Veins can move, or roll, which makes it more difficult to perform phlebotomy. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. 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. It is the best because its larger and rolls or moves less than other veins. 5. The median cubital creates less bruising and pain than other draw sites. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Large bruise caused by blood under the skin. 9. Specimens should not be obtained from the arm on the same side as a mastectomy. Antecubital fossa. Copyright These superficial veins lie within the subcutaneous tissue. Edematous extremities tissue fluid accumulation can alter test results. Remove plastic cap over needle and hold bevel up. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Alternative sites are the basilic, vein on the dorsum of the arm or dorsal hand veins. Increased resistance when trying to insert the needle and vein could roll away. The information we provide is grounded on academic literature and peer-reviewed research. Have appropriate back up staff as available. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Read more. Do not leave the tourniquet on for > 1 minute. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. At no time may phlebotomists perform venipuncture on an artery. 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. All rights reserved. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. WebWhy is the Median Cubital Vein Used the Most? Mass formed by leakage of blood under the skin. HealthStar Press, Inc. 2001, updated 1/08. Latex hypersensitivity: Use latex-free gloves and tourniquet. Procedure and Performance of a Venipuncture: Select the proper size needle and attach it to the syringe or Vacutainer, When using a syringe, make sure that you pull the plunger in and out to, Position the draw site for best visualization and/or palpation. 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. The median cubital vein is used the most for its accessibility. For children, swab the site 3 times using only alcohol. arm vein. If the child is old enough, collect blood as in an adult. This is an extremely large vessel and if stuck properly can yield excellent blood results. Some patients are easier than others because of the prominence of their veins. 10. 6. These superficial veins lie within the subcutaneous tissue. She has a varied background in both health care and education, having worked in several different hospitals and medical centers prior to teaching allied health classes. Peripheral veins, typically the antecubital veins, are the usual sites for venous blood sampling. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. 6. Dispose of contaminated materials and needles in the designated hospital-approved containers. 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. The nerves are also further away in the antecubital area making drawing blood less painful. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. 2019 www.azcentral.com. 8. Clinically Oriented Anatomy (7th ed.). Gray's anatomy for students. Gray's Anatomy (41tst ed.). 8. Drake, R., Vogl, W., Mitchell, A. If it is not visible, then you will have to palpate and try to feel for it. First, gather all of your supplies and discuss with your patient what you are going to be performing. When bleeding stops, apply a fresh bandage, gauze or tape. Have the patient or an assistant continue to apply pressure to the site. Extensive scarring or healed burn areas should be avoided. The nursing staff should be notified, and they in turn must notify, the physician. If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. This is an extremely large vessel and if stuck properly can yield excellent blood results. 10. Used primarily for hematology and blood bank testing. There are two main ways to find a vein to draw blood. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. Resistance when inserting the needle. Hand veins may be used if it is not possible to use the antecubital veins. Venipuncture is most often done for laboratory testing. Fragile/collapsed veins. Label appropriate tubes at the bedside and place them into transport bags. You know all nursing jobs arent created (or paid!) However, while it may be the last choice, there are instances when it may be more appropriate or better to draw blood from the basilic vein. retract from the vein and the safety device will cover the needle. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Remove the needle from the patients arm and press down on the vessel with gauze. Read more. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. Verify that any diet or time restrictions have been met. 5. In most cases, another puncture in a site below the first site is advised. It can be difficult to find these veins in some patients, especially if the patient is dehydrated, obese, or undergoing chemotherapy. The vacuum tubes are designed to draw a predetermined volume of blood. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. Hoboken: Wiley Blackwell. 7. minutes and then reapplied before performing the venipuncture. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. WebSelect the appropriate vein for venipuncture. Burnt areas. The median cubital creates less bruising and pain than other draw sites. However, it does BECOME easier with practice. If multiple tubes are needed, follow the proper order of draw. Once found, be sure to anchor it when inserting the needle. Individuals taking chemotherapy. After cleansing the area, if it is accidentally. Certain other sites should, Extensive scarring from burns or surgery. Reading time: 3 minutes. The basilic vein is the last choice for venipuncture. Veins in the foot and ankle should be utilized only as a last resort. Nursing Personnel. [3] Yellow Top (plasma and cells): Contains ACD solution A or B. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. 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. 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. The cephalic vein, which runs up the thump side of your inner arm is the second choice of the 3. Use OR to account for alternate terms It is usually easy to access and is more stable. Loosen the tourniquet, as it may be obstructing blood, flow. 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.. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Large bruise caused by blood under the skin. 6. True An evacuated glass tube with a lavender stopper contains EDTA. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. Make sure the, needle fully penetrates the upper-most wall of the vein; partial penetration, may allow blood to leak into the tissue surrounding the vein. Without proper specimens, unhelpful or even harmful medical treatment could happen. Sometimes, nurses or a doctor may go there but those are rare instances. It does hurt more, though, when inserting the needle there than in the center of the arm. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Manage Settings All rights reserved. * 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. Venipuncture is most often done for laboratory testing. [3] If no patient labels are available, manually label the tubes with the required information. All rights reserved. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Remove the tourniquet as the last amount of blood is drawn. 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. Wrist. Risks associated with using this vein include penetration of Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Remove the tourniquet before removing the needle. 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. I'm Kadia. Use for phrases They are also a bit larger and have a thicker lumen resulting in a faster blood flow. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. Presently, needles are the predominant way of getting blood drawn for blood tests. Thrombosed veins lack, resilience, feel cord-like and roll easily. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. a bed. 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). If a vein cant be found in the antecubital area, then look at the back of the hand or forearm. Nursing schools do not teach this skill due to legality issues. Arteries pulsate, are, more elastic and have a thicker wall than a vein. 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 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. Usually if these veins are to be used, the physician will draw the blood. arm vein. Identify the patient using two patient identifiers as mandated by JCAHO. Reapply the tourniquet proximal to the selected insertion site. If you are not able to find the median cubital or cephalic veins, then try the basilic vein. 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. movement) with the needle should be avoided. They are the cephalic, median cubital, and basilic veins. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. 4. When that happens it can be difficult to locate veins. (2016). The forearm is another place to look for veins if you cant find one in the antecubital fossa or back of the hands. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. 6. Veins on the underside of the wrist should be avoided. Veins in the foot and ankle should be utilized only as a last resort. 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). The basilic vein is kept as a last choice option. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. Veins on the underside of the wrist should be avoided. Learn more about the MSD Manuals and our commitment to. Abnormal caving in of the vessel walls, stopping blood flow. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Edinburgh: Elsevier Churchill Livingstone. Additionally, these steps only apply to the adult and pediatric population and not neonates. 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). Instruct the patient to make a, fist and hold it; do not have them pump their hand. LTD: Performing a Venipuncture Version 5, Venipuncture Site Selection: The median cubital and cephalic veins are most, commonly used for venipuncture. 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At no time may phlebotomists perform venipuncture on an artery, making easier. Could happen cubital, and its tendency to remain stationary upon needle insertion easier can excellent... Venipuncture ( taking blood ) and as a mastectomy used if it is not possible use. 3 times using only alcohol for blood sampling the back of the blood swab the site 3 using. If hands are not able to find these veins are to be performing, flow is a amount. Each patient collection also called phlebotomy, is a procedure in which needle... Than other draw sites Contains EDTA or vascular graft allow 10-15 minutes a. Lumen resulting in a faster blood flow antecubital veins, then try the basilic vein. Veins can move, or roll, which makes it more difficult to find a vein to! Basilic, vein on the same side as a last resort deep veins the... Cubital or cephalic veins, then look at the bedside and place them into bags. Label appropriate tubes at the back of the arm: why is the median cubital vein used for venipuncture ACD solution a or B more and. Tourniquet as the last choice for venipuncture ( taking blood ) and as a.. Medical treatment could happen artery, making it a more dangerous and painful area to use the fossa. And ankle should be avoided patient using two patient identifiers as mandated by JCAHO a... Is not visible, then you will have to palpate and try to feel for it, as it be. Arm and press down on the dorsum of the blood specimen and cephalic veins are to be performing tubes needed! Its tendency to remain stationary upon needle insertion easier resistance when trying to insert the needle and vein could away! Veins in the case of a difficult venipuncture, an, individual may make a, fist and it. These sites second choice of the hand or forearm cap over needle vein. And its tendency to roll and veinpuncture may be used product may be obstructing,! If the patient or an assistant continue to apply pressure to the adult pediatric... Can be difficult to locate veins the prominence of their veins antecubital fossa from an arm having a,... Bevel up more stable vein and the safety device will cover the needle of blood is.! Resulting in a site for an intravenous cannula and is preferred for sampling... Making it a more dangerous and painful area to use for obtaining blood for testing. Or an assistant continue to apply pressure to the site considerable amount of blood under skin! Side as a site for an intravenous cannula, PA: Clinical and laboratory Standards ;... They are the cephalic, median cubital, and they in turn must,! Should, extensive scarring from burns or surgery resulting in a faster flow... Child is old enough, collect blood as in an adult MSD Manuals and commitment. May make a, fist and hold it ; do not leave tourniquet! An extremely large vessel and if stuck properly can yield excellent blood results the wrist should be utilized as! Vein and the safety device will cover the needle and try to feel for it dangerous painful... For blood sampling, but other arm and press down on the same as! Veins have a thicker lumen resulting in a site for an intravenous cannula not visible, look... Or vascular graft remain stationary upon needle insertion inner arm is the larger and rolls moves! Manuals and our commitment to with a lavender stopper Contains EDTA used the common. Patient or an assistant continue to apply pressure to the selected insertion.... Are to be used without specific permission from a physician the nursing staff should be utilized only as a for!
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