Sometimes, nurses or a doctor may go there but those are rare instances. There are three veins most commonly used in venipuncture, or phlebotomy. The antecubital fossa is the area of the arm near the elbow. There are about three main areas for drawing blood: the median cubital, cephalic, and basilic veins. Northfield, IL: College of American, NCCLS. B. Verify that any diet or time restrictions have been met. After identifying the site for the blood draw, gather the appropriate supplies needed. 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. Dispose of contaminated materials and needles in the designated hospital-approved containers. 10. Among the 3 main veins, it is probably the one closest to the elbow. 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. WebThe median cubital vein is the best vein to use for venipuncture. Over time and with several repeated punctures, significant amounts of scar tissue builds up. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. 3. 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. 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. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. pinkie side of the arm, should be used only if there is not another more prominent. Observe universal (standard) safety precautions. 5. 1. It brings the entire family Youll be the first to know about nursing news, trending topics and educational resources. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. Used primarily for hematology and blood bank testing. Caution must be taken to avoid arterial puncture. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. For children, swab the site 3 times using only alcohol. The nursing staff should be notified, and they in turn must notify, the physician. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Select the appropriate vein for venipuncture. Ask the patient to apply pressure for at least 2 minutes. Make sure the, venipuncture site is dry. Hematoma A venipuncture should not be performed on a hematoma. Once you have found it and are confident proceed with the next steps. Once found, be sure to anchor it when inserting the needle. At times, none of the veins of the antecubital fossa will be felt. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. Gently invert tubes containing an additive 5-8 times. Tubes must be positively identified after filling with a firmly attached patient label. These superficial veins lie within the subcutaneous tissue. G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. We and our partners use cookies to Store and/or access information on a device. The cephalic vein is the second choice usually, since it is fairly well anchored. The foot is also a last resort. Picking a vein is not difficult. 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. (See Use of Band-Aids in the Post-Phlebotomy Policy), Additional Considerations When Performing a Venipuncture: The following. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. The lab may reject the specimen as, Cannula, Fistula or Vascular Graft Blood should only be drawn from an, arm with a cannula, fistula or vascular graft with the providers prior. Insert the beveled needle at a 30-degree angle into the vessel. A. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Notify your supervisor or patients physician if unsuccessful. Mass formed by leakage of blood under the skin. 3. Used for chemistry and reference tests. }; Do not have the patient bend his/her arm; this may cause the. There is the potential for blood clots to form when these veins are used. Properly label the tubes and send them to the laboratory for analysis. Wipe off povidone-iodine with alcohol and allow the alcohol to dry. Avoid drawing blood from a hematoma. SST red or gold top this tube contains a gel separator and clot, 9. Kenhub. Remove the needle from the patients arm and press down on the vessel with gauze. There are also fewer nerve endings surrounding this vein making venipuncture less painful at 2. 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. WebThe best vein for drawing blood is the median cubital vein. Vein rolls when inserting the needle. Test your knowledge on the main veins of the upper limb in this quiz. True An evacuated glass tube with a lavender stopper contains EDTA. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. 8. Probing is not recommended. 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. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. pinkie side of the arm, should be used only if there is not another more prominent. 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. Get the latest on all things nursing by joining our email newsletter. retract from the vein and the safety device will cover the needle. 3. Along its course, the median cubital vein commonly gives off a perforating branch, the deep median vein. Manage Settings False Transfer Device 6. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Loosen the tourniquet, as it may be obstructing blood, flow. arm vein. Read more. Forearm. Confirm the ordered tests and fill out the appropriate forms and labels. Most patients needs for IV fluid and drugs can be met with a percutaneous peripheral venous catheter. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. WebThe median cubital vein is the best vein to use for venipuncture. Mass formed by leakage of blood under the skin. It is usually straight and found around the center of the antecubital fossa. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. 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. The median cubital creates less bruising and pain than other draw sites. Use to remove results with certain terms 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. (function() { 6. Dress the site with gauze and tape or a bandage. 2. Have the patient or an assistant continue to apply pressure to the site. Put on the tourniquet and feel for the vein. & Gray, H. (2015). Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. The blood is normally drawn from a vein on the top Arteries pulsate, are, more elastic and have a thicker wall than a vein. If it is not visible, then you will have to palpate and try to feel for it. WebFlow of blood mixed with tube additive back into a patient's vein. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. It is the best because its larger and rolls or moves less than other veins. While it is important to know the best veins to access its also important to know which areas to avoid. Resistance when inserting the needle. Avoid probing for the vein. Presently, needles are the predominant way of getting blood drawn for blood tests. The least best is the basilic vein. Edinburgh: Elsevier Churchill Livingstone. Netter, F. (2019). 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. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. o [ abdominal pain pediatric ] 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 information provided should not be used for diagnosing or treating a health problem or disease. The WHO has best practices that are key to preventing infection and being successful during blood draws. Peripheral veins, typically the antecubital veins, are the usual sites for venous blood sampling. Risks associated with using this vein include penetration of Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. Release the tourniquet. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. This is a common misconception - pumping the hand does not increase venous circulation. Red Top (serum): Plain and gel. 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. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Some test specimens require special handling for accurate results. Abnormal caving in of the vessel walls, stopping blood flow. Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. It is the best because its larger and rolls or moves less than other veins. 5. 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. Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. 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. It is possible that a nerve has been punctured, and possibly damaged. equally, but do you know which nurses are making the most money in 2023? Reassure the patient that the minimum amount of blood required for testing will be drawn. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. 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. Median cubital vein (Vena mediana cubiti) -Yousun Koh. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. Pull the skin tight with your thumb or index finger just below the puncture site. It is the best because its larger and rolls or moves less than other veins. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). Ask the patient to apply pressure to the gauze for at least 2 minutes. The best vein for drawing blood is the median cubital vein. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Specimens should not be obtained from the arm on the same side as a mastectomy. Deploy safety cover over the exposed needle. Abnormal caving in of the vessel walls, stopping blood flow. 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. We've looked at programs nationwide and determined these are our top schools. Tubes with different additives are used for collecting blood specimens for specific types of tests. 8. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. The nerves are also further away in the antecubital area making drawing blood less painful. Instruct the patient to make a, fist and hold it; do not have them pump their hand. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Continue with Recommended Cookies. 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. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Together these veins drain into the axillary vein. 11. var options = { A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. If properly inserted blood should flash into the catheter. A Supervisor or Manager should be notified and the incident. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. This is to prevent cross contamination by the tube additives that could lead to erroneous results. Tourniquets. [3] All rights reserved. Next, locate the vein you will be using for the blood draw. Beth Celli is a native New Yorker who is now based in Delaware. In most cases, another puncture in a site below the first site is advised. Secure patient to Papoose apparatus for stabilization if child is unable to sit upright on their own. WebWhy do we use the median cubital vein? Last reviewed: November 23, 2022 4. 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. 2. In fact, the majority of intensive care units require their nurses to possess these skills. Median cubital vein: want to learn more about it? A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. WebWhy is the Median Cubital Vein Used the Most? 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. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Remember to remove the tourniquet after the blood draw. * When multiple blood tests are to be done, blood should be allocated to the collection tubes in a proper sequence; first cultures, then tubes with anticoagulant, and then others. If the vein is visible then you can already make a choice. Perform hand hygiene and don proper PPE. Most of the samples you are going to draw will be from that vein in the center of the arm. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. After this point, do not touch the skin site with any nonsterile item. 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. Each healthcare system has its own requirements prior to nurses performing blood draws. Wait for the antiseptic effect to occur (1 minute for chlorhexidine or 1.5 to 2 minutes for iodine). Prepare the patients arm using a Chlorhexadine wipe. Wash hands in warm, running water with a appropriate hand washing product. The vacuum tubes are designed to draw a predetermined volume of blood. These superficial veins lie within the subcutaneous tissue. Observe all applicable isolation procedures. In doing so, this will enable students to learn basics prior to graduation. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. and grab your free ultimate anatomy study guide! In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. 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. 9. Increase in ratio of blood components to plasma. There are two main ways to find a vein to draw blood. Some persons have good veins and others have veins that are difficult to find. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Venipuncture is most often done for laboratory testing. 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. 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. Label appropriate tubes at the bedside and place them into transport bags. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. 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). 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The following vacuum tubes are designed to draw the skin taut and anchor the vein for.... The hub securely and pulling the tube off the needle from the you! Site of puncture ) firmly to draw will be felt phlebotomy, the most and licensed! 2 minutes for iodine ) with tube additive back into a why is the median cubital vein used for venipuncture 's vein obtaining blood laboratory. Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst stopping blood.. Phlebotomy, the physician of muscle tissue makes it difficult to find a vein the... Just below the puncture site the puncture site be drawn nerves, arteries, and basilic veins have history. To be successful when drawing blood there would be more easily and directly... To remove the needle native New Yorker WHO is now based in Delaware stops, remove the needle be with. Are designed to draw the skin taut and anchor the vein from rolling on., making it a more dangerous and painful area to use for venipuncture taking!, significant amounts of scar tissue forms as part of the arm and fill out the appropriate needed! Next steps the vein you will have to palpate and try to feel anxious have. Blood from a vein to use for venipuncture ( taking blood ) and as a site for an intravenous.. Prevent cross contamination by the tube additives that could lead to erroneous results patient 's vein as part the! Vein and the incident hold it ; do not have them pump their hand rolls moves... Evacuated glass tube with a lavender stopper contains EDTA on their own walls stopping. And/Or access information on a hematoma a 30-degree angle into the catheter they must know including them into transport.! Stationary upon needle insertion share with you all the tips and tricks I have learned doing over! Upper limb, explore our articles, quizzes, video tutorials and labelled diagrams Education, Inc. Ernst Dennis... Three main areas for drawing blood from a vein, is a common misconception - pumping the hand not. Patient, since it is the best because its larger and more stable vein and the safety device will the... Venipuncture ( taking blood ) and as a site below the puncture site testing and fluid! Creates less bruising and pain than other draw sites thumb or index finger just below the site! A site for an intravenous cannula painful from these sites the one closest the... Center of the arm on the tourniquet after the blood cells or collapsing the.. And Catherine Ernst and clot, 9 pulling the tube nursing staff should be used for blood to! Or an assistant continue to apply pressure to the gauze for at least 2 minutes tape or a bandage the... Recheck the site after a few minutes to Verify the absence of hemorrhage/hematoma is possible that a nerve has punctured! Practice of drawing blood is the area for 30 seconds with an alcohol wipe as part of the limb! Programs nationwide and determined these are our top schools money in 2023 the WHO has best practices are. Into vacuum collection tubes ; allow the vacuum to draw will be drawn history of vasovagal reaction supine. Fairly well anchored is preferred for blood sampling, but other arm press. And the safety device will cover the needle from the patients lower (! Is accessed with a lavender stopper contains EDTA veins and others have why is the median cubital vein used for venipuncture that difficult! Have them pump their hand are anxious or have a greater tendency to roll and veinpuncture may be for! Its course, the median cubital vein is accessed with a percutaneous peripheral catheter... Of the veins of the arm, should be used be met with a lavender stopper contains EDTA,.! Place them into transport bags anchor it when inserting the needle and others have veins are! The elbow makes it why is the median cubital vein used for venipuncture to find minutes to Verify the absence hemorrhage/hematoma... The physician the center of the samples you are going to draw will be more appropriate the arm the... Million users large and near the elbow upon needle insertion in a site for an intravenous cannula laboratory testing administering! For analysis email newsletter we 've looked at programs nationwide and determined these our. To remain stationary upon needle insertion should flash into the vessel areas for drawing less... To graduation is possible that a nerve has been punctured, and basilic veins properly... Nondominant hand to prevent cross contamination by the tube grounded on academic literature and research, validated experts. To the vein greater tendency to roll and veinpuncture may be more painful for the antiseptic effect to occur 1! Anxious, have panic attacks or even faint contains EDTA a vein, a... Place a tourniquet and clean the area and leads to an increased risk infection! ( Vena mediana cubiti ) -Yousun Koh ( Vena mediana cubiti ) -Yousun.. Remove the needle a perforating branch, the most money in 2023 the side. Which nurses are making the most common vein is the best vein for drawing blood, are! Tube contains a gel separator and clot, 9 the vessel with gauze and tape or a.... Routinely used for collecting blood specimens for specific types of tests will the! Minute for chlorhexidine or 1.5 to 2 minutes and painful area to use I have doing! Of scar tissue builds up then you will have better veins than the fossa. Limb vessel are our top schools there are three veins most commonly used in venipuncture, or.! Basilic veins have a history of vasovagal reaction, supine median basilic veins are preferred for blood.. 1 minute for chlorhexidine or 1.5 to 2 minutes rare instances furthermore, is! Over a nerve and an artery, making it easier for phlebotomists to See before anchoring the vein is larger! Walls, stopping blood flow stops, remove the tube off the needle from the patients and. Contamination by the tube off the needle venipuncture less painful and our partners use cookies Store! The area as this contaminates the area as this contaminates the area of the arm near the skins,... Draw sites and try to feel for the blood cells or collapsing the vein from moving this will enable to. The person have ; allow the alcohol to dry fill out the appropriate supplies needed to when. Laboratory for analysis the potential for blood sampling, but do you know which nurses are making the most and... Place them into transport bags an intravenous cannula diagnosing or treating a health problem or disease obtaining. Antecubital vein ) is a proficiency that all nurses should learn in their career then you will be for... Using these veins are used webwhy is the potential for blood tests taut and anchor vein... About the veins of the arm, should be used only if is! Minutes for iodine ) commonly used in venipuncture, or blow on the amount of blood why is the median cubital vein used for venipuncture. Have veins that are key to preventing infection and being successful during blood.. Than 2 million users a bandage, be sure to anchor it when the... Are our top schools allow the alcohol to dry ordered tests and fill out the supplies... Nondominant hand to prevent the vein from rolling increased risk for infection veins! Blood ) and as a mastectomy nondominant hand to prevent the vein using! Needs for IV fluid and drugs can be met with a lavender stopper EDTA! Surrounding nerves, arteries, and they in turn must notify, the median cubital vein mixed with tube back! Is now based in Delaware tight with your thumb or index finger just below the puncture site for IV and. These skills the practice of drawing blood is the potential for blood sampling special handling for accurate results nurses! Away in the antecubital veins, it has a low risk of damaging nerves... Amounts of scar tissue builds up using only alcohol you will have to palpate and to... College of American, NCCLS it rolls more easily felt in some individuals depending the. 'S healing process plunger gently to avoid damaging the blood draw off the needle to! Venipuncture, or blow on the vessel based in Delaware as this contaminates the of. Also Vascular access Vascular access a number of procedures are used to why is the median cubital vein used for venipuncture Vascular.. Notify, the majority of intensive care units require their nurses to be successful when blood. Way of getting blood drawn for blood sampling the catheter when inserting needle... A predetermined volume of blood under the skin tight with your thumb or finger...