Blood draws, what are your tips for a relatively painless experience?

[AussieNeil]

I've just had my regular blood tests done, which prompted this post. (My routine is to go to a pathology collection centre for the blood draw, then two days later pick up my results from my GP after he has checked them. I schedule the test prior to my haematology appointment so I'm prepared with questions if there are any changes of note.)

This morning didn't start well. The results hadn't come through, then my doctor was on leave and the receptionist said the relieving doctor might get time to check them today, if not, I could pick them up tomorrow. I'm getting better at not worrying about how things are going between blood tests, but once the sample has been taken, I really want to know how I'm going! Finally, this afternoon I received a call from one of the more patient centred receptionists to say that I could collect my results and what's more they were good! My platelets were well up and just back into the normal range - the best they've been for almost 2 years. I had to check the date was correct - it wouldn't be the first time I'd been given old results. Thankfully I haven't had the experience that someone on the CLL Forum had. He picked up his results and his lymphocyte count had skyrocketed! Turns out he was given old results from before chemotherapy!

Here are my tips for getting through this necessary experience with minimal discomfort and obtaining the most accurate results possible.

If you can, find a collection centre that has plenty of room so you can avoid the risk of infection. These are not places healthy people frequent! Where I go they have face masks and gel hand wash at the counter and more hand wash outside the collection room.

Avoid the morning rush of people that have been fasting, or are squeezing in a test on the way to work.

Use the same pathology service - different pathology services use different test equipment and these can cause notable differences in the results on the same blood sample. (I've seen instances where a testing machine is being replaced and the pathology service provides tests on both machines for 3 to 6 months so medical staff can familiarise themselves with the different spread of measurements.)

Try to have your blood draw done at the same time of the day and try to follow the same routine prior to collection. Some blood components follow a diurnal cycle.

Don't be alarmed by some variation in your results. Test measurements have a known repeatability error, that is, measuring the same sample will give slightly different results within a known range. Long term trends are what is important.

Make sure you are well hydrated before visiting the pathology service - it will make it easier to draw the blood sample. You need to drink more a few hours before attending.

Avoid strenuous physical exercise before your blood draw. This can boost your neutrophil levels which may give you a false sense of security if you are nearing levels where you need to be on a neutropenic diet.

Try to share the blood draw locations around to avoid a build up of scar tissue; swap arms, etc, If you are finding the process painful, you can apply a local anaesthetic cream like Emla cream for 30 to 60 minutes beforehand. (This is also great prior to IVIG transfusions.)

emla.co.uk/emla-cream-instr...

Avoid lifting any heavy weights for a while after the blood draw, particularly if your platelets are low or clotting takes a while for you.

Some blood test results are influenced by the way the blood sample is taken and how it is treated afterwards. Of particular importance to us is the LD (or LDH) test, which indicates how rapidly our lymphocytes are growing. More seriously, an out of range result here may indicate a progression to Richter's Transformation, something that we are at increasing risk of developing the longer that we live with CLL. It can also just mean that the phlebotomist struggled to obtain a sample and bruised the already fragile CLL cells, releasing the LDH into the sample.

More tips on what to do afterwards can be found here:

healthunlocked.com/cllsuppo...

I've been fortunate in that a couple of years ago, a new collection centre opened within walking distance (though I usually cycle there). Amazingly it is about three times as large as the other nearby centres - they must have been given a great deal on the rent. Thus there's plenty of room for me to keep my distance from others attending and frequently I don't even have to wait!

What are your tips and experiences?

Neil

[Newdawn Administrator]

Hi Neil,

First of all, great to hear your results were good, that's the main thing!

We seem to have a different experience of blood gathering (well in England anyway). I can go to any NHS centre with a phlebotomy service, (including my GP surgery or haematology unit) clutching my lab request sheet and bag which my Consultant Haematologist efficiently supplies me with after each consultation. Blood is taken, usually with a mammoth struggle as my veins are not visible and are apparently deep and evasive! Always a problem but some phlebotomists seem better than others. And those centres are always busier!

The results are then sent to my haematologist in readiness for my consult and he has them in front of him when I arrive. My last consult took less than an hour door to door as a result and I left with the request sheet for next time. I request a copy which he prints out for me (I don't think it's routine to give them).

In terms of preparing for the test, the phlebotomist told me to drink plenty of fluid as it makes the process easier when the body is well hydrated. I was also told that it may be necessary to plunge my arms into very warm water the next time in order presumably to cause dilation if the difficult persisted.

I'm not built for illness unfortunately and I foresee this being a bit of a problem as cannulas are very problematic to get into my arm.

Seems to be a differing systems but I do like the system we have as I don't have to sit around at consults waiting for tests.

Newdawn

[Myrddin]

I choose to have my bloods done at the hospital before seeing the consultant. This means a 45-60min wait after bloods taken before results are available and seeing the consultant. I could have choosen to have had the blood taken at GP surgery and sent off etc but decided to have the bloods and consultation in one go was the simplest.

My last visit took less than 1.5 hours in total - Even get offered a drink and biscuit while waiting - helps relax people waiting for results/consultation.

They print out all the standard blood results they have each time if asked. I did find out they had done a test on my first visit that they had not mentioned being normal and is not in the printed set which have now been added to my records.

[PaulaS Volunteer]

I just got back from having bloods taken this morning, sat down with cuppa tea at my computer, and saw this post had appeared - all about having bloods taken. (I've not heard the phrase blood "draw" in the UK - maybe it's an Aussie thing). .

Anyway, I'd started the day by drinking as much as possible (water and tea). Then a 5 minute walk to the GP surgery (a quick walk because I always seem to leave it till the last minute then have to rush). Nodded and smiled at the others in waiting room, but sat as far away from them as possible. Don't touch any of the well-thumbed magazines around. Try not to touch anything at all. Didn't have to wait long before health care assistant called me in. I go there every 3 months, so I know her and she knows me. I give her the lab request form I got from the hospital last time, and tell her where I'd like her to stick the needle in. I usually ask for it to be done in the bend of my elbow. Once she tried to get it from the back of my hand, and it was very painful, didn't work, and bruised horribly afterwards. Anyway, today she got it at first attempt (in the elbow). I press on the site for a few minutes afterwards, then she puts a little round plaster on it. All done and back home within half an hour.

My haematology appointment is next Wednesday, at our local hospital (about 20 minutes drive away). The consultant will have the results in front of him, and I'll ask for a copy. I try not to think about it between now and then, but of course I do.... especially as my lymphocyte count is increasing much more rapidly these last couple of years. It doubled in less than a year, and was 91,000 at the last count. I've been warned that time for treatment might be getting nearer... which is why I'm more even keen than before, to get wise to all the various treatments that are around. (But I realise it's not just a numbers thing, and am reassured that I can't feel any new lumps and bumps, don't get drenching night sweats, and am not losing weight).

So glad to hear that your blood results were good this time. Neil. What a relief it is, to all of us, to get that sort of news.

I suppose with about 500 members of this site, it's highly likely that several of us, like me, will have had bloods "drawn" today. And be waiting for results...

[AussieNeil Partner Administrator in reply to PaulaS]

You've got me thinking now Paula about my use of "blood draw". I'm pretty sure it is more an American term, so I must be reading too many items from the States. I guess here we'd say "getting a blood sample taken" or "having a blood test", but "blood draw" was a quick way of describing the actual process. Phlebotomy courses here talk about "blood collection" but it isn't a topic that gets much discussion in the general community.

More importantly, as you point out, if on average, members of this community are having tests every 3 months, that's at least 5 of us going through this sometimes uncomfortable process every day and perhaps sweating on the results for a day or more. I've never had a sample taken from the back of my hand but can imagine it would be painful, particularly if the phlebotomist digs around for a while.

Anyway, I hope your appointment next week goes well and you get a further reprieve, given you aren't experiencing the obvious trigger factors for treatment.

Neil

[Newdawn Administrator]

That's interesting Paula, (I'm envious I don't get offered tea and biscuits like Myrddin! Lol). I've had them resorting to my hands too to take blood and I agree that it's more painful and bruises badly.

Hoping your results stay at least stable Paula. You're right, it isn't just a numbers game and the other warning factors are not evident. As much as I'd love to lose weight, I'm sometimes reassured that I don't! So hope all is well Paula when you go next Wed.

As much as we try not to worry, these consultations times are always unsettling.

Sending best wishes to all,

Newdawn x

[Cllcanada Top Poster CURE Hero]

A trick I have learned in getting blood drawn every 3 months over 15 years, is to lie down to have the blood drawn.... phlebotomists seem to be able to hit the vein with greater accuracy... also butterfly needles help a great deal. catalog.bd.com/bdCat/viewPr...

[Hidden]

I seem to be fortunate. The hospital where I have mine taken is so busy that their experience means they rarely have any problems. Just wish they had tape which is less sticky to remove . Ouch

[pilch]

Just had my three monthly blood tests. I always fix an appointment for it at my doctors and collect a copy of the results two or three days later.Normally no problems but this time I had a cholesterol test as well which meant no breakfast. Made the mistake of not drinking enough water which made the test harder than usual!

Also had a PSA test which has shown a raised reading so now having to have this looked into.Anyone any experience of a prostate biopsy ?Not to keen to have it unless absolutely essential.

[AussieNeil Partner Administrator in reply to pilch]

pilch,

I've just had the same tests and thankfully my results were OK. (I also remembered I was allowed to drink during the fasting period - and I wish they communicated that drinking while fasting is quite acceptable as I'm sure many don't know this.)

I see there's a prostate cancer HU site, healthunlocked.com/fops but considering how common it is, there is sadly very little activity. I've not had a prostate biospy, but can well understand why you aren't keen. From what I've read, the PSA test is not very accurate, so it is worth considering the biopsy to hopefully put your mind at rest.

Site update notifications are down (again) and I only came across your reply because I've been looking for any unreported activity, so I doubt you'll get an answer from anyone else.

You might try the ACOR site which claims to have around 1,300 members:

acor.org/listservs/join/115

I've not visited that specific group, but if it is anything like the CLL ACOR site, I'm sure you'll find it a valuable resource. When you join, you should be able to search previous posts for a wide range of prostate related topics.

Hope this helps and that in your case it is the unreliability of the PSA test that has caused a high reading without any underlying reason for concern.

Neil

[AussieNeil Partner Administrator in reply to pilch]

Pilch, I'd hoped someone would have responded about their prostate biopsy experience. I've not had one, but from what I've read, given the high chance of false positives associated with the PSA test, the discomfort will be worth it to know what is really happening. I hope your mind can be quickly put at rest.

Neil

[familyman in reply to pilch]

Hi! The thinking is changing all the time on transrectal biopsies. I have had 2 in 3 years both negative. I will not be having another unless I have a scan first. I did not tolerate the procedure very well and had post op. Infections which is why I wont have another. The psa loop can be over diagnosed and treated. What are your psa readings? I have mine tested when I go for my cll test every 6 months. My highest reading is 8.9. But it goes up and down. Cheers!

[AussieNeil Partner Administrator in reply to familyman]

Familyman, thanks for responding with your experiences on biopsies to check prostate status. Good point re infection risk; something we CLLers need to always keep in mind and which you've obviously learnt at considerable personal cost.

For such a common cancer, sadly, prostate diagnosis/prognosis needs so much more work.

Neil

[Quarry]

I have just been via GP for a blood sample: at moment I have them monthly. Routine is like Newdawn's.

Tues morning go to GPs with blood request form/bag, and have blood sample taken by a very efficient vampire (my veins stick out, so I think I am easy) on way to work

Receive results at hospital appointment Thurs pm from haematologist. I also request and get printouts. Get given new request form/bag for next appointment

I then book both next GP's vampire and haematologist appointments. Only mild irritation (when I switch back to 3 monthly) is that GP will not take a booking more than a month in advance. So I will have to remind myself to make the blood sample-taking appointment......

[AussieNeil Partner Administrator]

I've just had a good blood test experience with a student phlebotomist. I had a flat tyre on the way so ended up walking the final part of the journey, which I was informed "was good as exercise gets your heat pumping" and makes the collection easier.

I also asked about the options for protecting the needle wound afterwards and found that the phlebotomist makes a decision on what to use based on the degree of subsequent bleeding. This time I got a round bandaid with a small absorbent pad, rather than the regular rectangular bandaid that invariably gets torn loose in my sleeve but I was informed they can go all the way up to a gauze wrap if warranted.

So if you find the wound protection provided for you is inadequate, don't hesitate to ask for something better.

Neil

[Ragsgolf]

I now have a port! Makes blood tests so easy! I had to have a blood draw before every rituxan, so really appreciated the ease. Just a spray of cold numbing agent and it's done without even a prick. No bleeding after and no bruising. Yea! I'm glad I did it. Only thing now is waiting for insurance reports. Sure Hope Medicare doesn't balk! Should have made sure they did a preapproval.

[MsLockYourPosts Passed Volunteer]

I made the mistake of going in for IVIG dehydrated once, and learned that lesson the hard way. I went through three nurses - all very good ones, who I knew. They get three attempts and then pass you on to someone else. I have a fairly long drive to get to UCLA, so I started putting a bottle of water in the car the night before appointments so I could drink it on the way. One of the nurses told me to start hydrating the day before.

As for where I get poked for blood draws - definitely a term used in the US - and infusions, my feeling is that if the person poking me is happy with a vein then I probably will be, too. I do suggest that they not use a site that has been poked very recently for something else. UCLA has wet, heated towels that the nurses use if they aren't seeing a good vein. Some nurses also like to have you squeeze on a soft ball before they poke you. That seems to depend more on their individual training than anything else.

Pilch, I'm sorry that you now have an additional worry. My first hematologist, post diagnosis, ordered a PSA test for me! I'm a Patricia, not a Patrick! He denied it, but in those days I was obsessive about keeping copies of everything. I had a copy of his lab order. I hope whatever comes next shows that it was a false reading.

Pat

[AussieNeil Partner Administrator in reply to MsLockYourPosts]

Pat, thanks for sharing your experience and some useful tips. You've reminded me that I'd get asked to repeatedly squeeze my hand into a fist when donating blood to try and encourage a faltering flow and it often does work. I guess the tensing action helps compress the arm veins. I've been asked to do that during blood draws, but generally when they are trying to find a vein.

I've never had the offer of a wet, heated towel though!

Good we can see the funny side of ordering a PSA test for you.

Neil

[brad7]

Ive never had blood tests in relation to my CLL ,or if so the tests were not seen as relevant to explain to me .

I will be asking lots of things in my next appointment , perhaps one of our talkers can give me the things I should ask and the relavents of the readings

Drad7

[AussieNeil Partner Administrator in reply to brad7]

Considering Leukaemia is defined as a "cancer of blood-forming cells", I sincerely hope that you've had regular blood tests, if not I'd be looking for another specialist!

At your next appointment, you could take the minimalist approach of just asking if any of your blood test results are out of the normal range and what if anything you should do, or you could learn more from the following pinned posts. The fact that they are pinned gives you an idea of how important it is to understand this topic!

Lab tests, what they are, how they are done and what they mean:

healthunlocked.com/cllsuppo...

Why we need to track the Absolute Lymphocyte Count and not White Blood Count:

healthunlocked.com/cllsuppo...

How high can you go (with your ALC) and what does it matter:

healthunlocked.com/cllsuppo...

You might also find it useful to ask what prognostic testing has been done to provide you with an idea of how long it is likely to be before you need treatment and what stage you are at.

Any more questions, don't hesitate to ask,

Neil

[brad7 in reply to AussieNeil]

Neil I had many blood tests at the time I was told by hemotoligist I had Cll , his w&w sugested

[Cllcanada Top Poster CURE Hero]

Brad7... Here is an excellent website that discusses about every lab test imaginable. You might want to bookmark it for future reference... this link is to the Australasia page, so will have the correct tests and nomenclature for Australia, because it varies from country to country...

Labs on Line

labtestsonline.org.au

[JerrysGirl3]

Our blood collection center has one room and a bathroom and I don't see them wiping the chair or armrest with any cleaning solution between patients. The other center is a little bigger but they do bone scans and other imaging as well. But their waiting area is disgusting and goes out into the main hall! As I write this in response to your post it constantly amazes me that I live in such a wealthy town with the most horrendous medical resources!!

[bennevisplace]

I don't have any tips or tricks. My experience runs counter to all the theory.

I've had blood taken at my local surgery, by various duty nurses; by three different study nurses at a trial centre; and in days gone by at the haematology unit of the hospital. I've probably given a few hundred ampoules of blood by now, all in a sitting position and 99 % from the same vein, left arm - it delivers without fail at a good rate. The most I've had taken at a sitting is 9 ampoules.

The worst outcome I've suffered in all that time is a minor bruise, and of course the obligatory "sharp scratch" as the needle goes in.

The only real problem I ever had was when instead of a nurse a phlebotomist took on the job, and failed miserably. It was painful for me and he gave up. So much for specialist expertise.