I just got a tech job at a new hospital and they prefer to draw blood from the jugular vein, whereas I'm used to getting it from the cephalic vein. They want to save the cephalic veins for IV's in case anything happens. My 'trainer" seems to be getting frustrated with me because I'm not being aggressive enough when going in with the needle but I'm afraid to hit the trachea. I've been pressing down on the thoracic inlet to stop the blood flow in the vein but I feel like I'm having trouble actually recognizing the vein. Does anyone have any tips for me?!
I always hold the thoracic inlet with one thumb. Then, I feel for the jugular with my other hand first until I get a good feel for it. Do not be afraid to have your restrainer move the animals head or position if you cannot feel it! I usually aim for about a 45 degree angle of the head with a slight tilt the opposite direction of the vein I'm going for. Also, it helps to have the animal all the way at the end of the table with the front legs straight off the table and pointing to the floor. The straighter the line from the toes through the neck the better.
Once you feel the vein (it should feel a bit like a garden hose and may move a bit), use the fingers of the same hand that the thumb is holding off with to keep the vein lined up and stable. I use my index finger particularly to do this.
Then fo for it! You are not likely to hit anything you don't intend to with a normal 3/4 - 1 inch needle, just move your needle about a 1/4 inch in and stay steady after that, watch for your flash and when you get it, don't draw your plunger too hard and fast- you will collapse the vein. Slow and steady on the draw.
You will be fine!
Good Luck and post again how you're doing!
Great description Dana
I have done many blood draws and must say I always preferred cephalic over jugular....I always had a hard time with jugular mainly trying to find it or feel it...these are some great and suggestions Dana, I'm bookmarking this for future reference !
My boss says that it is in the hair whorl on the neck. I find it there alot, sometimes not. It is helpful if you use a very light touch when you are feeling for the vein. If you push too hard you can't find it as easy.
very helpful advice. thank you
You are usually a fair distance from the trachea. (although some critters insist on having the jugular right next to it!) We almost always draw from the jugular, it's faster and less chance of the vein "blowing up". Your "trainer" should show you where the vein is and then have you draw. You hold the vein off and have him/her feel for the vein and show you where it is, then you feel it and draw. Ask if you can do the easier ones first--some are easier than others for sure! I can usually feel it more than see it, although in some dogs I can actually see it raise (like a horse's does) when it's occluded. Practice makes perfect, however. Keep at it, it will come!
We almost always draw from the jugular vein. In general it is the easiest and the fastest. If you aim for the swirl of hair on the neck you are very close. Holding off at the thoracic inlet and gently feeling for the "tube" that bounces when you roll your finger across it. The vein is usually more superficial than you would think, it's what makes it easier. Hopefully this helps
At my clinic it depends on what we're doing.....for things like SNAP tests, glucose curves, etc....we usually use the cephalic on dogs, and on cats if their complacent enough, although usually about half way through the day we switch to the femoral for cats because they get tired of being stuck. When we have dogs or cats that are dropped off for surgery, we put catheters in pretty much right away, and if we need to draw blood for any reason then we use the jugular, or just take the cap off the catheter.
My clinic is also a very popular clinic for birds and exotics, so for birds we obviously use the jugular, and the 2nd most popular animal we see past birds is usually ferrets, and we use the jugular there, too.
A tip my supervisor taught me for drawing from the jugular is bend the needle slightly so its not as awkward trying to hit it. Femorals and jugulars do have the tendency to roll a lot, so if the person helping you can "hold" one side of the vein in place, you should be able to hold the other side with your hand and get it relatively easily.
Thats so cool that you get to see birds and exotics! We only see dogs and cats.
I agree with everyone answers! I would also suggest if anyone hasnt already dont be afrain to let up on you thumb to ensure you have the vein. I use my middle and inex finger and my thumb to occlude. May i also suggest trying on large breed dogs then move on to smaller dogs and then overweight and cats. (My favorite to draw via the jugular vein is greyhounds!) they have really great veins. Also dont be afraid to be "aggressive" sometimes the skin can be thick. and dont be afraid to ask your restrainer to re-postition the pets head. Also never be afraid to shave a small square of fur to ensure you see the vein on your super furry dogs as well as having really good light. its in appropriate but sometimes a little swear word (in your mind if you can) really helps!!! Good Luck!!
Thanks everyone for your suggestions, they've been really helpful!
All GREAT answers, Gang!
A wonderful secret here which multiple students have talked about is the anatomy of the thoracic inlet and the "jugular furrow". Both external jugular veins run parallel to the trachea coming right out of the thoracic inlet area on both sides of the trachea. Check the Bassert A&P lecture book or lab manual for pictures. As long as you are going parallel to the trachea, you will definitely not hit it.
And by the way, most veterinarians prefer jugular venipuncture for blood collection to save cephalic and saphenous veins for catheters and IV injections.
Here is one trick I like to use with smooth coated animals, like cats. Use a small amount of rubbing alcohol to wet down the fur in the area you are attempting to stick. Then use a flea comb to smooth the down the wet fur. This often helps the vein to visually stand out a little more.
That's a great idea, I'll have to try it...especially since we are not allowed to shave the area!
A trinck that I use is to hold off in the thoracic inlet and and I push up slighly with my fingers. If you look closely you can actually see the vein "puff" up under the skin. Also feeling with all of your fingers vs. one or tow fingers can help. Rubbing alcohol helps visulize thing as well. Good luck and know that things take time but before you know it you will be a pro!
I think someone else may have suggested this already, but one thing that really helps me a LOT when trying to locate the Jugular is putting my finger where I think it is, and then lifting my thumb that's holding the vein off, and pressing it back down. If you have the vein, you will feel it go down and then fill up again.
I'm glad you asked that leah. I do a small amount of jugular punctures I have been afraid as well. The girls I work with do it so quick and I'm still slow at it, with all the comments you got it should help me to. Keep me posted on how you progress.
you will get there! I was so nervous the first time i did a jugluar draw in my assistant school, but now i do em every day, and yea even techs who have been doing this 30 years will still have issues, but you just learn to not get discouraged. Youll get there.
Don't be afraid to practice finding jugulars on any animals you are working with even if you don't plan to take blood. Palpate jugulars on your boarders, animals under anesthesia, or just those in for appointments. The more you practice just feeling dogs and cats of different sizes and shapes without the stress of knowing you have to get blood, the more comfortable you will be in your own abilities. Don't get stressed about it. There are some animals that will never feel "normal" and only the most experienced techs (or doctors) can get those by simply knowing where the vein "should be" and not by being able to see or feel. It is an art as well as a skill, but one that is very learnable. Good luck!
I made this it's own discussion but I thought i'd put it on this one too so you guys can help me out!
So a few weeks ago I posted a discussion on drawing blood from the jugular because the new animal hospital I work it only takes blood from the jugular and I was used to taking it from the cephalic. Well, this new hospital has turned out to be a living **** for me..at least the boss. She not only didn't help me get the experience I need with drawing blood from the jugular, but she took away my duties of being a veterinary technician and has demoted me to a veterinary assistant. I'm not able to do any tech work, which I have already had in the past and am no scrubbing kennels, restraining animals, and lots of cleaning. Needless to say, I need a new job. So I called another animal hospital nearby and have an interview on Monday morning. Only problem is that I am supposed to be working on Monday morning at the other hospital. The doctor at the hospital I will be interviewing sounded like she would actually spend time with me to help me achieve what I need to accomplish and once done with this program, she would continue to have me on her staff.
Now, I need your suggestions to help me figure out what to tell the hospital I currently work at on Monday that I will be coming in late. My interview is at 9:30 a.m. I would say I have a doctor's appointment but I'm afraid that my boss, being the person she is, will ask for a doctor's note. I really do not want to miss this interview because I have no days off until next week and am desperately trying to get out of this current hospital. I AM NOT HAPPY.
Any suggestions would be helpful in this situation!!!
Hi, Leah Cygielman! An important Life Fundamental to always follow is "Honesty is ALWAYS the best policy!" Your reputation and integrity are so very important as you journey through life. Don't lie. The veterinary community is a small one, and word easily gets around...... both good and bad about staff members. There are soooooooooo many veterinary hospitals looking for hard workers who have integrity and honesty.
It is to your benefit to be honest. I would encourage you to call and say: "I have a previous commitment I cannot break and I won't be able to work on Monday". That way, you have been honest. If they fire you for not being there, it may be a blessing in disguise. Good luck!
Just be honest....honesty is always the best policy.
I agree with Dr. Jim Hurrell. You should always be honest no matter what. Let me tell you a little story.
Before I started working at the animal hospital I am at now, I was a freight manager at dollar tree. I liked the job I was doing but not the boss I had. She was one that only wanted things to be in her benefit not anyone elses. I got a little upset with her one day one taking credit on something she had nothing to do with just to impress her boss. In my situation I was able to schedule my Interview on a day I had off. After I went I talked to her the next time I worked and told her that I had an interview for a new job because I did not like the way she did things( the situation I told you was only one of many) and she didn't care for that to much. I knew she wouldn't but I didn't want to lie. I gave her a few hours and went back to talk to her about it and she didn't say to much.So my last two weeks because i did turn in a notice, she went on vacation. A month later I went back to the store to shop and she stopped me and told me she was proud of me for doing what I did.
I hope maybe you can see what I'm trying to tell you. They may get mad or upset but it's better to tell the truth. You lie once you'll have to make another lie to cover that one up and so on.
Thank you Ellen and Dr. Jim Hurrell, you've helped me so much! I appreciate you sharing your story with me Ellen, it really did put things in perspective for me as it sounds like you were in a similar situation. I plan on calling my boss tomorrow morning and just telling her that I have prior commitment and will be coming in to work late on Monday. I suppose if she has a problem with that and doesn't want me coming in to work at all on Monday she can let me know.
Just do what is best. I wish you good luck! :)
I try to help everyone. Please keep me posted on what happens. Good luck...ill be thinking of you tomorrow. Just be honest:)
well I left a message on the hospital's answering machine last night letting them know i'd be coming in to work late today. The interview went great and then i got a call from one of the vet assistants saying that since it was a slow day, I didn't need to come in so that settled that problem. Let's just see what happens tomorrow when I go in! Thanks everyone for all your help and guidance!
I Hold off on both sides of the thoracic inlet which seems to make the vein pop a bit more than just occluding one side. The vein will feel spongy, you should not have to worry about hitting the trach.
Thank You so much for this forum!! I'm starting to do blood draws and I'm usually very unconfident and can't find the vein. When I do, I'm so happy!! For Jug, I don't know how to "hold off" and use my other hand to feel for the vein and I don't understand "blowing the vein" what does that mean? I tried asking and my co-workers seem to just get irritated because I'm not "as fast" as the other techs. I'm very hard on myself and I don't give myself much credit at all When I can't hit the vein, I get confused whether you pull out or take the syringe and move it around slightly. When I do hit a vein, my hands start to shake when I'm pulling the plunger, any ideas on how to steady my hand?
I walked around for a few days with syringes of different sizes in my hand "practicing" pulling the plunger back. This got me used to pulling them back. I do move the needle around slightly if I don't "hit" it right on. Hold off with your less dominant hand using your thumb and feel with your dominant hand. The vein feels like it has a bounce to it. If you think you feel it let up from holding off and your should be able to feel the vein fill back up when you hold off again. If your co workers aren't supportive then find people who are. Remember practice makes perfect and every time you are successful you are one step closer!
Its quite alright to be nervous and a little bit shaky when getting into the groove of venipuncture, especially around them senior techs. However confidence is key! Confidence will better and enhance your ability to find, hit, and draw a fresh blood sample with care and ease. In jug draws of a cat or dog, having a good holder is a great start. spray the area with alcohol. You have two hands, with your free hand occlude jugular (one or both) you want to be applying pressure low on the neck and pulling downward will help in stabilizing the vein, with your syringe holding hand you want to be feeling in small back and forth movements over where the jugular should be laying, in most cases under the "cowlick" on either side of the neck, once you fond your bouncy vessel take your needle, bevel side up, and make a nice firm fast poke into the vein, gently pull back on your plunger to see if you get blood back, if so great! Continue to pull back on your plunger gently watching the flow of the blood, you do not want to pull back to fast, this can cause the vein to collapse and your sample can be affected by this and a new blood draw necessary, also this can cause a hematoma, where the vessel blows. If you do not get blood back initially, then gently and gingerly move your needle left right up or down pulling slightly on your plunger at each new adjustment looking for blood flow. These veins can be little movers and shakers as you get better using your fingers you will learn little tricks to stabilize your vein, such as laying a finger beside the vein while still holding off and pulling on your plunger. This sounds like a lot just don't be scared and don't worry, you will get better with time and confidence! We all started somewhere
"Blowing" the vein is when a hematoma pops up where you have inserted the needle. When you are pulling the plunger, do it slowly, let the pressure of the blood filling the syringe do most of the pulling. If you drag it back too much, you create a vacuum which in turn causes a blow. Carrying a syringe around in your hand and playing with it does help; you want to get very comfortable doing everything with it one handed.
Thanks for this thread! I am book marking this!! I am so nervous for jug sticks!!
Dont be afraid to be a little agressive when finding the vein. Sometimes that skin is tough. As well as making sure you have a good restrainer. They really do make the diffrence on getting the vein and not. I have ine tech that i can almost never get blood from an aninal she restrains since she always hold crooked. Also make sure you have good lighting and dont be afraud to shave in the area where your vein lies on a furry dog. Even ones straight fur can be tricky to feel.
Shave, Shave, Shave. It helps so much. Also I hold off both thoracic inlets and it really gets the jugular to fill. Like said above, do not be scared, be cautious. If you are slow and scared you are just going to push the jug around and not puncture it.
Yes, Ceph should not be used to draw blood in case an IV cath is needed.
I'm not in the Vet Tech program, though I admire all of you who are!! I'm currently taking the Dog Obedience Trainer/Instructor program as the first step in becoming a certified Service Dog trainer. Anyway, here's my question - have any of you ever drawn blood from the jugular vein in a goat? I raise dairy goats and would like to start testing through BioPRYN but don't have any experience drawing blood from livestock, just dogs. The nearest large animal vet is about 45 minutes away and she mainly works with horses. In fact, that's the only large animal I've ever seen her work with. So, if you have any experience drawing blood from the jugular vein in a goat, could you please let me know how easy/difficult it is and how different it is from a dog or horse? Thanks so much!
Hi kaycee18! A jugular blooddraw in a goat would be similar to a dog or to a horse (or to a cow, or to a... you get the idea). Each animal species will be only slightly different in regards to restraint (probably the most important with the goat, having a good helper to keep the animal in one place) and in location (in large animals with longer necks there are certain areas of the neck better then others).
I've cover this topic in Animal Care & Management Webinars. Here is the link to my powerpoint slides with some pictures, maybe that will help! Vet 200 Webinar Lesson 2 Intravenous Sampling.ppt
Hope this helps!
i am having trouble pulling from the jugular vein too...i have only tried on dogs so far...sometimes i can feel it and sometimes i have trouble feeling it....last night the doctor i work with let me try on her pit mix last night and i felt it and went exactly where i felt it and i got like one drop in the syringe but then nothing else and there was blood in the hub of the syringe too and i can't figure out what I'm doing wrong
Just keep practicing you will get it. Make sure the person restraining is holding properly. Press in on the thoracic inlet and feel for the vein. Release once you think you feel it shluld disapear and reappear once you occlud again. Dont be afraid to shave on super furry dogs and wet the area down with alcohol it helps pop the vein up also. Also dont be timid when you stick em. Sometimes they are deeper than they feel. And most of practice practice practice. And dont get discouraged.
ok thank you ...also not allowed to shave at my hospital because we do a lot of show dogs and one time a girl shaved the leg of the wrong dog so we aren't allowed to shave for blood draws
I learned by practicing on large animals while they were anesthetized. I was fortunate to work as a zoo technician at the start of my career and was able to learn on large cats and hoofstock while sedated/restrained. The real challenge for me was birds and small domestic cats. Now that I am employed in a small animal hospital only, I have had much more experience learning with larger dogs (Labs, Great Danes, Rottweilers.) Practice as often as you can getting a feel for how the vein palpates under the skin, even if you don't attempt to draw and someone else is holding the thoracic inlet. Try to get a feel for the vein on every anesthetized patient you can; this was a GREAT help for me. I tried to quickly practice on every surgery patient I could come in contact with. Most doctors in my experience have been very understanding and helpful with what I was trying to accomplish by invading their surgeries.
most clinics like to use the jugular in most cases, to save leg veins for catheters. you will get the hang of it eventually. Jug sticks are easier than leg sticks, the vein is bigger, unless the animal is trying to bite you then it can be harder.
Great thread! Very informational!!
This has been such an awesome thread.....
Thanks for posting a great question and I've really enjoyed reading all the comments/suggestions!
(Tami made an excellent point about practicing with syringes/tubes and Dr. Teter's power point presentation was so helpful)
Bottom line is that you have to practice because "practice makes permanent" in terms of your technique.
There are some days I can't hit the side of a barn, but I still try to go through the same steps in the same order so that my technique remains consistent.
Above all, stay confident! You can do this!
So Leah, what happened? Did you get the new job or not?
When I started drawing blood from the jugular vein, I was absolutely terrified. My biggest fear was the possibility of hitting the trachea. The CVT training me gave me 2 excellent tips that have helped me tremendously! (Now I only prefer to only draw from the jugular vein) Tip 1: If you're having trouble finding the vein, follow the corner of the pet's eye directly down. The vein is usually hiding right there. Tip 2: If you're pet has a "cowlick" where you're trying to draw, focus on that. The vein is almost always there for me! Hope this helps.
Cephalic veins should be saved for IV's just in case. Another helpful tip that another technician gave me...if the pet has 2 tone color...for example a rottweiler or black and tan coon hound...then the vein should be in close proximity to the color change. The cowlick is another good tip. Also, it helps me to really saturate the surrounding hair with alcohol. If you have to occlude the thoracic inlet and watch...then release it and see if you notice the vein clear, then real occlude and draw. I was watching another new girl draw who was also worried about hitting the trachea and the vet had her feel and touch the trachea first and then move to the side of it. My vets have told me that the only time we should NOT look to the jugular for venipuncture is if the pet is showing symptoms of hemorrhagic gastroenteritis! Good luck and have fun...I love venipuncture!!
I know this is an old post, but I too am learning how to do this after years of using the cephalic vein, and just wanted to share that I found everyone's responses to be very helpful. I've always occluded the jugular simply by pushing down, and the tip of applying pressure in a "down and up" manner really made a difference. Also, I won't hesitate in the future to ask the person holding to reposition the head if I'm having trouble palpating the vein. Tomorrow will likely be a busy day at the hospital, so hopefully I will get extra practice on my shift.
I learned to draw blood at an ER clinic. What the vet had me do was depress both sides of the thoracic inlet with first and second fingers to see what side is better. I never use cephalic veins for blood draws because of the ER. Have you practiced feeling for veins on sedated pets? Not with dexdomitor- drops blood pressure too much. That's how I plan on training my newest trainee. He's learned how to get respiratory rates on dentals and I had him practice auscultation and finding pulses that way too. He's not quite ready to draw blood yet but that's how I intend for him to get good at jug sticks, especially side sticks for cats. I also found having people draw flush from a still, hanging fluid bag one handed helped in teaching how to poke a jug vein.
Those are all excellent tips! No I haven't palpated on an anesthetized animal and we use dexdormitor often but that's a great way to learn, I like the idea! Also today I did a perfect jug stick today, it was the first time I felt it was easy to do so that was pretty cool
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I was very nervous about going for a jug and always felt like I just couldnt feel it. One of our vets just kept telling me keep trying and once you have the feel for it you will have no problem. I tried several times with no luck and that one glorious day when I did hit it felt so good and after that never had a problem feeling them again. I practices a lot on my own dogs, just holding off and trying to get a feel for it. The team at work when it wasnt crazy busy had me feel every dog that comes in, even if we didnt had to get blood, just to get the feel with my fingers how different dogs jugulars feel.
I still get a little kick out of every successful stick!
I had trouble for this too. One of the MOST helpful things my Dr told me is that it's usually more superficial than you think! If you don't feel it, one thing that I do is press down a little harder in the thoracic inlet, and also try to feel for where the jug is down IN the thoracic inlet so that you know you're right on top of it holding it off so it pops up really well. The other thing too is, feel free to be liberal with the alcohol. Remember, the alcohol will actually help the vein rise too.
Something that I learned to do when I first started was when you think you feel the jugular, release thoracic inlet. If what you think is the jugular "disappears", then that is a good indicator of where the it is. When occluded, the jugular will feel like a spongy rope/hose rolling under your finger. I also close my eyes if I'm having trouble locating it. Take away sense of sight, enhances sense of touch. At least seems to help me. It really is just learning how the jugular feels when occluded. Another good thing to try is follow the jaw line down towards the thoracic inlet. The jugular should rest between the trachea and front of shoulder. Some of course will be a little more medial or lateral, but is also good way to find where the jugular is. Just don't get discouraged, you'll get it in time. Attempt on healthy, sedated patients as well. I was fortunate to have a very good dog as well when I first started learning. I would attempt jugular draws on her on slower days. If you are able to take a pet to work and have a cooperative pet, practice on your own if comfortable doing so.
The hospital I work at uses the jugular on dogs and the rear leg on cats a lot because they want to save the front legs in case we need them. I wasn't very confident hitting a vein but have found now that I prefer the jugular on cats. The first DVM that I worked for always drew from the jugular on cats so that is how I learned to hold and also to draw from the neck. After you get it down you will like it better also. I surprised myself the other night and actually drew from a very wrinkly Bassett Hound neck and got it the first stick. He was in as an emergency for seizures. I have gotten a Pug one time from the neck. I just started drawing blood about a year ago so as someone said "Practice makes perfect". Good luck
Really a help to read through the previous posts. I seem to struggle with drawing blood and normally just end up letting my vet draw, just seems easier. Problem - I am not getting any better. And she would have no problem teaching me and letting me get the practice. Practice make perfect - that will be this coming weeks goal!!!
We like the jugular too at my hospital- Faster, better flow, less hemolysis, saves cephalic for IVC.
Keep plugging away, you'll get it!
Keep practicing! Jugular sticks are the way to go. I rarely draw from cephalic.
My problem with cephalic is, it is a slower blood flow. So, if you have to get a decent amount of blood, the probability of the blood clotting in the syringe is high. A jug stick flows fast and rarely clots. Plus, you get more blood from a jug than cephalic.
This is how I was taught and 90% of the time I always get it on the first poke. Face the dog face to face than put your hand behind its ear. Follow your hand down until you reach the other hand you are using to hold off. After that feel for the trachea after locating the trachea you now have narrowed your search by knowing the general idea of were the vein is also before you poke always poke fast never slow. Doing it slowly gives time and pressure for the vein to roll hit it fast don't give it a chance to move.
Sometimes I have a hard time explaining myself here is a picture to help. Look at wear is ear is and imagine yourself going behind it and following it down until you reach its sternum that will give you a good idea on were to poke hope this helps.
Leah, don't give up and don't be too hard on yourself. It's common practice in my clinic and the other clinics I have worked/shadowed at to use the cephalic only for IVCs. Though my techs at work draw blood more from jugulars than saphenous veins, it was an adjustment for me to learn to restrain a feline for a lateral jugular blood draw when I'd previously only seen/done the restraint the way that Dana has described for you. Practice makes perfect, as they say!
The last hospital I worked at did that too!!! I thought it was so weird!! The best advice I can give you is to make sure whoever is assisting you and holding the animal while you collect blood, put the patient in the right position!!! It's all about positioning for me. Make sure the person assisting you is holding the dogs nose up at a 90 degree angle. It is even more helpful if the person assisting you has the patient lay down on an exam table, hold both front legs forward to stretch the neck area more and tilt that snout up. When held in position properly, I can always get the jugular vein.
I see.... OK, first and foremost, optimize. LIGHTS, CLIPPING HAIR, WETTING THE SKIN, and a GOOD HOLDER, the BEST HOLDER.... all help. Now, when holding the thoracic inlet, avoit pinpoint pressure, meaning don't just jam tour thumb as if you are corking a leak. Lay your thumb over the WHOLE area, covering a wide area, and don't be afraid to direct the holder to turn the head and neck in all directions. You will eventually get the feel. Once you draw 3 mL from a severely dehydrated and ill old cat, you will feel VERY accomplished. Give it time! And I hope the best for you! It is acting responsible as a vet tech by savng the cephalics, but don't forget the saphenous too. But I have placed many IV catheters in cephalics that were blown and bruised by prior nurses too. It takes time and patience. Remember... OPTIMIZE!
- Daniel in VA