways hospitals are trying to reduce the pain and anxiety of venipuncture, the medical term for sticking a needle in a vein to draw blood, start an intravenous drip or deliver drugs.

Hospitals also are creating special teams of nurses who are experts at inserting IVs. They're increasing training for the medical technicians called phlebotomists and other staff who perform blood draws.

They're also using new kinds of intravenous catheters that reduce the risk of infection and smaller needles for less-painful blood draws. Some hospitals, including Northwest Community Hospital in Arlington Heights, now routinely offer adults the same numbing cream used for kids.

Other pain relief might be coming, too. Several manufacturers are releasing devices that speed absorption of numbing agents on the skin, meaning pricks could become pain-free.

Behind all this is an acknowledgment that one of the most common medical procedures is fraught with pain and fear for many patients. In surveys by consulting firm Press-Ganey Inc., blood draws and IV insertions often score among the lowest in patient satisfaction.

"Even though we'd all like to get it on one stick, sometimes it takes more than one," said Linda Virgili, director of nursing education at Northwest Community Hospital. "Very often, if it hasn't been a positive experience, we will hear about that."

To ease that pain, particularly for pediatric patients, Northwest Community is budgeting $27,000 for Luminetx's VeinViewer. So is Advocate Good Shepherd Hospital in Barrington. Both hospitals hope to get their machines by next year.

Hospitals often station the VeinViewer in pediatrics departments, where patients have the smallest veins. But other populations could also benefit from the technology, nurses said.

Tricky veins

Some people are genetically predisposed to veins that "roll" or move from a needle. Liver disease, heart disease and smoking can damage veins, making them harder to find.

As people age, they lose fatty tissue that supports veins, which become less prominent. Hardening of the arteries can make it tougher to puncture a vein wall.

A patient who is dehydrated is also in for a tough stick.

"It's like trying to get fluid out of a flattened straw," said Kathy Ferket, director of children's services at Northwest Community Hospital.

The skill of the nurse or phlebotomist is key in reaching difficult veins. Often the best skills are found in the neonatal intensive care unit, where nurses must navigate fragile veins in the tiniest premature infants. In some hospitals, NICU nurses will be called to treat a patient elsewhere after other staffers have tried and failed to reach a vein.

But some larger hospitals are creating teams of experts to perform all IV insertions the first time around.

Children's Memorial Hospital in Chicago created a vascular access team in 2005. This team of six nurses specializes in IV insertion.

"This is all we do all day long, so we're very proficient at placing the IV," said nurse Kathy Ginder, clinical manager of the team.

Since the team took charge of placing and caring for central lines, infections were cut in half, Ginder said.

At Lutheran General in Park Ridge, nurses formed a team of experts in peripherally inserted central catheter lines, or PICC lines, which can remain in place longer than traditional IVs and so reduce the number of needle sticks.

The result is more babies are getting PICC lines and fewer needle sticks over all, protecting fragile veins, said Pam Jones-Gibson, NICU clinical manager.

Getting it right

Improperly performed vein sticks can harm patients beyond simple bruises. A leaking intravenous line can inflame surrounding tissue and lead to infections. A poorly manipulated needle can pierce a nerve, causing loss of sensation or paralysis.

A blood sample that is drawn too fast can damage red blood cells, rendering the sample useless. The lab will request a new blood draw, which means another vein stick for the patient.

Some mistakes are harder to catch. Leaving a tourniquet tied on a patient's arm too long during a blood draw will cause blood to concentrate in the lower arm, resulting in an inaccurate test.

"It can really throw off the results," said Lisa Steinam, an educator and quality assurance associate in the lab at Central DuPage Hospital in Winfield. "The physician wouldn't necessarily know the tourniquet was left on over a minute."

In 2005, Central DuPage went back to a central phlebotomy team, which does most of the blood draws in the hospital and must take mandatory, monthly classes to improve technique.

The hospital also routinely assesses the quality of its blood draws. Earlier this year, monitors noticed more samples were damaged when blood was drawn off an existing IV line. They soon implemented a new policy to take a blood sample from a standard needle whenever possible.

"That way we get the most accurate test for our patient," said Steinam, who teaches a phlebotomy course for nurses at College of DuPage in Glen Ellyn.

Illinois doesn't require phlebotomists to be licensed or certified, though some hospitals do. Steinam thinks it should be mandatory statewide.

"The anatomy of veins is different from person to person," Steinam said. "That's why it's important to teach how to really evaluate each person, how to choose the needle, choose the site that's best for that patient."