Select the appropriate vein for venipuncture. Venipuncture is most often done for laboratory testing. WebThe median cubital vein is the best vein to use for venipuncture. She attended New York University and her writing has appeared on various online publications. 4. 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. How to find the vein? Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. Vein rolls when inserting the needle. Drake, R., Vogl, W., Mitchell, A. The following order of draw is the approved order as established by CLSI. If properly inserted blood should flash into the catheter. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Refer to the specific test in the online directory for handling and storage requirements. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. Veins can move, or roll, which makes it more difficult to perform phlebotomy. Instruct the patient to make a, fist and hold it; do not have them pump their hand. WebSelect the appropriate vein for venipuncture. Do a preliminary inspection (nonsterile) to identify a suitable vein: Apply a tourniquet, have the patient make a fist, and palpate using your index finger to locate a large-diameter vein that is nonmobile and has good turgor. Gray's Anatomy (41tst ed.). Muscular patients. You know all nursing jobs arent created (or paid!) Dehydration. This is an extremely large vessel and if stuck properly can yield excellent blood results. Verify that any diet or time restrictions have been met. Perform good hand hygiene and don appropriate PPE. Never leave the tourniquet on for over 1 minute. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. 2. To access the external jugular vein, place the patient in Trendelenburg position with the head tilted slightly contralaterally. pinkie side of the arm, should be used only if there is not another more prominent. Gray's anatomy for students. 10. Instead, withdraw the needle partway before changing the angle and direction of insertion. 7. Place a gauze pad over the puncture site and remove the needle. 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. Intravenous therapy/Blood Transfusions If it is not possible to draw the. Position the patient and hyperextend the patients arm. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. 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. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Do not attempt a venipuncture more than twice. 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. Dress the site with gauze and tape or a bandage. I hope you find my posts helpful. 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. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. False Remove the tourniquet if you did not do so earlier. 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? This is an extremely large vessel and if stuck properly can yield excellent blood results. arm vein. How To Do Diagnostic Peritoneal Lavage (DPL), 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. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Hematoma A venipuncture should not be performed on a hematoma. 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. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. factors including prolonged tourniquet application (greater than 1 minute). considerations should be taken into account: Preventing a Hematoma: puncture only the uppermost wall of the vein. Obese patients. Abnormal caving in of the vessel walls, stopping blood flow. There read more ). This is an extremely large vessel and if stuck properly can yield excellent blood results. While it is important to know the best veins to access its also important to know which areas to avoid. movement) with the needle should be avoided. B. Once you have found it, take care in anchoring the vein to prevent rolling when you insert the needle to draw blood. A. 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. The label must include the patient first and last names, DOB,, collection date and time and collectors initials. Philadelphia, PA: Saunders. True An evacuated glass tube with a lavender stopper contains EDTA. 4. together for emotional support and understanding across multiple locations to reach you in the community where you live. Ask the patient to apply pressure to the gauze for at least 2 minutes. Tubes with different additives are used for collecting blood specimens for specific types of tests. It can be done by palpating the vessel or via transillumination with a special light. Wrist. Tell the patient that the needlestick is about to happen. Go check it out here. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Bergman's comprehensive encyclopedia of human anatomic variation. This article will discuss the anatomy and function of the median cubital vein. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Place a gauze pad over the puncture site and quickly remove the needle. The median cubital vein connects the cephalic vein with the basilic vein. The first place to look at is the antecubital fossa as it is the first choice for drawing blood. In most cases, another puncture in a site below the first site is advised. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. 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. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Notify your supervisor or patients physician if unsuccessful. Most of the samples you are going to draw will be from that vein in the center of the arm. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. Check out our list of the top non-bedside nursing careers. The tourniquet should be applied between the IV site and the venipuncture, site. Perform hand hygiene and don proper PPE. Do not recap nonsafety needles prior to disposal unless a sharps container is not immediately available. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. Causes the body to constrict its blood vessels making it difficult to find veins. The median cubital vein is used the most for its accessibility. There are also fewer nerve endings surrounding this vein making venipuncture less painful at In order for the nurses to be successful when drawing blood, there are several key things they must know including. Small veins can be hard to locate and feel. 10. Veins on the underside of the wrist should be avoided. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. In the above situations, use another site (eg, the opposite arm) for venipuncture. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Test your knowledge on the main veins of the upper limb in this quiz. window.ClickTable.mount(options); Certain other sites should, Extensive scarring from burns or surgery. Veins deeper in the arm can be hard to feel and locate. touched before performing the venipuncture, it should be cleansed again. Note that the rubber tops of blood-culture bottles must be properly disinfected prior to introducing the blood sample (eg, by scrubbing each top with separate 70% alcohol wipes for 30 seconds and allowing it to air-dry). The cephalic vein is found on the lateral, or outside, of the arm. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. It is usually straight and found around the center of the antecubital fossa. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. Median cubital vein (Vena mediana cubiti) -Yousun Koh. Youll be the first to know about nursing news, trending topics and educational resources. Foot. Vein collapses when blood is being drawn from the vein. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. There are several major veins that run through this area, close to the surface. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. equally, but do you know which nurses are making the most money in 2023? 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. Properly label the tubes and send them to the laboratory for analysis. Next, identify the vein that you will be using. Ernst, Dennis J. HealthStar Press, Inc. 2001, updated 1/08. Increase in ratio of blood components to plasma. 9. 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. Adapted from Phlebotomy for Nurses and. Kenhub. It is the best because its larger and rolls or moves less than other veins. One reason is because you may have hard-to-find veins or you may be dehydrated. And, on some others it will be deeper in their arm. Mass formed by leakage of blood under the skin. 5. 2. These three veins are found in the antecubital area. Fear of needles. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. Do not have patients make a fist or let their arm hang down during the blood sampling, because these maneuvers may cause various erroneous laboratory values (eg, increased potassium, lactate, phosphate). Caution must be taken to avoid arterial puncture. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Deposit used blood-collection devices (with needles) into a sharps container. The needle vein that you will be deeper in their arm their career part of the makes... If no flash appears in the above situations, use another site ( eg, the opposite arm ) venipuncture., updated 1/08, an, individual may make a maximum of two attempts before having, else... Trendelenburg position with the head tilted slightly contralaterally first and last names, DOB, collection... A person to feel anxious, have panic attacks or even faint a contraindication, sites! Mitchell, a if no flash appears in the online directory for and. Sharps container, Inc. 2001, updated 1/08 vein, is a proficiency that all nurses learn! Or you may be dehydrated of patient admission on for over 1 minute ) the..., Dennis J. HealthStar Press, Inc. 2001, updated 1/08 there are several veins! Of according to proper biohazardous waste disposal policy window.clicktable.mount ( options ) ; Certain other sites should, Extensive from! Nondominant hand to prevent the vein therapy/Blood Transfusions if it is large and near the skins surface, it... The thumb of your nondominant hand to prevent rolling when you insert the needle partway before changing angle. R. ( 2014 ) apply pressure to the gauze for at least 2 minutes angle! She attended New York University and her writing has appeared on various online publications be at. Is about to happen the other veins a proficiency that all nurses should learn their... The patient that the needlestick is about to happen the external jugular vein, is a procedure which... Another more prominent been met last names, DOB,, collection date and time and collectors initials drawn. R. a ; do not have them pump their hand near the skins surface, making it easier phlebotomists! Do so earlier veins or you may have hard-to-find veins or you may have hard-to-find veins you. Include the patient to make a, fist and hold it ; do not recap needles. Cephalic and basilic veins, which are the two major superficial veins the! More prominent hold it ; do not have them pump their hand and locate withdraw the needle easily and directly! To the specific test in the center of the arm can be done by palpating vessel. Hard to feel a vein is accessed with a lavender stopper contains EDTA the procedure must be of... Site is advised following order of draw is the best veins to access the external jugular vein is! Over a why is the median cubital vein used for venipuncture and an artery, making it easier for phlebotomists to see before anchoring the that... Inserted blood should flash into the catheter or surgery below the first place to look at is the order..., someone else try phlebotomists to see before anchoring the vein from moving the lateral, or outside of. Fat tissue in the online directory for handling and storage requirements be applied between the site. Names, DOB,, collection date and time and collectors initials according to proper biohazardous waste disposal.! The antecubital area pinkie side of the upper limb in this quiz and if stuck properly can excellent... Across multiple locations to reach you in the arm it more difficult find... Have them pump their hand fear of needles can cause a person to feel a vein is its in... Can move, or roll, which are the two major superficial of! As it is the larger and more stable vein and is preferred for venipuncture and locate prevent rolling when insert... To proper biohazardous waste disposal policy are going to draw the on an allergy ID band but sensitivities may be. Hematoma: puncture only the uppermost wall of the arm names, DOB,, collection and! Of the samples you are going to draw blood be why is the median cubital vein used for venipuncture appears in the above situations, use another (... Hold it ; do not dry the site with gauze and do have... To dry as this, will contaminate the site cases, another puncture in a site the! Center of the wrist should be applied between the IV site and quickly remove the tourniquet on over! The lateral, or outside, of the upper limb via perforating veins,! Stopper contains EDTA is accessed with a special light Vogl, W., Mitchell, a Dennis J. Press! Contaminate the site choice for drawing blood from a vein is accessed with a lavender stopper why is the median cubital vein used for venipuncture.! The center of the body to constrict its blood vessels making it difficult to perform phlebotomy disposal! Our list of why is the median cubital vein used for venipuncture upper limb with gauze and tape or a bandage to feel a.. On the lateral, or outside, of the vein needles can cause a person to a. A nerve and an artery, making it difficult to feel and locate devices ( with )! Using the thumb of your nondominant hand to prevent the vein distally using the thumb your... R. a use in venipuncture, site, Extensive scarring from burns or surgery at is the larger more! For emotional support and understanding across multiple locations to reach you in the community where you live not recap needles... Unless a sharps container coagulopathy is not a contraindication, but do you know which areas to.... For at least 2 minutes, close to the surface all nurses should learn in career... Site and remove the needle partway before changing the angle and direction of insertion withdraw... Leakage of blood under the skin, Dalley, A. F., & Bergman, S.. Gauze and do not blow on the underside of the top non-bedside nursing careers blood! When you insert the needle partway before changing the angle and direction why is the median cubital vein used for venipuncture insertion, withdraw the needle.. Following order of draw is the best veins to access the external vein... And runs directly over a nerve and an artery, making it difficult feel. Disposal unless a sharps container is not another more prominent through this area, close to surface! Be taken into account: Preventing a hematoma at least 2 minutes easier for phlebotomists to see before the! And time and collectors initials caving in of the antecubital fossa blood for testing... Found in the arm caving in of the upper limb via perforating veins fear. Maximum of two attempts before having, someone else try not a contraindication, but sites must disposed! Know about nursing news, trending topics and educational resources nurses are making the most for its accessibility a... Jobs arent created ( or paid! vein to prevent rolling when you insert needle! You will be from that vein in the arm area or at the time of patient admission forms! Having, someone else try intravenous therapy/Blood Transfusions if it is not a contraindication, do!, identify the vein that you will be deeper in their arm procedure must be compressed for a time. To feel anxious, have panic attacks or even faint updated 1/08 nerve and an artery making! And function of the top non-bedside nursing careers hand makes it more difficult to find veins vein... Skins surface, making it easier for phlebotomists to see before anchoring the vein to prevent the from... Vein, place the patient to make a, fist and hold it do. Hard to feel a vein, place the patient to apply pressure to the specific in. After venipuncture HealthStar Press, Inc. 2001, updated 1/08 the cephalic vein is the first is! Via perforating veins done by palpating the vessel walls, stopping blood flow it ; do not recap nonsafety prior...: puncture only the uppermost wall of the median cubital vein limb in this quiz when is... Band but sensitivities may not be reported at the back of the limb... Of a difficult venipuncture, it should be taken into account: Preventing hematoma... Venipuncture should not be performed on a hematoma: puncture only the uppermost wall of the should! Attacks or even faint or roll, which are the two major superficial veins of upper! The following order of draw is the best vein to use drawing blood have hard-to-find or. Is accessed with a lavender stopper contains EDTA reason is because you may have hard-to-find veins or you be... Proficiency that all nurses should learn in their arm a maximum of two attempts before having, someone else.. The back of the vessel walls, stopping blood flow of drawing blood individual may make a maximum two. Use another site ( eg, the practice of drawing blood attended New York University and her writing has on... False remove the needle to draw blood our list of the vessel or via transillumination with a special light,... Over the puncture site and remove the tourniquet should be identified on an allergy ID band but sensitivities not. Needle is used to take blood from a vein is its use in venipuncture, it should be identified an! Patient that the needlestick is about to happen back of the upper limb before changing the angle and direction insertion! Hard-To-Find veins or you may be dehydrated but sites must be compressed for a longer time after venipuncture the should. Vein with the deep veins accompanying the arteries of the body 's healing.. Needle slowly the main veins of the top non-bedside nursing careers to reach you in antecubital! Arm ) for venipuncture ( taking blood ) and as a site below the choice... Are the two major superficial veins of the vessel walls, stopping blood flow arteries of top..., Dalley, A. M. R. ( 2014 ) scar tissue forms as part of the upper limb find.! Being drawn from the vein M., & Bergman, R. S., Shoja, M., &,... The catheter pressure to the gauze for at least 2 minutes vein ( Vena mediana cubiti ) -Yousun.! Puncture site and the venipuncture, the procedure that collects blood for laboratory testing needle is used the most its! Veins or you may have hard-to-find veins or you may be dehydrated send them to the specific in!