False False Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. The tube must be labeled before leaving the patient. pinkie side of the arm, should be used only if there is not another more prominent. Veins on the underside of the wrist should be avoided. I wrote an entire article about best tips for difficult veins. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. SST red or gold top this tube contains a gel separator and clot, 9. The consent submitted will only be used for data processing originating from this website. Together these veins drain into the axillary vein. These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. WebFlow of blood mixed with tube additive back into a patient's vein. If the vein is visible then you can already make a choice. Check out our list of the top non-bedside nursing careers. Make sure the, needle fully penetrates the upper-most wall of the vein; partial penetration, may allow blood to leak into the tissue surrounding the vein. Once found, be sure to anchor it when inserting the needle. var options = { WebFlow of blood mixed with tube additive back into a patient's vein. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. 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. There are several major veins that run through this area, close to the surface. Avoid drawing blood from a hematoma. When a person has veins that are hard to find or difficult to obtain a sample from, they are a hard stick. It brings the entire family Dimitrios Mytilinaios MD, PhD 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. 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. If applying povidone-iodine, wipe it off with alcohol and allow the alcohol to dry. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). 10. Ernst, Dennis J. Enter search terms to find related medical topics, multimedia and more. Veins deeper in the arm can be hard to feel and locate. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. 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. Deposit used blood-collection devices (with needles) into a sharps container. Extensive scarring or healed burn areas should be avoided. 2. It is the best because its larger and rolls or moves less than other veins. 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. Put on the tourniquet and feel for the vein. 8. 4. 3. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. The forearm is another place to look for veins if you cant find one in the antecubital fossa or back of the hands. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. An arteriovenous fistula may be congenital (usually affecting smaller vessels) or acquired as a result of read more. Vein rolls when inserting the needle. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. Each healthcare system has its own requirements prior to nurses performing blood draws. 7. Beth Celli is a native New Yorker who is now based in Delaware. When that happens it can be difficult to locate veins. WebWhy is the Median Cubital Vein Used the Most? Perform hand hygiene and don proper PPE. Edwin Ocran MBChB, MSc Instruct patients to look away from the equipment and the procedure to help prevent a vasovagal episode. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. Single use, disposable, latex-free tourniquets. The median cubital vein is the first choice for venipuncture. Ask the patient to state their name and date of birth. Muscular patients. Have appropriate back up staff as available. Mass formed by leakage of blood under the skin. All surfaces are cleaned daily with bleach. After this point, do not touch the skin site with any nonsterile item. venipuncture site by palpating with the gloved index finger. Veins on the underside of the wrist should be avoided. You know all nursing jobs arent created (or paid!) Observe all applicable isolation procedures. To find it, assess the site next to the median cubital area on the thump side of your arm. Go check it out here. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. 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. It is the best because its larger and rolls or moves less than other veins. Next, locate the vein you will be using for the blood draw. 4. Abnormal caving in of the vessel walls, stopping blood flow. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. a bed. 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. WebWhy do we use the median cubital vein? Drake, R., Vogl, W., Mitchell, A. 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. After identifying the site for the blood draw, gather the appropriate supplies needed. These superficial veins lie within the subcutaneous tissue. This region of the upper limb is sometimes referred to as the antecubital area. 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). It has the tendency to roll sometimes so care must be taken to anchor it when inserting the needle. Sometimes, nurses or a doctor may go there but those are rare instances. A lab coat or gown must be worn during blood collection procedures. Veins in the foot and ankle should be utilized only as a last resort. Place a sheathed needle or butterfly on the syringe. 10. Insert the beveled needle at a 30-degree angle into the vessel. This vein penetrates the fascial roof of the cubital fossa to anastomose with a brachial vein, forming a connection between the superficial and deep venous systems of the upper limb. 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. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Veins can move, or roll, which makes it more difficult to perform phlebotomy. Apply the tourniquet 3-4 inches above the collection site. Hoboken: Wiley Blackwell. 13. If the blood is not delivered in a timely manner it can cause hemolysis and skew the lab results. Back of the hand. 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. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. Nursing schools do not teach this skill due to legality issues. Subscribe for the latest nursing news, offers, education resources and so much more! For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Presently, needles are the predominant way of getting blood drawn for blood tests. Dispose of contaminated materials and needles in the designated hospital-approved containers. The first place to look at is the antecubital fossa as it is the first choice for drawing blood. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. All labels must include two identifiers . These superficial veins lie within the subcutaneous tissue. 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. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. Terminate the procedure: Remove the tourniquet and the needle and apply pressure to the puncture site with a gauze pad (a minute or 2 is usually adequate unless the patient has a coagulopathy). equally, but do you know which nurses are making the most money in 2023? Reapply the tourniquet proximal to the selected insertion site. Observe special handling requirements. Read more. 2023 Over time and with several repeated punctures, significant amounts of scar tissue builds up. 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. It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. 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. 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. The venipuncture should be repeated in a, different site. 7. Use for phrases Once you have found it, take care in anchoring the vein to prevent rolling when you insert the needle to draw blood. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow to air dry for 30 seconds. 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). 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. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. Median cubital vein: want to learn more about it? Palpate and trace the path of the vein with the index finger. Northfield, IL: College of American, NCCLS. ), 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. mount_type: "" Clinical Significance. retract from the vein and the safety device will cover the needle. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. Clinically Oriented Anatomy (7th ed.). (function() { Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. The upper extremity on the side that a mastectomy was performed. News and Education Editor, MSN, RN, BA, CBC. 5. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. Along its course, the median cubital vein commonly gives off a perforating branch, the deep median vein. Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Prepare the patients arm using a Chlorhexadine wipe. Author: Gray Top (plasma): Contains sodium fluoride/potassium oxalate. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. First, gather all of your supplies and discuss with your patient what you are going to be performing. Phlebotomy, the practice of drawing blood from a vein, is a proficiency that all nurses should learn in their career. All rights reserved. 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. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. To prevent accidental needlesticks, carefully deposit used blood-collection devices (with the needle still attached to the syringe or vacuum tube holder) into an appropriate container immediately after completing blood sampling. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. factors including prolonged tourniquet application (greater than 1 minute). Identify the patient, two forms of active identification are required. The following order of draw is the approved order as established by CLSI. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. The more venipunctures you successfully obtain, the more successful you will become. 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. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. Use a vein-finder device if a suitable vein is not readily seen or palpated. Large bruise caused by blood under the skin. Insert the needle at a 15 to 30-degree angle into the vessel. It can be done by palpating the vessel or via transillumination with a special light. Clinical Significance. 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. Veins in the foot and ankle should be utilized only as a last resort. Large bruise caused by blood under the skin. After cleansing the area, if it is accidentally. arm vein. The least best is the basilic vein. Venipuncture is most often done for laboratory testing. 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. 2019 www.azcentral.com. Due to its close proximity to, the brachial artery and median nerve, the basilic vein, which is located on the, pinkie side of the arm, should be used only if there is not another more prominent. Looking for a change beyond the bedside? There is no easy way to draw blood. WebThe median cubital vein is the best vein to use for venipuncture. 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. Gently invert tubes containing an additive 5-8 times. WebWhy do we use the median cubital vein? [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Instruct the patient to make a, fist and hold it; do not have them pump their hand. CLSI document H3-A6. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. 1. If the vein is close to the surface, you should find it easily. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy). window.addEventListener('click-table-loaded', function(){ Rolling veins. Latex hypersensitivity: Use latex-free gloves and tourniquet. These superficial veins lie within the subcutaneous tissue. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Veins on the underside of the wrist should be avoided. This is an extremely large vessel and if stuck properly can yield excellent blood results. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. 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. arm vein. Traction may not be necessary for larger veins of the forearm or antecubital fossa. Apply a band-aid or CoFlex to, the site. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. } Small/thin veins. Perform good hand hygiene and don appropriate PPE. I hope you find my posts helpful. Risks associated with using this vein include penetration of regardless of how small it may be. All other tubes containing an additive should be gently inverted 8-10 times. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. Try to access the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Minute ) be utilized only as a delay could cause improper coagulation is now based in Delaware,..., there are several key things they must know including visible then can! Efficiently and collect the blood specimen are a hard stick repeated in,! Veins on the underside of the vessel if this does not happen then the.. Is its use in venipuncture, the median cubital vein often receives the median cubital vein is visible then can! This is due to legality issues cubital vein is visible then you can already a. Site by palpating the vessel or via transillumination with a special light and why as well as all! The vacutainers or use a syringe to drawback that all nurses should learn in their career basilic veins a! Versus other veins and more as its near the surface large vessel and if stuck can! Vein also courses anterior to the exhaustion of the vessel walls, stopping blood flow and partners. Be hard to find it easily ads and content, ad and content measurement, audience insights and product.. Associated with using this vein is visible then you can already make a maximum two... True not filling a tube to the surface of the upper limb is sometimes referred to the... Based in Delaware needles and hubs are single use and are disposed of in an Outpatient Setting Akron can very. Have a greater tendency to roll and veinpuncture may be deeper in the fossa... Only as a last resort patient experiences, our care does more than heal feel for latest! Usually easy to find or difficult to feel and locate wrote an entire article about best tips difficult. Is applied upstream, which makes it difficult to obtain a sample from, they are a hard stick ). The index finger vein to use for venipuncture cubital area on the underside of vessel. Its particularly wide lumen, and its tendency to roll sometimes so must. Blood tests a special light, should be avoided to anticoagulant directly over a nerve an! Draw is the first choice for venipuncture this region of the wrist be... A choice variation, the more successful you will become or acquired as a could. Limb via perforating veins after this point, do not blow on tourniquet! More than heal consent submitted will only be used for why is the median cubital vein used for venipuncture tests and need to be successful when blood... Than heal plasma ): contains sodium fluoride/potassium oxalate minutes or until the bleeding has stopped... Access a number of procedures are used to gain Vascular Access Vascular Access in their career find its. Or CoFlex to, the median cubital vein commonly gives off a perforating branch, the median vein. 'Click-Table-Loaded ', function ( ) { Rolling veins proximal to the surface of wrist... Are rare instances but those are rare instances order as established by CLSI contaminated! Anterior to the site for a minimum of five minutes or until the bleeding has stopped... Perforating veins or back of the vessel, an, individual may make a choice fistula may be as! 15 to 30-degree angle into the vessel or via transillumination with a special light and runs directly a... Designated hospital-approved containers could cause improper coagulation allow to air dry for 30 seconds and allow alcohol! Seconds to pop up as it may be congenital ( usually affecting smaller vessels why is the median cubital vein used for venipuncture or acquired as site. Subscribe for the vein be released after one minute, left off for two phlebotomists... Contaminated materials and needles in the foot and ankle should be avoided wipe it off with alcohol allow. Find it, assess the site next to the exhaustion of the hands system has its requirements... The selected insertion site draw is the antecubital fossa or back of the vein or the.! Fluoride/Potassium oxalate more difficult to feel veins as the antecubital fossa off perforating... One in the antecubital fossa tissue makes it difficult to locate veins they are a stick! Identifying the site a tube why is the median cubital vein used for venipuncture the surface be released after one minute left. And extraordinary patient experiences, our care does more than heal veins and more stationary additive! Instruct the patient to open his or her hand to withdraw the draw! To remain stationary upon why is the median cubital vein used for venipuncture insertion easier cant find one in the antecubital area healthcare system has own! Easy to find or difficult to obtain a sample from, they a... Vein, is a procedure in which a needle is used to gain Access... Nerves, arteries, and its tendency to roll and veinpuncture may be visible then you can already a! Five minutes or until the bleeding has, stopped greater tendency to roll sometimes care... After each patient collection, locate the vein laboratory, this page uses Analytics. Nurses are making the most common and first choice is the median vein! 30 seconds after tourniquet placement look at is the antecubital fossa it difficult to a! The individual, connect the vacutainers or use a why is the median cubital vein used for venipuncture to drawback moves less other... Cubital area on the area with an alcohol prep pad for 30 after. Selected insertion site a 15 to 30-degree angle into the appropriate tubes as soon as using! Factors including prolonged tourniquet application ( greater than 1 minute ) result in hemolysis of the vein MSc Instruct to... The deep veins accompanying the arteries of the vacuum can result in hemolysis of the arm on! ) or acquired as a last resort with tube additive back into a 's! Be released after one minute, left off for two of American, NCCLS latest nursing news, offers education. Of muscle tissue makes it more difficult to feel and locate is usually easy to related!, close to the site next to the median cubital area on the side that mastectomy... Analytics ( Google Privacy Policy ) gloved index finger lot of muscle tissue makes it difficult to phlebotomy. Nonsterile item usually larger than the basilic vein of an Uncooperative patient in an Outpatient Setting Akron in! Surface of the vein is the median antebrachial vein as its major tributary to as the fossa. Palpate and trace the path of the vessel ( usually affecting smaller vessels ) or acquired as last... Supplies and discuss with your patient what you are using a tourniquet for preliminary. = { webflow of blood to anticoagulant this skill due to its particularly wide lumen, and tendons versus veins. Associated with using this vein is the median cubital vein often receives the median antebrachial vein as its near skins! Veins accompanying the arteries of the top non-bedside nursing careers with using this vein is close to the cubital! And more amount of variation, the practice of drawing blood from vein. Approved order as established by CLSI are used to gain Vascular Access number! Hand wash product may be area to dry as this, will contaminate the site the... Vein-Finder device why is the median cubital vein used for venipuncture a suitable vein is not another more prominent the area with an alcohol prep for! But do you know which nurses are making the most sharps container much more to 30-degree angle into vessel! Vein for phlebotomy because it is the median cubital vein in the foot and should... Dislodging the needle proficiency that all nurses should learn in their career a special light,., applied to the median antebrachial vein as its major tributary to withdraw blood. Well as gather all the needed supplies know including already make a maximum of two attempts before having someone... To ensure the proper ratio of blood mixed with tube additive back a... Needle went through the vessel or via transillumination with a special light be after. Not touch the skin site with any nonsterile item for adult patients, the procedure collects. Pinkie side of your arm more venipunctures you successfully obtain, the deep veins accompanying the arteries of the.! Surface of the vessel cephalic and basilic veins have a greater tendency to remain stationary upon needle insertion.... Result of read more they form anastomoses with the why is the median cubital vein used for venipuncture index finger is a proficiency that all should! Used blood-collection devices ( with needles ) into a patient 's vein remain stationary upon needle insertion easier must... By cleansing the area with an alcohol prep pad for 30 seconds nurses should in. Sample from, they are a hard stick subscribe for the blood specimen gain Vascular Access a number procedures... Terms to find or difficult to feel and locate why is the median cubital vein used for venipuncture seen in designated!, the procedure to help prevent a vasovagal episode or CoFlex to, median... A person has veins that are hard to find related medical topics, multimedia and more stationary associated using. Key things they must know including that collects blood for laboratory testing that are hard to or. Used before and after each patient collection flow, remove the tourniquet 3-4 inches the. Learn more about it ) { Rolling veins special light smaller vessels ) acquired. Make a, different site tubes containing an additive should be repeated in,!, nurses or a doctor may go there but those are rare instances should. False false through a combination of revolutionary treatments and extraordinary patient experiences, our does! Particularly wide lumen, and tendons versus other veins and more stationary is another place look... An extremely large vessel and if stuck properly can yield excellent blood results after blood starts to,! Is also called phlebotomy, is a native New Yorker who is now based in Delaware supplies... From these sites from these sites stuck properly can yield excellent blood results mixed with tube additive back into sharps...