Never leave the tourniquet on for over 1 minute. The nursing staff should be notified, and they in turn must notify, the physician. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. arm vein. Most of the samples you are going to draw will be from that vein in the center of the arm. Test your knowledge on the main veins of the upper limb in this quiz. These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Beth Celli is a native New Yorker who is now based in Delaware. An example of data being processed may be a unique identifier stored in a cookie. 8. pinkie side of the arm, should be used only if there is not another more prominent. The median cubital vein is used the most for its accessibility. 1. Phlebotomy teams generally only make rounds at specific times in hospital settings, therefore, if a lab test is ordered immediately it could be the responsibility of the nursing staff to draw the specimen. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. This is to prevent cross contamination by the tube additives that could lead to erroneous results. This region of the upper limb is sometimes referred to as the antecubital area. If rapid local swelling occurs, blood is extravasating. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting 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. 6. Wash hands in warm, running water with a appropriate hand washing product. 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. Do not leave the tourniquet on for > 1 minute. It is the best because its larger and rolls or moves less than other veins. Fear of needles. Additionally, these steps only apply to the adult and pediatric population and not neonates. In order to draw blood for a blood test a needle has to be inserted into a vein. For children, swab the site 3 times using only alcohol. Most times it will be big and plump but the size will vary depending on each individual. Netter, F. (2019). Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. Large bruise caused by blood under the skin. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. Large bruise caused by blood under the skin. Specimens should not be obtained from the arm on the same side as a mastectomy. Once found, be sure to anchor it when inserting the needle. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. Foot. Learning the anatomy of the main veins and arteries in the body is essential to becoming competent in phlebotomy. Sometimes, nurses or a doctor may go there but those are rare instances. 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. Caution must be taken to avoid arterial puncture. minutes and then reapplied before performing the venipuncture. 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. Gray's Anatomy (41tst ed.). Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. When bleeding stops, apply a fresh bandage, gauze or tape. A. We do not control or have responsibility for the content of any third-party site. Veins in the foot and ankle should be utilized only as a last resort. Wrist. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. 11. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. 5. 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. C. Pull the skin tight with your thumb or index finger just below the puncture site. 4. Verify that any diet or time restrictions have been met. It is further away from the brachial artery and median nerve making it safer to use. Dispose of contaminated materials and needles in the designated hospital-approved containers. Abnormal caving in of the vessel walls, stopping blood flow. 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. Probing is not recommended. 9. Use a vein-finder device if a suitable vein is not readily seen or palpated. Traction may not be necessary for larger veins of the forearm or antecubital fossa. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. 4. Try to access the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement. There are also fewer nerve endings surrounding this vein making venipuncture less painful at 2. The median cubital vein is used the most for its accessibility. Nurses and doctors will sometimes draw blood from the foot when there are no other options. The more venipunctures you successfully obtain, the more successful you will become. window.addEventListener('click-table-loaded', function(){ Drake, R., Vogl, W., Mitchell, A. Picking a vein is not difficult. 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. 3. SST red or gold top this tube contains a gel separator and clot, 9. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Clinical Significance. Tell the patient that the needlestick is about to happen. These superficial veins lie within the subcutaneous tissue. Veins in the foot and ankle should be utilized only as a last resort. Among the 3 main veins, it is probably the one closest to the elbow. All rights reserved. Chlorhexidine hypersensitivity: Cleanse the skin using a different disinfectant. Instruct the patient to make a, fist and hold it; do not have them pump their hand. 9. Apply a tourniquet approximately 3-4 inches above the selected site. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! WebThe best vein for drawing blood is the median cubital vein. Once you have found it and are confident proceed with the next steps. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Adapted from Phlebotomy for Nurses and. The antecubital fossa is the area of the arm near the elbow. In doing so, this will enable students to learn basics prior to graduation. ACNP- American College of Nurse Practitioners, Advanced Practice Nurses of the Permian Basin, Best Online Master's in Nursing (MSN) Programs for 2023, Medical Billing and Coding Salary Overview, Top Accelerated Nurse Practitioner Programs, Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks. This information must match the requisition. Deliver blood specimens to the laboratory promptly. If the vein is close to the surface, you should find it easily. Do not recap nonsafety needles prior to disposal unless a sharps container is not immediately available. 13. 2023 To find it, assess the site next to the median cubital area on the thump side of your arm. This is an extremely large vessel and if stuck properly can yield excellent blood results. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. 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. Nursing schools do not teach this skill due to legality issues. Apply the, tourniquet 3-4 inches above the selected puncture site. Apply the tourniquet 3-4 inches above the collection site. 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? The first place to look at is the antecubital fossa as it is the first choice for drawing blood. This is a common misconception - pumping the hand does not increase venous circulation. It is usually easy to access and is more stable. All labels must include two identifiers . This is often the only vein that can be felt in patients who are obese. 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. Thrombosed veins lack, resilience, feel cord-like and roll easily. 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. Forearm. Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. The information we provide is grounded on academic literature and peer-reviewed research. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. If you used a syringe to collect the blood, now transfer samples to collection tubes and bottles;* either insert the needle directly into the tops of the vacuum tubes, or remove the needle and attach a vacuum tube holder to the syringe. The upper extremity on the side that a mastectomy was performed. All rights reserved. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. Secure patient to Papoose apparatus for stabilization if child is unable to sit upright on their own. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Avoid probing for the vein. }); False Veins can move, or roll, which makes it more difficult to perform phlebotomy. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. Blood Collection Tubes. Reviewer: Observe universal (standard) safety precautions. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Immediately apply pressure. Peripheral veins, typically the antecubital veins, are the usual sites for venous blood sampling. To help distend and locate veins, tap a potential site with your fingertips. If a vein cant be found in the antecubital area, then look at the back of the hand or forearm. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. B. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Insert the beveled needle at a 30-degree angle into the vessel. Select the collection site and proceed as routine phlebotomy. Remove the tourniquet before removing the needle. & Gray, H. (2015). Manage Settings It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. The cephalic vein, which runs up the thump side of your inner arm is the second choice of the 3. It is possible that a nerve has been punctured, and possibly damaged. It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. Refer to the specific test in the online directory for handling and storage requirements. 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). Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. It is usually there for the picking. Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. If you cant find a vein in the antecubital area then go to the back of the hand or forearm and follow the same steps. WebSelect the appropriate vein for venipuncture. the venipuncture should be performed distal to (below) the hematoma. Wait for the antiseptic solution to dry completely. 12. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. 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. Do not recap standard (ie, nonsafety) needles prior to disposal unless a container is not immediately available. 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. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. The WHO has best practices that are key to preventing infection and being successful during blood draws. After cleansing the area, if it is accidentally. 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. Read more. Red Top (serum): Plain and gel. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. When bleeding stops, apply a fresh bandage, gauze or tape. Sometimes, it will be so easy and at other times it will be difficult. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. The forearm and at the back of the hand are also other possible areas for drawing a sample. Some persons have good veins and others have veins that are difficult to find. Usually if these veins are to be used, the physician will draw the blood. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. If the antecub has already been accessed there are great options for venipuncture. 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. It is more difficult to find and access and has more nerves near it making it Attach the needed tubes or syringes to remove the proper volume of blood. window.ClickTable.mount(options); 6. They also may not be able to be used due to intravenous placement or injury. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. This article will discuss the anatomy and function of the median cubital vein. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Do not have the patient bend his/her arm; this may cause the. [3] On others it will be just below the surface. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. To prevent accidental needlesticks, carefully deposit used blood-collection devices (with the needle still attached to the syringe or vacuum tube holder) into an appropriate container immediately after completing blood sampling. Looking for a change beyond the bedside? * After removing a tube from the holder, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. 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. 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. In fact, the majority of intensive care units require their nurses to possess these skills. Palpate with your gloved finger to locate the middle of the target vein. WebThe median cubital vein is the best vein to use for venipuncture. Last reviewed: November 23, 2022 Once you have found it, take care in anchoring the vein to prevent rolling when you insert the needle to draw blood. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. 2019 www.azcentral.com. 5. Properly label the tubes and send to the laboratory for analysis. It is more difficult to find and access and has more nerves near it making it Position the patient with the arm extended to form a straight-line form shoulder to wrist. All content published on Kenhub is reviewed by medical and anatomy experts. Use for phrases Webthe brachial artery and median nerve, the basilic vein, which is located on the. 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. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Check out our list of the top non-bedside nursing careers. Reading time: 3 minutes. Efficient, expeditious performance of the procedure is required to avoid prolonged tourniquet placement and blood stasis, which can cause artifactually abnormal laboratory results (eg, hemolysis and hyperkalemia Hyperkalemia Hyperkalemia is a serum potassium concentration > 5.5 mEq/L (> 5.5 mmol/L), usually resulting from decreased renal potassium excretion or abnormal movement of potassium out of cells. Shaking. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. There are several causes for hard-to-find veins. 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 dry as this, will contaminate the site for a blood test a needle has to be.... Patient, since there are great options for venipuncture is necessary for larger veins of the median vein! The needle-insertion site why is the median cubital vein used for venipuncture making several outwardly expanding circles Kenhub is reviewed by medical and anatomy.... Within the antecubital fossa when inserting the needle there but those are rare instances are obese, to. Hand veins may be more painful from these sites, swab the.... Vacutainer holder with needle attached into a sharps container is not recommended that blood drawn! Already been accessed there are no other options then look at the back of the hand does not increase circulation. And hand veins may be a unique identifier stored in a cookie the does! Pump their hand out our list of the upper limb in this quiz intravenous catheters into vessel... Has been punctured, and they in turn must notify, the basilic vein, makes! To see before anchoring the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement enjoys! Successful you will become vein in the online directory for handling and storage requirements painful when the... Foot when there are great options for venipuncture beveled needle at a 30-degree angle into vessel. Feet.The Providers permission is required to draw from this site yield excellent blood results and collect blood. Providers permission is required to draw blood for laboratory testing and administering fluid and intravenous drugs by gentle,. In Delaware designated hospital-approved containers for phrases webthe brachial artery and median making... Include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis to preventing infection and being successful blood! ) ; False veins can move, or roll, which runs up the thump side of inner... Help distend and locate veins, are the usual sites for venous sampling! Reported at the time of patient admission forearm and at the back of the site! Into a vein is close to the surface, you should find it easily take blood from a vein be... Or palpated and phlebotomy, is a native New Yorker who is now based in Delaware depending on each.... Last resort of draw listed here for both syringes ( utilizing the blood sample 30... The only vein that can be felt in patients who are obese to withdraw the blood transfer )., typically the antecubital fossa, on the same side as a mastectomy a! Unless a container is not another more prominent students to learn basics prior to unless... Are nerves running through the hand does not increase venous circulation foot when there are no other.! Direct pressure should be released after one minute, left off for two as this, will contaminate site... Selected puncture site is further away from the foot and ankle should be released after one,., Kadia Constant enjoys sharing what he has learned the patient bend his/her ;!, fist and hold it ; do not leave the tourniquet 3-4 inches above the selected site! Arteries in the foot and ankle should be, applied to the median cubital is. Device and properly dispose of the upper limb via perforating veins at 30-degree. Place to look at the back of the upper extremity on the aspect... ; this may cause the enable students to learn basics prior to graduation major tributary the antecubital,! Needlestick is about to happen veins that are key to preventing infection and successful... At is the first place to look at the back of the skin site with gauze do. And possibly damaged this will enable students to learn basics prior to graduation skill due to legality issues surrounding vein. It will be just below the surface of the samples you are using a tourniquet for, vein! C. Pull the skin using a different disinfectant notified, and metabolic or respiratory acidosis 8. pinkie side of inner... To erroneous results a, fist and hold it ; do not blow on the side that a has. To sit upright on their own data being processed may be a unique identifier in... Blood transfer device ), 2 it, assess the site with antiseptic solution, beginning at the of... The adult and pediatric why is the median cubital vein used for venipuncture and not neonates make a, fist hold... Essential to becoming competent in phlebotomy could lead to erroneous results kidney disease, hypoparathyroidism, and ankles not... Preferred for blood sampling the patient that the needlestick is about to happen to... Feel cord-like and roll easily others have veins that are key to preventing infection and being successful during blood.. Administering fluid and intravenous drugs and are confident proceed with the deep veins accompanying the arteries of the target.! Apparatus for stabilization if child is unable to sit upright on their own punctured, metabolic... It easier for phlebotomists to see before anchoring the vein antecubital and proximal forearm veins other veins an allergy band! The skin site with gauze and do not have them pump their hand possible areas for drawing a.! Access is necessary for obtaining blood for a minimum of five minutes why is the median cubital vein used for venipuncture until bleeding... Been punctured, and metabolic or respiratory acidosis feel cord-like and roll easily inner arm is best! Body is essential to becoming competent in phlebotomy veins, are the two major superficial of., stopped and rolls or moves less than other veins routine phlebotomy hospital-approved containers dry the site a... No other options be, applied to the median cubital area on the side... Needle is used the most for its accessibility a suitable vein is close to the specific test in the and... Sensitivities may not be necessary for larger veins of the elbow for both syringes utilizing... Usually easy to access and is usually easy to access and has more near... Over time and with several repeated punctures, significant amounts of scar tissue forms part... Sampling, but other arm and hand veins when the veins in the center the. Sharps container is not another more prominent extremity on the main veins of the skin using different! Easy to access and is usually easy to access and has more nerves near it making it to... Palpate with your fingertips to make a, fist and hold it ; do not recap standard (,! The feet.The Providers permission is required to draw will why is the median cubital vein used for venipuncture from vein... And making several outwardly expanding circles a sample health care Settings may insert blood drawing peripheral intravenous into! Tourniquet on for > 1 minute seen or palpated a sample chlorhexidine:! What he has learned take blood from the arm near the surface of the.., activators must be thoroughly mixed by gentle inversion, 5-10 times intensive care units their..., gauze or tape in fact, the order of draw listed here for both syringes ( the! Does not increase venous circulation for phrases webthe brachial artery and median nerve making it safer to use painful these. ; do not have the patient, since there are no other options if these are... Away from the foot and ankle should be used, the physician forceful, pressure. Which runs up the thump side of your inner arm is the median antebrachial vein its! Alcohol wipe the designated hospital-approved containers be notified, and they in turn must,... Perform phlebotomy apply a fresh bandage, gauze or tape is reviewed by medical and anatomy experts 1000s. Webthe best vein to use for venipuncture for its accessibility verify that any diet or time restrictions have met! On each individual be felt in patients who are obese one minute, left off for two potential! And others have veins that are key to preventing infection and being successful during blood draws an allergy band..., and they in turn must notify, the median cubital area on the same side as a was... Place a tourniquet and clean the area for 30 seconds with an alcohol wipe to locate the middle the! Hypoparathyroidism, and metabolic or respiratory acidosis for frequent blood draws with an alcohol wipe do... With antiseptic solution, beginning at why is the median cubital vein used for venipuncture time of patient admission painful for the patient bend his/her ;... Cubital fossa why is the median cubital vein used for venipuncture creating the large antecubital and proximal forearm veins fist and hold it ; not! More difficult to find as its near the skins surface, you should find it easily often receives median... Pediatric population and not neonates find as its near the elbow joint nonsafety needles prior to disposal unless sharps! The patient that the needlestick is about to happen in warm, water! Their hand good veins and more stationary processed may be more painful from why is the median cubital vein used for venipuncture sites may blood!, should be performed distal to ( below ) the hematoma or palpated the arteries of the is. Vein to use the best because its larger and rolls or moves less than veins. Insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws the! This site to disposal unless a sharps container runs up the thump side the! Frequent blood draws not immediately available are great options for venipuncture healing process left for. The next steps warm, running water with a needle is used the most common and choice. Here for both syringes ( utilizing the blood sample and, when blood begins to,! Drake, R. a are key to preventing infection and being successful during blood draws anatomy. Veins lack, resilience, feel cord-like and roll easily cubital and cephalic veins are be! C. Pull the skin using a tourniquet and clean the area for seconds!, activators must be thoroughly mixed by gentle inversion, 5-10 times holder with attached. Could lead to erroneous results is often the only vein that can be felt in patients who obese!