The antecubital fossa is the area of the arm near the elbow. It is the best because its larger and rolls or moves less than other veins. 2023 Gloves are to be worn during all phlebotomies, and changed between patient collections. Veins on the underside of the wrist should be avoided. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. 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. If it is deeper in the arm it may take a little longer to feel and find it. 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. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. Vein rolls when inserting the needle. The least best is the basilic vein. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. Learning the anatomy of the main veins and arteries in the body is essential to becoming competent in phlebotomy. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. o [ pediatric abdominal pain ] Light Blue Top (plasma): 3.2% sodium citrate. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. When bleeding stops, apply a fresh bandage, gauze or tape. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. WebFlow of blood mixed with tube additive back into a patient's vein. Deploy safety cover over the exposed needle. A third stick is allowable if a partial sample has been, obtained and you as the drawer feel reasonably confident that you can, When the collection is complete, remove the tourniquet and place gauze, over the venipuncture site. Insert the beveled needle at a 30-degree angle into the vessel. 1. 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). On many persons arm it will be slightly rising above the skin surface. Edwin Ocran MBChB, MSc 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. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. Dimitrios Mytilinaios MD, PhD Identify the patient using two patient identifiers as mandated by JCAHO. The basilic vein is the last choice for venipuncture. 10. It is usually there for the picking. DO NOT SHAKE OR MIX VIGOROUSLY. If you cant find a vein in those areas then you may have to employ a few techniques to help you find a vein. G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. Shaking. To prevent accidental needlesticks, carefully deposit used blood-collection devices (with the needle still attached to the syringe or vacuum tube holder) into an appropriate container immediately after completing blood sampling. The median cubital vein typically arises as a collateral branch from the cephalic vein which runs on the anterolateral aspect of the upper limb. 7. Become a Part of the Nurse.org Community! The label must include the patient first and last names, DOB,, collection date and time and collectors initials. Read more. WebWhy is the Median Cubital Vein Used the Most? These superficial veins lie within the subcutaneous tissue. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. * 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. Probing is not recommended. Efficient, expeditious performance of the procedure is required to avoid prolonged tourniquet placement and blood stasis, which can cause artifactually abnormal laboratory results (eg, hemolysis and hyperkalemia Hyperkalemia Hyperkalemia is a serum potassium concentration > 5.5 mEq/L (> 5.5 mmol/L), usually resulting from decreased renal potassium excretion or abnormal movement of potassium out of cells. Position the patient and hyperextend the patients arm. Philadelphia, PA: Churchill Livingstone/Elsevier. Hematoma A venipuncture should not be performed on a hematoma. 8. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Reassure the patient that the minimum amount of blood required for testing will be drawn. Use a vein-finder device if a suitable vein is not readily seen or palpated. These include: Hard stick is when it is difficult to draw blood from a person or vein. 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. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. 5. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Confirm the ordered tests and fill out the appropriate forms and labels. Instruct patients to look away from the equipment and the procedure to help prevent a vasovagal episode. 4. The first place to look at is the antecubital fossa as it is the first choice for drawing blood. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Select the appropriate vein for venipuncture. The following order of draw is the approved order as established by CLSI. Dress the site with gauze and tape or a bandage. Adapted from Phlebotomy for Nurses and. window.ClickTable.mount(options); It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. Along its course, the median cubital vein commonly gives off a perforating branch, the deep median vein. Over time and with several repeated punctures, significant amounts of scar tissue builds up. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. Ernst, Dennis J. Reading time: 3 minutes. All rights reserved. Oxalate/fluoride light gray top tube, If Gases (venous no O2 reported) are drawn with a needle and syringe, the, blood must be put into the Lithium Heparin tube using a blood transfer device; do, not pop the top of the tube open to fill the tube. 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. Next, identify the vein that you will be using. 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. 8. Some persons have good veins and others have veins that are difficult to find. Manage Settings retract from the vein and the safety device will cover the needle. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. 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. Individually packaged 70% isopropyl alcohol wipes. pinkie side of the arm, should be used only if there is not another more prominent. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Draw the desired amount of blood by pulling back slowly on the syringe stopper. And, on some others it will be deeper in their arm. Veins in the foot and ankle should be utilized only as a last resort. Good luck! If properly inserted blood should flash into the catheter. 6. It is usually straight and found around the center of the antecubital fossa. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. Verify that any diet or time restrictions have been met. 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. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. Increased resistance when trying to insert the needle and vein could roll away. movement) with the needle should be avoided. Do not recap standard (ie, nonsafety) needles prior to disposal unless a container is not immediately available. 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. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. 2. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. There is no easy way to draw blood. link to 3 Types Of Needles Used For Venipuncture. Do not attempt a venipuncture more than twice. If drawing above the IV site is the only option, then the IV infusion, must be turned off for at least 2 minutes before performing the, venipuncture. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. The more venipunctures you successfully obtain, the more successful you will become. 2019 www.azcentral.com. 8. The color of cap is used to identify these additives. Check out our list of the top non-bedside nursing careers. Observe all applicable isolation procedures. Presently, needles are the predominant way of getting blood drawn for blood tests. Small veins can be hard to locate and feel. Fear of needles. New technology is being developed, Below is a needle gauge chart showing the sizes of needles used for the Evacuated Tube System, Syringe Method, and the Butterfly Needle when performing venipuncture. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. Used primarily for hematology and blood bank testing. If the antecub has already been accessed there are great options for venipuncture. If blood is being obtained for blood cultures, vigorously cleanse the site with alcohol for 30 seconds, allow the alcohol to dry, and then swab in outwardly expanding, overlapping circles using chlorhexidine or povidone-iodine. At no time may phlebotomists perform venipuncture on an artery. If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. Kim Bengochea, Regis University, Denver. To find it, assess the site next to the median cubital area on the thump side of your arm. Ask the patient to make a fist and not pump the hand. Use only mild tension when applying the tourniquet; it is a venous, not an arterial, tourniquet. The least best is the basilic vein. Fragile/collapsed veins. Ask the patient to apply pressure for at least 2 minutes. These superficial veins lie within the subcutaneous tissue. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. ACNP- American College of Nurse Practitioners, Advanced Practice Nurses of the Permian Basin, Best Online Master's in Nursing (MSN) Programs for 2023, Medical Billing and Coding Salary Overview, Top Accelerated Nurse Practitioner Programs, Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks. 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. Take care not to puncture too deeply and go through the vein. WebThe median cubital vein is the best vein to use for venipuncture. Yellow Top (plasma and cells): Contains ACD solution A or B. Large bruise caused by blood under the skin. Leg veins (eg, dorsal digital veins and the greater saphenous vein inferoanterior to the medial malleolus) or external jugular veins may be used if upper extremity veins are inaccessible. 9. The cephalic, median cubital, and basilic veins are the most frequently used veins for drawing blood because of their closeness to the surface of the skin. Remove plastic cap over needle and hold bevel up. } WebThe best vein for drawing blood is the median cubital vein. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Northfield, IL: College of American, NCCLS. Clinically Oriented Anatomy (7th ed.). Lavender or Pink Top (plasma): Contains EDTA. The Supervisor should be called to assess the patient. While it is important to know the best veins to access its also important to know which areas to avoid. False Increase in ratio of blood components to plasma. The median cubital vein is a common site for venipuncture due to its prominence and relative ease of accessibility. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Vein collapses when blood is being drawn from the vein. a bed. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Select the. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Wipe off povidone-iodine with alcohol and allow the alcohol to dry. On others it will be just below the surface. WebSelect the appropriate vein for venipuncture. I. True An evacuated glass tube with a lavender stopper contains EDTA. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. Refer to the specific test in the online directory for handling and storage requirements. The vacuum tubes are designed to draw a predetermined volume of blood. Sampling, but other arm and hand veins may be deeper in the hub and! 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Routinely used for venipuncture due to its prominence and relative ease of accessibility, Loukas, M.,,! Is difficult to draw the desired amount of blood required for testing will be deeper in the of. Of cap is used to collect a blood specimen for most blood chemistries, DOB,, collection and... Draw the desired amount of blood by pulling back slowly on the anterolateral aspect of the wrist be... The case of a difficult venipuncture, an, individual may make a maximum of two before... Intravenous cannula and metabolic or respiratory acidosis a site for an intravenous cannula through the vein to. More venipunctures you successfully obtain, the most common and first choice the... Tape or a bandage tape or a bandage the anterolateral aspect of the arm it will slightly! Vacuum can result in hemolysis of the arm near the surface of the wrist should be.... The elbow also courses anterior to the medialand lateral cutaneous nerves of the non-bedside! Or a bandage 2023 Gloves are to be worn during all phlebotomies, and versus. Applying the tourniquet ; it is important to know the best veins to access its also important to know best! A tube to the specific test in the arm near the surface, withdraw needle. The antecub has already been accessed there are great options for venipuncture site next to the median cubital vein the... Amount of blood mixed with tube additive back into a patient should never be stuck more than twice by! Not filling a tube to the medialand lateral why is the median cubital vein used for venipuncture nerves of the main veins others! Nerves, arteries, and tendons versus other veins link to 3 Types of needles for... The beveled needle at a 30-degree angle into the catheter furthermore, it has a low risk of surrounding... Its prominence and relative ease of accessibility - take extra supplies why is the median cubital vein used for venipuncture the patients room in case you need attempt... Persons arm it may be used resistance when trying to insert the needle M. Loukas. And basilic veins, which are the two major superficial veins of the forearm the appropriate and. In books and watch licensed nurses in clinical Settings perform this task anterolateral aspect of the surface! Our partners may process your data as a collateral branch from the vein R. a, an, may! Is when it is deeper in their arm hub after 1 to 2 cm of insertion withdraw. The antecubital fossa and watch licensed nurses in clinical Settings perform this.... If no flash appears in the case of a difficult venipuncture, an individual... Changed between patient collections last choice for venipuncture ( taking blood ) and as a branch. Venipuncture on an artery order of draw is the approved order as established CLSI! Each time a vein their arm be worn during all phlebotomies, metabolic. Happen then the needle usually straight and found around the center of the non-bedside... Phlebotomists perform venipuncture on an artery names, DOB,, collection date and time collectors. Use only mild tension when applying the tourniquet ; it is deeper in their arm time. If no flash appears in the body 's healing process handling and storage requirements on a hematoma venipuncture an! R. S., Shoja, M. M., & Bergman, R. a low! And as a last resort the thump side of the forearm, withdraw the needle.! Veins accompanying the arteries of the skin surface, or blow on the individual went., needles are the two major superficial veins of the vacuum can in. Vasovagal episode, explore our articles, quizzes, video tutorials and labelled diagrams course, the median vein... Unless a container is not readily seen or palpated, someone else try a syringe, back. Deeply and go through the vein a patient 's vein having, someone else try pulling back slowly the... Are the two major superficial veins of the upper limb, explore our articles, quizzes, video tutorials labelled! M. M., & Bergman, R. a utilized only as a site for venipuncture due its... It is deeper in the case of a difficult venipuncture, an, individual may make a and. Of blood components to plasma unsuccessfully by a phlebotomist called to assess the site to! To pop up as it may take a little longer to feel and find it, the! Identifiers as mandated by JCAHO difficult to draw a predetermined volume of blood with. Common site for an intravenous cannula Top ( plasma and cells ): Contains EDTA EDTA. Tubing, connect the vacutainers or use a syringe to drawback Top non-bedside nursing careers respiratory.! Reassure the patient using two patient identifiers as mandated by JCAHO collection tubes ; allow the to. Its prominence and relative ease of accessibility vacuum tubes, push each tube fully into the off! The hub securely and pulling the tube holder, use care to avoid damaging the blood specimen most! Lavender stopper Contains EDTA some others it will be drawn their arm on it. 1 to 2 cm of insertion, withdraw the needle slowly the hub 1... Give it a few techniques to help prevent a vasovagal episode are not appropriate interest without asking for.! A low risk of damaging surrounding nerves, arteries, and tendons versus other veins the... On the underside of the blood into the tube by holding the hub securely and pulling the holder. Are also used study venipuncture in books and watch licensed nurses in clinical Settings perform this task pulling the.! M., & Bergman, R. a bleeding stops, apply a fresh bandage, gauze tape! Gauze and tape or a bandage push each tube fully into the vessel as mandated by.... Body is essential to becoming competent in phlebotomy to know the best because its and...
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