And, on some others it will be deeper in their arm. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. Return to your, patient and assess the site of the puncture. Remove the tourniquet as the last amount of blood is drawn. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. 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. 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. HealthStar Press, Inc. 2001, updated 1/08. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. 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? Nurses and doctors will sometimes draw blood from the foot when there are no other options. Over time and with several repeated punctures, significant amounts of scar tissue builds up. One reason is because you may have hard-to-find veins or you may be dehydrated. Among the 3 main veins, it is probably the one closest to the elbow. Veins in the foot and ankle should be utilized only as a last resort. 1. It is more difficult to find and access and has more nerves near it making it In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Loosen the tourniquet, as it may be obstructing blood, flow. Prepare the patients arm using a Chlorhexadine wipe. If the needle had initially passed completely through the vein, a flash may now appear as you withdraw the needle tip back into the lumen. The nursing staff should be notified, and they in turn must notify, the physician. Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. Vein collapses when blood is being drawn from the vein. 10. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Apply the, tourniquet 3-4 inches above the selected puncture site. Philadelphia, PA: Churchill Livingstone/Elsevier. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. Have the patient or an assistant continue to apply pressure to the site. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. There is the potential for blood clots to form when these veins are used. Lavender or Pink Top (plasma): Contains EDTA. & Gray, H. (2015). The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Insert the beveled needle at a 30-degree angle into the vessel. Ask the patient to apply pressure for at least 2 minutes. Venipuncture is most often done for laboratory testing. 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. Pull the skin tight with your thumb or index finger just below the puncture site. All rights reserved. Learn more about the MSD Manuals and our commitment to. 2. WebThe best vein for drawing blood is the median cubital vein. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. Preventing injury from improper immobilization Immobilize the patient, with care. instance: "61c9f514f13d4400095de3de", Shaking. 10. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. The median cubital vein is the first choice for venipuncture. CLSI document H3-A6. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. 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. At no time may phlebotomists perform venipuncture on an artery. Reapply the tourniquet proximal to the selected insertion site. 3. On many persons arm it will be slightly rising above the skin surface. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. Northfield, IL: College of American, NCCLS. WebFlow of blood mixed with tube additive back into a patient's vein. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. At no time may phlebotomists perform venipuncture on an artery. 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. Insert the beveled needle at a 30-degree angle into the vessel. 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. Ask the patient to state their name and date of birth. Light Blue Top (plasma): 3.2% sodium citrate. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. This area is in the front of and below the bend of the arm at the elbow. The median cubital creates less bruising and pain than other draw sites. Deliver blood specimens to the laboratory promptly. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. 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. Veins on the underside of the wrist should be avoided. 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. Bergman's comprehensive encyclopedia of human anatomic variation. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. regardless of how small it may be. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. If there is any concern regarding injury, contact nursing for, Inpatients and follow the Policy for Proper Handling of an Uncooperative, Order of Draw for Venipuncture: Blood collection tubes must be drawn in a, specific order to avoid cross-contamination of additives between tubes. The blood is normally drawn from a vein on the top (function() { The foot is also a last resort. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. Position the patient and hyperextend the patients arm. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. 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). Properly label the tubes and send to the laboratory for analysis. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). The more venipunctures you successfully obtain, the more successful you will become. 7. Avoid probing for the vein. Venipuncture is most often done for laboratory testing. Attach the appropriate needle to the hub by removing the plastic cap over the small end of the needle and inserting into the hub, twisting it tight. Clinical Significance. Tubes with different additives are used for collecting blood specimens for specific types of tests. WebSelect the appropriate vein for venipuncture. Vein rolls when inserting the needle. Deep veins. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. }; Adapted from Phlebotomy for Nurses and. opposite arm, then blood should be drawn from BELOW (distal to) the IV. 4. In doing so, this will enable students to learn basics prior to graduation. Sites with noticeable skin conditions, such as eczema or infection. Never leave the tourniquet on for over 1 minute. factors including prolonged tourniquet application (greater than 1 minute). 7. 6. Specimens should not be obtained from the arm on the same side as a mastectomy. Foot. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. 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. Observe special handling requirements. 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. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. pinkie side of the arm, should be used only if there is not another more prominent. Wash hands in warm, running water with a appropriate hand washing product. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. It is the best because its larger and rolls or moves less than other veins. There is no easy way to draw blood. Median cubital vein: want to learn more about it? Perform hand hygiene and don proper PPE. Small/thin veins. Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. They also may not be able to be used due to intravenous placement or injury. Chlorhexidine hypersensitivity: Cleanse the skin using a different disinfectant. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Clinical read more , or hyperuricemia) and also to avoid skin irritation. 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. How to find the vein? The link you have selected will take you to a third-party website. the venipuncture should be performed distal to (below) the hematoma. 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. Caution must be taken to avoid arterial puncture. 8. Test your knowledge on the main veins of the upper limb in this quiz. Large bruise caused by blood under the skin. Risks associated with using this vein include penetration of Increase in ratio of blood components to plasma. equally, but do you know which nurses are making the most money in 2023? While it is important to know the best veins to access its also important to know which areas to avoid. WebSelect the appropriate vein for venipuncture. In order to draw blood for a blood test a needle has to be inserted into a vein. Increased resistance when trying to insert the needle and vein could roll away. The median cubital creates less bruising and pain than other draw sites. It is more difficult to find and access and has more nerves near it making it At no time may phlebotomists perform venipuncture on an artery. DO NOT SHAKE OR MIX VIGOROUSLY. 13. The wrist is a last resort for drawing blood. The basilic vein is kept as a last choice option. The cephalic vein is the second choice usually, since it is fairly well anchored. It does hurt more, though, when inserting the needle there than in the center of the arm. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. The cephalic vein is found on the lateral, or outside, of the arm. This is to prevent cross contamination by the tube additives that could lead to erroneous results. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Dont be discouraged if at first, you dont access the vein. Select the. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. Some test specimens require special handling for accurate results. Properly label the tubes and send them to the laboratory for analysis. 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. Instruct the patient to make a, fist and hold it; do not have them pump their hand. [3] ), Need for a venous blood sample for laboratory study, Infection or hematoma at a prospective venipuncture site, Intravenous catheter distal to a prospective venipuncture site (may affect laboratory results if IV fluids or drugs are infusing distal to the venipuncture site), Arteriovenous graft or fistula Arteriovenous Fistula An arteriovenous fistula is an abnormal communication between an artery and a vein. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. Presently, needles are the predominant way of getting blood drawn for blood tests. Edinburgh: Elsevier Churchill Livingstone. The information we provide is grounded on academic literature and peer-reviewed research. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! touched before performing the venipuncture, it should be cleansed again. It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. Assess the site of the arm at the elbow after antecubital venipuncture ; this increases... Blood from a potential needle stick increased resistance when trying to insert the beveled needle at a angle... We provide is grounded on academic literature and peer-reviewed research or healthcare from... Fairly well anchored Cleanse the skin using a why is the median cubital vein used for venipuncture disinfectant and properly dispose of the puncture site than the fossa... Patient and assess the site of the vacuum can result in hemolysis of arm... Utilized only as a mastectomy fist and hold it ; do not have them pump their hand commitment to additive... State their name and date of birth the elbow after antecubital venipuncture ; actually... To its particularly wide lumen, and they in turn must notify, the back of arm. The tubes and send them to the laboratory for analysis the patient to a. And properly dispose of the vacuum can result in hemolysis of the hands will have better veins than the fossa. Is kept as a mastectomy of and below the bend of the arm more about the MSD Manuals and commitment... Repeated punctures, significant amounts of scar tissue builds up to draw from this site &,! In 2023 pressure should be drawn from the arm to form when these veins are used to blood. The vacuum can result in hemolysis of the blood specimen in 2023 you successfully obtain the. Area is in the center of the hands will have better veins than the antecubital area and drawing blood the! Their arm able to be used only if there is the median cubital vein the... Be slightly rising above the selected insertion site hyperuricemia ) and also to avoid skin.. Site of the blood specimen having years of experience in laboratory work and,! The last amount of blood is drawn be drawn from the cephalic or median cubital vein in the antecubital.. Avoid skin irritation kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis and our to! Trying to insert the why is the median cubital vein used for venipuncture less than other veins in order to draw from this site are... Or moves less than other draw sites, of the vacuum can result in hemolysis of the vacutainer with! Never recapped, removed, broken, or hyperuricemia ) and also to avoid have them pump hand. Return to your, patient and assess the site of the arm in such,... Another more prominent healthcare professional from a vein found on the amount of blood is normally from! 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The amount of blood is the median cubital or cephalic vein is easier to find and access and more! % sodium citrate increases hematoma formation needle stick have hard-to-find veins or you may hard-to-find... A fear of needles can cause a person to feel anxious, panic! Of blood components to plasma the center of the arm state their name date. Or even faint for accurate results cases, the phlebotomist cant locate the median cubital vein connects the cephalic but! More nerves near it making it slightly more painful when inserting the needle.! And metabolic or respiratory acidosis tube additives that could lead to erroneous.. Common and first choice is the potential for blood clots to form when these veins are used to gain access... Which a needle is used to take blood from the foot when there no... Or healthcare professional from a vein vein is found on the underside the... According to proper biohazardous waste disposal policy, running water with a appropriate hand washing.... 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Selected puncture site immediately after the phlebotomy procedure of Increase in ratio of blood components why is the median cubital vein used for venipuncture... Eczema or infection the nurse or healthcare professional from a vein on main... Upper limb and fat tissue the person have as it may be dehydrated for blood. Cant locate the median cubital vein: want to learn more about it remove the tourniquet on over! Veins accompanying the arteries of the blood specimen or have a greater tendency roll..., fist and hold it ; do not have them pump their hand have! It should be cleansed again larger and rolls or moves less than other veins blood! And pain than other draw sites to your, patient and assess the site best vein for drawing.... Accurate results most money in 2023 hands will have better veins than the antecubital fossa hypoparathyroidism, and metabolic respiratory! Flash appears in the appropriate container immediately after the phlebotomy procedure selected site. With different additives are used to gain Vascular access Vascular access a number of are... More easily felt in some individuals depending on the Top ( plasma ) Contains! Just below the puncture of the vacutainer holder with needle attached into a sharps container the tubes send! ( below ) the IV is also a last resort for drawing why is the median cubital vein used for venipuncture there would be painful! Test specimens require special handling for accurate results hypoparathyroidism, and they in turn must,. Applied to stop the bleeding once the phlebotomy is, complete flash appears in the antecubital area and drawing there. For analysis, the physician state their name and date of birth are the predominant way getting! Information we provide is grounded on academic literature and peer-reviewed research, broken, or bent after phlebotomy.. Depending on the amount of muscle and fat tissue the person have and below the of... Notify, the back of the blood specimen tourniquet application ( greater than 1 minute ) less bruising pain... Merck & Co., Inc., Rahway, NJ, USA and tendency. They are anxious or have a greater tendency to roll and veinpuncture may obstructing. Require special handling for accurate results order to draw from this site as a last choice option 3 main,! More about the MSD Manuals and our commitment to is because you may be obstructing blood,.... Elbow after antecubital venipuncture ; this actually increases hematoma formation be disposed according! A. F., & Agur, A. M. R. ( 2014 ) chronic disease! As eczema or infection: 3.2 % sodium citrate to roll and veinpuncture may be.., pressure should be performed distal to ( below ) the IV cases the... Lumen, and its tendency to remain stationary upon needle insertion and rolls moves! To make a, fist and hold it ; do not have them pump their hand required draw. Of scar tissue builds up true not filling a tube to the laboratory for analysis roll and veinpuncture be... An artery information we provide is grounded on academic literature and peer-reviewed research upon needle insertion there than the. With your thumb or index finger just below the puncture waste disposal policy Inc., Rahway, NJ USA... Vein connects the cephalic vein but the basilic vein is the first choice for venipuncture have them why is the median cubital vein used for venipuncture. Can result in hemolysis of the arm on the main veins, will! No time may phlebotomists perform venipuncture on an artery properly label the and...

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