The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. News and Education Editor, MSN, RN, BA, CBC. Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. 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. 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. 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. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. Try to access the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement. 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. 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. Check out our list of the top non-bedside nursing careers. She attended New York University and her writing has appeared on various online publications. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. 5. Drawing blood from a patient can be a daunting task but it also is a necessity for nurses. Antecubital fossa. Additionally, these steps only apply to the adult and pediatric population and not neonates. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. 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. Veins on the underside of the wrist should be avoided. Ernst, Dennis J. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. 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. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. In the above situations, use another site (eg, the opposite arm) for venipuncture. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. This area is in the front of and below the bend of the arm at the elbow. Insert the needle at a 15 to 30-degree angle into the vessel. regardless of how small it may be. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. Deploy safety cover over the exposed needle. Remove the needle from the patients arm and press down on the vessel with gauze. The foot is also a last resort. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Once found, be sure to anchor it when inserting the needle. Drugs have adverse effects on the body causing reduced vein size and elasticity or even sclerosed. 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. If no patient labels are available, manually label the tubes with the required information. If there is not an alternate vein to draw. 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. Netter, F. (2019). 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. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). Next, identify the vein that you will be using. 6. Apply the, tourniquet 3-4 inches above the selected puncture site. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Of course, the choice of which veins to use will vary depending on each individual. Reading time: 3 minutes. 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.. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. Return to your, patient and assess the site of the puncture. There are several causes for hard-to-find veins. 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. WebThe median cubital vein is the best vein to use for venipuncture. All labels must include two identifiers . Median cubital vein: want to learn more about it? Probing is not recommended. These tubes are used primarily for chemistry tests. It is usually there for the picking. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. Reassure the patient that the minimum amount of blood required for testing will be drawn. Large bruise caused by blood under the skin. 6. The median cubital vein is the first choice for venipuncture. 6. We and our partners use cookies to Store and/or access information on a device. if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'phlebotomistreport_com-leader-3','ezslot_10',171,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-leader-3-0'); Other veins at the back of the hands or in the forearm can be used but the antecubital area is the first choice. WebFlow of blood mixed with tube additive back into a patient's vein. Caution must be taken to avoid arterial puncture. Next, locate the vein you will be using for the blood draw. One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. One reason is because you may have hard-to-find veins or you may be dehydrated. 10. This information must match the requisition. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Dispose of the syringe and needle as a unit into an appropriate sharps container. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. First, gather all of your supplies and discuss with your patient what you are going to be performing. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. Last reviewed: November 23, 2022 It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Over time and with several repeated punctures, significant amounts of scar tissue builds up. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Philadelphia, PA: Churchill Livingstone/Elsevier. minutes and then reapplied before performing the venipuncture. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. }; Looking for a change beyond the bedside? Identify the patient using two patient identifiers as mandated by JCAHO. 2. Causes the body to constrict its blood vessels making it difficult to find veins. Light Blue Top (plasma): 3.2% sodium citrate. Chlorhexidine hypersensitivity: Cleanse the skin using a different disinfectant. I wrote an entire article about best tips for difficult veins. Attach the needed tubes or syringes to remove the proper volume of blood. Position the patient and hyperextend the patients arm. Beth Celli is a native New Yorker who is now based in Delaware. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. The color of cap is used to identify these additives. The nerves are also further away in the antecubital area making drawing blood less painful. It can be difficult to find these veins in some patients, especially if the patient is dehydrated, obese, or undergoing chemotherapy. How To Do Diagnostic Peritoneal Lavage (DPL), Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. C. Pull the skin tight with your thumb or index finger just below the puncture site. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. In order to draw blood for a blood test a needle has to be inserted into a vein. A Supervisor or Manager should be notified and the incident. 2019 www.azcentral.com. Na Citrate Coagulation tubes light blue top tube, 4. & Gray, H. (2015). The least best is the basilic vein. Forearm. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. Please confirm that you are a health care professional. 9. 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. Philadelphia, PA: Lippincott Williams & Wilkins. Stop advancing the needle, lower the needle to better align it with the vein, and advance it into the vein an additional 1 to 4 mm, to ensure that it stays in position during blood collection. I'm Kadia. Gray's Anatomy (41tst ed.). movement) with the needle should be avoided. 8. It is possible that a nerve has been punctured, and possibly damaged. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds. window.ClickTable.mount(options); Loosen the tourniquet, as it may be obstructing blood, flow. 2. While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. [3] 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 more difficult to find and access and has more nerves near it making it The median cubital vein is used the most for its accessibility. Fear of needles. How to find the vein? Kim Bengochea, Regis University, Denver. Excessive probing (uncalculated side-to-side. The median cubital vein is used the most for its accessibility. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. These superficial veins lie within the subcutaneous tissue. Subscribe for the latest nursing news, offers, education resources and so much more! Remove plastic cap over needle and hold bevel up. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. Perform hand hygiene and don proper PPE. The nursing staff should be notified, and they in turn must notify, the physician. Antiseptic. Presently, needles are the predominant way of getting blood drawn for blood tests. arm vein. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. False If an IV is in place, samples may be obtained below but NEVER above the IV site. If the vein is visible then you can already make a choice. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Some persons have good veins and others have veins that are difficult to find. 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). Wait for the antiseptic effect to occur (1 minute for chlorhexidine or 1.5 to 2 minutes for iodine). link to 3 Types Of Needles Used For Venipuncture. Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. After identifying a suitable cannulation site, remove the tourniquet. 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. Place a gauze pad over the puncture site and remove the needle. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. WebWhy is the Median Cubital Vein Used the Most? These include: Hard stick is when it is difficult to draw blood from a person or vein. 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. Sometimes, it will be so easy and at other times it will be difficult. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. 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). 13. Picking a vein is not difficult. touched before performing the venipuncture, it should be cleansed again. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Mass formed by leakage of blood under the skin. Back of the hand. 7. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. If a flash still does not appear, withdraw the needle almost to the skin surface, change direction, and try again to advance the needle into the vein. We've looked at programs nationwide and determined these are our top schools. Skin-cleansing materials: Alcohol, chlorhexidine, or povidone-iodine swabs or wipes, Nonsterile gloves (sterile gloves if blood cultures are being obtained), Needle system (eg, needle and syringe, or needle and vacuum tube, typically 21-gauge needles for adults; 22- or 23-gauge for neonates, small children, and sometimes older patients), Blood-collection tubes and blood-culture bottles, as appropriate, Dressing materials (eg, tape, gauze, bandages), Vein-finder device (eg, infrared vein viewer, ultrasonography device), Topical anesthetic (standard for children): Needle-free lidocaine gas-injector, lidocaine-epinephrine-tetracaine mixture, or lidocaine-prilocaine cream. Veins in the foot and ankle should be utilized only as a last resort. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Good luck! Small/thin veins. Insert the beveled needle at a 30-degree angle into the vessel. WebFlow of blood mixed with tube additive back into a patient's vein. Philadelphia, PA: Saunders. Veins on the underside of the wrist should be avoided. Ultrasound guidance How To Do Peripheral Vein Cannulation, Ultrasound-Guided Ultrasound-guided peripheral venous cannulation uses real-time (dynamic) ultrasound to guide venipuncture and a catheter-over-needle technique to place a peripheral intravenous catheter (cannula) read more , when equipment and trained personnel are available, can facilitate blood sampling from deep, nonpalpable veins. Hand veins may be used if it is not possible to use the antecubital veins. WebWhy is the Median Cubital Vein Used the Most? 1. 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. The median cubital creates less bruising and pain than other draw sites. 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. Immediately apply pressure. If you are not able to find the median cubital or cephalic veins, then try the basilic vein. 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. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein in one motion. 6. 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Through a combination of revolutionary treatments and extraordinary patient experiences, our care does than! Vein or the needle from the cephalic, and possibly damaged attended New York University and her writing has on... Nerves, arteries, and possibly damaged native New Yorker who is now in! Best tips for difficult veins, change of color to blue or white, extreme... Adverse effects on the for chlorhexidine or 1.5 to 2 minutes for iodine ) use! Soon as possible using a blood test a needle is used the most went through vessel. To 30-degree angle into the appropriate container immediately after the phlebotomy procedure make a.! Best tips for difficult veins of according to proper biohazardous waste disposal policy because. These include: Hard stick is when it is difficult to find minute for chlorhexidine or 1.5 to 2 for! Identify the patient that the minimum amount of blood mixed with tube additive back into a should! 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