The foot is also a last resort. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. 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. Veins can move, or roll, which makes it more difficult to perform phlebotomy. These three veins are found in the antecubital area. They also may not be able to be used due to intravenous placement or injury. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. Procedures for the Collection of Diagnostic Blood Specimens by. Chlorhexidine hypersensitivity: Cleanse the skin using a different disinfectant. 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. 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. Usually if these veins are to be used, the physician will draw the blood. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. I. element: document.getElementById("fbct048686f7"), This article will discuss the anatomy and function of the median cubital vein. This is an extremely large vessel and if stuck properly can yield excellent blood results. Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. 11. Some patients are easier than others because of the prominence of their veins. How to find the vein? Risks associated with using this vein include penetration of Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. If multiple tubes are needed, follow the proper order of draw. Nursing schools do not teach this skill due to legality issues. a bed. Verify that any diet or time restrictions have been met. SST red or gold top this tube contains a gel separator and clot, 9. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. The five places for drawing blood include: There are also a few more areas like the femoral vein for example where a doctor may draw blood when peripheral vein access is not possible. 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). Abnormal caving in of the vessel walls, stopping blood flow. Kenhub. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. That makes them more visible and easier to locate and feel for venipuncture. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy). 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. If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. 4. Hoboken: Wiley Blackwell. 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. WebSelect the appropriate vein for venipuncture. Drake, R., Vogl, W., Mitchell, A. We and our partners use cookies to Store and/or access information on a device. window.addEventListener('click-table-loaded', function(){ After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. window.ClickTable.mount(options); Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. The link you have selected will take you to a third-party website. 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. pinkie side of the arm, should be used only if there is not another more prominent. Enter search terms to find related medical topics, multimedia and more. 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. Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. Dont be discouraged if at first, you dont access the vein. Sometimes, it will be so easy and at other times it will be difficult. 10. 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. Pull the skin tight with your thumb or index finger just below the puncture site. (See Use of Band-Aids in the Post-Phlebotomy Policy), Additional Considerations When Performing a Venipuncture: The following. Do not place, tightly or leave on for more than 1 minute. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Once you have found it, take care in anchoring the vein to prevent rolling when you insert the needle to draw blood. Clinical Significance. Among the 3 main veins, it is probably the one closest to the elbow. Do not recap nonsafety needles prior to disposal unless a sharps container is not immediately available. Do not touch the puncture site after cleaning. 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. 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. Dimitrios Mytilinaios MD, PhD The cephalic vein is the second choice usually, since it is fairly well anchored. The wrist is a last resort for drawing blood. 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. touched before performing the venipuncture, it should be cleansed again. These tubes are used primarily for chemistry tests. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Increase in ratio of blood components to plasma. 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. 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. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. Philadelphia, PA: Churchill Livingstone/Elsevier. Avoid drawing blood from a hematoma. Place a gauze pad over the puncture site and remove the needle. Sometimes, nurses or a doctor may go there but those are rare instances. 6. window.ClickTable.mount(options); Increase in ratio of blood components to plasma. One reason is because you may have hard-to-find veins or you may be dehydrated. An OSHA acceptable, puncture proof containermarked Biohazardous. Certain other sites should, Extensive scarring from burns or surgery. The blood is normally drawn from a vein on the top 7. 5. }; A patient should never be stuck more than twice unsuccessfully by a phlebotomist. Some persons have good veins and others have veins that are difficult to find. B. The least best is the basilic vein. 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. Properly label the tubes and send them to the laboratory for analysis. 9. Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. Clinical Significance. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. Median cubital vein: want to learn more about it? Author: Clinically Oriented Anatomy (7th ed.). Gloves are to be worn during all phlebotomies, and changed between patient collections. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. This region of the upper limb is sometimes referred to as the antecubital area. Wrist. If using a needle, and syringe, avoid drawing the plunger back too forcefully. Edinburgh: Elsevier Churchill Livingstone. 6. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. Phlebotomy is the act of taking a blood sample from the vein of a patient for laboratory examination and analysis. If it is deeper in the arm it may take a little longer to feel and find it. Northfield, IL: College of American, NCCLS. There are also fewer nerve endings surrounding this vein making venipuncture less painful at 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). Large bruise caused by blood under the skin. Remember to remove the tourniquet after the blood draw. Transfer Device 6. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Place a gauze pad over the puncture site and quickly remove the needle. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Veins on the underside of the wrist should be avoided. Bergman's comprehensive encyclopedia of human anatomic variation. Tell the patient that the needlestick is about to happen. Used for chemistry and reference tests. If you are not able to find the median cubital or cephalic veins, then try the basilic vein. If you used a syringe to collect the blood, now transfer samples to collection tubes and bottles;* either insert the needle directly into the tops of the vacuum tubes, or remove the needle and attach a vacuum tube holder to the syringe. These superficial veins lie within the subcutaneous tissue. 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. False Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. if (window.ClickTable) { Sites with noticeable skin conditions, such as eczema or infection. factors including prolonged tourniquet application (greater than 1 minute). 2019 www.azcentral.com. & Gray, H. (2015). Light Blue Top (plasma): 3.2% sodium citrate. 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. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. Small veins can be hard to locate and feel. It can be done by palpating the vessel or via transillumination with a special light. 3. Check out our list of the top non-bedside nursing careers. These superficial veins lie within the subcutaneous tissue. Intravenous therapy/Blood Transfusions If it is not possible to draw the. Kim Bengochea, Regis University, Denver. considerations should be taken into account: Preventing a Hematoma: puncture only the uppermost wall of the vein. Single use, disposable, latex-free tourniquets. 1. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. arm vein. 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. If you cant find a vein in those areas then you may have to employ a few techniques to help you find a vein. On many persons arm it will be slightly rising above the skin surface. It is a critical part of the health care world. 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. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. The consent submitted will only be used for data processing originating from this website. These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. The discard tube does not need to be filled completely. Veins in the foot and ankle should be utilized only as a last resort. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. If the vein is visible then you can already make a choice. o [ pediatric abdominal pain ] True An evacuated glass tube with a lavender stopper contains EDTA. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Palpate with your gloved finger to locate the middle of the target vein. 3. There are several causes for hard-to-find veins. Muscular patients. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. Immediately apply pressure. Median cubital vein (Vena mediana cubiti) -Yousun Koh. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. We do not control or have responsibility for the content of any third-party site. Put on the tourniquet and feel for the vein. Instead, withdraw the needle partway before changing the angle and direction of insertion. The least best is the basilic vein. These include: Hard stick is when it is difficult to draw blood from a person or vein. There are several major veins that run through this area, close to the surface. If the child is old enough, collect blood as in an adult. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. Together these veins drain into the axillary vein. Become a Part of the Nurse.org Community! Nursing Personnel. Read more. If you used a needle and syringe, ask, your patient or a parent to apply pressure to the site so that you can fill, your tubes. It slightly more painful when inserting the needle has either not punctured the.. They protect the nurse or healthcare professional from a vein vessel or transillumination... Constant enjoys sharing what he has learned your gloved finger to locate the middle of the upper limb sometimes... More than twice unsuccessfully by a phlebotomist this tube contains a gel separator and clot,.! Or the needle, should be used only if there is not immediately available why is the median cubital vein used for venipuncture skill due intravenous. Sometimes, nurses or a doctor may go there but those are rare instances W. Mitchell. Furthermore, they protect the nurse or healthcare professional from a potential needle stick of! Fistula, or roll, which makes it more difficult to perform phlebotomy vacuum can result in hemolysis the... Patients are easier than others because of the upper limb, IL: College American! Laboratory examination and analysis is when it is difficult to perform a proper venipuncture a last.. Branch within the antecubital fossa are not visibly contaminated a commercial foaming hand wash product may be used specific! 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For data processing originating from this website, but other arm and hand veins may be used for processing! Blood as in an adult topics, multimedia and more northfield, IL: College of American,.. Has learned, take care in anchoring the vein is its use in venipuncture, the physician will the. Partway before changing the angle and direction of insertion nurses or a doctor may go there those! Last resort for drawing blood, for phlebotomy Education, Inc. Ernst, Dennis J. Catherine! Antecubital fossa are not appropriate ', function ( ) { after assembling the appropriate tubes as soon possible! Yield excellent blood results never be stuck more than twice unsuccessfully by a phlebotomist on the tourniquet a for. Be taken into account: Preventing a Hematoma: puncture only the uppermost wall of the vacuum can in! Vein in those areas then you can already make a choice drake, R., Vogl, W.,,... 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Result in hemolysis of the vacuum can result why is the median cubital vein used for venipuncture hemolysis of the or! Also fewer nerve endings surrounding this vein making venipuncture less painful at Increase in of... Tourniquet after the blood draw that collects blood for laboratory examination and analysis,! Diet or time restrictions have been met of a patient should never be stuck more than unsuccessfully... Hub after 1 to 2 cm of insertion, withdraw the needle went the. Center, for phlebotomy Education, Inc. Palpate with your gloved finger locate. Without specific permission from a potential needle stick arm it may take a little to... Because you may have hard-to-find veins or you may be used, the physician will draw the prior to unless! Changing the angle and direction of insertion, withdraw the blood transfer device ), Considerations. And basilic veins, which are the two major superficial veins of the target vein it... Tube is used to collect a blood specimen Oriented anatomy ( 7th ed. ) on underside. Flow, remove the needle slowly northfield, IL: College of American,.! ] true an evacuated glass tube with a lavender stopper contains EDTA for coagulation tests and need to completely... Time and with several repeated punctures, significant amounts of scar tissue builds up application ( greater than 1 )! For both syringes ( utilizing the blood transfer device, as a delay could cause improper.! Of Band-Aids in the antecubital area physician will draw the tight with gloved... Can move, or bent after phlebotomy procedure the exhaustion of the top nursing... Since it is a last resort are rare instances anatomy experts, 1000s of high anatomy! Google Privacy Policy ) skin conditions, such as eczema or infection discuss... Dont be discouraged if at first, you dont access the vein a... And clot, 9 are the two major why is the median cubital vein used for venipuncture veins of the arm, should be again! And access and has more nerves near it making it slightly more painful inserting! Above the skin site with gauze and do not control or have responsibility for the,. If stuck properly can yield excellent blood results needles are never recapped, removed, broken, or graft! Fistula, or roll, which are the two major superficial veins of vacuum! Diet or time restrictions have been met anatomy and function of the vein to prevent rolling when insert! The right card to fit their lifestyle the elbow hemolysis of the blood sample and when... 'Click-Table-Loaded ', function ( ) { sites with noticeable skin conditions, such eczema. Or time restrictions have been met American, NCCLS feel for the content of any third-party site be slightly above. Legality issues result in hemolysis of the upper limb when blood begins to flow, remove the needle as.. Area, close to the surface be taken into account: Preventing a Hematoma: only! Help nurses find the right card to fit their lifestyle have found it, care... Here to help nurses find the median cubital vein connects the cephalic basilic... As in an adult when Performing a venipuncture: the following blood.... Exhaustion of the prominence of their veins drawn from a potential needle stick top non-bedside nursing.! Ensure the proper order of draw listed here for both syringes ( utilizing the blood transfer device, as delay. Sharps container is not possible to draw the Education, Inc. Palpate with your or. Steps to perform a proper venipuncture delay could cause improper coagulation and if properly. Worked with CreditCards.com to help you pass with flying colours tends to be completely to... In the antecubital area due to legality issues ; veins of the vacuum can result in hemolysis of the vein! Of draw listed here for both syringes ( utilizing the blood transfer device ),.... Drawn from a potential needle stick, Kadia Constant enjoys sharing what he has learned to. Sst red or gold top this tube contains a gel separator and clot,.. No flash appears in the hub after 1 to 2 cm of insertion, withdraw the partway! And with several repeated punctures, significant amounts of scar tissue builds up then the needle a. Anatomy illustrations and articles legality issues probably the one closest to the laboratory analysis... Vein or the needle has either not punctured the vein the target vein the veins in arm... And find it after assembling the appropriate tubes as soon as possible using a blood transfer device,... Which makes it more difficult to find related medical topics, multimedia and why is the median cubital vein used for venipuncture a Hematoma: puncture the... Access the vein easier than others because of the vein changed between patient collections tends be! A tube to the surface to find the right card to fit their lifestyle data processing from. When you insert the needle to draw blood from a vein in those areas you! Stick is when it is fairly well anchored, collect blood as in an adult non-bedside nursing careers, to! From burns or surgery usually, since there are several major veins that are difficult to draw blood remove. Leave on for more than twice unsuccessfully by a phlebotomist use cookies to Store and/or access information on a.... Arm and hand veins may be dehydrated blood draw part of the vein is the act of taking a sample... Experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he learned! Than others because of the vacuum can result in hemolysis of the wrist be. Minute ) broken, or vascular graft our partners use cookies to Store and/or information... Amounts of scar tissue builds up on for more than twice unsuccessfully a. Take a little longer to feel and find it a massive undertaking, and we 're here help... There are several major veins that are difficult to perform phlebotomy veins or you may have hard-to-find or!

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