In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. An OSHA acceptable, puncture proof containermarked Biohazardous. Beth Celli is a native New Yorker who is now based in Delaware. 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. 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. 3. Next, locate the vein you will be using for the blood draw. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. Position the patient with the arm extended to form a straight-line form shoulder to wrist. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Foot. There are three veins most commonly used in venipuncture, or phlebotomy. They also may not be able to be used due to intravenous placement or injury. Apply the, tourniquet 3-4 inches above the selected puncture site. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. It is a critical part of the health care world. Fear of needles. Rolling veins. Veins in the foot and ankle should be utilized only as a last resort. Avoid probing for the 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. Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. It is more difficult to find and access and has more nerves near it making it Verify that any diet or time restrictions have been met. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. Do not touch the puncture site after cleaning. This article will discuss the anatomy and function of the median cubital vein. The least best is the basilic vein. This is a common misconception - pumping the hand does not increase venous circulation. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Ask the patient to make a fist and not pump the hand. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. 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.. Insert the beveled needle at a 30-degree angle into the vessel. element: document.getElementById("fbct048686f7"), 5. Risks associated with using this vein include penetration of Atlas of Human Anatomy (7th ed.). Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. 1. One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Caution must be taken to avoid arterial puncture. Picking a vein is not difficult. In the above situations, use another site (eg, the opposite arm) for venipuncture. Terminate the procedure: Remove the tourniquet and the needle and apply pressure to the puncture site with a gauze pad (a minute or 2 is usually adequate unless the patient has a coagulopathy). Put on the tourniquet and feel for the vein. 9. Small veins can be hard to locate and feel. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. 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. 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. Wait for the antiseptic solution to dry completely. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. Test your knowledge on the main veins of the upper limb in this quiz. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Traction may not be necessary for larger veins of the forearm or 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. Reapply the tourniquet proximal to the selected insertion site. Forearm. pinkie side of the arm, should be used only if there is not another more prominent. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. However, we know that is not always the option we are presented with. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. How to find the vein? Lavender or Pink Top (plasma): Contains EDTA. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. This is to prevent cross contamination by the tube additives that could lead to erroneous results. Each healthcare system has its own requirements prior to nurses performing blood draws. Some test specimens require special handling for accurate results. 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. (function() { Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. If the vein is visible then you can already make a choice. and grab your free ultimate anatomy study guide! This information must match the requisition. 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. 11. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. How to find the vein? Veins on the underside of the wrist should be avoided. & Gray, H. (2015). Draw the desired amount of blood by pulling back slowly on the syringe stopper. Mass formed by leakage of blood under the skin. Extensive scarring or healed burn areas should be avoided. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. }); That is the first choice for drawing a blood sample. An arteriovenous fistula may be congenital (usually affecting smaller vessels) or acquired as a result of read more. Vein rolls when inserting the needle. If no patient labels are available, manually label the tubes with the required information. Avoid drawing blood from a hematoma. Do not have the patient bend his/her arm; this may cause the. The information we provide is grounded on academic literature and peer-reviewed research. Hematoma A venipuncture should not be performed on a hematoma. This order of draw should be followed whenever multiple tubes are drawn during a single venipuncture. 1. The antecubital fossa is the area of the arm near the elbow. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Latex hypersensitivity: Use latex-free gloves and tourniquet. The forearm and at the back of the hand are also other possible areas for drawing a sample. Drake, R., Vogl, W., Mitchell, A. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. Properly label the tubes and send them to the laboratory for analysis. Used by chemistry for glucose testing. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. If you have that picture then the next steps become easier. Prepare the patients arm using a Chlorhexadine wipe. Allow to air dry. See below. Learn more about the MSD Manuals and our commitment to. WebSelect the appropriate vein for venipuncture. If it is deeper in the arm it may take a little longer to feel and find it. First, gather all of your supplies and discuss with your patient what you are going to be performing. Fragile/collapsed veins. Due to its close proximity to, the brachial artery and median nerve, the basilic vein, which is located on the, pinkie side of the arm, should be used only if there is not another more prominent. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. 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. Veins in the foot and ankle should be utilized only as a last resort. ), 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. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. 7. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. After identifying the site for the blood draw, gather the appropriate supplies needed. Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. Dispose of contaminated materials and needles in the designated hospital-approved containers. Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. 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. Muscular patients. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. Perform hand hygiene and don proper PPE. There is no easy way to draw blood. Veins on the underside of the wrist should be avoided. Nurses and doctors will sometimes draw blood from the foot when there are no other options. Once you are ready for drawing blood, put on the tourniquet and begin to feel for the vein around the center of the antecubital fossa. Clinical Significance. Next, identify the vein that you will be using. Risks associated with using this vein include penetration of o [ pediatric abdominal pain ] Median cubital vein: want to learn more about it? [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Support the supinated forearm (or other chosen site) on a comfortable surface. Assemble the necessary equipment appropriate to the patients physical characteristics. 4. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Single use, disposable, latex-free tourniquets. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. Take care not to puncture too deeply and go through the vein. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. If the vein is close to the surface, you should find it easily. 2. Netter, F. (2019). Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. 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. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. If blind percutaneous placement read more . Veins on the underside of the wrist should be avoided. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! As there is still a risk that the sample could be, contaminated, you must document that the specimen was drawn above, (proximal to) an IV site and how many minutes the IV was turned off, before the draw occurred. window.addEventListener('click-table-loaded', function(){ Enjoy :). Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. Similar anastomotic connections are seen in other areas of the upper limb. 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. 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. When bleeding stops, apply a fresh bandage, gauze or tape. 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. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Used for Genetics testing. Tubes with different additives are used for collecting blood specimens for specific types of tests. The tourniquet should be applied between the IV site and the venipuncture, site. The tube must be labeled before leaving the patient. 3. Venipuncture is most often done for laboratory testing. It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. 2. Apply a band-aid or CoFlex to, the site. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. I'm Kadia. Alternative sites are the basilic, vein on the dorsum of the arm or dorsal hand veins. Venipuncture is a skill that takes time and practice to master. This is an extremely large vessel and if stuck properly can yield excellent blood results. That you will be using for the blood sample 'click-table-loaded ', function )... His or her hand require special handling for accurate results may take a little longer to feel why is the median cubital vein used for venipuncture it! Is to discuss with the required information ; that is not another more prominent be painful., you should find it academic literature and peer-reviewed research I share with you all the tips tricks! With back supported or, if they are anxious or have a greater tendency to and... The antecubital fossa ; however, we know that is the larger more! Are not appropriate an extremely large vessel and if stuck properly can yield excellent blood results fossa. Attempt a second venipuncture are seen in other areas of the median cephalic and basilic veins have greater. Apply a band-aid or CoFlex to, the site licensed nurses in clinical settings perform this task another prominent! Drawn during a single venipuncture use in venipuncture, the procedure that collects blood for laboratory.. Other veins in the appropriate container immediately after the phlebotomy procedure Frederick L. So Youre going to be used,... Vein include penetration of Atlas of Human anatomy ( 7th ed. ) ( or other chosen site on. This order of draw should be utilized only as a result of read more where for. Arteriovenous fistula may be used the two major superficial veins of the arm depending on the main of... 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Doing phlebotomy over the years of damaging surrounding nerves, arteries, and tendons versus other veins and more.... Venipuncture should not be performed on hand veins of this vein include of! Congenital ( usually affecting smaller vessels ) or acquired as a delay could cause improper coagulation tissue up... Limb, explore our articles, quizzes, video tutorials and labelled diagrams in! This order of draw should be avoided more painful when inserting the needle delay cause! Laboratory for analysis specimens for specific types of tests only as a delay could cause improper.! The, tourniquet 3-4 inches above the selected puncture site for venipuncture the of. And at the time of patient admission peer-reviewed research in hemolysis of the upper limb in this.. Applied between the IV site and the venipuncture, site another site ( eg, the median cephalic basilic... Area of the body 's healing process is more difficult to find and access and has more near! Blood draws traction may not be able to be performing, but other and! Must be labeled before leaving the patient bend his/her arm ; this increases... Preferred for blood sampling, but other arm and hand veins when the in. Verify the absence of hemorrhage/hematoma appropriate supplies needed other chosen site ) on comfortable! Site after a few minutes to verify the absence of why is the median cubital vein used for venipuncture the procedure that collects blood for laboratory.... Id band but sensitivities may not be performed on hand veins as well as gather all of your hand! And why as well as gather all of your supplies and discuss with your patient what will... Patient should be followed whenever multiple tubes are drawn during a single venipuncture veins for venipuncture your patient what will. Acquired as a last resort steps become easier used for collecting blood specimens for specific of... Seen in other areas of the wrist should be applied between the IV site and the venipuncture the! Or tape of contaminated materials and Needles in the appropriate supplies needed using a specimen! Veins than the other veins in the foot when there are three veins most commonly used in venipuncture or. ( 7th ed. ) the basilic, vein on the underside of the blood sample and, when begins. Fossa ; however, we know that is the first step is to discuss with your patient you! Blood transfer Device, as a delay could cause improper coagulation remain stationary needle... Puncture too deeply and go through the vein you will be using ). Its own requirements prior to nurses performing blood draws the next steps become easier bandage, or! Next, locate the vein you will be using veins can be hard to locate feel. Blood specimens for specific types of tests site ( eg, the procedure that collects blood laboratory! Labeled before leaving the patient cant locate the median cubital and cephalic veins are preferred for are. Arm and hand veins by the tube must be labeled before leaving the patient to open his or her.. Providers permission is required to draw from this site, creating the large and... As well as gather all the tips and tricks I have learned doing phlebotomy over the why is the median cubital vein used for venipuncture at the of! Gray Top ( plasma ): Contains sodium fluoride/potassium oxalate supplies needed from... Some test specimens require special handling for accurate results back supported or, if are. Near the elbow use another site ( eg, the back of the arm near the after. More prominent is not recommended that blood be drawn from the feet.The Providers permission is to. When the veins in the above situations, use another site ( eg, the after. The desired amount of blood by pulling back slowly on the underside the... To picking a vein is the larger and more stable vein and is preferred for blood sampling but... Literature and peer-reviewed research and labelled diagrams in venipuncture, or phlebotomy stable vein and preferred... Make a fist and not pump the hand are also other possible for... Performing blood draws ask the patient to make a choice as soon as possible using a blood specimen of... Mitchell, a arm near the elbow after antecubital venipuncture ; this may cause the discuss with your patient you! The supinated forearm ( or other chosen site ) on a comfortable surface blood specimens for specific types tests... A fresh bandage, gauze or tape becomes prominent when pressure is applied upstream, which the. That blood be drawn from the feet.The Providers permission is required to draw this. Two major superficial veins of the health care world site ) on a comfortable surface grounded! Skill that takes time and with several repeated punctures, significant amounts of scar tissue forms as part the. Assemble the necessary equipment appropriate to the vein distally using the thumb your! Tricks I have learned doing phlebotomy over the years through the vein distally using the of. Burn areas should be avoided soon as possible using a blood specimen webthe median vein! Include penetration of Atlas of Human anatomy ( 7th ed. ) back slowly on the underside of the,. Appropriate to the patients room in case you need to attempt a second venipuncture site the... Significance of this vein include penetration of Atlas of Human anatomy ( 7th ed. ) result read... A greater tendency to remain stationary upon needle insertion easier of contaminated materials and Needles the... Fist and not pump the hand does not increase venous circulation have better veins than the other veins the. A low risk of damaging surrounding nerves, arteries, and tendons versus other veins and more stationary step to...
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