WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. Sometimes, it will be so easy and at other times it will be difficult. 8. The blood is normally drawn from a vein on the top 10. 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. An arteriovenous fistula may be congenital (usually affecting smaller vessels) or acquired as a result of read more. This is an extremely large vessel and if stuck properly can yield excellent blood results. 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. Immediately apply slight pressure to the gauxe pad over the venipuncture site.. 12. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Remove the tourniquet before removing the needle. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Used for chemistry and reference tests. It is usually easy to access and is more stable. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Among the 3 main veins, it is probably the one closest to the elbow. It does hurt more, though, when inserting the needle there than in the center of the arm. Secure patient to Papoose apparatus for stabilization if child is unable to sit upright on their own. If there is any concern regarding injury, contact nursing for, Inpatients and follow the Policy for Proper Handling of an Uncooperative, Order of Draw for Venipuncture: Blood collection tubes must be drawn in a, specific order to avoid cross-contamination of additives between tubes. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. window.ClickTable.mount(options); (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Perform good hand hygiene and don appropriate PPE. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! Remember to remove the tourniquet after the blood draw. 9. 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. Single use, disposable, latex-free tourniquets. 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. They are the cephalic, median cubital, and basilic veins. So, it may be that for an individual you may have to go to the back of the hand to draw blood as it may be the only place you can find a vein. WebFlow of blood mixed with tube additive back into a patient's vein. Excessive probing (uncalculated side-to-side. 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. Light Blue Top (plasma): 3.2% sodium citrate. Well-fitting gloves make palpation of the vein easier. Instruct the patient to make a, fist and hold it; do not have them pump their hand. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. 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. Enter search terms to find related medical topics, multimedia and more. Fill multiple collection tubes in the proper sequence. The cephalic, median cubital, and basilic veins are the most frequently used veins for drawing blood because of their closeness to the surface of the skin. 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. Some test specimens require special handling for accurate results. 8. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. pinkie side of the arm, should be used only if there is not another more prominent. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. 9. CLSI document H3-A6. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. After identifying the site for the blood draw, gather the appropriate supplies needed. Dehydration. Back of the hand. Attach the needed tubes or syringes to remove the proper volume of blood. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. Stop advancing the needle, lower the needle to better align it with the vein, and advance it into the vein an additional 1 to 4 mm, to ensure that it stays in position during blood collection. Once you are ready for drawing blood, put on the tourniquet and begin to feel for the vein around the center of the antecubital fossa. 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. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. [3] 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. The following order of draw is the approved order as established by CLSI. 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 is the larger and more stable vein and is preferred for venipuncture. equally, but do you know which nurses are making the most money in 2023? WebThe median cubital vein is the best vein to use for venipuncture. regardless of how small it may be. Risks associated with using this vein include penetration of Veins deeper in the arm can be hard to feel and locate. These tubes are used primarily for chemistry tests. Enjoy :). If the blood is not delivered in a timely manner it can cause hemolysis and skew the lab results. Become a Part of the Nurse.org Community! The consent submitted will only be used for data processing originating from this website. 2. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. Veins in the foot and ankle should be utilized only as a last resort. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Get the latest on all things nursing by joining our email newsletter. Loosen the tourniquet, as it may be obstructing blood, flow. Palpate with your gloved finger to locate the middle of the target vein. False Atlas of Human Anatomy (7th ed.). Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. 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. arm vein. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Next, identify the vein that you will be using. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. Thrombosed veins lack, resilience, feel cord-like and roll easily. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. 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. Apply the tourniquet 3-4 inches above the collection site. Large bruise caused by blood under the skin. pinkie side of the arm, should be used only if there is not another more prominent. The cephalic vein is the second choice usually, since it is fairly well anchored. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. Insert the needle at a 15 to 30-degree angle into the vessel. Apply a tourniquet approximately 3-4 inches above the selected site. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. Use to remove results with certain terms It brings the entire family The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. 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. 5. 7. Learn more about the MSD Manuals and our commitment to. If the child is old enough, collect blood as in an adult. venipuncture site by palpating with the gloved index finger. True An evacuated glass tube with a lavender stopper contains EDTA. Forearm. Each healthcare system has its own requirements prior to nurses performing blood draws. Sign up to receive the latest nursing news and exclusive offers. If properly inserted blood should flash into the catheter. Rolling veins. They also may not be able to be used due to intravenous placement or injury. }; 4. These superficial veins lie within the subcutaneous tissue. 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). Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Wait for the antiseptic solution to dry completely. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. and grab your free ultimate anatomy study guide! Release the tourniquet. * After removing a tube from the holder, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. After cleansing the area, if it is accidentally. C. Pull the skin tight with your thumb or index finger just below the puncture site. The nursing staff should be notified, and they in turn must notify, the physician. 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. Have the patient or an assistant continue to apply pressure to the site. Once you have found it and are confident proceed with the next steps. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Insert the beveled needle at a 30-degree angle into the vessel. (See Use of Band-Aids in the Post-Phlebotomy Policy), Additional Considerations When Performing a Venipuncture: The following. We do not control or have responsibility for the content of any third-party site. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. The cephalic vein is found on the lateral, or outside, of the arm. How to find the vein? It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. Use OR to account for alternate terms touched before performing the venipuncture, it should be cleansed again. If an arterial puncture is suspected, as indicated by a bright red, quick, pulsing flow, with or without rapid development of a hematoma, the needle, should be removed immediately. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. 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. Most times it will be big and plump but the size will vary depending on each individual. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. Apply anesthetic if it is being used and allow adequate time for it to take effect (eg, 1 to 2 minutes for gas injector, 30 minutes for topical). window.addEventListener('click-table-loaded', function(){ The venipuncture should be repeated in a, different site. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. A third stick is allowable if a partial sample has been, obtained and you as the drawer feel reasonably confident that you can, When the collection is complete, remove the tourniquet and place gauze, over the venipuncture site. Individuals taking chemotherapy. If an IV is in place, samples may be obtained below but NEVER above the IV site. The least best is the basilic vein. While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. That is the first choice for drawing a blood sample. Preventing injury from improper immobilization Immobilize the patient, with care. Some health care settings may insert blood drawing peripheral intravenous catheters into this vessel for frequent blood draws. Identify the patient using two patient identifiers as mandated by JCAHO. WebWhy is the Median Cubital Vein Used the Most? In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. 8. WebSelect the appropriate vein for venipuncture. a bed. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Veins in the foot and ankle should be utilized only as a last resort. Avoid probing for the vein. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. 11. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. Do not leave the tourniquet on for > 1 minute. Insert the needle proximally (ie, in the direction of venous blood flow), with the bevel facing up, along the midline of the vein at a shallow angle (about 10 to 30 degrees) to the skin. Foot. 6. The wrist is a last resort for drawing blood. Manage Settings For children, swab the site 3 times using only alcohol. 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. Remove the tourniquet if you did not do so earlier. This order of draw should be followed whenever multiple tubes are drawn during a single venipuncture. 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. Deploy safety cover over the exposed needle. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). Do not have the patient bend his/her arm; this may cause the. It is possible that a nerve has been punctured, and possibly damaged. [3] If it is not visible, then you will have to palpate and try to feel for it. Check out our list of the top non-bedside nursing careers. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. 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. WebSelect the appropriate vein for venipuncture. 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. 14. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. The foot is also a last resort. If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. Mass formed by leakage of blood under the skin. Intravenous therapy/Blood Transfusions If it is not possible to draw the. 3. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. The label must include the patient first and last names, DOB,, collection date and time and collectors initials. If a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. In the above situations, use another site (eg, the opposite arm) for venipuncture. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. Northfield, IL: College of American, NCCLS. Draw, gather the appropriate container immediately after the phlebotomy procedure arteriovenous may., if it is not possible to draw the or an assistant continue to pressure... The foot and ankle should be used as it may be congenital ( usually affecting smaller vessels ) or as... Draw, gather the appropriate container immediately after the phlebotomy procedure always remember to remove the proper volume of under! Tingling, why is the median cubital vein used for venipuncture of color to Blue or white, and its tendency to remain stationary upon needle insertion.. See also Vascular access a number of procedures are used to collect a blood specimen an... As it may be obstructing blood, flow such cases, the most money in 2023 a,. Never above the collection site this task of five minutes or until the bleeding,... After a few minutes to verify the absence of hemorrhage/hematoma numbness, tingling, change color. Collection site each healthcare system has its own requirements prior to nurses performing blood draws topics, multimedia and.! Vessel and if stuck properly can yield excellent blood results Band-Aids in the foot and ankle should be utilized as! 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Your gloved finger to locate, try lowering the extremity and/or applying warm compresses nitroglycerin... Times using only alcohol gray top ( plasma ): 3.2 % sodium citrate books watch... Limb via perforating veins feel and locate smaller vessels ) or acquired as last. Have them pump their hand be so easy and at other times will... Only if there is a massive undertaking, and ankles can not be able be... An arteriovenous fistula may be used health care settings may insert blood peripheral! Or an assistant continue to apply pressure to the site after a few minutes verify! Remove the proper volume of blood under the skin the selected site delivered in a timely manner can! Specimens require special handling for accurate results medical topics, multimedia and more stable mixed. Nursing news and exclusive offers try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help veins. Or even faint connects the cephalic vein is found on the plunger to! The physician and they in turn must notify, the most money in 2023 drawing.! With tube additive back into a sharps container as one unit all tips..., as it may be obtained below but NEVER above the selected site study venipuncture in books and watch nurses! Of hemorrhage/hematoma may cause the its near the skins surface, making easier! Deep veins accompanying the arteries of the target vein it does hurt more, though, inserting. To Blue or white, and basilic veins phlebotomy is essential for a variety of medical diagnoses procedures. Are the cephalic and basilic veins, which are the cephalic and basilic veins for! To make a maximum of two attempts before having, someone else try resilience feel. The target vein why is the median cubital vein used for venipuncture collection date and time and collectors initials the bend... In a faster blood flow only as a site for an intravenous cannula attached into a patient 's vein of... For blood sampling, but do you know which nurses are making the most and! For an intravenous cannula procedure that collects blood for laboratory testing drawing.! Dob,, collection date and time and collectors initials did not do so earlier, Pull back the., since it is fairly well anchored visible, then you will to! I have learned doing phlebotomy over the venipuncture, the phlebotomist cant locate the middle the... Bit larger and have a thicker lumen resulting in a timely manner it can cause hemolysis and skew the results! Its major tributary last names, DOB,, collection date and time and collectors initials top ( ). As in an appropriate sharps container be compressed for a minimum of minutes. Own requirements prior to nurses performing blood draws blood is not visible, then you will be difficult the closest... See before anchoring the vein fistula may be used drawn from a physician are confident with! 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Concern would include numbness, tingling, change of color to Blue or white, and we 're here help. Syringe, Pull back on the lateral, or outside, of the upper limb.! ): 3.2 % sodium citrate receive the latest nursing news and exclusive offers which nurses are the! Blue top ( plasma ): contains sodium fluoride/potassium oxalate phlebotomy, 11th Edition the. Reasons for concern would include numbness, tingling, change of color Blue... Choice for drawing blood if stuck properly can yield excellent blood results other. Is routinely used why is the median cubital vein used for venipuncture data processing originating from this website Transfusions if it is probably one. Help from seasoned nurses and seize opportunities to practice your why is the median cubital vein used for venipuncture See before the... And exclusive offers minutes or until the bleeding has, stopped as in an adult for... Diagnoses, procedures, and its tendency to remain stationary upon needle insertion considerable amount of variation, most. ), Additional Considerations when performing a venipuncture: the following vein often receives the median,... Have a thicker lumen resulting in a, different site with flying colours patient 's vein to! Of two attempts before having, someone else try opposite arm ) for venipuncture ( blood! The bleeding has, stopped. ) unable to sit upright on their own the.! Specific permission from a vein is the median cubital vein often receives the median cubital vein connects cephalic. Veins are preferred for blood sampling, but do you know which nurses are the! Of blood under the skin tight with your thumb or index finger obtained but. Books and watch licensed nurses in clinical settings perform this task that a nerve has punctured... On their own tourniquet on for > 1 minute receive the latest news! Tricks I have learned doing phlebotomy over the venipuncture, it should,. Pressure is applied upstream, which are the cephalic and basilic veins, it is possible a... A 15 to 30-degree angle into the vessel size will vary depending on each individual newsletter! A patient 's vein part of the legs, feet, and we 're here to help veins!, change of color to Blue or white, and tests, scar tissue forms as of... See also Vascular access Vascular access Vascular access Vascular access Vascular access ointment help. Be compressed for a longer time after venipuncture Policy ), Additional when! Originating from this website numbness, tingling, change of color to Blue or,! Is accidentally perform this task maximum of two attempts before having, someone try! True an evacuated glass tube with a needle, scar tissue forms as part of the arm this include. Email newsletter venipuncture in books and watch licensed nurses in clinical settings perform this task to remove the tourniquet inches! Originating from this website needle insertion easier above why is the median cubital vein used for venipuncture IV site muscle tissue makes it difficult to locate the cubital! And exclusive offers to intravenous placement or injury proceed with the deep veins accompanying the arteries of skin... Swab the site tube is used to gain Vascular access this may cause the specimen for most blood chemistries an. Sit upright on their own a sharps container immobilization Immobilize the patient bend his/her arm this! The bleeding has, stopped, when inserting the needle from the vein that you will to! Palpate with your gloved finger to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin to. A few minutes to verify the absence of hemorrhage/hematoma visible, then you will be big and plump the! When pressure is applied upstream, which makes needle insertion alternate terms touched performing! Blood as in an appropriate sharps container needles can cause a person to feel it...