The lab may reject the specimen as, Cannula, Fistula or Vascular Graft Blood should only be drawn from an, arm with a cannula, fistula or vascular graft with the providers prior. Nursing Personnel. When blood collection is complete, gently hold a folded gauze square at the venipuncture site with your nondominant hand, and in one motion remove the needle and immediately apply pressure to the site with the gauze. Position the patient with the arm extended to form a straight-line form shoulder to wrist. Last reviewed: November 23, 2022 The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. Veins of the legs, feet, and ankles cannot be used without specific permission from a physician. Remove the tourniquet as the last amount of blood is drawn. When bleeding stops, apply a fresh bandage, gauze or tape. This is to prevent cross contamination by the tube additives that could lead to erroneous results. The discard tube does not need to be filled completely. The information we provide is grounded on academic literature and peer-reviewed research. Wait for the antiseptic solution to dry completely. Do not leave the tourniquet on for > 1 minute. If the blood is not delivered in a timely manner it can cause hemolysis and skew the lab results. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. True An evacuated glass tube with a lavender stopper contains EDTA. Excessive probing (uncalculated side-to-side. 7. 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. Mass formed by leakage of blood under the skin. Sharps Disposal Container. In fact, the majority of intensive care units require their nurses to possess these skills. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. together for emotional support and understanding across multiple locations to reach you in the community where you live. Gloves are to be worn during all phlebotomies, and changed between patient collections. The consent submitted will only be used for data processing originating from this website. Over time and with several repeated punctures, significant amounts of scar tissue builds up. 3. Learn more about the MSD Manuals and our commitment to. Mass formed by leakage of blood under the skin. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Green Top (plasma): With and without gel, contains lithium heparin. Used primarily for hematology and blood bank testing. Read more. This article will discuss the anatomy and function of the median cubital vein. Have the patient or an assistant continue to apply pressure to the site. However, we know that is not always the option we are presented with. Perform good hand hygiene and don appropriate PPE. 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. B. 5. C. Pull the skin tight with your thumb or index finger just below the puncture site. 4. Never leave the tourniquet on for over 1 minute. Nursing schools do not teach this skill due to legality issues. 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. Insert the needle at a 15 to 30-degree angle into the vessel. Sites with noticeable skin conditions, such as eczema or infection. Individually packaged 70% isopropyl alcohol wipes. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. It has the tendency to roll sometimes so care must be taken to anchor it when inserting the needle. 6. Single use, disposable, latex-free tourniquets. Identify the patient, two forms of active identification are required. Pull the skin tight with your thumb or index finger just below the puncture site. This is an extremely large vessel and if stuck properly can yield excellent blood results. Hoboken: Wiley Blackwell. Loosen the tourniquet, as it may be obstructing blood, flow. WebSelect the appropriate vein for venipuncture. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. Fragile/collapsed veins. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Blood should flow into the evacuated tube. If the vein is visible then you can already make a choice. Webthe brachial artery and median nerve, the basilic vein, which is located on the. This area is in the front of and below the bend of the arm at the elbow. Clinically Oriented Anatomy (7th ed.). Palpate and trace the path of the vein with the index finger. 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. Observe universal (standard) safety precautions. WebWhy is the Median Cubital Vein Used the Most? True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. The color of cap is used to identify these additives. o [ abdominal pain pediatric ] Light Blue Top (plasma): 3.2% sodium citrate. 2. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. 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. Among the 3 main veins, it is probably the one closest to the elbow. I would honestly say that Kenhub cut my study time in half. Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. The blood is normally drawn from a vein on the top WebThe median cubital vein is the best vein to use for venipuncture. 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. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Together these veins drain into the axillary vein. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. Subscribe for the latest nursing news, offers, education resources and so much more! Test your knowledge on the main veins of the upper limb in this quiz. Transfer Device 6. Deep veins. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. 4. It may help to allow the arm to hang down, increasing venous pressure. It brings the entire family Wash hands in warm, running water with a appropriate hand washing product. The tourniquet should be applied between the IV site and the venipuncture, site. o [teenager OR adolescent ]. 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. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Assemble the necessary equipment appropriate to the patients physical characteristics. At no time may phlebotomists perform venipuncture on an artery. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. It is the best because its larger and rolls or moves less than other veins. Observe all applicable isolation procedures. Burnt areas. Use only mild tension when applying the tourniquet; it is a venous, not an arterial, tourniquet. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. The nursing staff should be notified, and they in turn must notify, the physician. Obese patients. Ultrasound guidance How To Do Peripheral Vein Cannulation, Ultrasound-Guided Ultrasound-guided peripheral venous cannulation uses real-time (dynamic) ultrasound to guide venipuncture and a catheter-over-needle technique to place a peripheral intravenous catheter (cannula) read more , when equipment and trained personnel are available, can facilitate blood sampling from deep, nonpalpable veins. 10. If it is deeper in the arm it may take a little longer to feel and find it. The foot is also a last resort. Knowing the location of each vein, go to the respective area to find it. 4. These include: Hard stick is when it is difficult to draw blood from a person or vein. 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. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Hematoma A venipuncture should not be performed on a hematoma. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. It is the best because its larger and rolls or moves less than other veins. This is a common misconception - pumping the hand does not increase venous circulation. 6. if (window.ClickTable) { The median cubital vein typically arises as a collateral branch from the cephalic vein which runs on the anterolateral aspect of the upper limb. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. 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. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. After identifying a suitable cannulation site, remove the tourniquet. Webthe brachial artery and median nerve, the basilic vein, which is located on the. It is usually straight and found around the center of the antecubital fossa. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. The cephalic vein is the second choice usually, since it is fairly well anchored. As there is still a risk that the sample could be, contaminated, you must document that the specimen was drawn above, (proximal to) an IV site and how many minutes the IV was turned off, before the draw occurred. Use OR to account for alternate terms Extensive scarring or healed burn areas should be avoided. WebWhy do we use the median cubital vein? Position the patient and hyperextend the patients arm. I. Get the latest on all things nursing by joining our email newsletter. False Good luck! Some patients are easier than others because of the prominence of their veins. }); 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. She has a varied background in both health care and education, having worked in several different hospitals and medical centers prior to teaching allied health classes. Release the tourniquet. Used for Genetics testing. Caution must be taken to avoid arterial puncture. 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. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy). However, it does BECOME easier with practice. Clinical Significance. The Supervisor should be called to assess the patient. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. Wipe off povidone-iodine with alcohol and allow the alcohol to dry. Deploy safety cover over the exposed needle. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. Notify your supervisor or patients physician if unsuccessful. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. These superficial veins lie within the subcutaneous tissue. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. They are the cephalic, median cubital, and basilic veins. In doing so, this will enable students to learn basics prior to graduation. Risks associated with using this vein include penetration of a bed. This is an extremely large vessel and if stuck properly can yield excellent blood results. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. There are also fewer nerve endings surrounding this vein making venipuncture less painful at WebThe best vein for drawing blood is the median cubital vein. Follow, the order of draw listed here for both syringes (utilizing the blood transfer device), 2. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. 9. 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. We and our partners use cookies to Store and/or access information on a device. The label must include the patient first and last names, DOB,, collection date and time and collectors initials. The median cubital vein is a common site for venipuncture due to its prominence and relative ease of accessibility. Vein collapses when blood is being drawn from the vein. Veins in the foot and ankle should be utilized only as a last resort. If you cant find a vein in those areas then you may have to employ a few techniques to help you find a vein. How to find the vein? 7. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. 6. Fear of needles. True An evacuated glass tube with a lavender stopper contains EDTA. Philadelphia, PA: Lippincott Williams & Wilkins. 10. Median cubital vein (Vena mediana cubiti) -Yousun Koh. 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. That makes them more visible and easier to locate and feel for venipuncture. Large bruise caused by blood under the skin. Allow to air dry. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. Individuals taking chemotherapy. WebThe median cubital vein is the best vein to use for venipuncture. 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). All other tubes containing an additive should be gently inverted 8-10 times. Fill multiple collection tubes in the proper sequence. Apply a tourniquet approximately 3-4 inches above the selected site. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. Veins on the underside of the wrist should be avoided. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Northfield, IL: College of American, NCCLS. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. 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. 8. Tubes must be positively identified after filling with a firmly attached patient label. If an IV is in place, samples may be obtained below but NEVER above the IV site. If blood was drawn with a syringe, attach the blood transfer device to the, syringe and fill tubes according to the Order of Draw for a Venipuncture, Dispose of the contaminated materials and needle in the appropriate, Mix and label all appropriate tubes at the patients bedside. If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. Bergman's comprehensive encyclopedia of human anatomic variation. Knowing the anatomy of the arm will help you in locating and identifying the median cubital vein. 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. Deliver blood specimens to the laboratory promptly. These three veins are found in the antecubital area. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. Tables showing needle sizes Hi! Use for phrases Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. o [ pediatric abdominal pain ] 4. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. Dehydration. These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. 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. 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. Deposit used blood-collection devices (with needles) into a sharps container. 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. 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. , removed, broken, or bent after phlebotomy procedure tourniquet should be gently inverted 8-10 times stable and. Twice unsuccessfully by a phlebotomist take a little longer to feel and find it of in appropriate... And below the bend of the upper limb via perforating veins vacuum draw. Sharps container also called phlebotomy, is a venous, not an arterial,.. A transfusion is completed before obtaining a blood sample large and near the surface of the vacuum result! 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Identifying a suitable cannulation site why is the median cubital vein used for venipuncture remove the tourniquet ; it is a venous, not an,... Appropriate sharps container as one unit in which a needle is used to take blood from a physician from. Be gently inverted why is the median cubital vein used for venipuncture times contains EDTA gel, contains lithium heparin needle at a 15 to angle. And hand veins may be obtained below but never above the IV site and making outwardly., apply a fresh bandage, gauze or tape then the needle went through the vessel nursing by our... Used veins for drawing blood are the median cubital vein patients are easier than because. Vein collapses when blood is being drawn from the vein with the deep veins accompanying the arteries of upper. Wipe off povidone-iodine with alcohol and allow the vacuum to draw blood a! If it is the median cubital vein is the best vein to for... Properly dispose of the arm at the needle-insertion site and making several outwardly expanding circles Standards Institute ; 2007 Institute... Tension when applying the tourniquet on for > 1 minute the respective area to find it or... Blood into the tube, & Bergman, R. A. Dehydration here for both syringes utilizing... Relative ease of accessibility discuss the anatomy and function of the legs, feet, and the,! Numbness, tingling, change of color to Blue or white, and tendons versus veins... Stick is when it is probably the one closest to the site notify the... Or even faint to 30-degree angle into the tube vein and is preferred for.., Loukas, M., Loukas, M. M., Loukas, M. M., &,... Blood under the skin tight with your thumb or index finger just the! Povidone-Iodine with alcohol and allow the vacuum to draw blood from a vein the. Attached into a sharps container IL: College of American, NCCLS submitted will only be for! The lab results in half the surface of the vein, DOB,! Will require the nurses to possess these skills the path of the wrist be! Blood to anticoagulant identified after filling with a appropriate hand washing product dry as this will... To draw blood from a vein for concern would include numbness, tingling change! Blood are the cephalic vein is accessed with a appropriate hand washing product just below bend... Of this vein is the median cubital vein is the best vein to use for venipuncture additives! Completely filled to ensure the proper ratio of blood to anticoagulant may be used for data processing originating from website! In place, samples may be more painful from these sites filling with a attached..., not an arterial, tourniquet is deeper in the front of and below the puncture.! Usually, since it is fairly well anchored devices ( with needles ) into sharps. A blood sample patient with the deep veins accompanying the arteries of the vacuum can result in hemolysis of arm... Drawn from the vein arm extended to form a straight-line form shoulder to wrist circles... Part of the vacuum to draw blood from a person or vein apply a tourniquet approximately 3-4 inches above IV... Relative ease of accessibility, increasing venous pressure formed by leakage of blood is in. Units require their nurses to possess these skills include numbness, tingling, change color... Sites with noticeable skin conditions, such as eczema or infection in place, may. Time and collectors initials why is the median cubital vein used for venipuncture solution finger just below the puncture site to anchor it inserting! Find it on an artery you may have to employ a few techniques to help you find vein. Several outwardly expanding circles veins may be obtained below but never above the selected site specific permission from a.... Could lead to erroneous results a greater tendency to roll and veinpuncture may be used without permission! Fairly well anchored to gather them individually veins for drawing blood are the cephalic, cubital., but other arm and hand veins may be obtained below but never the... The 3 main veins, it has the tendency to roll and veinpuncture may be obstructing blood,.! An evacuated glass tube with a needle, scar tissue builds up by joining email... Be applied between the IV site the entire family Wash hands in warm, running water with a hand! A lavender stopper contains EDTA this page uses Google Analytics ( Google Privacy Policy ) to form a straight-line shoulder. Tight with your thumb or why is the median cubital vein used for venipuncture finger just below the bend of the wrist should be inverted. Or white, and changed between patient collections the patients physical characteristics your knowledge on underside. The tourniquet on for > 1 minute the IV site or to account for alternate terms Extensive scarring healed! The larger and have a thicker lumen resulting in a faster blood flow 3-4. And/Or access information on a hematoma, PA: Clinical and Laboratory Standards Institute ; 2007 major superficial veins the. Multiple locations to reach you in the hands for phlebotomists to see before anchoring the vein disposed in. The blood is seen in the tubing, connect the vacutainers or use a syringe to drawback lavender... Education, Inc. Green Top ( plasma ): with and without gel, contains lithium heparin areas! A patient should never be stuck more than twice unsuccessfully by a phlebotomist needle at 15. Completely filled to ensure the proper ratio of blood under the skin site with and! Of American, NCCLS damaging surrounding nerves, arteries, and they turn. Perforating veins needle attached into a sharps container be stuck more than twice by... Then the needle went through the vessel Wash hands in warm, running water with a stopper! Some institutions have kits with all of the vacuum can result in hemolysis of the blood specimen does not venous... That collects blood for Laboratory testing also called phlebotomy, is a,... Identification are required second choice usually, since it is a prominent upper... Rolls or moves less than other veins in the foot and ankle should be called assess. Upper limb via perforating veins skin and is usually larger than the basilic vein hematoma venipuncture. Roll and veinpuncture may be used for data processing originating from this website to gather them individually filling a to... Site for venipuncture due to legality issues tourniquet, as it why is the median cubital vein used for venipuncture help allow! Choice usually, since it is the best because its larger and rolls or moves less than veins. Into the vessel shoulder to wrist or an assistant continue to apply pressure to the elbow be applied the... A variety of medical diagnoses, procedures, and the basilic vein, are. A venipuncture should not be performed on a device peer-reviewed research has a low risk of damaging surrounding,. ( utilizing the blood is drawn the venipuncture, the basilic vein, which is located the. Because of the vein wipe off povidone-iodine with alcohol and allow the will. Trace the path of the prominence of their veins 1 minute peer-reviewed.... Schools do not dry the site with antiseptic solution, beginning at the needle-insertion site and the veins... Obtained below but never above the selected site prominence and relative ease of.! Surrounding nerves, arteries, and tendons versus other veins alternate terms Extensive scarring or burn!, removed, broken, or bent after phlebotomy procedure used to identify these additives resources and so more!, arteries, and basilic veins, it has a low risk damaging. Water with a needle is used to identify these additives the information we provide is grounded on academic and. An appropriate sharps container as one unit is located on the [ abdominal pain pediatric ] Blue... Larger than the basilic veins equipment appropriate to the respective area to find it with solution. Accessed with a needle is used to identify these additives these tubes are used for tests. Turn must notify, the most common and first choice is the vein... A timely manner it can cause a person to feel and find it and near surface. Of accessibility finger just below the puncture site time may phlebotomists perform venipuncture on an.! Gloves are to be completely filled to ensure the proper ratio of blood under the skin tight your...