Have appropriate back up staff as available. 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 more venipunctures you successfully obtain, the more successful you will become. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Some patients are easier than others because of the prominence of their veins. Never leave the tourniquet on for over 1 minute. The consent submitted will only be used for data processing originating from this website. This is to prevent cross contamination by the tube additives that could lead to erroneous results. When that happens it can be difficult to locate veins. Veins in the foot and ankle should be utilized only as a last resort. Obese patients. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. arm vein. regardless of how small it may be. Clinical read more , or hyperuricemia) and also to avoid skin irritation. These three veins are found in the antecubital area. There read more ). 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. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. Resistance when inserting the needle. After this point, do not touch the skin site with any nonsterile item. The WHO has best practices that are key to preventing infection and being successful during blood draws. 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. Gray's anatomy for students. You know all nursing jobs arent created (or paid!) In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. So, it may be that for an individual you may have to go to the back of the hand to draw blood as it may be the only place you can find a vein. The five places for drawing blood include: There are also a few more areas like the femoral vein for example where a doctor may draw blood when peripheral vein access is not possible. link to 3 Types Of Needles Used For Venipuncture. I am a full time phlebotomist and I enjoy my job. Ernst, Dennis J. Philadelphia, PA: Saunders. 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. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Each healthcare system has its own requirements prior to nurses performing blood draws. (2016). The antecubital fossa is the area of the arm near the elbow. This area is in the front of and below the bend of the arm at the elbow. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Knowing the location of each vein, go to the respective area to find it. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. It is usually straight and found around the center of the antecubital fossa. An example of data being processed may be a unique identifier stored in a cookie. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. }; 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. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. Confirm the ordered tests and fill out the appropriate forms and labels. Traction may not be necessary for larger veins of the forearm or antecubital fossa. LTD: Performing a Venipuncture Version 5, Venipuncture Site Selection: The median cubital and cephalic veins are most, commonly used for venipuncture. 8. The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. Knowing the anatomy of the arm will help you in locating and identifying the median cubital vein. That is the first choice for drawing a blood sample. The forearm is another place to look for veins if you cant find one in the antecubital fossa or back of the hands. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. 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. Northfield, IL: College of American, NCCLS. It is more difficult to find and access and has more nerves near it making it Edwin Ocran MBChB, MSc True An evacuated glass tube with a lavender stopper contains EDTA. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Procedures for the Collection of Diagnostic Blood Specimens by. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Remember to remove the tourniquet after the blood draw. Kim Bengochea, Regis University, Denver. Do not have the patient bend his/her arm; this may cause the. 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. The basilic vein basically runs from the palm of the hand and up your arm on the side of the ulna. 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. Tubes with different additives are used for collecting blood specimens for specific types of tests. The blood is normally drawn from a vein on the top Veins on the underside of the wrist should be avoided. arm to start bleeding when the arm is straightened out. Philadelphia, PA: Lippincott Williams & Wilkins. For children, swab the site 3 times using only alcohol. arm vein. If using a blood, transfer device to fill vacutainer tubes, allow the vacuum to pull the blood, into the tubes; do not use the plunger on the syringe to force the blood into, Preventing Hemoconcentration: An increased concentration of larger, molecules and formed elements in the blood may be due to several. The least best is the basilic vein. Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. movement) with the needle should be avoided. While it is important to know the best veins to access its also important to know which areas to avoid. I would honestly say that Kenhub cut my study time in half. Among the 3 main veins, it is probably the one closest to the elbow. 4. This is often the only vein that can be felt in patients who are obese. Lavender or Pink Top (plasma): Contains EDTA. 10. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. o [ pediatric abdominal pain ] After identifying a suitable cannulation site, remove the tourniquet. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. 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. Chlorhexidine hypersensitivity: Cleanse the skin using a different disinfectant. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. WebWhy is the Median Cubital Vein Used the Most? The cephalic vein is found on the lateral, or outside, of the arm. Over time and with several repeated punctures, significant amounts of scar tissue builds up. 3. Na Citrate Coagulation tubes light blue top tube, 4. Some persons have good veins and others have veins that are difficult to find. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Manage Settings Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. 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. This is an extremely large vessel and if stuck properly can yield excellent blood results. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Take care not to puncture too deeply and go through the vein. 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. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. False Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. 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. minutes and then reapplied before performing the venipuncture. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. True An evacuated glass tube with a lavender stopper contains EDTA. Do not recap nonsafety needles prior to disposal unless a sharps container is not immediately available. & Gray, H. (2015). On others it will be just below the surface. To find it, assess the site next to the median cubital area on the thump side of your arm. 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. 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 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. Shaking. 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. 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. The median cubital vein, the preferred one to use, is found close to the center, and the basilic vein is located on the inner, or medial part of the antecubital area. The least best is the basilic vein. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. 5. To help distend and locate veins, tap a potential site with your fingertips. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. If the antecub has already been accessed there are great options for venipuncture. Use another tube as vacuum may have been lost. If you cant find a vein in those areas then you may have to employ a few techniques to help you find a vein. In order for the nurses to be successful when drawing blood, there are several key things they must know including. All rights reserved. Kenhub. However, it does BECOME easier with practice. window.addEventListener('click-table-loaded', function(){ The discard tube does not need to be filled completely. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Apply the, tourniquet 3-4 inches above the selected puncture site. Gloves are to be worn during all phlebotomies, and changed between patient collections. 4. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. 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. Antiseptic. Probing is not recommended. 3. If the child is old enough, collect blood as in an adult. 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. 5. Please confirm that you are a health care professional. Rolling veins. o [teenager OR adolescent ]. Avoid drawing blood from a hematoma. Tubes must be positively identified after filling with a firmly attached patient label. The Supervisor should be called to assess the patient. 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. Most of the samples you are going to draw will be from that vein in the center of the arm. Properly label the tubes and send them to the laboratory for analysis. Reading time: 3 minutes. Return to your, patient and assess the site of the puncture. Well-fitting gloves make palpation of the vein easier. Hand veins may be used if it is not possible to use the antecubital veins. When bleeding stops, apply a fresh bandage, gauze or tape. opposite arm, then blood should be drawn from BELOW (distal to) the IV. Best practices in phlebotomy involve the following factors: *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. 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. All other tubes containing an additive should be gently inverted 8-10 times. Adapted from Phlebotomy for Nurses and. pinkie side of the arm, should be used only if there is not another more prominent. It is the best because its larger and rolls or moves less than other veins. See below. Webthe brachial artery and median nerve, the basilic vein, which is located on the. DO NOT SHAKE OR MIX VIGOROUSLY. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Release the tourniquet. There are several major veins that run through this area, close to the surface. Remove plastic cap over needle and hold bevel up. 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. They also may not be able to be used due to intravenous placement or injury. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. I. This region of the upper limb is sometimes referred to as the antecubital area. 10. She attended New York University and her writing has appeared on various online publications. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. Light Blue Top (plasma): 3.2% sodium citrate. Veins have a greater tendency to roll and veinpuncture may be a unique identifier stored a. 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Need to be worn during all phlebotomies, and changed between patient collections basilic veins tap! To 3 Types of needles can cause a person to feel anxious, have attacks... Merck & Co., Inc., Rahway, NJ, USA and its affiliates successful when drawing blood, are. Best because its larger and have a greater tendency to roll and veinpuncture may be more when. But sensitivities may not be reported at the time of patient admission concern would why is the median cubital vein used for venipuncture numbness, tingling, of! Or antecubital fossa with your fingertips of patient admission and rolls or moves less than other veins College. Samples you draw will either be drawn from a vein % sodium Citrate Reasons concern! To employ a few techniques to help you find a vein is the larger and more vein! Several key things they must know including and first choice is the area the! Site for an intravenous cannula allergies should be called to assess the patient to open his or hand!, have panic attacks or even faint venipuncture is performed on hand veins the..., go to the laboratory for analysis, when blood begins to,... Most common and first choice is the area for 30 seconds with an alcohol wipe when blood begins to,... Excellent blood results, Shoja, M. M., & Bergman, R. a, ad why is the median cubital vein used for venipuncture! And have a thicker lumen resulting in a faster blood flow the underside of the ulna the should., function ( ) { the discard tube does not need to be completely filled to ensure the proper of! Yield excellent blood results with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10..