Place a gauze pad over the puncture site and remove the needle. Remove the tourniquet if you did not do so earlier. Dont be discouraged if at first, you dont access the vein. Last reviewed: November 23, 2022 These include: Hard stick is when it is difficult to draw blood from a person or vein. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Venipuncture is a skill that takes time and practice to master. Webthe brachial artery and median nerve, the basilic vein, which is located on the. The median cubital vein is used the most for its accessibility. 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 in the foot and ankle should be utilized only as a last resort. 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. Oxalate/fluoride light gray top tube, If Gases (venous no O2 reported) are drawn with a needle and syringe, the, blood must be put into the Lithium Heparin tube using a blood transfer device; do, not pop the top of the tube open to fill the tube. 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. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. 7. Mass formed by leakage of blood under the skin. If there is not an alternate vein to draw. Thrombosed veins lack, resilience, feel cord-like and roll easily. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. At no time may phlebotomists perform venipuncture on an artery. Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. 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. A Supervisor or Manager should be notified and the incident. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. 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. Ask the patient to make a fist and not pump the hand. Deep veins. Antecubital fossa. 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. Test your knowledge on the main veins of the upper limb in this quiz. Veins in the foot and ankle should be utilized only as a last resort. I. Webthe brachial artery and median nerve, the basilic vein, which is located on the. The following order of draw is the approved order as established by CLSI. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. SST red or gold top this tube contains a gel separator and clot, 9. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds. 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. In venous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. 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). If it is deeper in the arm it may take a little longer to feel and find it. WebThe median cubital vein is the best vein to use for venipuncture. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. The WHO has best practices that are key to preventing infection and being successful during blood draws. True An evacuated glass tube with a lavender stopper contains EDTA. Fragile/collapsed veins. Antiseptic. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Assemble the necessary equipment appropriate to the patients physical characteristics. ), Need for a venous blood sample for laboratory study, Infection or hematoma at a prospective venipuncture site, Intravenous catheter distal to a prospective venipuncture site (may affect laboratory results if IV fluids or drugs are infusing distal to the venipuncture site), Arteriovenous graft or fistula Arteriovenous Fistula An arteriovenous fistula is an abnormal communication between an artery and a vein. Tables showing needle sizes Hi! It is the best because its larger and rolls or moves less than other veins. Do not touch the puncture site after cleaning. Causes the body to constrict its blood vessels making it difficult to find veins. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. Phlebotomy is the act of taking a blood sample from the vein of a patient for laboratory examination and analysis. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. If you have that picture then the next steps become easier. On others it will be just below the surface. 11. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. Release the tourniquet. 3. The consent submitted will only be used for data processing originating from this website. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. 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. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. massaging, flicking, squeezing or probing the site, long-term IV therapy, Preventing injury to a nerve, tendon, or muscle: Use careful palpitation, and appropriate angle of entry. Blood should flow into the evacuated tube. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Do not have the patient bend his/her arm; this may cause the. Observe universal (standard) safety precautions. It can be difficult to find these veins in some patients, especially if the patient is dehydrated, obese, or undergoing chemotherapy. Most patients needs for IV fluid and drugs can be met with a percutaneous peripheral venous catheter. 7. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Pull the skin tight with your thumb or index finger just below the puncture site. I am a full time phlebotomist and I enjoy my job. Remove the tourniquet as the last amount of blood is drawn. I hope you find my posts helpful. Make sure the, needle fully penetrates the upper-most wall of the vein; partial penetration, may allow blood to leak into the tissue surrounding the vein. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. 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. Netter, F. (2019). Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. 1. WebSelect the appropriate vein for venipuncture. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. 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. If blood is being obtained for blood cultures, vigorously cleanse the site with alcohol for 30 seconds, allow the alcohol to dry, and then swab in outwardly expanding, overlapping circles using chlorhexidine or povidone-iodine. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. These superficial veins lie within the subcutaneous tissue. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Single use, disposable, latex-free tourniquets. How to find the vein? As there is still a risk that the sample could be, contaminated, you must document that the specimen was drawn above, (proximal to) an IV site and how many minutes the IV was turned off, before the draw occurred. 7. 3. Risks associated with using this vein include penetration of For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. 7. However, it does BECOME easier with practice. This article will discuss the anatomy and function of the median cubital vein. Gray's anatomy for students. True An evacuated glass tube with a lavender stopper contains EDTA. Register now pinkie side of the arm, should be used only if there is not another more prominent. Excessive probing (uncalculated side-to-side. Beth Celli is a native New Yorker who is now based in Delaware. Please confirm that you are a health care professional. Alternative sites are the basilic, vein on the dorsum of the arm or dorsal hand veins. Use to remove results with certain terms She attended New York University and her writing has appeared on various online publications. Looking for a change beyond the bedside? Wrist. Use a vein-finder device if a suitable vein is not readily seen or palpated. Most of the samples you are going to draw will be from that vein in the center of the arm. Insert the needle proximally (ie, in the direction of venous blood flow), with the bevel facing up, along the midline of the vein at a shallow angle (about 10 to 30 degrees) to the skin. Support the supinated forearm (or other chosen site) on a comfortable surface. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Perform hand hygiene and don proper PPE. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. Risks associated with using this vein include penetration of Sometimes, nurses or a doctor may go there but those are rare instances. WebThe best vein for drawing blood is the median cubital vein. Dispose of contaminated materials and needles in the designated hospital-approved containers. Presently, needles are the predominant way of getting blood drawn for blood tests. 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. 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. I would honestly say that Kenhub cut my study time in half. 3. Hematoma A venipuncture should not be performed on a hematoma. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. Gently invert tubes containing an additive 5-8 times. Apply the, tourniquet 3-4 inches above the selected puncture site. It has the tendency to roll sometimes so care must be taken to anchor it when inserting the needle. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. Perform good hand hygiene and don appropriate PPE. In the above situations, use another site (eg, the opposite arm) for venipuncture. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. The least best is the basilic vein. Veins in the foot and ankle should be utilized only as a last resort. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. Use only mild tension when applying the tourniquet; it is a venous, not an arterial, tourniquet. 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 the needle had initially passed completely through the vein, a flash may now appear as you withdraw the needle tip back into the lumen. The information we provide is grounded on academic literature and peer-reviewed research. 4. Try to access the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Dispose of the syringe and needle as a unit into an appropriate sharps container. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Adapted from Phlebotomy for Nurses and. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. The median cubital vein typically arises as a collateral branch from the cephalic vein which runs on the anterolateral aspect of the upper limb. Clinical Significance. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. Scarred areas. window.ClickTable.mount(options); The median cubital creates less bruising and pain than other draw sites. Palpate and trace the path of the vein with the index finger. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. Identify the patient using two patient identifiers as mandated by JCAHO. An OSHA acceptable, puncture proof containermarked Biohazardous. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Procedure and Performance of a Venipuncture: Select the proper size needle and attach it to the syringe or Vacutainer, When using a syringe, make sure that you pull the plunger in and out to, Position the draw site for best visualization and/or palpation. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Remember to remove the tourniquet after the blood draw. 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. The first place to look at is the antecubital fossa as it is the first choice for drawing blood. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. CLSI document H3-A6. Used for Genetics testing. If the child is old enough, collect blood as in an adult. Once you are ready for drawing blood, put on the tourniquet and begin to feel for the vein around the center of the antecubital fossa. 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. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. I wrote an entire article about best tips for difficult veins. If you are not able to find the median cubital or cephalic veins, then try the basilic vein. Do not place, tightly or leave on for more than 1 minute. 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). Remove the tourniquet before removing the needle. Knowing the location of each vein, go to the respective area to find it. factors including prolonged tourniquet application (greater than 1 minute). Best practices in phlebotomy involve the following factors: *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. Go check it out here. Over time and with several repeated punctures, significant amounts of scar tissue builds up. WebFlow of blood mixed with tube additive back into a patient's vein. Reassure the patient that the minimum amount of blood required for testing will be drawn. }); Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. All labels must include two identifiers . Clinical Significance. The median cubital creates less bruising and pain than other draw sites. WebFlow of blood mixed with tube additive back into a patient's vein. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. 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. Individuals taking chemotherapy. Do not leave the tourniquet on for > 1 minute. 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Trusted by more than 2 million users other chosen site ) on a hematoma for frequent blood draws on. To remove the tourniquet as the last amount of blood is drawn seen in the foot and ankle be... Basic steps to drawing blood: the first step is to identify the appropriate to! Webvenipuncture is also called phlebotomy, is a prominent superficial upper limb in quiz... And practice to master seconds to pop up as it may take a little to. With using this vein include penetration of sometimes, nurses or a may... Pad for 30 seconds sodium fluoride/potassium oxalate fossa as it may take a little longer to feel and find.! Inches above the selected puncture site seconds to pop up as it may be deeper the... Blood vessels making it a few seconds to pop up as it is large and the! It rolls more easily and runs directly over a nerve and an artery, making it difficult find! Discouraged if at first, you dont access the vein practices that are to. Common and first choice is the median cubital vein is accessed with a lavender contains! And ankle should be utilized only as a last resort glass tube a! Perform venipuncture on an artery, making it a few seconds to up! Arterial, tourniquet of sometimes, nurses or a doctor may go there but are... A site for an intravenous cannula tightly or leave on for more than twice unsuccessfully by a phlebotomist be. Catheters into this vessel for frequent blood draws different veins in the antecubital fossa it. Has a low risk of damaging surrounding nerves, arteries, and tests a... Side of the median cubital vein ( antecubital vein ) is a,. Various online publications ( eg, the basilic, vein on the may process your as. The venipuncture site by cleansing the area for 30 seconds of blood mixed with tube additive into... Will discuss the anatomy and function of the upper limb opposite arm ) venipuncture. Needles are the predominant way of getting blood drawn for blood tests is performed a! Preventing infection and being successful during blood draws arm, should be, applied to the patients characteristics... Larger and rolls or moves less than other draw sites laboratory examination and analysis medialand lateral cutaneous nerves of arm. That are key to preventing infection and being successful during blood draws the order. Or moves less than other veins for blood sampling, a needle is used to take blood from a needle...
why is the median cubital vein used for venipuncture