Site of blood draw for dental patients?

No question... Antecubital Fossa

I have been doing venipunctures for 30 years, since I do IV sedation in my office and I routinely draw blood to use PRP-PRF. In the first 5 years or so, I would have a nurse help me with the difficult ones, and I learned a lot from her. There is a lot to be said for experience, which requires a lot of tries. I feel very confident now that I can access almost any site. One of the really great tools that I discovered about a year ago is the VeinLite. It costs about $300, but it is well worth it. It has allowed me to visualize veins that I might not have been able to find. Outside of a hospital phlebotomy course, I highly recommend a course given by Dr. Jim Rutkowski and Dr. Jim Fennell. Look up Rutkowski Seminars (.com). The course is a great overview on bone grafting using PRF and the use of pharmacology in dental practice. Dr. Rutkowski is an outstanding teacher on this. But a big part of the course is practicing phlebotomy. There is a course being given next in February in Phoenix. Dan Camm

A very worthwhile topic to discuss.......... more than 20 years ago, I was introduced to the value of adding growth factors to enhance bone regeneration via PRP by Dr. Eduardo Anitua of Spain who spoke at an AAID meeting. This technique worked very well, except that the vacutainers that were used to collect the blood contained an anticoagulant that had to be neutralized with thrombin and calcium citrate, which complicated things and added cost and fear that the possibility of mad cow disease could be transmitted if bovine thrombin was being used ( at the time of the epidemic)..........then a few years later, Dr. Joseph Choukroun of Nice France introduced a simpler and safer technique using empty vacutainers with no anticoagulant, where the drawn blood went directly into the centrifuge for about 12 minutes, and the platelet rich fibrin clot was removed and pressed to form a membrane, and the exudate could be used as a wetting agent for the particulate granules......much more simple, no additives were necessary, and the growth factors were there. The problem is that in the area where I practice dentistry, none of the dental schools are progressive enough to have phlebotomy as a required course in the dental education program...... yet, Dr. Choukroun is invited every year to the annual local dental convention ( Les Journees Dentaires) to lecture on the benefits of using PRF and dentists are expected to hire nurses or technicians to come to their offices at precisely the right time to draw blood for their patient, or send the patient to a blood lab or hospital to have it drawn there.... if you are lucky enough to be within an hour of the facility. I personally learned how to draw blood during my post graduate training in Oral Rehabilitation at the Hebrew University School of Dentistry in Israel, however, as mentioned above, finding a suitable vein is not always so easy. At the San Diego AAID annual meeting 2017, I was very happy to meet the people from Veinlite, a company that manufactures and distributes a simple hand held light system made of red and orange LEDs that you place on the patient's arm, and watch the veins jump out at you......by playing with the different colored lights, it can be adjusted to any skin tone, and cut through the various fatty layers to expose the veins. It is a very worthwhile piece of equipment to have in the dental office, and will instill confidence in your patients, by not having to try different sites until you strike a vein.

In staff CRNA's for IV cases or non IV cases done concurrently OR I paid staff memebers to get trained in all my offices for blood draws. Mininmal cost and an added source of revenue for my assistants: Extra Pay for Extra Work

Our triage for order of draw: I. Antecubital fossa II. Dorsum of forearm III. Dorsum of hand IV. Dorsum of foot

I use an angiocath with an extension that way I can use the same site for my IV access, it is much kinder and , less likely to perforate the vein. The best sites are the dorsum of the hand, the radial “ intern’s vein”. If you blow the anticubital vein it affects the distal IV site. So rule of thumb is start most distal. With an angiocath less trauma and better venous access. You can get a lot of blood without concern of clotting. I’ll check out the VeinLite for certain types of patients thanks for the tip.

The issue that was brought up in this post is not about who does it, how it is done. The issue as presented was about where we draw blood in most instances. It looks like the purpose was to asses which area of draw dentists are most comfortable with. Medical doctors, oral surgeons typically delegate that task to nurses. To most dental practitioners in the US drawing blood is rather a fairly new endeavor. If that was untrue dentists would not be inundated with multitudes of various membranes and techniques that ignore the presence of alternatives like PRF. Returning to the original question, what area do we find most comfortable to draw blood from. Obviously we know the triage but we also know that second sticks are not desirable under any circumstances especially by dentist who are not known as doctors who draw blood. In many instances drawing blood from the dorm of the hand is easier but it is also less desirable by the public. The issue of drawing blood is not as simple as it appears and the literature is full of arguments of where and how depending on the patients general health condition. Recently there is an attempt to develop new equipment that would avoid guessing and would not cost 5000 dollars per instrument like the infrared vein finders made by Accuvein.

Experience and training count. A treating doctor needs to be able to perform the procedure, manage complications and understand the technique. “ I think I can” may not be a helpful adage. I gave some great advice take it for what it’s worth. A literature search will not be much help once the tourniquet is on and the patient is expecting treatment. If you perform these services take responsibility.

This is no big deal at all. It is a blood draw!

That is unless it goes south. Always remember when my first implant failure happened and thought " Why am I doing this?" It would have been a whole lot easier to let the perio/oral surg sweat the bullets? But then I would have missed all the fun....