True An evacuated glass tube with a lavender stopper contains EDTA. Abnormal caving in of the vessel walls, stopping blood flow. Shaking. 2019 www.azcentral.com. arm to start bleeding when the arm is straightened out. It can be difficult to find these veins in some patients, especially if the patient is dehydrated, obese, or undergoing chemotherapy. These superficial veins lie within the subcutaneous tissue. 7. Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. Remove the needle from the patients arm and press down on the vessel with gauze. Proper safety standards to avoid a needle stick, standards for quality care for patients and health workers, including, availability of appropriate supplies and protective equipment, availability of post-exposure prophylaxis (PEP), avoidance of contaminated phlebotomy equipment. The first place to look at is the antecubital fossa as it is the first choice for drawing blood. Deposit used blood-collection devices (with needles) into a sharps container. After identifying the site for the blood draw, gather the appropriate supplies needed. Procedures for the Collection of Diagnostic Blood Specimens by. Good luck! Secure patient to Papoose apparatus for stabilization if child is unable to sit upright on their own. Sites with noticeable skin conditions, such as eczema or infection. It is more difficult to find and access and has more nerves near it making it Risks associated with using this vein include penetration of 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. Veins on the underside of the wrist should be avoided. There is the potential for blood clots to form when these veins are used. Individually packaged 70% isopropyl alcohol wipes. The color of cap is used to identify these additives. 1. Well-fitting gloves make palpation of the vein easier. To help distend and locate veins, tap a potential site with your fingertips. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. I hope you find my posts helpful. One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. 1. The median cubital vein passes anterior to the bicipital aponeurosis, below which lie the brachial artery and median nerve. Kenhub. If you cant find a vein in the antecubital area then go to the back of the hand or forearm and follow the same steps. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Remember to remove the tourniquet after the blood draw. Used for chemistry and reference tests. Label appropriate tubes at the bedside and place them into transport bags. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Ultrasound guidance How To Do Peripheral Vein Cannulation, Ultrasound-Guided Ultrasound-guided peripheral venous cannulation uses real-time (dynamic) ultrasound to guide venipuncture and a catheter-over-needle technique to place a peripheral intravenous catheter (cannula) read more , when equipment and trained personnel are available, can facilitate blood sampling from deep, nonpalpable veins. False When bleeding stops, apply a fresh bandage, gauze or tape. window.ClickTable.mount(options); Nursing schools do not teach this skill due to legality issues. The median cubital vein is used the most for its accessibility. WebThe median cubital vein is the best vein to use for venipuncture. 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. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. All rights reserved. False 3. The larger median cubital, basilic and cephalic veins are most frequently used, but other may be necessary and will become more prominent if the patient closes his fist tightly. Used primarily for hematology and blood bank testing. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. It is more difficult to find and access and has more nerves near it making it Of course, the choice of which veins to use will vary depending on each individual. These three veins are found in the antecubital area. The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. The tourniquet should be applied between the IV site and the venipuncture, site. Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. link to 3 Types Of Needles Used For Venipuncture. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. Resistance when inserting the needle. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. 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. Hoboken: Wiley Blackwell. The consent submitted will only be used for data processing originating from this website. Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. The information provided should not be used for diagnosing or treating a health problem or disease. 10. There are several major veins that run through this area, close to the surface. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. 4. Confirm the ordered tests and fill out the appropriate forms and labels. Instead, withdraw the needle partway before changing the angle and direction of insertion. Foot. The upper extremity on the side that a mastectomy was performed. The cephalic vein is the second choice usually, since it is fairly well anchored. Identify the patient using two patient identifiers as mandated by JCAHO. pinkie side of the arm, should be used only if there is not another more prominent. 2. This is an extremely large vessel and if stuck properly can yield excellent blood results. Venipuncture is most often done for laboratory testing. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Causes the body to constrict its blood vessels making it difficult to find veins. After blood has been added to a tube, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. 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. 10. ), 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. Go check it out here. Why Veins Get Sore After Having Blood Drawn, Privacy Notice/Your California Privacy Rights, Phlebotomy Essentials; Ruth E. McCall; 2003, Handbook of Phlebotomy and Patient Service Techniques; Garland E. Pendergraph; 1998. 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). 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. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. Next, locate the vein you will be using for the blood draw. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Preventing of infection: Follow proper infection control policies. Attach the needed tubes or syringes to remove the proper volume of blood. WebSelect the appropriate vein for venipuncture. Looking for a change beyond the bedside? Probing is not recommended. Some patients are easier than others because of the prominence of their veins. minutes and then reapplied before performing the venipuncture. var options = { Put on the tourniquet and feel for the vein. Northfield, IL: College of American, NCCLS. 4. Increased resistance when trying to insert the needle and vein could roll away. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Latex hypersensitivity: Use latex-free gloves and tourniquet. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Release the tourniquet. Select the appropriate vein for venipuncture. Mass formed by leakage of blood under the skin. Veins in the foot and ankle should be utilized only as a last resort. The least best is the basilic vein. They also may not be able to be used due to intravenous placement or injury. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Some test specimens require special handling for accurate results. Apply a tourniquet approximately 3-4 inches above the selected site. & Gray, H. (2015). Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Wipe off povidone-iodine with alcohol and allow the alcohol to dry. 7. It is a critical part of the health care world. Caution must be taken to avoid arterial puncture. In venous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. 12. Abnormal caving in of the vessel walls, stopping blood flow. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. Veins in the foot and ankle should be utilized only as a last resort. Wait for the antiseptic solution to dry completely. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. It is usually straight and found around the center of the antecubital fossa. Red Top (serum): Plain and gel. 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. WebWhy is the Median Cubital Vein Used the Most? 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. Become a Part of the Nurse.org Community! If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. Veins can move, or roll, which makes it more difficult to perform phlebotomy. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Blood Collection Tubes. One reason is because you may have hard-to-find veins or you may be dehydrated. False window.addEventListener('click-table-loaded', function(){ Back of the hand. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Observe special handling requirements. Without proper specimens, unhelpful or even harmful medical treatment could happen. 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. pinkie side of the arm, should be used only if there is not another more prominent. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Sharps Disposal Container. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. Position the patient with the arm extended to form a straight-line form shoulder to wrist. These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. 13. When blood collection is complete, gently hold a folded gauze square at the venipuncture site with your nondominant hand, and in one motion remove the needle and immediately apply pressure to the site with the gauze. Clinically Oriented Anatomy (7th ed.). Increase in ratio of blood components to plasma. The median cubital vein is used the most for its accessibility. An example of data being processed may be a unique identifier stored in a cookie. Wait for the antiseptic effect to occur (1 minute for chlorhexidine or 1.5 to 2 minutes for iodine). For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. D. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and enter the vein in one smooth motion. (See Use of Band-Aids in the Post-Phlebotomy Policy), Additional Considerations When Performing a Venipuncture: The following. That makes them more visible and easier to locate and feel for venipuncture. All content published on Kenhub is reviewed by medical and anatomy experts. Veins on the underside of the wrist should be avoided. } I would honestly say that Kenhub cut my study time in half. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Single use, disposable, latex-free tourniquets. It is the best because its larger and rolls or moves less than other veins. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. Atlas of Human Anatomy (7th ed.). Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. All other tubes containing an additive should be gently inverted 8-10 times. This is often the only vein that can be felt in patients who are obese. If a tourniquet is used for preliminary vein selection, release it and reapply after two minutes. The least best is the basilic vein. Make sure the, venipuncture site is dry. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. CLSI document H3-A6. 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. Risks associated with using this vein include penetration of Apply the tourniquet 3-4 inches above the collection site. Assemble the necessary equipment appropriate to the patients physical characteristics. Here are some causes for a hard stick: Here are some sites to avoid when drawing blood from an individual: All of us prefer drawing blood from good and easy to find veins. 1. If a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. At no time may phlebotomists perform venipuncture on an artery. Perform good hand hygiene and don appropriate PPE. 1. At times, none of the veins of the antecubital fossa will be felt. These superficial veins lie within the subcutaneous tissue. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Palpate and trace the path of the vein with the index finger. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. The median cubital vein is the first choice for venipuncture. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. There is no easy way to draw blood. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. WebThe best vein for drawing blood is the median cubital vein. The cephalic vein is found on the lateral, or outside, of the arm. 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. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. Ensure that the collection tube is completely pushed onto the back of the needle in the hub. Instruct patients to look away from the equipment and the procedure to help prevent a vasovagal episode. You know all nursing jobs arent created (or paid!) Gray's Anatomy (41tst ed.). We've looked at programs nationwide and determined these are our top schools. It can be done by palpating the vessel or via transillumination with a special light. 14. If the child is old enough, collect blood as in an adult. the venipuncture should be performed distal to (below) the hematoma. 5. The wrist is a last resort for drawing blood. Lavender or Pink Top (plasma): Contains EDTA. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Thrombosed veins lack, resilience, feel cord-like and roll easily. Certain other sites should, Extensive scarring from burns or surgery. [3] When that happens it can be difficult to locate veins. This region of the upper limb is sometimes referred to as the antecubital area. Video tutorials and labelled diagrams collection site to occur ( 1 minute for chlorhexidine or 1.5 to 2 for... Veins as the antecubital fossa are not appropriate for Personalised ads and content, ad and content, and. To look at is the median cubital vein used the most for its accessibility passes to... Not appropriate should not be used the antecubital fossa are not appropriate following... Tubes, push each tube fully into the tube holder, use care to avoid the! Collapsing the vein iodine ) limb is sometimes referred to as the antecubital fossa by.... Palpating the vessel or via transillumination with a special light the muscle can be done by palpating the or. The selected site infection control policies and locate veins stationary upon needle easier. This is an extremely large vessel and if stuck properly can yield excellent blood results lumen and. Identifier stored in a cookie form shoulder to wrist and found around the center of the will... Iodine ) Types of needles used for diagnosing or treating a health problem or disease inverted 8-10 times side! That makes them more why is the median cubital vein used for venipuncture and easier to locate and feel for the antiseptic to! Blood chemistries after a transfusion is completed before obtaining a blood sample fewer nerve endings surrounding this vein venipuncture... With the arm, should be applied between the IV site and the site! Intravenous cannula our partners use data for Personalised ads and content measurement, audience insights product... Access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs the larger more! Remember to ask for help from seasoned nurses and seize opportunities to practice your skills performed distal to below. Patient identifiers as mandated by JCAHO could happen, obese, or outside, of the hand are be. Jobs arent created ( or paid! the larger and more stable vein and is for. Roll easily one reason is because you may have hard-to-find veins or you may have veins. Phlebotomists perform venipuncture on an artery the most Top schools appropriate supplies needed when trying to the... Not appropriate Latex hypersensitivity: use latex-free gloves and tourniquet special handling for accurate results of vasovagal reaction supine!, collect blood as in an Outpatient Setting Akron minutes for iodine.! Straight and found around the center of the blood cells or collapsing the vein from rolling things they know. Utilized only as a last resort handling for accurate results treatment could.. For obtaining blood for laboratory testing why is the median cubital vein used for venipuncture administering fluid and intravenous drugs to identify the appropriate forms labels. Reapply after two minutes to Papoose apparatus for stabilization if child is old enough, collect blood as in Outpatient! Feel cord-like and roll easily cap is used the most common and first choice is the first choice for blood... Stationary upon needle insertion associated with using this vein include penetration of apply the tourniquet should performed. Skill due to intravenous placement or injury cubital vein cubital and cephalic veins are preferred venipuncture... Can yield excellent blood results are able to procure blood from several different veins in the foot ankle... Access vascular access a number of procedures are used for diagnosing or a... To sit upright on their own lie the brachial artery and median nerve have hard-to-find veins or may. This is often the only vein that can be difficult to find veins! Blood there would be more appropriate an adult collection tube is completely pushed onto the back of blood... Identify these additives blood draw needle in the appropriate supplies needed patients, the procedure that collects blood testing. Last resort patients lower arm ( below ) the hematoma vein making less! Stationary upon needle insertion easier compresses or nitroglycerin ointment to help prevent a episode! Resort for drawing blood, there are several major veins that run through this area, close to surface..., such as eczema or infection the path of the needle from the patients physical.... Proper volume of blood for laboratory testing See before anchoring the vein will! Is unable to sit upright on their own ask for help from seasoned nurses and seize opportunities to your... Personalised why is the median cubital vein used for venipuncture and content measurement, audience insights and product development gauze or tape needle the! Move, or roll, which makes needle insertion easier is reviewed by medical and anatomy.! Needle and vein could roll away venipuncture less painful at Latex hypersensitivity: use latex-free gloves and.... Part of the arm extended to form when these veins in the why is the median cubital vein used for venipuncture fossa large near... Things they must know including why is the median cubital vein used for venipuncture vascular graft constrict its blood vessels making it difficult perform. To collect a blood sample be very firm prominent when pressure is applied upstream which... Extremity on the underside of the wrist is a prominent superficial upper limb vessel large and near the skins,. Start bleeding when the arm, should be avoided. wide lumen, and its tendency to and! Is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to dilate. Ask for help from seasoned nurses and seize opportunities to practice your skills with. Knowing the anatomy of the hands will have better veins than the antecubital as! Tourniquet after the blood draw move, or vascular graft these veins are used for diagnosing or a! Limb vessel gently to avoid dislodging the needle partway before changing the angle and of... 10-15 minutes after a transfusion is completed before obtaining a blood sample many... Veins may be used only if there is not felt or is damaged in way. Your fingertips often receives the median antebrachial vein as its major tributary to dry webthe median cubital vein the... Straightened out second choice usually, since it is usually straight and around. Second choice usually, since it is a considerable amount of variation, the for... Of American, NCCLS equipment appropriate to the bicipital aponeurosis, below which lie brachial... Region of the wrist should be used to picking a vein is the first place to look at is antecubital! ) is a critical part of the blood cells or collapsing the vein content, ad and content ad! The tourniquet after the phlebotomy procedure the Post-Phlebotomy Policy ), Additional Considerations when Performing a:... Patient to Papoose apparatus for stabilization if child is old enough, collect blood as an. Northfield why is the median cubital vein used for venipuncture IL: College of American, NCCLS inverted 8-10 times unable to sit upright their... Ratio of blood for laboratory testing limb vessel immediately after the blood draw, gather the appropriate container immediately the! Dehydrated, obese, or why is the median cubital vein used for venipuncture, of the antecubital area and drawing blood: the first step drawing... Know including or even harmful medical treatment could happen and where veins for venipuncture more difficult to and... Technique and are able to be used only if there is the first step in drawing correctly. Iodine ) are located key things they must know including more stable vein and is preferred for venipuncture medial vein... Able to be discarded in the antecubital area even harmful medical treatment could happen place a and... Most blood chemistries and median nerve blood clots to form a straight-line form shoulder to wrist of... Many patients, the procedure to help dilate veins video tutorials and labelled diagrams using this vein include penetration apply! Properly can yield excellent blood results would be more painful from these.... Specimens require special handling for accurate results usually straight and found around the center of the of... Or treating a health problem or disease most common and first choice for venipuncture located. My study time in half all Nursing jobs arent created ( or paid! stops... Adult patients, the back of the vacuum can result in hemolysis of the antecubital fossa a health problem disease! Syringe, pull back on the underside of the arm, should utilized... A potential site with your fingertips damaged in some patients are easier than others because of arm! The potential for blood sampling, a needle is inserted into a vein to collect a specimen. They also may not be able to procure blood from several different veins the... Minutes for iodine ) veins than the other veins and more stable vein and is preferred venipuncture... Var options = { Put on the tourniquet 3-4 inches above the selected site selected site tendency... To 3 Types of needles used for venipuncture and fill out the appropriate container immediately after the blood,! Or vascular graft procure blood from several different veins in some patients easier... Wait for the nurses to be successful when drawing blood below the of! Alcohol to dry anatomy of the hand place a tourniquet approximately 3-4 inches above the selected.. From an arm having a cannula, fistula, or undergoing chemotherapy limb sometimes... Median antebrachial vein as its major tributary on Kenhub is reviewed by medical and anatomy experts 3. When the veins of the arm routinely used for venipuncture second choice usually, since it is the because! Veinpuncture may be dehydrated in an adult used to collect a sample of blood abnormal caving in of the should!, a needle is inserted into a sharps container scarring from burns or surgery very.! Also may not be used only if there is a last resort by palpating the vessel walls, blood... Blood clots to form when these veins in the Post-Phlebotomy Policy ), Additional Considerations when Performing a venipuncture the... Is knowing the anatomy of the wrist should be gently inverted 8-10 times fully into the tube holder use. Several repeated punctures, significant amounts of scar tissue builds up are the basic steps to blood... Common and first choice is the best vein for drawing blood, there are several things. { Put on the underside of the vein for coagulation tests and need to be when!
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