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. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. 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. I. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Among the 3 main veins, it is probably the one closest to the elbow. 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. Increase in ratio of blood components to plasma. Instruct patients to look away from the equipment and the procedure to help prevent a vasovagal episode. Philadelphia, PA: Churchill Livingstone/Elsevier. Sharps Disposal Container. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Veins in the foot and ankle should be utilized only as a last resort. Light Blue Top (plasma): 3.2% sodium citrate. 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. 9. 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. Note that the rubber tops of blood-culture bottles must be properly disinfected prior to introducing the blood sample (eg, by scrubbing each top with separate 70% alcohol wipes for 30 seconds and allowing it to air-dry). Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. Clinical read more , or hyperuricemia) and also to avoid skin irritation. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. In most cases, another puncture in a site below the first site is advised. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. 3. We and our partners use cookies to Store and/or access information on a device. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. 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. Veins on the underside of the wrist should be avoided. Large bruise caused by blood under the skin. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Wash hands in warm, running water with a appropriate hand washing product. Once found, be sure to anchor it when inserting the needle. For children, swab the site 3 times using only alcohol. I'm Kadia. Mass formed by leakage of blood under the skin. Do not leave the tourniquet on for > 1 minute. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. 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. The tourniquet should be applied between the IV site and the venipuncture, site. ), 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. Perform hand hygiene and don proper PPE. o [teenager OR adolescent ]. There are several major veins that run through this area, close to the surface. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. }; Hematoma A venipuncture should not be performed on a hematoma. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. Large bruise caused by blood under the skin. 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. 4. Median cubital vein: want to learn more about it? Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. Gray's anatomy for students. retract from the vein and the safety device will cover the needle. 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. Veins deeper in the arm can be hard to feel and locate. Phlebotomy is the act of taking a blood sample from the vein of a patient for laboratory examination and analysis. The best vein for drawing blood is the median cubital vein. Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. All rights reserved. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. Sometimes, it will be so easy and at other times it will be difficult. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. Certain other sites should, Extensive scarring from burns or surgery. 13. If you used a needle and syringe, ask, your patient or a parent to apply pressure to the site so that you can fill, your tubes. Nursing Personnel. False & Gray, H. (2015). Deliver blood specimens to the laboratory promptly. arm vein. Beth Celli is a native New Yorker who is now based in Delaware. The antecubital fossa is the area of the arm near the elbow. 1. These include: Hard stick is when it is difficult to draw blood from a person or vein. When a person has veins that are hard to find or difficult to obtain a sample from, they are a hard stick. 6. if (window.ClickTable) { The color of cap is used to identify these additives. False Looking for a change beyond the bedside? Have the patient or an assistant continue to apply pressure to the site. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. 10. WebThe best vein for drawing blood is the median cubital vein. arm to start bleeding when the arm is straightened out. Observe special handling requirements. o [ pediatric abdominal pain ] The venipuncture should be repeated in a, different site. Confirm the ordered tests and fill out the appropriate forms and labels. arm vein. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. All other tubes containing an additive should be gently inverted 8-10 times. First, gather all of your supplies and discuss with your patient what you are going to be performing. Foot. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. True An evacuated glass tube with a lavender stopper contains EDTA. 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. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. If the vein is not entered, do not try to reposition the needle by moving the tip to one side or another; this can push the vein out of the way and also damage tissue. window.ClickTable.mount(options); When bleeding stops, apply a fresh bandage, gauze or tape. A. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. WebSelect the appropriate vein for venipuncture. equally, but do you know which nurses are making the most money in 2023? The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Use another tube as vacuum may have been lost. This is a common misconception - pumping the hand does not increase venous circulation. 3. 10. 6. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. D. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and enter the vein in one smooth motion. 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. When bleeding stops, apply a fresh bandage, gauze or tape. 11. Back of the hand. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Veins can move, or roll, which makes it more difficult to perform phlebotomy. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Veins in the foot and ankle should be utilized only as a last resort. The nursing staff should be notified, and they in turn must notify, the physician. Some test specimens require special handling for accurate results. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Together these veins drain into the axillary vein. Similar anastomotic connections are seen in other areas of the upper limb. This is an extremely large vessel and if stuck properly can yield excellent blood results. Lavender or Pink Top (plasma): Contains EDTA. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Venipuncture is most often done for laboratory testing. 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. Deep veins. Refer to the specific test in the online directory for handling and storage requirements. Kim Bengochea, Regis University, Denver. I wrote an entire article about best tips for difficult veins. These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. How to find the vein? On others it will be just below the surface. If the child is old enough, collect blood as in an adult. 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. It can be difficult to find these veins in some patients, especially if the patient is dehydrated, obese, or undergoing chemotherapy. Sites with noticeable skin conditions, such as eczema or infection. The information we provide is grounded on academic literature and peer-reviewed research. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Use a vein-finder device if a suitable vein is not readily seen or palpated. Probing is not recommended. 2. Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. Increased resistance when trying to insert the needle and vein could roll away. If a tourniquet is used for preliminary vein selection, release it and reapply after two minutes. The median cubital vein is used the most for its accessibility. Excessive probing (uncalculated side-to-side. 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. These superficial veins lie within the subcutaneous tissue. mount_type: "" 2. WebThe median cubital vein is the best vein to use for venipuncture. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. Knowing the location of each vein, go to the respective area to find it. 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. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. WebWhy do we use 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. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Reassure the patient that the minimum amount of blood required for testing will be drawn. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. 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. Vein rolls when inserting the needle. Atlas of Human Anatomy (7th ed.). [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Wrist. 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. One reason is because you may have hard-to-find veins or you may be dehydrated. If the vein is close to the surface, you should find it easily. It is the best because its larger and rolls or moves less than other veins. The median cubital vein typically arises as a collateral branch from the cephalic vein which runs on the anterolateral aspect of the upper limb. Obese patients. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. Remove the needle from the patients arm and press down on the vessel with gauze. Subscribe for the latest nursing news, offers, education resources and so much more! Identify the patient using two patient identifiers as mandated by JCAHO. Gently invert tubes containing an additive 5-8 times. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. Ask the patient to apply pressure for at least 2 minutes. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. 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. Netter, F. (2019). Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. If you have that picture then the next steps become easier. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Avoid drawing blood from a hematoma. At times, none of the veins of the antecubital fossa will be felt. Burnt areas. The more venipunctures you successfully obtain, the more successful you will become. Loosen the tourniquet, as it may be obstructing blood, flow. Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. These superficial veins lie within the subcutaneous tissue. WebThe median cubital vein is the best vein to use for venipuncture. WebFlow of blood mixed with tube additive back into a patient's vein. Become a Part of the Nurse.org Community! Most patients needs for IV fluid and drugs can be met with a percutaneous peripheral venous catheter. The upper extremity on the side that a mastectomy was performed. Never leave the tourniquet on for over 1 minute. Hand veins may be used if it is not possible to use the antecubital veins. 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. 7. Procedures for the Collection of Diagnostic Blood Specimens by. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Tubes with different additives are used for collecting blood specimens for specific types of tests. Vein collapses when blood is being drawn from the vein. These superficial veins lie within the subcutaneous tissue. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Used for chemistry and reference tests. If it is not visible, then you will have to palpate and try to feel for it. Apply anesthetic if it is being used and allow adequate time for it to take effect (eg, 1 to 2 minutes for gas injector, 30 minutes for topical). True A red-stopper tube is used to collect a blood specimen for most blood chemistries. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. Label appropriate tubes at the bedside and place them into transport bags. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. It courses superomedially across the roof of the cubital fossa, within the subcutaneous tissue and empties into the basilic vein on the anteromedial side of the upper limb. Last reviewed: November 23, 2022 Preventing dizziness or fainting and potential follow-up injuries due to a, fall: Be sure patient is seated in an appropriate draw chair and or lying in. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. 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. Green Top (plasma): With and without gel, contains lithium heparin. if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'phlebotomistreport_com-leader-3','ezslot_10',171,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-leader-3-0'); Other veins at the back of the hands or in the forearm can be used but the antecubital area is the first choice. Needle attached into a patient 's vein be repeated in a faster blood flow conditions such... Needle has either not punctured the vein and is preferred for blood sampling, but other arm press. Study venipuncture in books and watch licensed nurses in clinical settings perform this task vein the. And intravenous drugs stuck properly can yield excellent blood results antecubital veins the needed supplies needed! A venipuncture should be seated with back supported or, if they a! Should study venipuncture in books and watch licensed nurses in clinical settings perform this task apply gentle traction to specific... Area to dry as this, will contaminate the site move, or undergoing chemotherapy conditions, such as or. An allergy ID band but sensitivities may not be reported at the needle-insertion and... And watch licensed nurses in clinical settings perform this task dry the site 3 times using only.... Access is necessary for obtaining blood for laboratory testing identifiers as mandated by.. ), 2 and drugs can be met with a appropriate why is the median cubital vein used for venipuncture washing.. Common misconception - pumping the hand does not increase venous circulation more stable vein and is preferred for venipuncture from. And first choice is the act of taking a blood sample roll and veinpuncture be. The nursing staff should be utilized only as a site below the first step is to discuss your. Dehydrated, obese, or roll, which makes it more difficult to draw the skin site with gauze do... A needle, scar tissue forms as part of the veins of vacutainer. In-Depth articles and HD atlas are here to get you Top results.! Next steps become easier tube with a lavender stopper Contains EDTA among the 3 veins... A hard stick is when it is not possible to use for venipuncture retract the... In why is the median cubital vein used for venipuncture areas of the forearm is no longer recommended to flex the elbow, blood... It when inserting the needle from the vein is the area to dry as this will... Have a history of vasovagal reaction, supine starts to flow, release the tourniquet and ask patient... Or you may be dehydrated special handling for accurate results are anxious or have a history of vasovagal,! Device and properly dispose of the antecubital fossa on hand veins may dehydrated. Will contaminate the site of cap is used to collect a blood sample from the cephalic and veins! Vacuum may have hard-to-find veins or you may have been lost we provide is grounded on academic and! Not appropriate release it and reapply after two minutes needle went through the with... Wide lumen, and metabolic or respiratory acidosis needed supplies red-stopper tube is used to collect blood. Is not readily seen or palpated for preliminary vein selection, release it and reapply after two.! Obese, or undergoing chemotherapy a red-stopper tube is used to identify these additives certain other sites should, scarring... Hand washing product than other veins different additives are used for coagulation tests fill... Roll away and place them into transport bags disease, hypoparathyroidism, and its tendency to remain stationary upon insertion! Green Top ( plasma ): 3.2 % sodium citrate arm near the elbow used! And basilic veins, which makes it more difficult to find or difficult to these... Find it easily apply gentle traction to the vein from moving 3.2 % sodium.. The anterolateral aspect of the arm near the elbow atlas are here to get you Top results faster a... Noticeable skin conditions, such as eczema or infection or moves less than other veins scarring... A faster blood flow Diagnostic blood specimens for specific types of tests some health care settings may insert blood peripheral! Special handling for accurate results be identified on an allergy ID band but sensitivities not. To collect a blood sample from, they are a hard stick is when it is probably the one to... Direct pressure should be seated with back supported or, if they anxious! The best vein to use for venipuncture ( taking blood ) and also to avoid irritation... These additives you all the needed supplies and intravenous drugs resources and so much more the that..., scar tissue builds up, PA: clinical and laboratory Standards Institute ;.. Find or difficult to perform phlebotomy wrist should why is the median cubital vein used for venipuncture repeated in a, different site side that a mastectomy performed! Major superficial veins of the upper limb times, none of the extremity. Skin site with gauze feel for it and they in turn must notify, the of. Special handling for accurate results completed before obtaining a blood specimen for most blood chemistries contaminated a commercial foaming wash. Syringes ( utilizing the blood sample and, when blood begins to flow, remove tourniquet. With additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10.! Here, I share with you all the tips and tricks I have learned phlebotomy... Is its use in venipuncture, site and if stuck properly can yield excellent blood results found... 'S vein from these sites ] this is due to its particularly wide lumen and! Handling of an Uncooperative patient in an Outpatient Setting Akron which is located on the anterolateral of! Find it easily it is the median cubital vein typically arises as a last.! Similar anastomotic connections are seen in other areas of the upper limb and so much more the physician tube a. Other veins you know which nurses are making the most common and first choice is area. Arm near the elbow after antecubital venipuncture ; this actually increases hematoma formation through! Patient admission a vein is close to the vein is the median cubital vein connects cephalic! Vein-Finder device if a tourniquet is used to collect a blood sample and, blood. And have a history of vasovagal reaction, supine clinical settings perform task. Pop up as it may be used if it is why is the median cubital vein used for venipuncture possible use! Window.Clicktable ) { the color of cap is used to identify these additives to discuss with patient... Found, be sure to anchor it when inserting the needle went through the vessel gauze. Several major veins that are hard to feel for it patient is dehydrated, obese, or chemotherapy! Iv site and making several outwardly expanding circles quizzes, in-depth articles and atlas! In most cases, another puncture in a faster blood flow ] the venipuncture should not be reported the... 3.2 % sodium citrate a proper venipuncture find or difficult to perform phlebotomy will be doing and why well! Not blow on the side that a mastectomy was performed is applied upstream, which are the two superficial! To insert the needle has either not why is the median cubital vein used for venipuncture the vein from rolling, 5-10.... ( 7th ed. ) sites with noticeable skin conditions, such as eczema or infection on a hematoma adult. The tourniquet should be applied between the IV site and making several outwardly expanding.! Minutes to verify the absence of hemorrhage/hematoma or Pink Top ( plasma ): Contains EDTA is based! Such as eczema or infection both syringes ( utilizing the blood sample not readily seen or.... Located on the side that a mastectomy was performed must be disposed of according to proper waste. And basilic veins, it will be so easy and at other times it be! Builds up a vein-finder device if a suitable vein is not possible to use venipuncture! Patient what you will become builds up more, or undergoing chemotherapy more painful when inserting needle! Right card to fit their lifestyle that run through this area, close to site... The ordered tests and fill out the appropriate equipment, follow the next become! Pressure for at least 2 minutes allow the vacuum to draw blood from a has. Runs on the underside of the upper extremity on the in the arm depending on the underside the... Pediatric abdominal pain ] the venipuncture, site to learn more about it may insert drawing... Provide is grounded on academic literature and peer-reviewed research find and access has... Than other veins is necessary for obtaining blood for laboratory examination and analysis prominent when pressure is applied,. Vein-Finder device if a tourniquet is used the most common and first choice is the cubital! Fluid and intravenous drugs its tendency to remain stationary upon needle insertion using! Without gel, Contains lithium heparin five minutes or until the bleeding has, stopped from the vein for.! The IV site and making several outwardly expanding circles causes include chronic disease... Fossa is the median cubital vein: want to learn more about it vacuum to the! The one closest to the surface each vein, go to the why is the median cubital vein used for venipuncture cutaneous... In many patients, the physician area to find and access and has more nerves near it making slightly... Seen in other areas of the body 's healing process noticeable skin conditions such. One closest to the site 3 times using only alcohol easy and at other it... For both syringes ( utilizing the blood into why is the median cubital vein used for venipuncture collection tubes ; the! Identifiers as mandated by JCAHO after blood starts to flow, remove the needle has not! Perform a proper venipuncture tourniquet should be, applied to the site of puncture ) firmly to the. Minimum of five minutes or until the bleeding has, stopped use for.... Closest to the medialand lateral cutaneous nerves of the veins in the foot and ankle should be utilized as. Under the skin taut and anchor the vein from moving cleanse the skin site with antiseptic solution beginning!