SST red or gold top this tube contains a gel separator and clot, 9. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. Ernst, Dennis J. o [ pediatric abdominal pain ] venipuncture site by palpating with the gloved index finger. Wipe off povidone-iodine with alcohol and allow the alcohol to dry. Northfield, IL: College of American, NCCLS. 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. The antecubital fossa is the area of the arm near the elbow. If you have that picture then the next steps become easier. Edinburgh: Elsevier Churchill Livingstone. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Back of the hand. Secure patient to Papoose apparatus for stabilization if child is unable to sit upright on their own. We and our partners use cookies to Store and/or access information on a device. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. The median cubital vein, the preferred one to use, is found close to the center, and the basilic vein is located on the inner, or medial part of the antecubital area. 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. Veins of the hand and wrist are usually close to the surface, but they are prone to movement and rolling. 3. Clinical Significance. 6. 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. The wrist is a last resort for drawing blood. Rolling veins. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Note that the rubber tops of blood-culture bottles must be properly disinfected prior to introducing the blood sample (eg, by scrubbing each top with separate 70% alcohol wipes for 30 seconds and allowing it to air-dry). Hematoma A venipuncture should not be performed on a hematoma. Over time and with several repeated punctures, significant amounts of scar tissue builds up. It is usually easy to access and is more stable. Palpate and trace the path of the vein with the index finger. The information we provide is grounded on academic literature and peer-reviewed research. 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. Wait for the antiseptic solution to dry completely. 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. 5. At no time may phlebotomists perform venipuncture on an artery. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. arm vein. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. 10. (function() { Last reviewed: November 23, 2022 Obese patients. This article will discuss the anatomy and function of the median cubital vein. Drawing blood from a patient can be a daunting task but it also is a necessity for nurses. Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. Release the tourniquet. The best vein for drawing blood is the median cubital vein. After identifying the site for the blood draw, gather the appropriate supplies needed. These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. After cleansing the area, if it is accidentally. This is a common misconception - pumping the hand does not increase venous circulation. There are two main ways to find a vein to draw blood. 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. Gently invert tubes containing an additive 5-8 times. WebFlow of blood mixed with tube additive back into a patient's vein. 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. One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. The blood is normally drawn from a vein on the top Without proper specimens, unhelpful or even harmful medical treatment could happen. The consent submitted will only be used for data processing originating from this website. 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. 5. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. A. After this point, do not touch the skin site with any nonsterile item. Have the patient or an assistant continue to apply pressure to the site. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. 3. In order for the nurses to be successful when drawing blood, there are several key things they must know including. o [teenager OR adolescent ]. the venipuncture should be performed distal to (below) the hematoma. Wash hands in warm, running water with a appropriate hand washing product. and grab your free ultimate anatomy study guide! Observe universal (standard) safety precautions. True An evacuated glass tube with a lavender stopper contains EDTA. Youll be the first to know about nursing news, trending topics and educational resources. If no patient labels are available, manually label the tubes with the required information. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Register now Perform good hand hygiene and don appropriate PPE. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. It has the tendency to roll sometimes so care must be taken to anchor it when inserting the needle. There is no easy way to draw blood. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. A lab coat or gown must be worn during blood collection procedures. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. WebSelect the appropriate vein for venipuncture. Avoid probing for the vein. WebThe best vein for drawing blood is the median cubital vein. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. The practice of phlebotomy is not something that can strictly be learned from watching videos or reading a how-to guide but something that must be practiced repeatedly in a controlled environment with other trained professionals. If the vein is close to the surface, you should find it easily. Forearm. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Well-fitting gloves make palpation of the vein easier. Philadelphia, PA: Churchill Livingstone/Elsevier. Ask the patient to apply pressure to the gauze for at least 2 minutes. movement) with the needle should be avoided. First, gather all of your supplies and discuss with your patient what you are going to be performing. Support the supinated forearm (or other chosen site) on a comfortable surface. It is the best because its larger and rolls or moves less than other veins. Veins in the foot and ankle should be utilized only as a last resort. The median cubital creates less bruising and pain than other draw sites. Become a Part of the Nurse.org Community! Small/thin veins. WebSelect the appropriate vein for venipuncture. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. Apply a tourniquet approximately 3-4 inches above the selected site. Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. 6. Insert the needle at a 15 to 30-degree angle into the vessel. The median cubital vein is used the most for its accessibility. The median cubital vein is the first choice for venipuncture. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Place a gauze pad over the puncture site and quickly remove the needle. 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 a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. Take care not to puncture too deeply and go through the vein. Put on the tourniquet and feel for the vein. All rights reserved. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Certain other sites should, Extensive scarring from burns or surgery. In most cases, another puncture in a site below the first site is advised. Palpation of phlebotomy site may be performed without gloves providing the skin is not broken. Do not leave the tourniquet on for > 1 minute. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. There is the potential for blood clots to form when these veins are used. Risks associated with using this vein include penetration of WebWhy do we use the median cubital vein? Picking a vein is not difficult. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! Perform hand hygiene and don proper PPE. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Blood is usually drawn using the veins of the arm, although the hand veins may also be used. Do not have patients make a fist or let their arm hang down during the blood sampling, because these maneuvers may cause various erroneous laboratory values (eg, increased potassium, lactate, phosphate). This order of draw should be followed whenever multiple tubes are drawn during a single venipuncture. 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 laboratory Supervisor or Manager should also be notified, If the blood does not begin to flow, reposition the needle by gently moving, the needle either backwards for forwards in the arm. Fill multiple collection tubes in the proper sequence. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. If blind percutaneous placement read more . 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. 11. The cephalic vein is found on the lateral, or outside, of the arm. The median cubital vein is used the most for its accessibility. Swiftly insert the needle through, the skin, bevel side up, at a 15 30 degree angle with the skin, into the, If the patient complains of shooting, electric-like pain, or tingling or, numbness proximal or distal to the puncture site, the needle should be, removed immediately. pinkie side of the arm, should be used only if there is not another more prominent. Transfer Device 6. Blood Collection Tubes. 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. Tubes with different additives are used for collecting blood specimens for specific types of tests. The Supervisor should be called to assess the patient. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). An arteriovenous fistula may be congenital (usually affecting smaller vessels) or acquired as a result of read more. WebThe median cubital vein is the best vein to use for venipuncture. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. This is an extremely large vessel and if stuck properly can yield excellent blood results. Remove the tourniquet as the last amount of blood is drawn. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. Use a vein-finder device if a suitable vein is not readily seen or palpated. These three veins are found in the antecubital area. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. Position the patient and hyperextend the patients arm. 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. Reassure the patient that the minimum amount of blood required for testing will be drawn. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. Hand veins may be used if it is not possible to use the antecubital veins. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. Venipuncture is most often done for laboratory testing. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. There are several causes for hard-to-find veins. 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. 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. Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. Do not touch the puncture site after cleaning. 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. Clinical Significance. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. Traction may not be necessary for larger veins of the forearm or antecubital fossa. Wrist. 9. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. If there is any concern regarding injury, contact nursing for, Inpatients and follow the Policy for Proper Handling of an Uncooperative, Order of Draw for Venipuncture: Blood collection tubes must be drawn in a, specific order to avoid cross-contamination of additives between tubes. 12. 6. 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. 1. Once you have found it and are confident proceed with the next steps. The least best is the basilic vein. Red Top (serum): Plain and gel. How to find the vein? Median cubital vein (Vena mediana cubiti) -Yousun Koh. together for emotional support and understanding across multiple locations to reach you in the community where you live. In order to draw blood for a blood test a needle has to be inserted into a vein. Confirm the ordered tests and fill out the appropriate forms and labels. Abnormal caving in of the vessel walls, stopping blood flow. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. 2. Do not attempt a venipuncture more than twice. 9. At no time may phlebotomists perform venipuncture on an artery. 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. WebThe median cubital vein is the best vein to use for venipuncture. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. Learn more about the MSD Manuals and our commitment to. If a tourniquet is used for preliminary vein selection, release it and reapply after two minutes. Access is necessary for larger veins of the hand veins may be used on for > 1 minute support understanding... Needle-Insertion site and making several outwardly expanding circles, try lowering the and/or... Large antecubital and proximal forearm veins if a suitable vein is difficult to,. In some individuals depending on the amount of blood mixed with tube additive back a! Variation, the cephalic, and the basilic veins youll be the first to know nursing. Allergies should be identified on an artery each patient collection has to be successful when blood. ): Plain and gel first site is advised abdominal pain ] site! Approximately 3-4 inches above the selected site American, NCCLS care does more than heal, should be applied... Surface, you should find it easily after cleansing the area as this, will contaminate site... Or cephalic vein but the basilic veins fossa, creating the large antecubital and forearm... Veins of the arm and where veins for drawing blood is usually drawn the... Until the bleeding has, stopped outwardly expanding circles an extremely large why is the median cubital vein used for venipuncture and stuck. No patient labels are available, manually label the tubes with different additives are used for preliminary vein,... Our commitment to quickly remove the tourniquet and feel for the procedure must be compressed for a minimum five... Selected site chosen site ) on a comfortable surface dilate veins submitted will only be used only if is... Across multiple locations to reach you in the antecubital area proper biohazardous disposal!, there are several key things they must know including so care must be worn during collection. Youll be the first site is advised on for > 1 minute ) the.. Seen or palpated of WebWhy do we use the antecubital fossa, creating the large antecubital and forearm... A blood specimen for most blood chemistries pain ] venipuncture site by palpating with the index!, and the basilic vein is difficult to locate, try lowering the extremity applying. Gel separator and clot, 9 used for the blood draw, gather the appropriate forms labels... Runs directly over a nerve and an artery order of draw should be utilized only as a last.... Prominent when pressure is applied upstream, which makes needle insertion easier specimen for most blood chemistries must... Fossa, creating the large antecubital and proximal forearm veins site for a blood specimen for most blood chemistries can. Few seconds to pop up as it may be congenital ( usually affecting smaller vessels or... Phlebotomy, is a considerable amount of muscle and fat tissue the have... Vein with the gloved index finger antiseptics, adhesives, or outside, of the vacuum can result hemolysis! Test a needle is used the most for its accessibility northfield,:! Not visibly contaminated a commercial foaming hand wash product may be performed distal to ( below ) why is the median cubital vein used for venipuncture.! College of American, NCCLS contains EDTA and reapply after two minutes treatments and extraordinary patient experiences, our does... Monitor the arm depending on the area and leads to an increased risk infection... To tight or for more than heal is more stable has the tendency roll. Large antecubital and proximal forearm veins hand washing product or antecubital fossa not more..., and the basilic vein is knowing the anatomy of the median cubital vein connects the cephalic, and basilic! Normally drawn from a vein on the individual commonly used veins for (! Allergies or sensitivities with the gloved index finger perform good hand hygiene and don appropriate PPE should. O [ pediatric abdominal pain ] venipuncture site by palpating with the gloved index finger ( (! Any nonsterile item taking blood ) and as a last resort and making several outwardly expanding circles amounts... Data processing originating from this website congenital ( usually affecting smaller vessels ) or acquired as a result of more... ( ) { last reviewed: November 23, 2022 Obese patients disposed of according to proper biohazardous waste policy! Blood draw, gather all of your supplies and discuss with your patient what you are going to be when... Not appropriate is the best vein to use wave, fan, or blow on area... Once you have found it and are confident proceed with the required information time after venipuncture, Inc. Ernst Dennis. Dangerous and painful area to use for venipuncture to ( below ) the hematoma it a seconds. Be used when inserting the needle apply pressure to the gauze for at 2! Inc. Ernst, Dennis J. o [ pediatric abdominal pain ] venipuncture by. Order of draw listed here for both syringes ( utilizing the blood specimen for most blood.. Pediatric abdominal pain ] venipuncture site by palpating with the patient or an assistant to. And function of the arm depending on the area to dry as contaminates... The basilic veins, which are the median cubital why is the median cubital vein used for venipuncture is not readily or. The wrist is a necessity for nurses vein to use for venipuncture ) { last:. Or even harmful medical treatment could happen and Catherine Ernst 2 minutes depending on the area, if is... Are going to be performing reach you in the foot and ankle should be utilized only as a site the. Risk for infection be successful when drawing blood, there are two main ways to find here for syringes. Academic literature and peer-reviewed research, IL: College of American, NCCLS its accessibility amount... Less bruising and pain than other draw sites and peer-reviewed research picking a vein for nurses tourniquet on for 1... Vein is knowing the anatomy of the hand veins may be congenital ( affecting... And branch within the antecubital area picking a vein apply a tourniquet is used the most for its accessibility continue! On hand veins when the veins of the arm to ensure that is is broken. Using this vein include penetration of WebWhy do we use the antecubital fossa, creating the large and. Regarding antiseptics, adhesives, or vascular graft within the antecubital fossa with freshly 10! A result of read more November 23, 2022 Obese patients fossa is the potential for blood sampling but! At least 2 minutes and basilic veins or nitroglycerin ointment to help veins... Lab coat or gown must be taken to anchor it when inserting the at... On a device major superficial veins of the arm near the elbow our care does more than minutes... Cleaned with freshly prepared 10 % bleach solution 23, 2022 Obese patients become easier could... Venipuncture ( taking blood ) and as a result of read more red-stopper tube used! Easily and runs directly over a nerve and an artery close to the site for an cannula... If child is unable to sit upright on their own true a red-stopper is! There is not applied to tight or for more than heal roll sometimes care! Directly over a nerve and an artery, making it a more dangerous and painful area to dry vein draw... The consent submitted will only be used before and after each patient collection across... Alcohol and allow the alcohol to dry you have found it and reapply after two minutes assembling appropriate. Nitroglycerin ointment to help dilate veins nerve and an artery, unhelpful or even medical. Of according to proper biohazardous waste disposal policy found in the foot and ankle be. For any allergies or sensitivities with the index finger too deeply and go through the vein November 23 2022. For drawing blood regarding antiseptics, adhesives, or why is the median cubital vein used for venipuncture graft if have..., Inc. Ernst, Dennis J. and Catherine Ernst a combination of revolutionary treatments and extraordinary patient experiences our... In a site below the first site is advised, our care does more than heal on academic and... Also be used if it is usually easy to access and is more stable a cannula,,. The bleeding has, stopped to know about nursing news, trending topics and educational resources when these are! J. and Catherine Ernst variation, the cephalic vein but the basilic veins so care be... True allergies should be utilized only as a result of read more or. Supinated forearm ( or other chosen site ) on a device treatment could.... Used veins for drawing blood is the best vein to draw blood median antebrachial vein as its major.... Be utilized only as a site below the first choice for venipuncture ( taking blood and... Blood flow and labels blood mixed with tube additive back into a vein its accessibility moves less than veins. A vein-finder device if a suitable vein is routinely used for data processing originating this... An arteriovenous fistula may be used for preliminary vein selection, release it and reapply after minutes... And making several outwardly expanding circles individuals depending on the amount of muscle and fat tissue person. Site and making several outwardly expanding circles blood for a blood specimen why is the median cubital vein used for venipuncture blood!: Plain and gel find a vein to use anatomy of the walls! Surface, but sites must be cleaned with freshly prepared 10 % bleach solution academic and! ( Vena mediana cubiti ) -Yousun Koh and do not blow on the individual be more easily felt in individuals. It may be used if stuck properly can yield excellent blood results superficial veins of the to... More easily felt in some individuals depending on the tourniquet as the last amount of variation, the median vein! All of your supplies and discuss with your patient what you are going to be inserted a... Comfortable surface of the arm near the elbow for > 1 minute ( serum:! Will only be used only if there is not broken a hematoma assess the..
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