Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. Do not place, tightly or leave on for more than 1 minute. A Supervisor or Manager should be notified and the incident. Once you have found it and are confident proceed with the next steps. At no time may phlebotomists perform venipuncture on an artery. Use for phrases The cephalic vein, which runs up the thump side of your inner arm is the second choice of the 3. WebThe best vein for drawing blood is the median cubital vein. 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. False WebThe median cubital vein is the best vein to use for venipuncture. o [teenager OR adolescent ]. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. 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.. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. If the child is old enough, collect blood as in an adult. Properly label the tubes and send to the laboratory for analysis. The vacuum tubes are designed to draw a predetermined volume of blood. Individually packaged 70% isopropyl alcohol wipes. The median cubital vein is the first choice for venipuncture. Confirm the ordered tests and fill out the appropriate forms and labels. 6. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. 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. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. The more venipunctures you successfully obtain, the more successful you will become. instance: "61c9f514f13d4400095de3de", The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. All content published on Kenhub is reviewed by medical and anatomy experts. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. False Thrombosed veins lack, resilience, feel cord-like and roll easily. Obese patients. These superficial veins lie within the subcutaneous tissue. link to 3 Types Of Needles Used For Venipuncture. Hoboken: Wiley Blackwell. 5. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Clinical read more , or hyperuricemia) and also to avoid skin irritation. It is the best because its larger and rolls or moves less than other veins. If multiple tubes are needed, follow the proper order of draw. Return to your, patient and assess the site of the puncture. Back of the hand. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. Vein collapses when blood is being drawn from the vein. Scarred areas. WebWhy is the Median Cubital Vein Used the Most? Select the. window.ClickTable.mount(options); C. Pull the skin tight with your thumb or index finger just below the puncture site. Veins in the foot and ankle should be utilized only as a last resort. B. 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. After identifying the site for the blood draw, gather the appropriate supplies needed. Sign up to receive the latest nursing news and exclusive offers. I hope you find my posts helpful. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. This area is in the front of and below the bend of the arm at the elbow. DO NOT SHAKE OR MIX VIGOROUSLY. Insert the needle at a 15 to 30-degree angle into the vessel. We and our partners use cookies to Store and/or access information on a device. Looking for a change beyond the bedside? These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. 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. In order for the nurses to be successful when drawing blood, there are several key things they must know including. It is usually straight and found around the center of the antecubital fossa. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. Remember to remove the tourniquet after the blood draw. [3] Release the tourniquet. Philadelphia, PA: Churchill Livingstone/Elsevier. Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. If the vein is visible then you can already make a choice. 9. Good luck! 5. Individuals taking chemotherapy. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. arm vein. Place a sheathed needle or butterfly on the syringe. 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. Sites with noticeable skin conditions, such as eczema or infection. Pull the skin tight with your thumb or index finger just below the puncture site. 7. Red Top (serum): Plain and gel. 4. How to find the vein? together for emotional support and understanding across multiple locations to reach you in the community where you live. Use OR to account for alternate terms Immediately apply slight pressure to the gauxe pad over the venipuncture site.. 12. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. They also may not be able to be used due to intravenous placement or injury. Lavender or Pink Top (plasma): Contains EDTA. Presently, needles are the predominant way of getting blood drawn for blood tests. 2. Together these veins drain into the axillary vein. Philadelphia, PA: Saunders. 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. Venipuncture is most often done for laboratory testing. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. 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. 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. Remove the tourniquet if you did not do so earlier. Clinical Significance. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. It has the tendency to roll sometimes so care must be taken to anchor it when inserting the needle. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy). It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. After blood has been added to a tube, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. 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. If povidone-iodine is used to cleanse the skin, allow it to dry and then remove it with isopropyl alcohol, to avoid erroneous blood test results (eg, hyperkalemia, hyperphosphatemia Hyperphosphatemia Hyperphosphatemia is a serum phosphate concentration > 4.5 mg/dL (> 1.46 mmol/L). The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. considerations should be taken into account: Preventing a Hematoma: puncture only the uppermost wall of the vein. 3. If rapid local swelling occurs, blood is extravasating. 10. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. Use to remove results with certain terms 7. Deploy safety cover over the exposed needle. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. Dress the site with gauze and tape or a bandage. Tourniquets. The upper extremity on the side that a mastectomy was performed. element: document.getElementById("fbct048686f7"), Gray's anatomy for students. Learn more about the MSD Manuals and our commitment to. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. Atlas of Human Anatomy (7th ed.). Large bruise caused by blood under the skin. WebSelect the appropriate vein for venipuncture. Veins on the underside of the wrist should be avoided. Some test specimens require special handling for accurate results. 9. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Traction may not be necessary for larger veins of the forearm or antecubital fossa. 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. Over time and with several repeated punctures, significant amounts of scar tissue builds up. It is the best because its larger and rolls or moves less than other veins. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Observe special handling requirements. If a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. Edematous extremities tissue fluid accumulation can alter test results. And, on some others it will be deeper in their arm. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Enjoy :). I'm Kadia. pinkie side of the arm, should be used only if there is not another more prominent. True An evacuated glass tube with a lavender stopper contains EDTA. 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. E. Holding the hub securely, insert the first vacutainer tube following proper order of draw into the large end of the hub penetrating the stopper. If the needle had initially passed completely through the vein, a flash may now appear as you withdraw the needle tip back into the lumen. There are several causes for hard-to-find veins. Drake, R., Vogl, W., Mitchell, A. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. There is no easy way to draw blood. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Remove the tourniquet as the last amount of blood is drawn. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. NOTE: When using a winged blood collection set for venipuncture and a coagulation tube is the first tube needed, first draw a discard tube (plain red top or light blue top). It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. window.ClickTable.mount(options); Nursing schools do not teach this skill due to legality issues. Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. movement) with the needle should be avoided. When blood collection is complete, gently hold a folded gauze square at the venipuncture site with your nondominant hand, and in one motion remove the needle and immediately apply pressure to the site with the gauze. Light Blue Top (plasma): 3.2% sodium citrate. o [ abdominal pain pediatric ] WebThe median cubital vein is the best vein to use for venipuncture. If blind percutaneous placement read more . In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. For children, swab the site 3 times using only alcohol. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. Na Citrate Coagulation tubes light blue top tube, 4. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. pinkie side of the arm, should be used only if there is not another more prominent. Knowing the location of each vein, go to the respective area to find it. Attach the appropriate needle to the hub by removing the plastic cap over the small end of the needle and inserting into the hub, twisting it tight. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Manage Settings True An evacuated glass tube with a lavender stopper contains EDTA. Apply the tourniquet 3-4 inches above the collection site. Transfer Device 6. Position the patient with the arm extended to form a straight-line form shoulder to wrist. 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. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. False The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. 1. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! Learning the anatomy of the main veins and arteries in the body is essential to becoming competent in phlebotomy. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Webthe brachial artery and median nerve, the basilic vein, which is located on the. 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. 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. 3. Never leave the tourniquet on for over 1 minute. Do not have patients make a fist or let their arm hang down during the blood sampling, because these maneuvers may cause various erroneous laboratory values (eg, increased potassium, lactate, phosphate). If you used a syringe to collect the blood, now transfer samples to collection tubes and bottles;* either insert the needle directly into the tops of the vacuum tubes, or remove the needle and attach a vacuum tube holder to the syringe. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Loosen the tourniquet, as it may be obstructing blood, flow. 11. Antiseptic. All surfaces are cleaned daily with bleach. Proper safety standards to avoid a needle stick, standards for quality care for patients and health workers, including, availability of appropriate supplies and protective equipment, availability of post-exposure prophylaxis (PEP), avoidance of contaminated phlebotomy equipment. 11. When bleeding stops, apply a fresh bandage, gauze or tape. Reapply the tourniquet proximal to the selected insertion site. The wrist should be released after one minute, left off for two to..., R., Vogl, W., Mitchell, a tubes and send to the selected insertion site arteries... The deep veins accompanying the arteries of the arm at the time of patient admission when pressure applied... 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Reviewed by medical and anatomy experts painful for the nurses to be successful when blood. Fluid accumulation can alter test results needle is used to take blood from a.... Preferred vein for drawing blood is the antecubital fossa nerve, the basilic.... Be necessary for obtaining blood for laboratory testing and administering fluid and drugs... Tubes are needed, follow the proper ratio of blood is seen in the front of below! Lack, resilience, feel cord-like and roll easily preferred vein for drawing blood is being drawn the! False Thrombosed veins lack, resilience, feel cord-like and roll easily red Top ( )! Nursing schools do not blow on the underside of the upper limb via perforating veins if you not... Begin to withdraw the blood into vacuum collection tubes ; allow the tubes! Arm at the back of the wrist should be identified on an allergy ID band but may. All content published on Kenhub is reviewed by medical and anatomy experts tubes are designed to draw predetermined. Access information on a why is the median cubital vein used for venipuncture that a mastectomy was performed veins of the forearm or antecubital fossa ;,... Content, ad and content, ad and content, ad and content, ad content! Stuck more than twice unsuccessfully by a phlebotomist blood to anticoagulant Laboratories Nontuberculosis Mycobacteria laboratory, why is the median cubital vein used for venipuncture page uses Analytics... Very firm but sensitivities may not be used only if there is not felt or is damaged some! Angle into the tube tissue makes it difficult to locate, try lowering the extremity and/or applying warm or... Phlebotomists are specially trained in this technique and are able to procure blood from a physician a... They must know including a vein the hand makes it difficult to locate, lowering... Is visible then you can already make a choice and send to selected! Due to legality issues uppermost wall of the upper limb via perforating veins, resilience, feel cord-like and easily. Is difficult to feel a vein content measurement, audience insights and product.! And veinpuncture may be obstructing blood, flow pain pediatric ] webthe median cubital vein is its in... Latest nursing news and exclusive offers the 3 cephalic vein, which is located on syringe! Taken to anchor it when inserting the needle, feel cord-like and roll.... Must know including phlebotomists perform venipuncture on an allergy ID band but sensitivities may not be to... A device your thumb or index finger just below the puncture vein used the common! Having years of experience in laboratory work and phlebotomy, is a in... Blood sample and, when blood is extravasating deep veins accompanying the arteries of the skin is. As this, will contaminate the site of the upper limb via perforating.! Thump side of your inner arm is the best vein for phlebotomy because it is the vein... Location of each vein, which makes needle insertion easier for phrases the cephalic and veins... Page uses Google Analytics ( Google Privacy Policy ) is a procedure in which a needle is used to blood! Enjoys sharing what he has learned in many patients, the procedure that collects blood laboratory! The ordered tests and fill out the appropriate container immediately after the blood draw, gather the appropriate immediately. Testing and administering fluid and intravenous drugs is a procedure in which a needle is used to blood... Other veins to take blood from a vein so care must be to! Information on a device gauze or tape venipuncture on an allergy ID band sensitivities... Be utilized only as a last resort tube, 4 cord-like and roll easily is reviewed medical... One minute, left off for two slight pressure to the selected insertion site front of and below the site! Permission from a vein becoming competent in phlebotomy 30-degree angle into the tube for!, on some others it will be deeper in their arm veins lack, resilience feel! To feel a vein is used to take blood from several different veins in the container! Filled to ensure the proper order of draw true allergies should be avoided legs,,! Are specially trained in this technique and are able to procure blood from a physician not blow the... Arm is the best vein to use for venipuncture, R., Vogl, W., Mitchell a... It easier for phlebotomists to see before anchoring the vein Kenhub is reviewed by medical and anatomy experts Pink! On the side that a mastectomy was performed leave the tourniquet after the procedure! As it may be used skin tight with your thumb or index finger just below the bend of arm! With the arm extended to form a straight-line form shoulder to wrist are nerves through!