Worried about bloods I took today

First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.

I don't think anyone's going to be calling the GMC on you just yet!

People get bruises occasionally, it's just one of those things. Happens even more with cannulas than phlebotomy. Sounds like you did pretty much what anyone would - tourniquet off, pressure on. Don't beat yourself up!

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Are these patients usually on anticoagulants?

First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.

Which patients? Most inpatients are on daily LMWH but that shouldn't really make a big difference to this sort of thing. Warfarin does make people a bit more likely to bruise, but mostly it's just technique and the quality of the vein.

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I remember when I was on a ward round in my third year and the patient had significant bruising in both anterior cubital fossa regions. The consultant explained that the patients blood was taken but that she was also on warfarin. Are there any other medications that can lead to easily brusing? Steroids???

Steroids thin the skin so make the patient bruise easily in response to minor trauma that wouldn't bruise a normal person, but they are not anticoagulants so wouldn't increase bruising from invasive procedures. The majority of patients are not on warfarin. Bruising when you stick needles into blood vessels is just something that happens sometimes. You should see the mess I made overnight putting in a Vascath + central line!

Just for future reference (and relating to this thread) if you think you made a mess when doing a procedure do you inform anyone or write it in the notes? This sounds like an SJT question but I just wanted to know what you would do in reality.

Thanks

First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.

If I've made a mess, I usually tell (& apologise to) the nurse looking after the patient so that they know and don't get mad at me, but I don't write it in the notes.

This is why we usually insist you put a pad under the patient before doing any invasive line insertion so that it's not a major issue

It's a messy procedure though, so it's to be expected, I've never seen any of the doctors document that it was messy though. Just the usual, used ultrasound, GGHM, technique used and what length the lines were secured at and all that jazz.

If you want bonus points though, offer to help roll the patient to get rid of any messy sheets :P

Oh yeah, inco pads are a given for things like art lines (or catheters). But sometimes you make a mess doing something simple like a venflon. I usually always help to clean up (depending on how much mess I made) unless I'm in call with a million other jobs to do.

What's GGHM?

Just for future reference (and relating to this thread) if you think you made a mess when doing a procedure do you inform anyone or write it in the notes? This sounds like an SJT question but I just wanted to know what you would do in reality.

Thanks

First bloods after being signed off as competent. Think needle went through the vein but took samples as normal. Thought the area looked swollen when I put the plaster on but panicked - told patient to apply pressure and that was it. I'm a worrier and now am feeling really anxious that I did the wrong thing - read that I should have taken the tourniquet off immediately, elevated the arm etc. Think I'm getting to get chased up or a report made against me for this huge haematoma I likely caused.
Really feel like I'm not cut out to be a doctor - even when things go well I worry that I did something wrong. Now that I feel I made a mistake I feel sick to my stomach.
Has this happened to anyone else? What did you do? I'm sure we never got taught about how to deal with this though it does sound common sense.

I find it quite hard to stabilise the needle while putting vacutainers on/off - that is how I think I went through the vein in the first place. Any tips or is it just practice?

This is true in all fairness. If you're gonna mess up doing bloods, it's probably during this part because the needle can fly all over the shop when you're trying to remove the vacutainer.

I hold the plastic vacutainer needle cover with one hand, making sure to rest my hand against the patient and use the other to remove the bottle. Make sure you apply counter traction with the cover (i.e. with your free hand holding the bottle, push the vacutainer cover away with your index and thumb right at the top of the bottle while overall pulling the bottle, if that makes sense).

Also removing the bottle with a twisting back and forth motion helps it come off with less of a sudden jerk.

But yeah stabilising against the patient is most helpful.