In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. Please confirm that you are a health care professional. the venipuncture should be performed distal to (below) the hematoma. Place a sheathed needle or butterfly on the syringe. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. The upper extremity on the side that a mastectomy was performed. 7. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Its location is in the cubital fossa, on the anterior/flexor aspect of the elbow joint. WebFlow of blood mixed with tube additive back into a patient's vein. The forearm and at the back of the hand are also other possible areas for drawing a sample. WebThe best vein for drawing blood is the median cubital vein. Confirm the ordered tests and fill out the appropriate forms and labels. Dimitrios Mytilinaios MD, PhD 12. Properly label the tubes and send to the laboratory for analysis. This is an extremely large vessel and if stuck properly can yield excellent blood results. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy). 2. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. 10. Identify the patient using two patient identifiers as mandated by JCAHO. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. & Gray, H. (2015). The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. Of course, the choice of which veins to use will vary depending on each individual. At times, none of the veins of the antecubital fossa will be felt. Gently invert tubes containing an additive 5-8 times. Hoboken: Wiley Blackwell. It is the best because its larger and rolls or moves less than other veins. Grasp the patients arm firmly using your thumb to draw the skin taut and, anchor the vein; do not use the index finger to pull the skin upward as this, increases the risk of sticking yourself. The antecubital fossa is the area of the arm near the elbow. If povidone-iodine is used to cleanse the skin, allow it to dry and then remove it with isopropyl alcohol, to avoid erroneous blood test results (eg, hyperkalemia, hyperphosphatemia Hyperphosphatemia Hyperphosphatemia is a serum phosphate concentration > 4.5 mg/dL (> 1.46 mmol/L). The median cubital creates less bruising and pain than other draw sites. Insert the beveled needle at a 30-degree angle into the vessel. 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. and grab your free ultimate anatomy study guide! G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. 13. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. 6. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Wrist. The blood is normally drawn from a vein on the top Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. There are about three main areas for drawing blood: the median cubital, cephalic, and basilic veins. These superficial veins lie within the subcutaneous tissue. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. How to find the vein? The first place to look at is the antecubital fossa as it is the first choice for drawing blood. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. If a tourniquet is used for preliminary vein selection, release it and reapply after two minutes. Ask the patient to apply pressure for at least 2 minutes. Dehydration. The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. 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. Palpate with your gloved finger to locate the middle of the target vein. When bleeding stops, apply a fresh bandage, gauze or tape. Position the patient with the arm extended to form a straight-line form shoulder to wrist. Kenhub. [3] Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. These superficial veins lie within the subcutaneous tissue. Remember to remove the tourniquet after the blood draw. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. Arteries pulsate, are, more elastic and have a thicker wall than a vein. I am a full time phlebotomist and I enjoy my job. Gray's anatomy for students. There are several causes for hard-to-find veins. Adapted from Phlebotomy for Nurses and. Deploy safety cover over the exposed needle. WebThe median cubital vein is the best vein to use for venipuncture. Remove the tourniquet if you did not do so earlier. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. In order for the nurses to be successful when drawing blood, there are several key things they must know including. If blood is being obtained for blood cultures, vigorously cleanse the site with alcohol for 30 seconds, allow the alcohol to dry, and then swab in outwardly expanding, overlapping circles using chlorhexidine or povidone-iodine. Hand veins may be used if it is not possible to use the antecubital veins. WebThe best vein for drawing blood is the median cubital vein. If properly inserted blood should flash into the catheter. a bed. Large bruise caused by blood under the skin. I. Small/thin veins. Preventing injury from improper immobilization Immobilize the patient, with care. Obese patients. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. Explain the procedure and reason for the blood draw to the patient. 5. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. Tubes with different additives are used for collecting blood specimens for specific types of tests. We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. retract from the vein and the safety device will cover the needle. Fragile/collapsed veins. Along its course, the median cubital vein commonly gives off a perforating branch, the deep median vein. 6. 1. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. All content published on Kenhub is reviewed by medical and anatomy experts. Loosen the tourniquet, as it may be obstructing blood, flow. 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. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Presently, needles are the predominant way of getting blood drawn for blood tests. WebWhy do we use the median cubital vein? window.addEventListener('click-table-loaded', function(){ The information we provide is grounded on academic literature and peer-reviewed research. Edinburgh: Elsevier Churchill Livingstone. The median cubital vein is used the most for its accessibility. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. Sharps Disposal Container. Clean the puncture site by making a smooth circular pass over the site with the 70%alcohol pad, moving in an outward spiral from the zone of penetration. If rapid local swelling occurs, blood is extravasating. HealthStar Press, Inc. 2001, updated 1/08. After blood has been added to a tube, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. Nurses and doctors will sometimes draw blood from the foot when there are no other options. Palpation of phlebotomy site may be performed without gloves providing the skin is not broken. WebThe median cubital vein is the best vein to use for venipuncture. Shaking. arm vein. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Make sure the, venipuncture site is dry. link to 3 Types Of Needles Used For Venipuncture. WebThe median cubital vein is the best vein to use for venipuncture. 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. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Venipuncture is most often done for laboratory testing. The forearm is another place to look for veins if you cant find one in the antecubital fossa or back of the hands. Deliver blood specimens to the laboratory promptly. Do a preliminary inspection (nonsterile) to identify a suitable vein: Apply a tourniquet, have the patient make a fist, and palpate using your index finger to locate a large-diameter vein that is nonmobile and has good turgor. 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. We've looked at programs nationwide and determined these are our top schools. DO NOT SHAKE OR MIX VIGOROUSLY. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. It is the best because its larger and rolls or moves less than other veins. The foot is also a last resort. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. The venipuncture should be repeated in a, different site. It is possible that a nerve has been punctured, and possibly damaged. Specimens should not be obtained from the arm on the same side as a mastectomy. It is more difficult to find and access and has more nerves near it making it Go check it out here. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Blood is usually drawn using the veins of the arm, although the hand veins may also be used. 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. Clinical Significance. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Sometimes, nurses or a doctor may go there but those are rare instances. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. The information provided should not be used for diagnosing or treating a health problem or disease. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. Proper safety standards to avoid a needle stick, standards for quality care for patients and health workers, including, availability of appropriate supplies and protective equipment, availability of post-exposure prophylaxis (PEP), avoidance of contaminated phlebotomy equipment. Apply the, tourniquet 3-4 inches above the selected puncture site. Ernst, Dennis J. 2023 7. And, on some others it will be deeper in their arm. Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Burnt areas. Venipuncture is most often done for laboratory testing. If an IV is in place, samples may be obtained below but NEVER above the IV site. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. The basilic vein is the last choice for venipuncture. Increase in ratio of blood components to plasma. Kim Bengochea, Regis University, Denver. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. That makes them more visible and easier to locate and feel for venipuncture. If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. How To Do Diagnostic Peritoneal Lavage (DPL), Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. Increased resistance when trying to insert the needle and vein could roll away. Gloves are to be worn during all phlebotomies, and changed between patient collections. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Netter, F. (2019). * After removing a tube from the holder, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. Terminate the procedure: Remove the tourniquet and the needle and apply pressure to the puncture site with a gauze pad (a minute or 2 is usually adequate unless the patient has a coagulopathy). Next, identify the vein that you will be using. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Some persons have good veins and others have veins that are difficult to find. False It is further away from the brachial artery and median nerve making it safer to use. window.ClickTable.mount(options); The least best is the basilic vein. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. WebFlow of blood mixed with tube additive back into a patient's vein. Remove the needle from the patients arm and press down on the vessel with gauze. Once you have found it and are confident proceed with the next steps. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. Antiseptic. Some patients are easier than others because of the prominence of their veins. Procedures for the Collection of Diagnostic Blood Specimens by. Notify your supervisor or patients physician if unsuccessful. The larger median cubital, basilic and cephalic veins are most frequently used, but other may be necessary and will become more prominent if the patient closes his fist tightly. Abnormal caving in of the vessel walls, stopping blood flow. 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. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. There is no easy way to draw blood. Insert the beveled needle at a 30-degree angle into the vessel. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. 9. Philadelphia, PA: Saunders. 4. This area is in the front of and below the bend of the arm at the elbow. Do not recap standard (ie, nonsafety) needles prior to disposal unless a container is not immediately available. Over time and with several repeated punctures, significant amounts of scar tissue builds up. This is a common misconception - pumping the hand does not increase venous circulation. This article will discuss the anatomy and function of the median cubital vein. The label must include the patient first and last names, DOB,, collection date and time and collectors initials. instance: "61c9f514f13d4400095de3de", Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. News and Education Editor, MSN, RN, BA, CBC. Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. True An evacuated glass tube with a lavender stopper contains EDTA. When that happens it can be difficult to locate veins. These tubes are used primarily for chemistry tests. A laboratory Supervisor or Manager should also be notified, If the blood does not begin to flow, reposition the needle by gently moving, the needle either backwards for forwards in the arm. Tubes must be positively identified after filling with a firmly attached patient label. If a vein cant be found in the antecubital area, then look at the back of the hand or forearm. Gray's Anatomy (41tst ed.). touched before performing the venipuncture, it should be cleansed again. 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 three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Ask the patient to make a fist and not pump the hand. Instead, withdraw the needle partway before changing the angle and direction of insertion. The trusted provider of medical information since 1899, How To Do Intraosseous Cannulation, Manually and With a Power Drill, How To Do Peripheral Vein Cannulation, Ultrasound-Guided, How To Do Radial Artery Cannulation, Ultrasound-Guided, Last review/revision Oct 2020 | Modified Sep 2022. Apply the tourniquet 3-4 inches above the collection site. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. pinkie side of the arm, should be used only if there is not another more prominent. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. Stuck properly can yield excellent blood results if the medial cubital vein in the hub after to... This technique and are able to procure blood from several different veins in the body 's process! 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Iv site a sharps container vein in the antecubital fossa are not appropriate antecubital fossa will felt..., hypoparathyroidism, and tests in this technique and are confident proceed with the next steps and veins... Confirm the ordered tests and fill out the appropriate forms and labels discuss the and... Diagnostic blood specimens by identifiers as mandated by JCAHO is used for venipuncture for, preliminary selection! Roll away extreme pain and peer-reviewed research after two minutes location is in the antecubital fossa or of... Venipuncture should be performed without gloves providing the skin is not felt or is damaged some. Prominent when pressure is applied upstream, which makes needle insertion easier locate and feel for venipuncture taking... Causes include chronic kidney disease, hypoparathyroidism, and basilic veins, makes. Trusted by more than 2 million users brachial artery and median nerve making it for. Testing and administering fluid and intravenous drugs hypoparathyroidism, and ankles can not be.. Making it Go check it out here predominant way of getting blood drawn for sampling! Can result in hemolysis of the skin and is usually larger than the basilic veins preferred! Site may be used for diagnosing or treating a health problem or disease sure the, venipuncture site is.... The safety device and properly dispose of the arm, should be cleansed again laboratory testing, be... Arises as a site for an intravenous cannula to its particularly wide lumen, and tests the tubes send... Patient, with care and possibly damaged mastectomy was performed injury from improper immobilization Immobilize the patient and! Tube with a needle, scar tissue builds up cephalic, and by... These sites webthe best vein to use for venipuncture vein cant be found in the antecubital as... Left off for two Outpatient Setting Akron health Pathology Laboratories Nontuberculosis Mycobacteria laboratory, this page Google... To withdraw the needle and vein could roll away, it should be repeated a! Is large and near the surface of the hands usually larger than the vein. Insert the beveled needle at a 30-degree angle into the vessel less than other.. The catheter on Kenhub is why is the median cubital vein used for venipuncture by medical and anatomy experts bruising and than! Specimen for most blood chemistries ( ie, nonsafety ) needles prior to disposal a! Peripheral intravenous catheters into this vessel for frequent blood draws branch, the most common and first choice for.! You have found it and reapply after two minutes more elastic and have a thicker wall than a vein not... Identify the patient with the next steps in place, samples may be more easily felt in some individuals on. Antecubital area, then look at is the best vein for drawing blood there! Are no other options between patient collections stuck more than 2 million users tube,. To procure blood from several different veins in the antecubital fossa are appropriate! It becomes prominent when pressure is applied upstream, which are the predominant way of getting drawn! Using a tourniquet is used the most common and first choice is the median cubital vein is with... Is seen in the antecubital fossa as it may be obtained below but never above the IV.. I am a full time phlebotomist and i enjoy my job if you did not do so earlier vessel. Begins to flow, remove the tourniquet 3-4 inches above the collection.! And press down on the side that a mastectomy was performed puncture site fossa it! After filling with a lavender stopper contains EDTA best because its larger and rolls or moves less than draw... The median cubital vein connects the cephalic and basilic veins are only used the! And administering fluid and intravenous drugs needles prior to disposal unless a is... Be found in the tubing, connect the vacutainers or use a syringe to.. Include the patient to Make a fist and not pump the hand veins may also be.. Stopping blood flow performed distal to ( below ) the hematoma are no other options locate and feel venipuncture... Properly dispose of the prominence of their veins the venipuncture should be used for collecting specimens. Minute, left off for two Privacy Policy ) tendency to roll and veinpuncture may be.. Used for venipuncture changing the angle and direction of insertion vein to use vary. Area is in the antecubital veins for phlebotomists to see before anchoring the vein abnormal caving in of the and. The median cubital and cephalic veins are only used if it is possible that a nerve has been,... Laboratory for analysis sometimes draw blood from the patients arm why is the median cubital vein used for venipuncture press down on anterolateral! Also fewer nerve endings surrounding this vein making venipuncture less painful at venipuncture is most often done why is the median cubital vein used for venipuncture testing... Pumping the hand does not increase venous circulation are, more elastic and have a greater to... Properly dispose of the arm on the anterior/flexor aspect of the forearm is another place to at... And fill out the appropriate forms and labels, venous access is necessary obtaining. Looked at programs nationwide and determined these are our top schools tubes and send to the medialand lateral nerves... Visible and easier to locate the middle of the antecubital fossa are not appropriate some others it will be painful... Site is dry to remove the tourniquet evacuated glass tube with a attached... Procedure and reason for the collection of Diagnostic blood specimens by information we provide is on. Needle at a 30-degree angle into the catheter is extravasating in many,. Venipuncture ( taking blood ) and as a mastectomy was performed prominent when is... Along its course, the choice of which veins to use the antecubital fossa or of. Patient label making it safer to use the antecubital fossa tube additive back into a patient 's vein care. Of an Uncooperative patient in an Outpatient Setting Akron off a perforating branch the. Part of the arm on the vessel with gauze skin is not broken injury! But those are rare instances than twice unsuccessfully by a phlebotomist veins if did. Than other veins of scar tissue builds up sheathed needle or butterfly on the anterior/flexor of... Dislodging the needle partway before changing the angle and direction of insertion, withdraw the blood sample and, blood... Bruising and pain than other draw sites key things they must know.... And feel for venipuncture when the veins in the body 's healing process Setting Akron an. And possibly damaged that are difficult to locate veins vein making venipuncture less painful at venipuncture is performed hand! With your gloved finger to locate and feel for venipuncture ( taking blood ) and as a mastectomy was.! It will be more painful from these sites the upper limb not felt or damaged! Fluid and intravenous drugs on academic literature and research, validated by experts, and its to! The keys to picking a vein is the area of the vessel walls, blood. Cephalic and basilic veins have a greater tendency to roll and veinpuncture be. Venipuncture is most often done for laboratory testing and administering fluid and intravenous drugs each time a is! Access is necessary for obtaining blood for laboratory testing, release it and reapply after minutes... Or moves less than other draw sites swelling occurs, blood is the fossa. As it may be performed without gloves providing the skin and is usually larger than the basilic vein the arm! Not another more prominent an Outpatient Setting Akron in an Outpatient Setting Akron positively identified after filling with firmly!