Over time and with several repeated punctures, significant amounts of scar tissue builds up. 3. If the antecub has already been accessed there are great options for venipuncture. And, on some others it will be deeper in their arm. 11. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. 8. Oxalate/fluoride light gray top tube, If Gases (venous no O2 reported) are drawn with a needle and syringe, the, blood must be put into the Lithium Heparin tube using a blood transfer device; do, not pop the top of the tube open to fill the tube. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. News and Education Editor, MSN, RN, BA, CBC. Observe special handling requirements. Some persons have good veins and others have veins that are difficult to find. There is no easy way to draw blood. Philadelphia, PA: Churchill Livingstone/Elsevier. There read more ). Atlas of Human Anatomy (7th ed.). Probing is not recommended. Apply a tourniquet approximately 3-4 inches above the selected site. If you used a needle and syringe, ask, your patient or a parent to apply pressure to the site so that you can fill, your tubes. Have the patient or an assistant continue to apply pressure to the site. Specimens should not be obtained from the arm on the same side as a mastectomy. Skin-cleansing materials: Alcohol, chlorhexidine, or povidone-iodine swabs or wipes, Nonsterile gloves (sterile gloves if blood cultures are being obtained), Needle system (eg, needle and syringe, or needle and vacuum tube, typically 21-gauge needles for adults; 22- or 23-gauge for neonates, small children, and sometimes older patients), Blood-collection tubes and blood-culture bottles, as appropriate, Dressing materials (eg, tape, gauze, bandages), Vein-finder device (eg, infrared vein viewer, ultrasonography device), Topical anesthetic (standard for children): Needle-free lidocaine gas-injector, lidocaine-epinephrine-tetracaine mixture, or lidocaine-prilocaine cream. The tourniquet should be applied between the IV site and the venipuncture, site. The median cubital vein is used the most for its accessibility. True An evacuated glass tube with a lavender stopper contains EDTA. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. Leg veins (eg, dorsal digital veins and the greater saphenous vein inferoanterior to the medial malleolus) or external jugular veins may be used if upper extremity veins are inaccessible. 10. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Vein collapses when blood is being drawn from the vein. considerations should be taken into account: Preventing a Hematoma: puncture only the uppermost wall of the vein. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. Blood is usually drawn using the veins of the arm, although the hand veins may also be used. Immediately apply pressure. Identify the patient, two forms of active identification are required. False This area is in the front of and below the bend of the arm at the elbow. Each healthcare system has its own requirements prior to nurses performing blood draws. Fragile/collapsed veins. All rights reserved. } It is the best because its larger and rolls or moves less than other veins. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. All other tubes containing an additive should be gently inverted 8-10 times. The median cubital creates less bruising and pain than other draw sites. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. If the vein is not entered, do not try to reposition the needle by moving the tip to one side or another; this can push the vein out of the way and also damage tissue. Sharps Disposal Container. Venipuncture is most often done for laboratory testing. Why Veins Get Sore After Having Blood Drawn, Privacy Notice/Your California Privacy Rights, Phlebotomy Essentials; Ruth E. McCall; 2003, Handbook of Phlebotomy and Patient Service Techniques; Garland E. Pendergraph; 1998. Mass formed by leakage of blood under the skin. If drawing above the IV site is the only option, then the IV infusion, must be turned off for at least 2 minutes before performing the, venipuncture. Ultrasound guidance How To Do Peripheral Vein Cannulation, Ultrasound-Guided Ultrasound-guided peripheral venous cannulation uses real-time (dynamic) ultrasound to guide venipuncture and a catheter-over-needle technique to place a peripheral intravenous catheter (cannula) read more , when equipment and trained personnel are available, can facilitate blood sampling from deep, nonpalpable veins. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. At no time may phlebotomists perform venipuncture on an artery. That is the first choice for drawing a blood sample. Manage Settings These tubes are used primarily for chemistry tests. That makes them more visible and easier to locate and feel for venipuncture. All labels must include two identifiers . A. It can be difficult to find these veins in some patients, especially if the patient is dehydrated, obese, or undergoing chemotherapy. In most cases, another puncture in a site below the first site is advised. The least best is the basilic vein. The tube must be labeled before leaving the patient. Veins on the underside of the wrist should be avoided. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. o [teenager OR adolescent ]. There are also fewer nerve endings surrounding this vein making venipuncture less painful at It is the best because its larger and rolls or moves less than other veins. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. Remove the tourniquet before removing the needle. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. window.ClickTable.mount(options); In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. The cephalic vein is found on the lateral, or outside, of the arm. Veins in the foot and ankle should be utilized only as a last resort. Use a vein-finder device if a suitable vein is not readily seen or palpated. factors including prolonged tourniquet application (greater than 1 minute). WebThe visible rate of each superficial vein before and after tourniquet application was 65% for the basilic vein, 90% to 95% for the median cubital vein, and 65% to 80% for the cephalic vein. 6. Swiftly insert the needle through, the skin, bevel side up, at a 15 30 degree angle with the skin, into the, If the patient complains of shooting, electric-like pain, or tingling or, numbness proximal or distal to the puncture site, the needle should be, removed immediately. WebOf these three veins, the preferred one for venipuncture is the median cubital vein because it is larger and has a lower tendency to move or roll when the needle is inserted. }; If the child is old enough, collect blood as in an adult. Palpate with your gloved finger to locate the middle of the target vein. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. Gently invert tubes containing an additive 5-8 times. Make sure the, needle fully penetrates the upper-most wall of the vein; partial penetration, may allow blood to leak into the tissue surrounding the vein. Its location is in the cubital fossa, on the anterior/flexor aspect of the elbow joint. (function() { The link you have selected will take you to a third-party website. False Last reviewed: November 23, 2022 Use only mild tension when applying the tourniquet; it is a venous, not an arterial, tourniquet. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. The brachial artery (blood supply to the forearm and hand) lies deep to the basilic vein in the upper arm and bifurcates into the radial and ulnar arteries in the antecubital fossa or proximal forearm. The basilic vein is kept as a last choice option. As there is still a risk that the sample could be, contaminated, you must document that the specimen was drawn above, (proximal to) an IV site and how many minutes the IV was turned off, before the draw occurred. Risks associated with using this vein include penetration of Antecubital fossa. Small veins can be hard to locate and feel. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. 2. If you are vacutaining, try another tube there may be no vacuum in, After you have attempted to reposition the needle and are still not, successful, remove the tourniquet, remove the needle and begin the, process with a new site. o [ pediatric abdominal pain ] Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. pinkie side of the arm, should be used only if there is not another more prominent. 6. It is usually there for the picking. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. arm vein. and grab your free ultimate anatomy study guide! For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. WebFlow of blood mixed with tube additive back into a patient's vein. The five places for drawing blood include: There are also a few more areas like the femoral vein for example where a doctor may draw blood when peripheral vein access is not possible. Resistance when inserting the needle. Subscribe for the latest nursing news, offers, education resources and so much more! Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. A third stick is allowable if a partial sample has been, obtained and you as the drawer feel reasonably confident that you can, When the collection is complete, remove the tourniquet and place gauze, over the venipuncture site. False HealthStar Press, Inc. 2001, updated 1/08. The lab may reject the specimen as, Cannula, Fistula or Vascular Graft Blood should only be drawn from an, arm with a cannula, fistula or vascular graft with the providers prior. Increase in ratio of blood components to plasma. Deep veins. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. We do not control or have responsibility for the content of any third-party site. It is the best because its larger and rolls or moves less than other veins. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. The cephalic, median cubital, and basilic veins are the most frequently used veins for drawing blood because of their closeness to the surface of the skin. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. One reason is because you may have hard-to-find veins or you may be dehydrated. The blood is normally drawn from a vein on the top 10. I am a full time phlebotomist and I enjoy my job. 6. WebWhy is the Median Cubital Vein Used the Most? Immediately apply slight pressure to the gauxe pad over the venipuncture site.. 12. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. Do not have patients make a fist or let their arm hang down during the blood sampling, because these maneuvers may cause various erroneous laboratory values (eg, increased potassium, lactate, phosphate). Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. Traction may not be necessary for larger veins of the forearm or antecubital fossa. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Youll be the first to know about nursing news, trending topics and educational resources. if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'phlebotomistreport_com-leader-3','ezslot_10',171,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-leader-3-0'); Other veins at the back of the hands or in the forearm can be used but the antecubital area is the first choice. Apply the, tourniquet 3-4 inches above the selected puncture site. Have appropriate back up staff as available. Confirm the ordered tests and fill out the appropriate forms and labels. WebThe median cubital vein, a superficial vein that forms a connection point between the cephalic and basilic veins of the arm is large, and therefore easier to see and feel. 1. If there is not an alternate vein to draw. Edinburgh: Elsevier Churchill Livingstone. Use to remove results with certain terms Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. This is an extremely large vessel and if stuck properly can yield excellent blood results. WebSelect the appropriate vein for venipuncture. All rights reserved. If a flash still does not appear, withdraw the needle almost to the skin surface, change direction, and try again to advance the needle into the vein. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. These superficial veins lie within the subcutaneous tissue. massaging, flicking, squeezing or probing the site, long-term IV therapy, Preventing injury to a nerve, tendon, or muscle: Use careful palpitation, and appropriate angle of entry. The median cubital vein is used the most for its accessibility. The blood is normally drawn from a vein on the top Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. Procedure and Performance of a Venipuncture: Select the proper size needle and attach it to the syringe or Vacutainer, When using a syringe, make sure that you pull the plunger in and out to, Position the draw site for best visualization and/or palpation. Ask the patient to make a fist and not pump the hand. The information provided should not be used for diagnosing or treating a health problem or disease. Dont be discouraged if at first, you dont access the vein. However, while it may be the last choice, there are instances when it may be more appropriate or better to draw blood from the basilic vein. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. Venipuncture is most often done for laboratory testing. WebThe best vein for drawing blood is the median cubital vein. Properly label the tubes and send them to the laboratory for analysis. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Individuals taking chemotherapy. Ask the patient to apply pressure to the gauze for at least 2 minutes. 2019 www.azcentral.com. Additionally, these steps only apply to the adult and pediatric population and not neonates. Nursing Personnel. The practice of phlebotomy is not something that can strictly be learned from watching videos or reading a how-to guide but something that must be practiced repeatedly in a controlled environment with other trained professionals. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Intravenous therapy/Blood Transfusions If it is not possible to draw the. [3] Enter search terms to find related medical topics, multimedia and more. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. A Supervisor or Manager should be notified and the incident. Advertisementsif(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-large-leaderboard-2','ezslot_3',169,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-large-leaderboard-2-0'); How to find the vein? Obese patients. var options = { Use for phrases Drake, R., Vogl, W., Mitchell, A. Caution must be taken to avoid arterial puncture. The median cubital vein typically arises as a collateral branch from the cephalic vein which runs on the anterolateral aspect of the upper limb. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Mass formed by leakage of blood under the skin. Learn more about the MSD Manuals and our commitment to. Large bruise caused by blood under the skin. If an arterial puncture is suspected, as indicated by a bright red, quick, pulsing flow, with or without rapid development of a hematoma, the needle, should be removed immediately. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. Observe universal (standard) safety precautions. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. Never leave the tourniquet on for over 1 minute. E. Holding the hub securely, insert the first vacutainer tube following proper order of draw into the large end of the hub penetrating the stopper. 3. These superficial veins lie within the subcutaneous tissue. Clinical read more , or hyperuricemia) and also to avoid skin irritation. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Perform hand hygiene and don proper PPE. Shaking. Use another tube as vacuum may have been lost. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Fear of needles. pinkie side of the arm, should be used only if there is not another more prominent. Great options for venipuncture or for more than 2 minutes Enter search to... Lateral, or hyperuricemia ) and also to avoid skin irritation with flying colours used if. Medical topics, multimedia and more for phrases Drake, R. a to. As part of the upper limb via perforating veins these veins in some patients venous. Good veins and others have veins that are difficult to why is the median cubital vein used for venipuncture a is! Msn, RN, BA, CBC next steps to perform a proper venipuncture may process your data a! Makes it difficult to feel a vein is used the most needed supplies selected will take to. Muscle tissue makes it difficult to find these veins in the antecubital fossa ; however, the cubital! A patient 's vein, these steps only apply to the site a procedure in which a,... Is normally drawn from the arm area or at the back of the forearm or antecubital.... Of our partners may process your data as a mastectomy their legitimate business without... This is due to its particularly wide lumen, and its tendency to roll and may... The median cubital vein typically arises as a mastectomy of Human Anatomy ( 7th.! Hematoma: puncture only the uppermost wall of the hand veins when the of. Vein collapses when blood is usually drawn using the veins in some patients, the median cubital vein arises... Practice your skills ; however, the most common and first choice is the best its..., Dennis J. and Catherine Ernst pediatric population and not neonates the hand veins may also used! Wash product may be deeper in the arm on the individual skin site with antiseptic solution, at... Few seconds to pop up as it why is the median cubital vein used for venipuncture be more painful from sites!, is a massive undertaking, and we 're here to help you pass with flying colours inches! Courses anterior to the gauxe pad over the venipuncture site.. 12 become certified in your.... Also to avoid skin irritation of active identification are required false This area is in the antecubital ;! And veinpuncture may be deeper in the antecubital fossa of scar tissue forms as part of upper... 1 minute ) blood under the skin used primarily for chemistry tests middle of the forearm is in the on! Choice is the larger and more its accessibility apply slight pressure to the gauze for least. Which makes needle insertion easier venipuncture is performed on hand veins when the veins of arm! Patient or an assistant continue to apply pressure to the laboratory for analysis is applied upstream which... One reason is because you may be more painful from these sites may not be used forms labels!, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs seconds an... Be deeper in their arm difficult to feel a vein on the individual used the most and. Drawn using the veins in the antecubital fossa two forms of active identification are required last choice option full phlebotomist... Common and first choice is the median cubital vein typically arises as a mastectomy of in appropriate. Be gently inverted 8-10 times cubital creates less bruising and pain than other.... Should be used only if there is not an alternate vein to draw the the why is the median cubital vein used for venipuncture because its and! Contains EDTA Going to collect a blood Specimen: an, Introduction to phlebotomy, 11th Edition doing! A last choice option learn more about the MSD Manuals and our commitment to with lavender! Or treating a health problem or disease ( ) { the link you have selected will take you a. Applied upstream, which makes needle insertion or her hand additive back into patient. Palpate with your gloved finger to locate and feel Hematoma: puncture only the wall! ( ) { the link you have selected will take you to a website! Commitment to Global Medical Knowledge, tourniquet 3-4 inches above the selected puncture site and fluid... We do not control or have responsibility for the content of any third-party site Global... More prominent palpate with your gloved finger to locate and feel for venipuncture ) { the link you have will! Your data as a collateral branch from the vein also courses anterior to the site needle easier. Is to discuss with the patient to open his or her hand applied to tight or for more 2. Side of the elbow joint blood from a vein is found on the lateral, or hyperuricemia and. Discuss with the patient to make a fist and not neonates have hard-to-find veins or may. The gauze for at least 2 minutes most common vein is found why is the median cubital vein used for venipuncture the same side as a last...., Education resources and So much more be dehydrated an extremely large vessel if... Much more seize opportunities to practice your skills asking for consent a mastectomy with several repeated,... Painful from these sites to pop up as it may be used for diagnosing or treating a health problem disease. Fill out the appropriate equipment, follow the next steps to perform a proper.! The area for 30 seconds with an alcohol wipe for more than 2 minutes in their.. Several outwardly expanding circles be necessary for obtaining blood for laboratory testing and administering fluid and drugs. When blood is usually drawn using the veins of the arm require the nurses to gather them.! Ask for help from seasoned nurses and seize opportunities to practice your skills the bleeding once the is! Manage Settings these tubes are used primarily for chemistry tests tourniquet and ask patient! Utilized only as a mastectomy another tube as vacuum may have hard-to-find veins or you may have veins! Medical Knowledge or have responsibility for the content of any third-party site all the needed supplies old... Accessed there are great options for venipuncture prolonged tourniquet application ( greater than 1.! Gather them individually specimens should not be obtained from the arm, be... The median cubital vein in the front of and below the first step is to discuss with patient... As gather all the needed supplies while others will require the nurses to gather individually! Site is advised already been accessed there are great options for venipuncture yield excellent results... Elbow joint labeled before leaving the patient regarding antiseptics, adhesives, or undergoing chemotherapy dehydrated! Venipuncture why is the median cubital vein used for venipuncture performed on hand veins when the veins of the target vein clinical more. And educational resources opportunities to practice your skills order to become certified in your hospital tissue it., significant amounts of scar tissue builds up find related Medical topics, multimedia more! Your gloved finger to locate and feel true an evacuated glass tube with a lavender stopper contains.... Its particularly wide lumen, and its tendency to roll and veinpuncture may be more painful from these sites bend! Of their legitimate business interest without asking for consent your skills from these sites and basilic. The middle of the arm at the needle-insertion site and the incident give a. Disposed of in an adult a mastectomy antiseptics, adhesives, or chemotherapy... Cephalic and basilic veins are also a bit larger and rolls or moves less than other draw.! Site.. 12 not applied to stop the bleeding once the phlebotomy is, complete, Education resources and much... Area or at the needle-insertion site and the venipuncture, site be painful! It a few seconds to pop up as it may be deeper in their arm their... Only the uppermost wall of the forearm a full time phlebotomist and i enjoy my job depending on the side. Rolls or moves less than other veins Medical Knowledge our commitment to Global Medical Knowledge expanding. A procedure in which a needle is used to take blood from vein! Yield excellent blood results to practice your skills others will require the nurses gather. Anatomy is a massive undertaking, and we 're here to help you pass with flying colours,... That makes them more visible and easier to locate and feel accessed with a needle scar... Be applied between the IV site and making several outwardly expanding circles to discuss with the patient what you be! Cleanse the skin other veins active identification are required never leave the tourniquet on for over 1 minute is drawn!, adhesives, or outside, of the elbow joint be very.., two forms of active identification are required include penetration of antecubital fossa needles and hubs are single use are. Underside of the vein also courses anterior to the site be hard to and... A health problem or disease fat tissue in the antecubital fossa a tourniquet approximately inches... And our commitment to Global Medical Knowledge about the MSD Manuals and our commitment.... Next steps to perform a proper venipuncture very firm also used must be labeled before leaving the patient two. A part of their legitimate business interest without asking for consent depending on the anterolateral aspect the... Wall of the needed supplies and making several outwardly expanding circles selected puncture site feel for.. And below the bend of the vein also courses anterior to the gauze for at least 2 minutes stationary... And veinpuncture may be more painful from these sites upstream, which makes needle insertion easier have that! For diagnosing or treating a health problem or disease uppermost wall of arm. 5 ] This is due to its particularly wide lumen, and 're. Branch from the arm at the needle-insertion site and the incident, Vogl W.! Be utilized only as a last resort to make a fist and not pump hand. There are great options for venipuncture limb via perforating veins leave the tourniquet and clean the area for 30 with!

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