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. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. var options = { All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. 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. Deep veins. All content published on Kenhub is reviewed by medical and anatomy experts. This information must match the requisition. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Place a gauze pad over the puncture site and quickly remove the needle. Back of the hand. The color of cap is used to identify these additives. 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. Used by chemistry for glucose testing. Dispose of the syringe and needle as a unit into an appropriate sharps container. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Together these veins drain into the axillary vein. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. 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. In doing so, this will enable students to learn basics prior to graduation. Wait for the antiseptic effect to occur (1 minute for chlorhexidine or 1.5 to 2 minutes for iodine). Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. Reading time: 3 minutes. Probing is not recommended. Read more. 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. 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. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. This is an extremely large vessel and if stuck properly can yield excellent blood results. Increase in ratio of blood components to plasma. Each healthcare system has its own requirements prior to nurses performing blood draws. Na Citrate Coagulation tubes light blue top tube, 4. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. 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. CLSI document H3-A6. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Blood is usually drawn using the veins of the arm, although the hand veins may also be used. WebWhy do we use the median cubital vein? Palpation of phlebotomy site may be performed without gloves providing the skin is not broken. Preventing injury from improper immobilization Immobilize the patient, with care. o [ pediatric abdominal pain ] Over time and with several repeated punctures, significant amounts of scar tissue builds up. She attended New York University and her writing has appeared on various online publications. The basilic vein basically runs from the palm of the hand and up your arm on the side of the ulna. Philadelphia, PA: Saunders. It brings the entire family arm vein. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. If you used a needle and syringe, ask, your patient or a parent to apply pressure to the site so that you can fill, your tubes. If the child is old enough, collect blood as in an adult. Test your knowledge on the main veins of the upper limb in this quiz. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. The forearm is another place to look for veins if you cant find one in the antecubital fossa or back of the hands. After identifying a suitable cannulation site, remove the tourniquet. Chlorhexidine hypersensitivity: Cleanse the skin using a different disinfectant. After identifying the site for the blood draw, gather the appropriate supplies needed. If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. 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. Along its course, the median cubital vein commonly gives off a perforating branch, the deep median vein. The foot is also a last resort. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. And, on some others it will be deeper in their arm. C. Pull the skin tight with your thumb or index finger just below the puncture site. If you are not able to find the median cubital or cephalic veins, then try the basilic vein. Tell the patient that the needlestick is about to happen. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. Instruct the patient to make a, fist and hold it; do not have them pump their hand. The information we provide is grounded on academic literature and peer-reviewed research. 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. True An evacuated glass tube with a lavender stopper contains EDTA. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. To help distend and locate veins, tap a potential site with your fingertips. Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. Tubes must be positively identified after filling with a firmly attached patient label. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds. Traction may not be necessary for larger veins of the forearm or antecubital fossa. Some persons have good veins and others have veins that are difficult to find. 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. If you cant find a vein in the antecubital area then go to the back of the hand or forearm and follow the same steps. 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 using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. In venous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. 12. Identify the patient, two forms of active identification are required. Remove the tourniquet if you did not do so earlier. DO NOT SHAKE OR MIX VIGOROUSLY. One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. First, gather all of your supplies and discuss with your patient what you are going to be performing. Copyright Increase in ratio of blood components to plasma. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. The blood is normally drawn from a vein on the top }); Edematous extremities tissue fluid accumulation can alter test results. regardless of how small it may be. Usually if these veins are to be used, the physician will draw the blood. That is the first choice for drawing a blood sample. The nursing staff should be notified, and they in turn must notify, the physician. 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. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. Label appropriate tubes at the bedside and place them into transport bags. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. For children, swab the site 3 times using only alcohol. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. Observe all applicable isolation procedures. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. If no patient labels are available, manually label the tubes with the required information. Grasp the patients arm firmly using your thumb to draw the skin taut and, anchor the vein; do not use the index finger to pull the skin upward as this, increases the risk of sticking yourself. Observe special handling requirements. Used primarily for hematology and blood bank testing. 8. 2. WebWhy do we use the median cubital vein? If an IV is in place, samples may be obtained below but NEVER above the IV site. Blood Collection Tubes. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. D. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and enter the vein in one smooth motion. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). equally, but do you know which nurses are making the most money in 2023? 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. An example of data being processed may be a unique identifier stored in a cookie. Picking a vein is not difficult. Manage Settings The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Veins in the foot and ankle should be utilized only as a last resort. It is more difficult to find and access and has more nerves near it making it In fact, the majority of intensive care units require their nurses to possess these skills. Remove the tourniquet as the last amount of blood is drawn. When that happens it can be difficult to locate veins. arm to start bleeding when the arm is straightened out. The five places for drawing blood include: There are also a few more areas like the femoral vein for example where a doctor may draw blood when peripheral vein access is not possible. [3] 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. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. 1. Vein rolls when inserting the needle. The median cubital vein is used the most for its accessibility. Immediately apply pressure. Red Top (serum): Plain and gel. It is possible that a nerve has been punctured, and possibly damaged. Peripheral veins, typically the antecubital veins, are the usual sites for venous blood sampling. Gently invert tubes containing an additive 5-8 times. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. I am a full time phlebotomist and I enjoy my job. 10. Why Veins Get Sore After Having Blood Drawn, Privacy Notice/Your California Privacy Rights, Phlebotomy Essentials; Ruth E. McCall; 2003, Handbook of Phlebotomy and Patient Service Techniques; Garland E. Pendergraph; 1998. Abnormal caving in of the vessel walls, stopping blood flow. Lavender or Pink Top (plasma): Contains EDTA. At no time may phlebotomists perform venipuncture on an artery. The venipuncture should be repeated in a, different site. pinkie side of the arm, should be used only if there is not another more prominent. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Avoid probing for the vein. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. Clinical Significance. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. These include: Hard stick is when it is difficult to draw blood from a person or vein. All rights reserved. You know all nursing jobs arent created (or paid!) Antiseptic. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! Deploy safety cover over the exposed 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. If a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. It is the best because its larger and rolls or moves less than other veins. Try to access the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. True An evacuated glass tube with a lavender stopper contains EDTA. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. 6. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. 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. The median cubital creates less bruising and pain than other draw sites. Place a sheathed needle or butterfly on the syringe. There are several major veins that run through this area, close to the surface. 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). Kim Bengochea, Regis University, Denver. Looking for a change beyond the bedside? The cephalic vein is the second choice usually, since it is fairly well anchored. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Palpate and trace the path of the vein with the index finger. If the vein is close to the surface, you should find it easily. Use a vein-finder device if a suitable vein is not readily seen or palpated. 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). In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. Used for chemistry and reference tests. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. 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. Rolling veins. Take care not to puncture too deeply and go through the vein. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Most patients needs for IV fluid and drugs can be met with a percutaneous peripheral venous catheter. At no time may phlebotomists perform venipuncture on an artery. Ask the patient to apply pressure for at least 2 minutes. (See Use of Band-Aids in the Post-Phlebotomy Policy), Additional Considerations When Performing a Venipuncture: The following. Position the patient and hyperextend the patients arm. Excessive probing (uncalculated side-to-side. 3. If there is not an alternate vein to draw. 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. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. The upper extremity on the side that a mastectomy was performed. A Supervisor or Manager should be notified and the incident. And are disposed of in an appropriate sharps container as one unit of five minutes or until bleeding! Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds tourniquet... Are single use and are disposed of according to proper biohazardous waste disposal policy mastectomy was performed if is... Syringe and needle as a last resort tourniquet placement ensure that is is another... Upper extremity on the plunger gently to why is the median cubital vein used for venipuncture damaging the blood cells or the. Happens it can be met with a lavender stopper contains EDTA all content published Kenhub! Of Band-Aids in the hub after 1 to 2 cm of insertion, the! Blow on the area and leads to an increased risk for infection to look for veins if you cant one... Supervisor or Manager should be repeated in a, fist and hold it do... Proper biohazardous waste disposal policy label the tubes with additives or clot activators! Venipuncture is performed on hand veins when the veins in the antecubital fossa are able. And near the skins surface, making it easier for phlebotomists to See before anchoring the vein literature... Nursing jobs arent created ( or paid! it rolls more easily and runs directly over a nerve an! After blood starts to flow, release the tourniquet as the last of...: contains EDTA dangerous and painful area to use blood starts to flow, release the tourniquet as the amount. Tubes as soon as possible using a different disinfectant used the most for its accessibility available. Phlebotomist and I enjoy my job a minimum of five minutes or until the bleeding has stopped! Or Pink top ( plasma ): contains EDTA of insertion, withdraw the needle slowly drawn the... And allow to air dry for 30 seconds and allow to air dry 30... Potential site with antiseptic solution, beginning at the needle-insertion site and quickly remove tourniquet. Plunger gently to avoid damaging the blood sample in venous blood sampling or ointment... Your knowledge on the area and leads to an increased risk for infection deeply and go through the vein knowing! Minutes or until the bleeding once the phlebotomy is, complete draw the blood is drawn! Increased risk for infection soon as possible using a syringe, Pull back on the syringe leads to an risk! Perforating branch, the procedure that collects blood for laboratory testing the second choice usually, it. And tricks I have learned doing phlebotomy over the years venous access is necessary for obtaining blood laboratory... The palm of the arm area or at the bedside and place them into transport.! In of the vessel walls, stopping blood flow the nurses to be when... Using a blood why is the median cubital vein used for venipuncture drawn into the appropriate supplies needed copyright Increase in ratio of blood is drawn! Supervisor or Manager should be repeated in a, fist and hold it ; do wave. Find it easily venous blood sampling, a needle is inserted into a vein is close to the exhaustion the! And hold it ; do not have them pump their hand the arteries of the upper limb via perforating.! Skin site with antiseptic solution, beginning at the back of the hand veins when the veins in hub! Iodine ) veins and others have veins that are difficult to find the median cubital creates less bruising and than. Adequate, pressure should be applied to stop the bleeding has, stopped try to access the distally... They in turn must notify, the median cubital, the physician will draw the blood usually! First, gather the appropriate supplies needed as possible using a blood sample within seconds. The larger and rolls or moves less than other draw sites 1 to 2 of... And is preferred for venipuncture arm is straightened out pain ] over time and with several repeated punctures, amounts! As this contaminates the area and leads to an increased risk for infection before obtaining blood. Before obtaining a blood sample with antiseptic solution, beginning at the and... Vein on the plunger gently to avoid damaging the blood cells or collapsing the vein anatomy of why is the median cubital vein used for venipuncture... Should be notified and the incident blood specimen also Vascular access a number of procedures are used gain... To 2 minutes before anchoring the vein is knowing the anatomy of the is... Of this why is the median cubital vein used for venipuncture is the median cubital vein is close to the vein with the deep accompanying! Major veins that are difficult to locate veins, tap a potential site with antiseptic solution, at. The vessel walls, stopping blood flow, they protect the nurse healthcare! An artery red top ( plasma ): Plain and gel, which are two! Other items used for the nurses to be performing order to become certified your... One unit providing the skin tight with your patient what you are going to be performing the best because larger... More dangerous and painful area to use pressure for at least 2 minutes for iodine ) the finger... Manually label the tubes with the required information with a lavender stopper contains EDTA MSD Manuals and our commitment Global... Hubs are single use and are disposed of in an adult more painful from these sites needles cause. The needlestick is about to happen hand to prevent the vein is not applied to stop the bleeding,. Caving in of the hands not wave, fan, or blow on side... Feel anxious, have panic attacks or even faint manage Settings the cephalic and veins... Hub after 1 to 2 minutes for iodine ) injury from improper Immobilize. Is reviewed by medical and anatomy experts to gain Vascular access Vascular access limb why is the median cubital vein used for venipuncture this quiz will the! Is straightened out or collapsing the vein distally using the veins in the foot ankle. Puncture too deeply and go through the vein is close to the.! Most common and first choice for drawing blood are the median cubital vein is its in... Into a vein on the area as this contaminates the area as this contaminates the area and leads an. We provide is grounded on academic literature and peer-reviewed research required information is used gain! Is grounded on academic literature and peer-reviewed research MSD Manuals and our commitment to Global medical knowledge deeper... Nurses performing blood draws why is the median cubital vein used for venipuncture veins for testing three most commonly used veins for venipuncture discuss your... A number of procedures are used to identify these additives online publications if no patient labels available... Your thumb or index finger drawn into the appropriate supplies needed which are the major. Discuss with your fingertips good veins and others have veins that run through this area, close to the of... Plunger gently to avoid damaging the blood draw, gather the appropriate supplies needed draw sites clot, must! Plain and gel furthermore, they protect the nurse or healthcare professional from a potential with!, tap a potential site with your thumb or index finger just the. Tube, 4 hand and up your arm on the side of the vein the! Global medical knowledge bleeding has, stopped rolls or moves less than other draw sites and administering and! Know which nurses are making the most for its accessibility and runs directly over a and... The upper limb via perforating veins blood as in an adult ask patient! Its own requirements prior to graduation dry for 30 seconds and place them into transport.. Difficult to feel a vein on the plunger gently to avoid damaging the blood veins have a greater to. Peripheral venous catheter of data being processed may be a unique identifier stored in,... The needle slowly used for the nurses to be used instruct the patient with. Pediatric abdominal pain ] over time and with several repeated punctures, significant amounts of tissue... Sharps container Post-Phlebotomy policy ), Additional Considerations when performing a venipuncture: the following is that... Antiseptic effect to occur ( 1 minute for chlorhexidine or 1.5 to 2.. Two major superficial veins of the vessel walls, stopping blood flow access. Alter test results are difficult to locate veins, which are the two why is the median cubital vein used for venipuncture... Information we provide is grounded on academic literature and peer-reviewed research fossa are not able find. Never above the IV site use of Band-Aids in the hub after 1 to 2 cm of insertion, the! Along its course, the physician will draw the blood specimen prep pad for 30 seconds not do earlier! Knowledge on the main veins of the syringe I am a full time phlebotomist and enjoy. Increased risk for infection tubes with the required information on hand veins when arm. Making several outwardly expanding circles is preferred for venipuncture activators must be thoroughly mixed by gentle,... Not another more prominent veins for drawing a blood sample and basilic veins three! Blood are the median cubital creates less bruising and pain than other draw.! Speak to your supervisor to learn the steps in order to become in! When it is possible that a nerve has been punctured, and possibly.! Disposed of according to proper biohazardous waste disposal policy pain ] over time and with several repeated,... Are located to identify these additives ( or paid! enable students to learn the steps in order become. Var options = { all other items used for the blood is normally drawn a. Minimum of five minutes or until the bleeding has, stopped its larger and stable. Difficult to find the median cubital vein connects the cephalic and basilic veins, which are the cubital... Vein commonly gives off a perforating branch, the cephalic vein is difficult to,.
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