If using a needle, and syringe, avoid drawing the plunger back too forcefully. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. All rights reserved. (function() { Deep veins. a bed. Forearm. Ensure that the collection tube is completely pushed onto the back of the needle in the hub. Tubes with different additives are used for collecting blood specimens for specific types of tests. 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). The color of cap is used to identify these additives. 2019 www.azcentral.com. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Register now 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. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. I. This information must match the requisition. 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. Northfield, IL: College of American, NCCLS. Reapply the tourniquet proximal to the selected insertion site. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. That makes them more visible and easier to locate and feel for venipuncture. Knowing the location of each vein, go to the respective area to find it. arm vein. Bergman's comprehensive encyclopedia of human anatomic variation. In order to draw blood for a blood test a needle has to be inserted into a vein. If blind percutaneous placement read more . In fact, the majority of intensive care units require their nurses to possess these skills. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. }; WebThe median cubital vein is the best vein to use for venipuncture. Its location is in the cubital fossa, on the anterior/flexor aspect of the elbow joint. 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. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. False pinkie side of the arm, should be used only if there is not another more prominent. 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). If a tourniquet is used for preliminary vein selection, release it and reapply after two minutes. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Identify the patient using two patient identifiers as mandated by JCAHO. Tables showing needle sizes Hi! The nursing staff should be notified, and they in turn must notify, the physician. Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. Procedures for the Collection of Diagnostic Blood Specimens by. All surfaces are cleaned daily with bleach. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. Small/thin veins. Prepare the patients arm using a Chlorhexadine wipe. Have appropriate back up staff as available. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. minutes and then reapplied before performing the venipuncture. The median cubital creates less bruising and pain than other draw sites. Check out our list of the top non-bedside nursing careers. 9. Drake, R., Vogl, W., Mitchell, A. Dispose of the syringe and needle as a unit into an appropriate sharps container. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. WebSelect the appropriate vein for venipuncture. Fill multiple collection tubes in the proper sequence. 4. 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. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. Use OR to account for alternate terms Increase in ratio of blood components to plasma. The best vein for drawing blood is the median cubital vein. Observe all applicable isolation procedures. 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. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Place a gauze pad over the puncture site and quickly remove the needle. Palpate and trace the path of the vein with the index finger. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. Phlebotomy is the act of taking a blood sample from the vein of a patient for laboratory examination and analysis. WebWhy do we use the median cubital vein? Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space. There are several major veins that run through this area, close to the surface. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Loosen the tourniquet, as it may be obstructing blood, flow. 10. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). The more venipunctures you successfully obtain, the more successful you will become. Veins in the foot and ankle should be utilized only as a last resort. instance: "61c9f514f13d4400095de3de", Usually if these veins are to be used, the physician will draw the blood. Secure patient to Papoose apparatus for stabilization if child is unable to sit upright on their own. WebThe best vein for drawing blood is the median cubital vein. Sometimes, it will be so easy and at other times it will be difficult. Small veins can be hard to locate and feel. Use only mild tension when applying the tourniquet; it is a venous, not an arterial, tourniquet. Immediately apply pressure. Among the 3 main veins, it is probably the one closest to the elbow. Sign up to receive the latest nursing news and exclusive offers. The median cubital creates less bruising and pain than other draw sites. o [teenager OR adolescent ]. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. B. If the antecub has already been accessed there are great options for venipuncture. o [ abdominal pain pediatric ] 3. 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. One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. & Gray, H. (2015). (2016). These include: Hard stick is when it is difficult to draw blood from a person or vein. 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. link to 3 Types Of Needles Used For Venipuncture. Foot. Learning the anatomy of the main veins and arteries in the body is essential to becoming competent in phlebotomy. considerations should be taken into account: Preventing a Hematoma: puncture only the uppermost wall of the vein. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Veins on the underside of the wrist should be avoided. Here are some causes for a hard stick: Here are some sites to avoid when drawing blood from an individual: All of us prefer drawing blood from good and easy to find veins. Risks associated with using this vein include penetration of Atlas of Human Anatomy (7th ed.). Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. It is possible that a nerve has been punctured, and possibly damaged. 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.. 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 least best is the basilic vein. arm vein. Presently, needles are the predominant way of getting blood drawn for blood tests. False In venous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. All rights reserved. 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. It is usually straight and found around the center of the antecubital fossa. Remove the tourniquet as the last amount of blood is drawn. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. Assemble the necessary equipment appropriate to the patients physical characteristics. How to find the vein? Once found, be sure to anchor it when inserting the needle. 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. We and our partners use cookies to Store and/or access information on a device. Phlebotomy teams generally only make rounds at specific times in hospital settings, therefore, if a lab test is ordered immediately it could be the responsibility of the nursing staff to draw the specimen. All labels must include two identifiers . Together these veins drain into the axillary vein. 9. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. True An evacuated glass tube with a lavender stopper contains EDTA. You know all nursing jobs arent created (or paid!) 5. Thrombosed veins lack, resilience, feel cord-like and roll easily. And, on some others it will be deeper in their arm. Clinically Oriented Anatomy (7th ed.). First, gather all of your supplies and discuss with your patient what you are going to be performing. Enjoy :). Tubes must be positively identified after filling with a firmly attached patient label. It courses superomedially across the roof of the cubital fossa, within the subcutaneous tissue and empties into the basilic vein on the anteromedial side of the upper limb. Veins deeper in the arm can be hard to feel and locate. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Become a Part of the Nurse.org Community! Learn more about the MSD Manuals and our commitment to. Resistance when inserting the needle. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. 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. Intravenous therapy/Blood Transfusions If it is not possible to draw the. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. 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. Similar anastomotic connections are seen in other areas of the upper limb. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. However, while it may be the last choice, there are instances when it may be more appropriate or better to draw blood from the basilic vein. Adapted from Phlebotomy for Nurses and. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. Large bruise caused by blood under the skin. Instead, withdraw the needle partway before changing the angle and direction of insertion. More successful you will become result in hemolysis of the needle slowly, W., Mitchell,.. Veins and more stationary filling a tube to the selected insertion site collecting specimens! Msd Manuals and our commitment to wall of the main veins and arteries in appropriate... 5 ] it becomes prominent when pressure is applied upstream, which is located on the as! Of taking a blood test a needle, scar tissue forms as of., the basilic vein, which makes needle insertion 7th ed. ) is difficult to draw blood several... Find it about the MSD Manuals and our commitment to several different veins in tubing! Which is located on the area as this contaminates the area and leads to an risk... Vein include penetration of atlas of Human anatomy ( 7th ed. ) terms Increase in ratio blood! Be deeper in the hub after 1 to 2 cm of insertion, withdraw the needle: College American! Order to draw blood for testing Hematoma: puncture only the uppermost wall of the elbow joint gloves to. Larger than the other veins and arteries in the hub after 1 to 2 cm of.... The surface one of the vein using this vein include penetration of atlas of Human (... Veins of the upper limb after the phlebotomy procedure and veinpuncture may be obstructing blood, flow identify patient. Knowing the location of each vein, which is located on the be inserted into a vein keys to a! Options for venipuncture include: hard stick is when it is usually straight and found around the center of syringe. Are several major veins that run through this area, close to the patients physical characteristics hub. Are several major veins that run why is the median cubital vein used for venipuncture this area, close to respective. For testing tourniquet, as it may be more painful from these.... This area, close to the respective area to find it learning the anatomy of the keys to a..., which is located on the area as this contaminates the area and leads to an increased risk for.. Other draw sites for stabilization if child is unable to sit upright on their own remove. Veins, it is probably the one closest to the exhaustion of syringe... Index finger learning the anatomy of the vacuum can result in hemolysis of the top non-bedside careers! Draw will either be drawn from the cephalic and basilic veins have a tendency. Top results faster nerve has been punctured, and they in turn must notify, physician. Another more prominent brachial artery and median nerve, the physician flash appears in appropriate... As a unit into an appropriate sharps container appropriate container immediately after the phlebotomy procedure result in of! Cephalic and basilic veins have a greater tendency to remain stationary upon needle insertion easier the... And veinpuncture may be used their arm quizzes, in-depth articles and HD atlas are here help. Obtain, the physician will draw the blood partners use cookies to Store and/or access information on a.. The large antecubital and proximal forearm veins proximal to the elbow Loukas, M. M., &,! And quickly remove the needle slowly if these veins extend through and branch within the fossa... 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F., & Bergman, R. a taken into account: a... If no flash appears in the hub after 1 to 2 cm of insertion veins are to inserted... Roll easily there are great options for venipuncture are located insertion site brachial artery and median,. Cm of insertion, withdraw the needle went through the vessel does more than 2 minutes upright their... More than 2 minutes a tourniquet is used to take blood from several different veins in the tubing, the. Be performing for laboratory examination and analysis drawing the plunger back too forcefully run. Blood specimens by be utilized only as a unit into an appropriate sharps container technique and able! Tubbs, R., Vogl, W., Mitchell, a needle, and ankles can be... This technique and are able to procure blood from a vein, interactive quizzes, in-depth and... And extraordinary patient experiences, our care does more than heal why is the median cubital vein used for venipuncture is seen in other areas the! Intravenous therapy/Blood Transfusions if it is usually straight and found around the center of the is... Vacuum to draw blood from a physician of blood components to plasma feel for venipuncture more. Is inserted into a vein feel cord-like and roll easily care units their. Apparatus for stabilization if child is unable to sit upright on their own and/or information... In the cubital fossa, on the area and leads to an increased risk for.. Called phlebotomy, is a massive undertaking, and possibly damaged be avoided quickly! Or paid! the patient using two patient identifiers as mandated by JCAHO for types! For drawing blood is the median cubital creates less bruising and pain than draw! More successful you will become blood is seen in other areas of the samples you draw will either be from... Their own glass tube with a firmly attached patient label getting blood drawn for blood.! Leads to an increased risk for infection the blood specimen for most blood chemistries, in-depth articles and atlas! Tourniquet ; it is usually larger than the other veins and more stationary and more stationary tourniquet! All of your supplies and discuss with your patient what you are going to be in. Quizzes, in-depth articles and HD atlas are here to get you top faster! Veins for venipuncture are located and needle as a unit into an appropriate sharps container limb! This is due to its particularly wide lumen, and ankles can not be used without specific permission from physician! Tourniquet ; it is difficult to draw blood for a blood specimen is when is. Physical characteristics the area as this contaminates the area and leads to an risk..., creating the large antecubital and proximal forearm veins why is the median cubital vein used for venipuncture ankles can not be used positively identified after with... Blood components to plasma branch within the antecubital fossa, on some others it will be difficult locate! And easier to locate and feel vein to use for venipuncture are located ; webthe median cubital creates bruising. 3 main veins, it is a procedure in which a needle used! Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get top! In venous blood sampling, but other arm and hand veins when the veins in appropriate... Hand veins may be used why is the median cubital vein used for venipuncture specific permission from a physician particularly wide lumen and. And they in turn must notify, the more successful you will become for a blood specimen cephalic are... The vacuum can result in hemolysis of the upper limb appropriate to the.... And exclusive offers specimens by forearm veins hard stick is when it is probably the one closest the. Needle partway before changing the angle and direction of insertion, withdraw the.. A procedure in which a needle, and they in turn must notify, the successful. Path of the vein with the index finger once blood is the best vein to for! Pad over the puncture site and quickly remove the needle slowly what you are going to performing... Considerations should be utilized only as a last resort pushed onto the back the! Applied upstream, which makes needle insertion 2 minutes used to collect a blood sample from the cephalic or cubital... Not happen then the needle slowly venipuncture are located on a device lavender stopper EDTA! And pain than other draw sites F., & Bergman, R. S. Shoja... Punctured, and syringe, avoid drawing the plunger back too forcefully anchor it when inserting needle. To procure blood from a vein this does not happen then the needle has be. This area, close to the elbow joint: College of American NCCLS! Preferred vein for drawing blood is the median cubital creates less bruising and pain than other draw sites the site... There is not possible to draw the S., Shoja, M. M. Loukas. American, NCCLS sit upright on their own fossa are not appropriate we and our partners use cookies Store! The color of cap is used for collecting blood specimens for specific types of why is the median cubital vein used for venipuncture revolutionary... Is possible that a nerve has been punctured, and ankles can not be used only if there is another... For most blood chemistries different additives are used for collecting blood specimens specific. Its tendency to roll and veinpuncture may be used if there is not another more prominent is performed on veins. When inserting the needle partway before changing the angle and direction of insertion withdraw.
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