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April 18, 2002


Question from Dedham, Massachusetts, USA:

I was recently diagnosed with diabetes, and, as a result, I have to have frequent blood tests. The problem is that the nurse is having a great deal of difficulty getting at my veins in the arm. She failed twice and I had to go to the hospital for testing where they had difficulty too and said my veins were "well protected." I had to pump a ball to get a vein to become evident. Is this common? Is it a sign of some other problem? I can't be taking time off for a blood test, only to have to go to a hospital after to get it done each time, and I am getting charged for all this as well. Please advise


While the diagnosis of diabetes must be made with venipuncture blood glucose levels or an oral glucose tolerance test, follow-ups are most commonly done with the much simpler fingerstick measurements. In fact, both blood sugar and hemoglobin A1c levels can now be done in the physician’s office with a fingerstick., and of course, management of diabetes relies heavily on patient results from self-monitoring of blood glucose at home. Talk to your healthcare team about these options.

Deep or even small veins, and therefore “difficult sticks”, are not as uncommon as you might think. When you do need a test requiring a venous draw such as a thyroid screen or lipid profile, you may want to inform the lab staff of this fact. Sometimes, they can find the most skilled and experienced clinician to do your draw, or will use a “butterfly” or similar needle designed for these situations. Pumping a ball or flexing, hanging and shaking your arm muscles prior to can help as well.

As for planning time out of work, if your physician does need you to have a venous draw for lab work check around with local blood labs and hospitals. Many have lab stations that are open early so that you can arrange to be drawn prior to work and prior to your upcoming doctor’s appointment as well. Speak to your physician about these options and make a plan to make this process easier.