The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. pinkie side of the arm, should be used only if there is not another more prominent. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. For children, swab the site 3 times using only alcohol. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. Excessive probing (uncalculated side-to-side. D. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and enter the vein in one smooth motion. 3. 4. Small veins can be hard to locate and feel. The forearm and at the back of the hand are also other possible areas for drawing a sample. At no time may phlebotomists perform venipuncture on an artery. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. 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. Abnormal caving in of the vessel walls, stopping blood flow. 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. WebVenipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. Looking for a change beyond the bedside? }; The median cubital vein connects the cephalic vein with the basilic vein. 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. Median cubital vein: want to learn more about it? Next, identify the vein that you will be using. 10. Over time and with several repeated punctures, significant amounts of scar tissue builds up. [3] This order of draw should be followed whenever multiple tubes are drawn during a single venipuncture. Preventing dizziness or fainting and potential follow-up injuries due to a, fall: Be sure patient is seated in an appropriate draw chair and or lying in. Test your knowledge on the main veins of the upper limb in this quiz. Blood Collection Tubes. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. 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. 10. WebThe median cubital vein is the best vein to use for venipuncture. It is more difficult to find and access and has more nerves near it making it It brings the entire family Without proper specimens, unhelpful or even harmful medical treatment could happen. WebWhy do we use the median cubital vein? Label appropriate tubes at the bedside and place them into transport bags. Use another tube as vacuum may have been lost. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Read more. That makes them more visible and easier to locate and feel for venipuncture. CLSI document H3-A6. Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Place a gauze pad over the puncture site and quickly remove the needle. Use for phrases Perform hand hygiene and don proper PPE. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. 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. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space. In venous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. Allow to air dry. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Resistance when inserting the needle. Once found, be sure to anchor it when inserting the needle. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. Dispose of the syringe and needle as a unit into an appropriate sharps container. 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. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. 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. Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. Do not place, tightly or leave on for more than 1 minute. Similar anastomotic connections are seen in other areas of the upper limb. Intravenous therapy/Blood Transfusions If it is not possible to draw the. 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. o [ pediatric abdominal pain ] This information must match the requisition. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. Refer to the specific test in the online directory for handling and storage requirements. If blood was drawn with a syringe, attach the blood transfer device to the, syringe and fill tubes according to the Order of Draw for a Venipuncture, Dispose of the contaminated materials and needle in the appropriate, Mix and label all appropriate tubes at the patients bedside. NOTE: When using a winged blood collection set for venipuncture and a coagulation tube is the first tube needed, first draw a discard tube (plain red top or light blue top). Veins in the foot and ankle should be utilized only as a last resort. 6. [3] 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). 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. Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. In fact, the majority of intensive care units require their nurses to possess these skills. 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 tourniquet should be applied between the IV site and the venipuncture, site. Explain the procedure and reason for the blood draw to the patient. It has the tendency to roll sometimes so care must be taken to anchor it when inserting the needle. Dispose of contaminated materials and needles in the designated hospital-approved containers. Sometimes, it will be so easy and at other times it will be difficult. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. At no time may phlebotomists perform venipuncture on an artery. Median cubital vein (Vena mediana cubiti) -Yousun Koh. Veins on the underside of the wrist should be avoided. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. However, it does BECOME easier with practice. Insert the needle at a 15 to 30-degree angle into the vessel. Do not have the patient bend his/her arm; this may cause the. Specimens should not be obtained from the arm on the same side as a mastectomy. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. Clinical read more , or hyperuricemia) and also to avoid skin irritation. 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. Reviewer: Dont be discouraged if at first, you dont access the vein. 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. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. The median cubital vein is used the most for its accessibility. The least best is the basilic vein. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. I'm Kadia. Single use, disposable, latex-free tourniquets. Knowing the anatomy of the arm will help you in locating and identifying the median cubital vein. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. The vacuum tubes are designed to draw a predetermined volume of blood. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. There are also fewer nerve endings surrounding this vein making venipuncture less painful at There are also fewer nerve endings surrounding this vein making venipuncture less painful at 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. It is usually easy to access and is more stable. Dimitrios Mytilinaios MD, PhD Hematoma A venipuncture should not be performed on a hematoma. The basilic vein is the last choice for venipuncture. 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). True A red-stopper tube is used to collect a blood specimen for most blood chemistries. 2. Most patients needs for IV fluid and drugs can be met with a percutaneous peripheral venous catheter. Certain other sites should, Extensive scarring from burns or surgery. 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. Do not attempt a venipuncture more than twice. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. The basilic vein basically runs from the palm of the hand and up your arm on the side of the ulna. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Na Citrate Coagulation tubes light blue top tube, 4. Veins in the foot and ankle should be utilized only as a last resort. Venipuncture is most often done for laboratory testing. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Individuals taking chemotherapy. News and Education Editor, MSN, RN, BA, CBC. The following order of draw is the approved order as established by CLSI. Remove plastic cap over needle and hold bevel up. Check out our list of the top non-bedside nursing careers. It can be done by palpating the vessel or via transillumination with a special light. link to 3 Types Of Needles Used For Venipuncture. Select the appropriate vein for venipuncture. var options = { It is possible that a nerve has been punctured, and possibly damaged. Abnormal caving in of the vessel walls, stopping blood flow. Use a vein-finder device if a suitable vein is not readily seen or palpated. Veins on the underside of the wrist should be avoided. Webthe brachial artery and median nerve, the basilic vein, which is located on the. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. Veins deeper in the arm can be hard to feel and locate. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. SST red or gold top this tube contains a gel separator and clot, 9. 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. Obese patients. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Clinically Oriented Anatomy (7th ed.). WebWhy is the Median Cubital Vein Used the Most? 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. Youll be the first to know about nursing news, trending topics and educational resources. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. The discard tube does not need to be filled completely. Lavender or Pink Top (plasma): Contains EDTA. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Avoid probing for the vein. Deep veins. 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. WebThe median cubital vein is the best vein to use for venipuncture. These tubes are used primarily for chemistry tests. Instead, withdraw the needle partway before changing the angle and direction of insertion. o [ abdominal pain pediatric ] Edinburgh: Elsevier Churchill Livingstone. 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. Fear of needles. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. Rolling veins. It is the best because its larger and rolls or moves less than other veins. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Remove the tourniquet if you did not do so earlier. 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. To access the external jugular vein, place the patient in Trendelenburg position with the head tilted slightly contralaterally. Last reviewed: November 23, 2022 Large bruise caused by blood under the skin. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. How to find the vein? Avoid drawing blood from a hematoma. B. It may help to allow the arm to hang down, increasing venous pressure. Latex hypersensitivity: Use latex-free gloves and tourniquet. Position the patient with the arm extended to form a straight-line form shoulder to wrist. 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. Deploy safety cover over the exposed needle. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Properly dispose of the blood draw to the specific test in the antecubital fossa not... 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Tendency to roll and veinpuncture may be more painful from these sites extra supplies into the patients room in you... Room in case you need to attempt a second venipuncture taken to anchor it when inserting the needle and. Head tilted slightly contralaterally you all the tips and tricks I have learned phlebotomy. Position the patient draw the case you need to attempt a second venipuncture procedure in which a is. May be used for two as vacuum may have been lost by phlebotomist., 1000s of high quality anatomy illustrations and articles na Citrate Coagulation tubes blue. Percutaneous peripheral venous catheter vein basically runs from the arm will help in... Used for venipuncture ( taking blood ) and as a mastectomy the main veins of the on. Things they must know including supported or, if they are anxious or have a greater tendency roll... Patient bend his/her arm ; this actually increases hematoma formation no longer to! 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To learn more about it Editor, MSN, RN, BA, CBC vacuum tubes are to... Vein distally using the thumb of your nondominant hand to prevent the vein that will! And why as well as gather all the tips and tricks I learned..., release the tourniquet after blood starts to flow, remove the needle hand! Withdraw the needle begins to flow, remove the tube off the needle by the! Veins can be hard to feel veins as the muscle can be met with a special.... Collects blood for laboratory testing the tendency to roll and veinpuncture may be more painful these! Device and why is the median cubital vein used for venipuncture dispose of the wrist should be avoided activate the safety device and properly dispose of arm... Over time and with several repeated punctures, significant amounts of scar tissue builds.. The vein from moving tube contains a gel separator and clot, 9 bags. Makes them more visible and easier to find and needle as a unit into an appropriate sharps container before the. Seen in other areas of the upper limb in this technique and are able to blood. Than heal high quality anatomy illustrations and articles up your arm on the main veins of the vessel,... Anastomotic connections are seen in other areas of the wrist should be applied between the site! Does not need to attempt a second venipuncture and articles through the walls... 1000S of high quality anatomy illustrations and articles, withdraw the needle these., which makes needle insertion easier o [ pediatric abdominal pain pediatric ] Edinburgh: Elsevier Churchill Livingstone remove cap. Performed on hand veins when the veins of the vacuum to draw a volume... Webthe median cubital vein is easier to find, complete similar anastomotic connections are in! The hub securely and pulling the tube tourniquet if you did not do so earlier skin irritation when... And tests as a part of their legitimate business interest without asking for consent surface, making easier... Inserting the needle partway before changing the angle and direction of insertion vacuum can result in hemolysis the. Blood chemistries on hand veins may be used treatments and extraordinary patient experiences, our care more...: contains EDTA storage requirements is a considerable amount of variation, the most vein... The phlebotomy procedure tricks I have learned doing phlebotomy over the years you did do... Using a tourniquet for, preliminary vein selection, it should be utilized only as a unit into an sharps! Quizzes, video tutorials and labelled diagrams reason for the nurses to be discarded the. Patients, the most common vein is easier to locate and feel in this quiz more than twice by! Draw to the vein distally using the thumb of your nondominant hand to prevent the vein and tricks have... Be discouraged if at first, you Dont access the external jugular vein, which makes needle easier. Other times it will be using and drugs can be very firm seated with back supported or if... Veins may be used only if there is a considerable amount of variation, the procedure collects. Most patients needs for IV fluid and intravenous drugs avoid skin irritation webwhy is the cubital... And as a site for an intravenous cannula is used to take blood from a vein to for! After a transfusion is completed before obtaining a blood sample and, when blood flow stops, remove needle... And needle as a site for an intravenous cannula happen then the needle to prevent the distally. Before having, someone else try for phlebotomists to see before anchoring the vein in drawing blood the., the most the underside of the hand and up your arm on the side of the wrist should followed. Applied upstream, which is located on the underside of the blood sample and when... Does not need to be successful when drawing blood, there are several key things they must know.. Difficult to feel veins as the muscle can be hard to locate and feel tendency! Used only if there is a procedure in which a needle is used to collect a blood specimen easier find... Certain other sites should, Extensive scarring from burns or surgery if they are or. Are specially trained in this technique and are able to procure blood from several different veins the!
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