2. Alternative sites are the basilic, vein on the dorsum of the arm or dorsal hand veins. 7. Dont be discouraged if at first, you dont access the vein. It brings the entire family Presently, needles are the predominant way of getting blood drawn for blood tests. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. WebWhy do we use the median cubital vein? In order for the nurses to be successful when drawing blood, there are several key things they must know including. Clinically Oriented Anatomy (7th ed.). Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. Edwin Ocran MBChB, MSc 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. 8. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. If you are vacutaining, try another tube there may be no vacuum in, After you have attempted to reposition the needle and are still not, successful, remove the tourniquet, remove the needle and begin the, process with a new site. G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. The WHO has set forth the following standards of patient care for hospitals to adhere by: They also identify dangerous and unsafe practices for blood draws including, >> Related: Arterial Blood Gases (ABGs) Explained. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. Arteries pulsate, are, more elastic and have a thicker wall than a vein. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. News and Education Editor, MSN, RN, BA, CBC. CLSI document H3-A6. 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. The cephalic vein is the second choice usually, since it is fairly well anchored. When bleeding stops, apply a fresh bandage, gauze or tape. Register now (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. Wrist. Subscribe for the latest nursing news, offers, education resources and so much more! Veins deeper in the arm can be hard to feel and locate. Label appropriate tubes at the bedside and place them into transport bags. 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. Veins on the underside of the wrist should be avoided. Similar anastomotic connections are seen in other areas of the upper limb. The median cubital creates less bruising and pain than other draw sites. 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. Palpation of phlebotomy site may be performed without gloves providing the skin is not broken. Philadelphia, PA: Churchill Livingstone/Elsevier. Place a sheathed needle or butterfly on the syringe. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. Best practices in phlebotomy involve the following factors: *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. These tubes are used primarily for chemistry tests. Risks associated with using this vein include penetration of An example of data being processed may be a unique identifier stored in a cookie. 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. Author: Apply the, tourniquet 3-4 inches above the selected puncture site. The cephalic vein is found on the lateral, or outside, of the arm. Blood Collection Tubes. venipuncture site by palpating with the gloved index finger. Foot. If using a needle, and syringe, avoid drawing the plunger back too forcefully. If multiple tubes are needed, follow the proper order of draw. WebWhy do we use the median cubital vein? movement) with the needle should be avoided. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. 2023 Procedures for the Collection of Diagnostic Blood Specimens by. WebSelect the appropriate vein for venipuncture. That is the first choice for drawing a blood sample. Use OR to account for alternate terms Tables showing needle sizes Hi! Wait for the antiseptic effect to occur (1 minute for chlorhexidine or 1.5 to 2 minutes for iodine). WebThe median cubital vein is the best vein to use for venipuncture. retract from the vein and the safety device will cover the needle. 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. Over time and with several repeated punctures, significant amounts of scar tissue builds up. 5. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. There are about three main areas for drawing blood: the median cubital, cephalic, and basilic veins. 13. Avoid probing for the vein. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. WebThe best vein for drawing blood is the median cubital vein. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. arm to start bleeding when the arm is straightened out. Red Top (serum): Plain and gel. Notify your supervisor or patients physician if unsuccessful. The median cubital vein connects the cephalic vein with the basilic vein. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. Veins in the foot and ankle should be utilized only as a last resort. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. Make sure the, venipuncture site is dry. The link you have selected will take you to a third-party website. Youll be the first to know about nursing news, trending topics and educational resources. Large bruise caused by blood under the skin. When bleeding stops, apply a fresh bandage, gauze or tape. pinkie side of the arm, should be used only if there is not another more prominent. Insert the beveled needle at a 30-degree angle into the vessel. Mass formed by leakage of blood under the skin. Return to your, patient and assess the site of the puncture. The median cubital vein passes anterior to the bicipital aponeurosis, below which lie the brachial artery and median nerve. 10. Position the patient with the arm extended to form a straight-line form shoulder to wrist. HealthStar Press, Inc. 2001, updated 1/08. Over time and with several repeated punctures, significant amounts of scar tissue builds up. There are also fewer nerve endings surrounding this vein making venipuncture less painful at New technology is being developed, Below is a needle gauge chart showing the sizes of needles used for the Evacuated Tube System, Syringe Method, and the Butterfly Needle when performing venipuncture. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. Drawing blood from a patient can be a daunting task but it also is a necessity for nurses. When that happens it can be difficult to locate veins. 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. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. In order to draw blood for a blood test a needle has to be inserted into a vein. Phlebotomy teams generally only make rounds at specific times in hospital settings, therefore, if a lab test is ordered immediately it could be the responsibility of the nursing staff to draw the specimen. There are also fewer nerve endings surrounding this vein making venipuncture less painful at 6. 3. Select the collection site and proceed as routine phlebotomy. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. 8. Identify the patient, two forms of active identification are required. The nursing staff should be notified, and they in turn must notify, the physician. Veins on the underside of the wrist should be avoided. If a tourniquet is used for preliminary vein selection, release it and reapply after two minutes. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. The WHO has best practices that are key to preventing infection and being successful during blood draws. Select the. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein in one motion. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. equally, but do you know which nurses are making the most money in 2023? Median cubital vein: want to learn more about it? Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Avoid drawing blood from a hematoma. Check out our list of the top non-bedside nursing careers. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Kim Bengochea, Regis University, Denver. Preventing of infection: Follow proper infection control policies. Median cubital vein (Vena mediana cubiti) -Yousun Koh. Do not attempt a venipuncture more than twice. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Back of the hand. (2016). Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. At no time may phlebotomists perform venipuncture on an artery. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. It does hurt more, though, when inserting the needle there than in the center of the arm. Fear of needles. Along its course, the median cubital vein commonly gives off a perforating branch, the deep median vein. To find it, assess the site next to the median cubital area on the thump side of your arm. Increase in ratio of blood components to plasma. Use another tube as vacuum may have been lost. 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. The wrist is a last resort for drawing blood. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Explain the procedure and reason for the blood draw to the patient. WebThe median cubital vein is the best vein to use for venipuncture. 10. The blood is normally drawn from a vein on the top Rolling veins. While it is important to know the best veins to access its also important to know which areas to avoid. 3. First, gather all of your supplies and discuss with your patient what you are going to be performing. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. At no time may phlebotomists perform venipuncture on an artery. 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. Reapply the tourniquet proximal to the selected insertion site. Apply adequate pressure to the puncture site to stop the bleeding and, avoid formation of a hematoma. Mass formed by leakage of blood under the skin. 2. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. 3. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. All content published on Kenhub is reviewed by medical and anatomy experts. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Reading time: 3 minutes. Standring, S. (2016). Sharps Disposal Container. if (window.ClickTable) { Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Confirm the ordered tests and fill out the appropriate forms and labels. In fact, the majority of intensive care units require their nurses to possess these skills. For children, swab the site 3 times using only alcohol. Deploy safety cover over the exposed needle. If no patient labels are available, manually label the tubes with the required information. Dehydration. 2. WebFlow of blood mixed with tube additive back into a patient's vein. Fill multiple collection tubes in the proper sequence. The blood is normally drawn from a vein on the top In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. The foot is also a last resort. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Place a gauze pad over the puncture site and quickly remove the needle. Dress the site with gauze and tape or a bandage. arm vein. Ask the patient to make a fist and not pump the hand. The median cubital vein is used the most for its accessibility. These superficial veins lie within the subcutaneous tissue. The median cubital vein is a common site for venipuncture due to its prominence and relative ease of accessibility. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Individuals taking chemotherapy. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. If a flash still does not appear, withdraw the needle almost to the skin surface, change direction, and try again to advance the needle into the vein. opposite arm, then blood should be drawn from BELOW (distal to) the IV. These include: Hard stick is when it is difficult to draw blood from a person or vein. Abnormal caving in of the vessel walls, stopping blood flow. 10. One reason is because you may have hard-to-find veins or you may be dehydrated. I'm Kadia. WebThe median cubital vein is the best vein to use for venipuncture. WebFlow of blood mixed with tube additive back into a patient's vein. Causes the body to constrict its blood vessels making it difficult to find veins. An OSHA acceptable, puncture proof containermarked Biohazardous. How to find the vein? Over time and with several repeated punctures, significant amounts of scar tissue builds up. The blood is normally drawn from a vein on the top WebSelect the appropriate vein for venipuncture. 5. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Lavender or Pink Top (plasma): Contains EDTA. 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. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. 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. [3] Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. Read more. Loosen the tourniquet, as it may be obstructing blood, flow. Observe all applicable isolation procedures. There is no easy way to draw blood. Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. Remember to remove the tourniquet after the blood draw. The tube must be labeled before leaving the patient. Veins of the hand and wrist are usually close to the surface, but they are prone to movement and rolling. A perforating branch, the most for its accessibility the required information over time and several... It also is a considerable amount of variation, the median cubital vein gives! With several repeated punctures, significant amounts of scar tissue builds up site of puncture ) to! Nerves of the top rolling veins tubing, connect the vacutainers or use a syringe to.... 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