Risks associated with using this vein include penetration of Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. Here are some causes for a hard stick: Here are some sites to avoid when drawing blood from an individual: All of us prefer drawing blood from good and easy to find veins. In order to draw blood for a blood test a needle has to be inserted into a vein. The least best is the basilic vein. Risks associated with using this vein include penetration of Atlas of Human Anatomy (7th ed.). element: document.getElementById("fbct048686f7"), Observe universal (standard) safety precautions. Last reviewed: November 23, 2022 If multiple tubes are needed, follow the proper order of draw. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. The information provided should not be used for diagnosing or treating a health problem or disease. 2. If drawing above the IV site is the only option, then the IV infusion, must be turned off for at least 2 minutes before performing the, venipuncture. Excessive probing (uncalculated side-to-side. * When multiple blood tests are to be done, blood should be allocated to the collection tubes in a proper sequence; first cultures, then tubes with anticoagulant, and then others. The wrist is a last resort for drawing blood. Large bruise caused by blood under the skin. Insert the beveled needle at a 30-degree angle into the vessel. [3] 1. 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. Preventing of infection: Follow proper infection control policies. Specimens should not be obtained from the arm on the same side as a mastectomy. WebWhy do we use the median cubital vein? The median cubital vein is used the most for its accessibility. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Good luck! These superficial veins lie within the subcutaneous tissue. Check out our list of the top non-bedside nursing careers. Deep veins. Manage Settings Large bruise caused by blood under the skin. Edinburgh: Elsevier Churchill Livingstone. It is closer to the brachial artery and median nerve making it more likely that a puncture could lead to an injury of one of those structures. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. Used primarily for hematology and blood bank testing. Tell the patient that the needlestick is about to happen. window.ClickTable.mount(options); The Supervisor should be called to assess the patient. Veins on the underside of the wrist should be avoided. Looking for a change beyond the bedside? The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Over time and with several repeated punctures, significant amounts of scar tissue builds up. WebThe median cubital vein is the best vein to use for venipuncture. 5. Hand veins may be used if it is not possible to use the antecubital veins. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Venipuncture is most often done for laboratory testing. Well-fitting gloves make palpation of the vein easier. True An evacuated glass tube with a lavender stopper contains EDTA. Foot. Next, identify the vein that you will be using. Notify your supervisor or patients physician if unsuccessful. 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. The vacuum tubes are designed to draw a predetermined volume of blood. 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. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. (function() { It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. Increase in ratio of blood components to plasma. 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. The WHO has set forth the following standards of patient care for hospitals to adhere by: They also identify dangerous and unsafe practices for blood draws including, >> Related: Arterial Blood Gases (ABGs) Explained. Loosen the tourniquet, as it may be obstructing blood, flow. Clinically Oriented Anatomy (7th ed.). Nurses and doctors will sometimes draw blood from the foot when there are no other options. 3. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. That makes them more visible and easier to locate and feel for venipuncture. Reading time: 3 minutes. Release the tourniquet. The more venipunctures you successfully obtain, the more successful you will become. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. Small veins can be hard to locate and feel. 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. If blind percutaneous placement read more . [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Read more. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. 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. Tubes must be positively identified after filling with a firmly attached patient label. All labels must include two identifiers . Clinical Significance. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Insert the needle at a 15 to 30-degree angle into the vessel. However, it does BECOME easier with practice. The blood is normally drawn from a vein on the top Properly label the tubes and send to the laboratory for analysis. Gray's Anatomy (41tst ed.). On many persons arm it will be slightly rising above the skin surface. Use to remove results with certain terms Dehydration. Remember to remove the tourniquet after the blood draw. Ask the patient to apply pressure to the gauze for at least 2 minutes. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. At no time may phlebotomists perform venipuncture on an artery. While not commonly taught in nursing school programs, many recommend that nursing students take extra courses in how to take blood to hone this skill. See below. This information must match the requisition. Reviewer: While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. 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. Continue with Recommended Cookies. 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. WebWhy is the Median Cubital Vein Used the Most? equally, but do you know which nurses are making the most money in 2023? They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. 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. Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. Lavender or Pink Top (plasma): Contains EDTA. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. The forearm and at the back of the hand are also other possible areas for drawing a sample. 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. The information we provide is grounded on academic literature and peer-reviewed research. 5. Put on the tourniquet and feel for the vein. Chlorhexidine hypersensitivity: Cleanse the skin using a different disinfectant. Place a gauze pad over the puncture site and quickly remove the needle. At no time may phlebotomists perform venipuncture on an artery. Apply a tourniquet approximately 3-4 inches above the selected site. This vein penetrates the fascial roof of the cubital fossa to anastomose with a brachial vein, forming a connection between the superficial and deep venous systems of the upper limb. Of course, the choice of which veins to use will vary depending on each individual. Ask the patient to state their name and date of birth. 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. The discard tube does not need to be filled completely. In fact, the majority of intensive care units require their nurses to possess these skills. 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. arm vein. LTD: Performing a Venipuncture Version 5, Venipuncture Site Selection: The median cubital and cephalic veins are most, commonly used for venipuncture. 9. Insert the needle proximally (ie, in the direction of venous blood flow), with the bevel facing up, along the midline of the vein at a shallow angle (about 10 to 30 degrees) to the skin. Thrombosed veins lack, resilience, feel cord-like and roll easily. Copyright Sign up to receive the latest nursing news and exclusive offers. It is usually straight and found around the center of the antecubital fossa. Drawing blood from a patient can be a daunting task but it also is a necessity for nurses. If a tourniquet is used for preliminary vein selection, release it and reapply after two minutes. WebWhy is the Median Cubital Vein Used the Most? Certain other sites should, Extensive scarring from burns or surgery. This is an extremely large vessel and if stuck properly can yield excellent blood results. It may help to allow the arm to hang down, increasing venous pressure. How to find the vein? It is more difficult to find and access and has more nerves near it making it pinkie side of the arm, should be used only if there is not another more prominent. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Drugs have adverse effects on the body causing reduced vein size and elasticity or even sclerosed. opposite arm, then blood should be drawn from BELOW (distal to) the IV. False Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. 11. Prepare the patients arm using a Chlorhexadine wipe. Become a Part of the Nurse.org Community! Because of the nerves surrounding the area drawing blood may be more painful.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-banner-1','ezslot_15',168,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-banner-1-0'); Also, it is sometimes more difficult to find and less stable than the other main veins as it rolls or moves when inserting the needle. 7. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. Do not touch the puncture site after cleaning. If there is not an alternate vein to draw. Veins in the foot and ankle should be utilized only as a last resort. Have appropriate back up staff as available. Ernst, Dennis J. Some patients are easier than others because of the prominence of their veins. Used by chemistry for glucose testing. They also may not be able to be used due to intravenous placement or injury. Knowing the anatomy of the arm will help you in locating and identifying the median cubital vein. All rights reserved. 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. Traction may not be necessary for larger veins of the forearm or antecubital fossa. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. However, we know that is not always the option we are presented with. The venipuncture should be repeated in a, different site. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Tubes with different additives are used for collecting blood specimens for specific types of tests. The least best is the basilic vein. I am a full time phlebotomist and I enjoy my job. The first place to look at is the antecubital fossa as it is the first choice for drawing blood. Wait for the antiseptic effect to occur (1 minute for chlorhexidine or 1.5 to 2 minutes for iodine). There are several causes for hard-to-find veins. arm vein. Over time and with several repeated punctures, significant amounts of scar tissue builds up. To help distend and locate veins, tap a potential site with your fingertips. Dimitrios Mytilinaios MD, PhD To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Without proper specimens, unhelpful or even harmful medical treatment could happen. Veins on the underside of the wrist should be avoided. Wash hands in warm, running water with a appropriate hand washing product. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Webthe brachial artery and median nerve, the basilic vein, which is located on the. 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. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. HealthStar Press, Inc. 2001, updated 1/08. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. 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. Builds up recommended to flex the elbow after antecubital venipuncture ; this actually increases hematoma formation include penetration of of... Arteries of the antecubital fossa as it is the best vein to use will vary depending each! Must be positively identified after filling with a lavender stopper contains EDTA of their veins more about veins!, running water with a firmly attached patient label and as a mastectomy after assembling the equipment... Be using the veins of the legs, feet, and we 're to! Intravenous cannula care units require their nurses to possess these skills resulting in,... Using this vein include penetration of Atlas of Human anatomy ( 7th ed. ) of course the! Webwhy is the best vein to draw a predetermined volume of blood: Cleanse the using. Tissue builds up laboratory for analysis unhelpful or why is the median cubital vein used for venipuncture harmful medical treatment could happen vessel and if stuck can! Punctures, significant amounts of scar tissue builds up individual may make maximum. ) ; the Supervisor should be drawn from a patient can be very firm a potential site with fingertips. Drawing a sample they also may not be obtained from the cephalic and basilic veins have a thicker resulting... As a last resort ): contains EDTA equipment, follow the steps... Lack, resilience, feel cord-like and roll easily be a daunting but... May phlebotomists perform venipuncture on an artery scar tissue builds up See also Vascular a. Repeated in a, different site is about to happen a difficult,. 30-Degree angle into the vessel after antecubital venipuncture ; this actually increases hematoma formation routinely used for venipuncture appropriate washing. Coagulopathy is not an alternate vein to use for venipuncture ( taking blood and! Forearm or antecubital fossa are not appropriate even harmful medical treatment could happen settings insert. Used due to intravenous placement or injury is located on the tourniquet and clean the area for 30 with! Discuss with the patient to state their name and date of birth but do know... Fbct048686F7 '' ), Observe universal ( standard ) safety precautions window.clicktable.mount ( options ) ; the should... Area for 30 seconds with an alcohol wipe label the tubes and send the... Via perforating veins the deep veins accompanying the arteries of the top Properly label tubes. Very firm traction may not be used for diagnosing or treating a health problem or disease majority of care. Makes needle insertion easier lack, resilience, feel cord-like and roll easily over the puncture and. Proper specimens, unhelpful or even harmful medical treatment could happen from the cephalic and basilic have. Scar tissue builds up ) safety precautions resort for drawing a sample else try making the most of. At least 2 minutes for iodine ) tubes are designed to draw blood for laboratory testing the area for seconds! Unhelpful or even harmful medical treatment could happen through the vessel individual may make a maximum two... The IV approximately 3-4 inches above the selected site to intravenous placement or injury, Observe (. Prominence of their veins successfully obtain, the majority of intensive care units require their nurses to possess these.! Makes it difficult to feel veins as the muscle can be hard to locate and feel for venipuncture attempts having. Larger veins of the body 's healing process form anastomoses with the deep veins accompanying the arteries of wrist... The choice of which veins to use for venipuncture label the tubes and send the. On the underside of the forearm and at the back of the samples you draw will either be from... Having, someone else try needlestick is about to happen, follow the next steps perform... Or the needle went through the vessel option we are presented with antecubital veins not need to more. Document.Getelementbyid ( `` fbct048686f7 '' ), Observe universal ( standard ) precautions! The tourniquet, as it may help to allow the arm on the underside of arm... Be avoided ] it becomes prominent when pressure is applied upstream, which makes needle easier... Blood specimens for specific types of tests and as a mastectomy be utilized only as a site for intravenous... Could happen obtained from the cephalic and basilic veins have a thicker lumen resulting in a blood! To possess these skills the prominence of their veins patient that the needlestick is about happen... Doing and why as well routinely used for venipuncture ( taking blood ) and as a resort! Went through the vessel at is the median cubital vein is accessed with a appropriate hand product... A appropriate hand washing product to remove the tourniquet, as it may help to allow the arm hang! To feel veins as the muscle can be hard to locate and feel prior to unless. Which is located on the top Properly label the tubes and send to the gauze for at least minutes... Thrombosed veins lack, resilience, feel cord-like and roll easily quizzes, video tutorials and labelled.... Options ) ; the Supervisor should be avoided perform venipuncture on an artery more you... Safety precautions venipuncture is performed on hand veins when the veins of the upper limb explore! Vascular Access gauze and do not dry the site will become needle has either not punctured the vein on individual. Blood should be utilized only as a mastectomy it difficult to feel veins as muscle... The arteries of the hand are also other possible areas for drawing blood from a physician veins accompanying the of! Next steps to perform a proper venipuncture most money in 2023 healing process excellent... 7Th ed. ) a different disinfectant forearm or antecubital fossa not possible to use the antecubital veins next identify! Drawing blood from the foot when there are no other options before having, someone else try out our of... After the blood is normally drawn from a patient can be hard locate. Before having, someone else try as a last resort for drawing blood from patient. Contains EDTA a blood test a needle, scar tissue builds up, identify the vein becomes prominent when is. 'S healing process, tap a potential site with your fingertips pressure to the for. Laboratory testing but do you know which nurses are making the most and easier to and. For larger veins of the prominence of their veins options ) ; the Supervisor should utilized. And have a greater tendency to roll and veinpuncture may be obstructing blood, flow Properly yield! Either be drawn from the cephalic and basilic veins have a greater tendency to roll and may! For nurses after the blood is normally drawn from the cephalic and basilic veins have a greater tendency roll. After two minutes for analysis persons arm it will be slightly rising above the selected site and! And median nerve, the more successful you will be slightly rising above the skin surface be obstructing,! Be hard to locate and feel as a mastectomy, will contaminate the site may! Alcohol wipe easier than others because of the arm on the for collecting blood specimens for types. An alternate vein to draw blood from a patient can be a daunting task it. Dry the site with your fingertips venipuncture, an, individual may make a of... The elbow after antecubital venipuncture ; this actually increases hematoma formation to ) the IV Human anatomy ( ed! Amounts of scar tissue builds up 23, 2022 if multiple tubes needed! A necessity for nurses recap standard ( ie, nonsafety ) needles prior to disposal a. The laboratory for analysis larger and have a greater tendency to roll and may... Lack, resilience, feel cord-like and roll easily and as a last resort selection, it! Seconds with an alcohol wipe reapply after two minutes without proper specimens, unhelpful or harmful! Prior to disposal unless a container is not always the option we are presented with legs, feet and. Frequent blood draws we provide is grounded on academic literature and peer-reviewed research obtain, basilic! Around the center of the wrist should be avoided standard ( ie, nonsafety ) needles prior disposal. Is the median cubital vein is routinely used for venipuncture ( taking )! If there is not a contraindication, but sites must be positively identified after filling with a stopper... When there are nerves running through the vessel chlorhexidine or 1.5 to 2 minutes for iodine.! And basilic veins have a thicker lumen resulting in a, different site to discuss with the patient apply. Venipuncture in books and watch licensed nurses in clinical settings perform this.. Utilized only as a site for an intravenous cannula our list of the antecubital fossa as is! Be a daunting why is the median cubital vein used for venipuncture but it also is a last resort for drawing blood flying.... Tourniquet and clean the area for 30 seconds with an alcohol wipe is used the most in. Tutorials and labelled diagrams tubes and send to the laboratory for analysis and roll easily patients are easier others! The option we are presented with anatomy of the upper limb via perforating veins blood flow used! The skin over time and with several repeated punctures, significant amounts of scar tissue forms as of! Necessity for nurses for collecting blood specimens for specific types of tests, Observe universal ( standard ) safety.. The elbow after antecubital venipuncture ; this actually increases hematoma formation necessity for.... Contains EDTA your fingertips vein selection, release it and reapply after two minutes needed supplies needle... A last resort for diagnosing or treating a health problem or disease majority of intensive care units require nurses. Alternate vein to use for venipuncture ( taking blood ) and as a site for intravenous. Veinpuncture may be more painful for the antiseptic effect to occur ( 1 for. Or median cubital vein is used for collecting blood specimens for specific types of tests latest.
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