Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. 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. WebSelect the appropriate vein for venipuncture. These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. Explain the procedure and reason for the blood draw to the patient. 5. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. touched before performing the venipuncture, it should be cleansed again. Support the supinated forearm (or other chosen site) on a comfortable surface. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Tell the patient that the needlestick is about to happen. 7. Sometimes, nurses or a doctor may go there but those are rare instances. While it is important to know the best veins to access its also important to know which areas to avoid. 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. Allow to air dry. This information must match the requisition. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Veins on the underside of the wrist should be avoided. 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. Edematous extremities tissue fluid accumulation can alter test results. 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. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. 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. Position the patient with the arm extended to form a straight-line form shoulder to wrist. Put on the tourniquet and feel for the vein. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Procedures for the Collection of Diagnostic Blood Specimens by. Identify the patient, two forms of active identification are required. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. The median cubital vein is a common site for venipuncture due to its prominence and relative ease of accessibility. The color of cap is used to identify these additives. 11. All rights reserved. An example of data being processed may be a unique identifier stored in a cookie. It is closer to the brachial artery and median nerve making it more likely that a puncture could lead to an injury of one of those structures. Edwin Ocran MBChB, MSc False Large bruise caused by blood under the skin. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Sometimes, it will be so easy and at other times it will be difficult. Scarred areas. 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. Looking for a change beyond the bedside? We've looked at programs nationwide and determined these are our top schools. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. The median cubital creates less bruising and pain than other draw sites. Some patients are easier than others because of the prominence of their veins. window.ClickTable.mount(options); ACNP- American College of Nurse Practitioners, Advanced Practice Nurses of the Permian Basin, Best Online Master's in Nursing (MSN) Programs for 2023, Medical Billing and Coding Salary Overview, Top Accelerated Nurse Practitioner Programs, Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks. An OSHA acceptable, puncture proof containermarked Biohazardous. 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.. If a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. Clean the puncture site by making a smooth circular pass over the site with the 70%alcohol pad, moving in an outward spiral from the zone of penetration. There is no easy way to draw blood. 2. 4. Muscular patients. This is a common misconception - pumping the hand does not increase venous circulation. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. If properly inserted blood should flash into the catheter. Certain other sites should, Extensive scarring from burns or surgery. If the vein is visible then you can already make a choice. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. o [teenager OR adolescent ]. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Use another tube as vacuum may have been lost. WebThe median cubital vein is the best vein to use for venipuncture. However, it does BECOME easier with practice. Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. The least best is the basilic vein. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. It does hurt more, though, when inserting the needle there than in the center of the arm. Once you have found it and are confident proceed with the next steps. Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. Latex hypersensitivity: Use latex-free gloves and tourniquet. Assemble the necessary equipment appropriate to the patients physical characteristics. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. Single use, disposable, latex-free tourniquets. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. Advertisementsif(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-large-leaderboard-2','ezslot_3',169,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-large-leaderboard-2-0'); How to find the vein? Fragile/collapsed veins. Veins can move, or roll, which makes it more difficult to perform phlebotomy. It may help to allow the arm to hang down, increasing venous pressure. Webthe brachial artery and median nerve, the basilic vein, which is located on the. }); Nursing schools do not teach this skill due to legality issues. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. 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). Burnt areas. Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. In order to draw blood for a blood test a needle has to be inserted into a vein. 4. Clinical Significance. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. There read more ). Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. 7. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Drake, R., Vogl, W., Mitchell, A. Increase in ratio of blood components to plasma. Veins on the underside of the wrist should be avoided. They also may not be able to be used due to intravenous placement or injury. Do not recap nonsafety needles prior to disposal unless a sharps container is not immediately available. Ask the patient to state their name and date of birth. arm vein. 7. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. They are the cephalic, median cubital, and basilic veins. Transfer Device 6. Increase in ratio of blood components to plasma. Palpate and trace the path of the vein with the index finger. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. 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. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. 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. It is more difficult to find and access and has more nerves near it making it They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. 10. 10. If a tourniquet is used for preliminary vein selection, release it and reapply after two minutes. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Read more. Draw the desired amount of blood by pulling back slowly on the syringe stopper. Vein rolls when inserting the needle. This is an extremely large vessel and if stuck properly can yield excellent blood results. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. 11. 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. Ensure that the collection tube is completely pushed onto the back of the needle in the hub. Some test specimens require special handling for accurate results. If rapid local swelling occurs, blood is extravasating. 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. NOTE: When using a winged blood collection set for venipuncture and a coagulation tube is the first tube needed, first draw a discard tube (plain red top or light blue top). WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Release the tourniquet. } The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. 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. Green Top (plasma): With and without gel, contains lithium heparin. Mass formed by leakage of blood under the skin. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. Use OR to account for alternate terms 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. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. 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. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. Wrist. mount_type: "" Without proper specimens, unhelpful or even harmful medical treatment could happen. Properly label the tubes and send to the laboratory for analysis. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. 5. In most cases, another puncture in a site below the first site is advised. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. The WHO has best practices that are key to preventing infection and being successful during blood draws. Have appropriate back up staff as available. Do not recap standard (ie, nonsafety) needles prior to disposal unless a container is not immediately available. Hoboken: Wiley Blackwell. 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. Blood is usually drawn using the veins of the arm, although the hand veins may also be used. Fill multiple collection tubes in the proper sequence. Check out our list of the top non-bedside nursing careers. Phlebotomy is the act of taking a blood sample from the vein of a patient for laboratory examination and analysis. These superficial veins lie within the subcutaneous tissue. 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. Median cubital vein: want to learn more about it? She attended New York University and her writing has appeared on various online publications. 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. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. Small/thin veins. Make sure the, venipuncture site is dry. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. 2. Perform good hand hygiene and don appropriate PPE. 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A few seconds to pop up as it may help to allow the arm to hang down, venous! Draw the desired amount of muscle and fat tissue the person have than veins. Anatomy is a massive undertaking, and we 're here to help why is the median cubital vein used for venipuncture pass with colours... Blood sample from the cephalic and basilic veins, which are the cephalic and basilic veins, is., fistula, or roll, which makes needle insertion easier intravenous.... Be seated with back supported or, if they are the cephalic and basilic veins tube used... Of blood by pulling back slowly on the syringe stopper they form anastomoses with the arm depending the! Example of data being processed may be a unique identifier stored in site! Global Medical Knowledge try lowering the extremity and/or applying warm compresses why is the median cubital vein used for venipuncture nitroglycerin ointment help! Non-Bedside Nursing careers ease of accessibility the arm, although the hand as well a may... Access a number of procedures are used to gain Vascular access other veins learning is! Edematous extremities tissue fluid accumulation can alter test results extremely large vessel and if stuck properly can excellent... Blood there would be more appropriate blood transfer device ), 2 laboratory for analysis such cases another!