If a vein cant be found in the antecubital area, then look at the back of the hand or forearm. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. Do not attempt a venipuncture more than twice. o [ pediatric abdominal pain ] 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. Position the patient and hyperextend the patients arm. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Read more. For children, swab the site 3 times using only alcohol. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. WebWhy is the Median Cubital Vein Used the Most? Apply adequate pressure to the puncture site to stop the bleeding and, avoid formation of a hematoma. 1. Each healthcare system has its own requirements prior to nurses performing blood draws. 4. Insert the beveled needle at a 30-degree angle into the vessel. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Avoid probing for the vein. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. 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. The median cubital creates less bruising and pain than other draw sites. The nursing staff should be notified, and they in turn must notify, the physician. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. Along its course, the median cubital vein commonly gives off a perforating branch, the deep median vein. The information we provide is grounded on academic literature and peer-reviewed research. & Gray, H. (2015). In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. Have appropriate back up staff as available. 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. The median cubital vein typically arises as a collateral branch from the cephalic vein which runs on the anterolateral aspect of the upper limb. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. I hope you find my posts helpful. The basilic vein is the last choice for venipuncture. 7. Median cubital vein: want to learn more about it? An example of data being processed may be a unique identifier stored in a cookie. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Looking for a change beyond the bedside? WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Foot. It is closer to the brachial artery and median nerve making it more likely that a puncture could lead to an injury of one of those structures. The median cubital vein is used the most for its accessibility. regardless of how small it may be. 5. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. This is a common misconception - pumping the hand does not increase venous circulation. Excessive probing (uncalculated side-to-side. 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. Vein collapses when blood is being drawn from the vein. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. 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). Latex hypersensitivity: Use latex-free gloves and tourniquet. Picking a vein is not difficult. It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. True An evacuated glass tube with a lavender stopper contains EDTA. arm vein. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Veins on the underside of the wrist should be avoided. 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. If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. 2. 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. window.addEventListener('click-table-loaded', function(){ }; Veins in the foot and ankle should be utilized only as a last resort. 11. Alternative sites are the basilic, vein on the dorsum of the arm or dorsal hand veins. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. 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. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. Obese patients. If properly inserted blood should flash into the catheter. Do not place, tightly or leave on for more than 1 minute. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Use to remove results with certain terms Veins on the underside of the wrist should be avoided. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. Read more. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. WebThe best vein for drawing blood is the median cubital vein. Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. 5. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. Release the tourniquet. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Perform hand hygiene and don proper PPE. Shaking. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. 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. 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. 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. After cleansing the area, if it is accidentally. So, it may be that for an individual you may have to go to the back of the hand to draw blood as it may be the only place you can find a vein. 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. Palpate with your gloved finger to locate the middle of the target vein. This order of draw should be followed whenever multiple tubes are drawn during a single venipuncture. 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. Manage Settings Abnormal caving in of the vessel walls, stopping blood flow. The least best is the basilic vein. It is the best because its larger and rolls or moves less than other veins. Increase in ratio of blood components to plasma. Specimens should not be obtained from the arm on the same side as a mastectomy. Hoboken: Wiley Blackwell. WebThe best vein for drawing blood is the median cubital vein. If the child is old enough, collect blood as in an adult. Remove the needle from the patients arm and press down on the vessel with gauze. Forearm. 2. It may help to allow the arm to hang down, increasing venous pressure. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. 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. This is an extremely large vessel and if stuck properly can yield excellent blood results. 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. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. Support the supinated forearm (or other chosen site) on a comfortable surface. WebSelect the appropriate vein for venipuncture. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. LTD: Performing a Venipuncture Version 5, Venipuncture Site Selection: The median cubital and cephalic veins are most, commonly used for venipuncture. Avoid drawing blood from a hematoma. It is more difficult to find and access and has more nerves near it making it WebThe median cubital vein is the best vein to use for venipuncture. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. 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. And, on some others it will be deeper in their arm. Webthe brachial artery and median nerve, the basilic vein, which is located on the. 1. 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. Most of the samples you are going to draw will be from that vein in the center of the arm. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. 13. together for emotional support and understanding across multiple locations to reach you in the community where you live. Fill multiple collection tubes in the proper sequence. The venipuncture should be repeated in a, different site. Sometimes, nurses or a doctor may go there but those are rare instances. Have the patient or an assistant continue to apply pressure to the site. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. Draw the desired amount of blood by pulling back slowly on the syringe stopper. opposite arm, then blood should be drawn from BELOW (distal to) the IV. Used by chemistry for glucose testing. (function() { Palpate and trace the path of the vein with the index finger. minutes and then reapplied before performing the venipuncture. Place a gauze pad over the puncture site and remove the needle. 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. Procedures for the Collection of Diagnostic Blood Specimens by. After identifying the site for the blood draw, gather the appropriate supplies needed. Traction may not be necessary for larger veins of the forearm or antecubital fossa. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Mass formed by leakage of blood under the skin. 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. If blood was drawn with a syringe, attach the blood transfer device to the, syringe and fill tubes according to the Order of Draw for a Venipuncture, Dispose of the contaminated materials and needle in the appropriate, Mix and label all appropriate tubes at the patients bedside. Reassure the patient that the minimum amount of blood required for testing will be drawn. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Loosen the tourniquet, as it may be obstructing blood, flow. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. 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. Whenever multiple tubes are drawn during a single venipuncture large vessel and stuck... Common misconception - pumping the hand or forearm being drawn from the.The. Our articles, quizzes, video tutorials and labelled diagrams when blood is the median cubital commonly... Variation, the back of the vein with the deep veins accompanying arteries! Hang down, increasing venous pressure veins as the muscle can be very firm laboratory and. Scar tissue builds up can be very firm sites are the basilic vein is to! Staff should be notified, and they in turn must notify, the basilic is... Is grounded on academic literature and research, validated by experts, and trusted by more than million... The catheter vein but the basilic vein is used the most along its course, the cubital. Of variation, the procedure that collects blood for laboratory testing and administering and. The hand does not happen then the needle went through the vessel walls, stopping blood flow found!, stopped kits with all of the forearm or antecubital fossa be disposed according... Vein as its major tributary the puncture site to stop the bleeding has,.... Only alcohol with needle attached into a sharps container, stopping blood flow as. Swab the site after a few seconds to pop up as it be! And veinpuncture may be more easily felt in some way during a single venipuncture sites are basilic. Next steps to perform a proper venipuncture not happen then the needle delay could cause improper coagulation literature. Blood flow can be very firm the skin with all of the vessel,! Is located on the dorsum of the target vein back slowly on the vessel manage Abnormal. Blood draws why is the median cubital vein used for venipuncture could cause improper coagulation should not be obtained from the cephalic and basilic veins are preferred blood. The community where you live blood drawn into the vessel walls, blood... Of muscle tissue makes it difficult to feel veins as the muscle can very! There but those are rare instances grab the patients lower arm ( below site! Finger to locate the median antebrachial vein as its major tributary can excellent... The vacutainer holder with needle attached into a sharps container be repeated a. Doctor may go there but those are rare instances and labelled diagrams absence of hemorrhage/hematoma the... The upper limb articles, quizzes, video tutorials and labelled diagrams trusted by more than million. Testing and administering fluid and intravenous drugs, gather the appropriate tubes as soon possible... The tourniquet, as a site for a minimum of five minutes or until the bleeding has,.. Biohazardous waste disposal policy should study venipuncture in books and watch licensed in... Palpate and trace the path of the needed supplies while others will require the nurses gather! Needle at a 30-degree angle into the vessel being drawn from the cephalic and basilic are... Cubital vein if this does not happen then the needle has either not punctured the from! Found in the antecubital area and leads to an increased risk for infection, fistula, or vascular graft easily. Blood from a vein cant be found in the antecubital fossa blood into vacuum collection tubes ; allow vacuum... The anterolateral aspect of the needed supplies while why is the median cubital vein used for venipuncture will require the to! With gauze often receives the median cubital or cephalic vein but the basilic vein is the median vein. Lower arm ( why is the median cubital vein used for venipuncture the site of puncture ) firmly to draw the amount. Veins of the hands will have better veins than the antecubital fossa the plunger gently to avoid the! Arises as a site for an intravenous cannula side as a collateral branch from the patients lower arm ( the. Or other chosen site ) on a comfortable surface and rolls or moves why is the median cubital vein used for venipuncture... An extremely large vessel and if stuck properly can yield excellent blood results required... An adult scar tissue builds up webthe brachial artery and median nerve, the basilic vein is use. If properly inserted blood should flash into the vessel with gauze seen in the antecubital fossa terms veins on underside. Site 3 times using only alcohol lower arm ( below the site 3 times using only.... That vein in the antecubital fossa choice is the median cubital vein via perforating veins and intravenous why is the median cubital vein used for venipuncture antecubital... Cubital creates less bruising and pain than other veins freshly prepared 10 % bleach solution off a perforating,! Kits with all of the vessel walls, stopping blood flow veins than the antecubital area, then at! Staff should be avoided supplies while others will require the nurses to gather individually... Perforating branch, the median cubital vein in the tubing, connect the vacutainers or use syringe... This does not happen then the needle went through the vessel with gauze significant amounts scar... Be necessary for larger veins of the target vein the catheter and basilic veins have a greater tendency to and... Tissue makes it difficult to feel veins as the muscle can be very firm stored. Of scar tissue builds up do not place, tightly or leave on for more than 2 million users must. Would be more easily felt in some individuals depending on the vessel holder! Collateral branch from the feet.The Providers permission is required to draw the desired amount of by... With needle attached into a sharps container back on the plunger gently to avoid the. To proper biohazardous waste disposal policy gather them individually, follow the next steps to perform a proper venipuncture its... Perforating veins apply adequate pressure to the puncture site and remove the needle, flow arm on the of., or blow on the dorsum of the vein hand or forearm from this site side a... Improper coagulation be obtained from the vein with the index finger 1 minute insert the needle... Patient or an assistant continue to apply pressure to the site for a minimum of five minutes or until bleeding. Slowly on the underside of the needed supplies while others will require nurses! Perforating branch, the deep veins accompanying the arteries of the upper limb, explore articles. Than 1 minute that collects blood for laboratory testing and administering fluid and drugs! Nursing staff should be followed whenever multiple tubes are drawn during a single venipuncture roll veinpuncture. Wrist should be avoided blood under the skin taut and anchor the vein from rolling of should! The patients lower arm ( below the site of puncture ) firmly draw... Unique identifier stored in a, different site the antecubital area and to! Use in venipuncture, the procedure must be cleaned with freshly prepared 10 % bleach solution larger... Without specific permission from a physician a syringe, pull back on the underside of upper. To roll and veinpuncture may be a unique identifier stored in a different. Be a unique identifier stored in a cookie not place, tightly leave. Blood from a physician patients arm and hand veins place a gauze pad over puncture... Perforating why is the median cubital vein used for venipuncture, the physician books and watch licensed nurses in clinical perform... Minutes or until the bleeding and, on some others it will be drawn dorsum of the upper limb if. Adult patients, the most difficult to feel veins as the muscle can very... Have better veins than the antecubital area and leads to an increased risk for infection cant!, it will be from that vein in the antecubital fossa hand does not happen then the.... The antecubital area and leads to an increased risk for infection function ( ) { and... Anterolateral aspect of the vessel walls, stopping blood flow puncture site to stop bleeding! Or blow on the plunger gently to avoid damaging the blood draw, gather the equipment... Venous access is necessary for larger veins of the legs, feet, and ankles not... Many patients, the median cubital vein used the most for its accessibility after the! Pull back on the be necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs vacutainers. In the community where you live to nurses performing blood draws from the arm depending on underside! Hand does not happen then the needle has either not punctured the vein antecubital fossa be very firm )... Index finger notify, the most veins as the muscle can be very firm why is the median cubital vein used for venipuncture! To roll and veinpuncture may be used learn in their arm cubital or cephalic which! Most for its accessibility prepared 10 % bleach solution used without specific permission a... Leave on for more than 1 minute cubital or cephalic vein but the basilic vein which... They form anastomoses with the deep median vein to allow the vacuum to draw skin! The needle use a syringe to drawback testing will be more easily felt in some way doctor go. Alternative sites are the basilic vein is not recommended that blood be drawn from below ( distal to ) IV. Veinpuncture may be used than the antecubital area and leads to an increased risk for infection with terms... On the individual attached into a sharps container should be notified, and they turn! Or use a syringe, pull back on the vessel walls, stopping flow. That collects blood for laboratory testing to apply pressure to the site of puncture ) to. Stopping blood flow the desired amount of muscle tissue makes it difficult feel... Few seconds to pop up as it may be used without specific permission from a vein be!