They also may not be able to be used due to intravenous placement or injury. The forearm is another place to look for veins if you cant find one in the antecubital fossa or back of the hands. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. Its location is in the cubital fossa, on the anterior/flexor aspect of the elbow joint. movement) with the needle should be avoided. o [ pediatric abdominal pain ] WebSelect the appropriate vein for venipuncture. Veins in the foot and ankle should be utilized only as a last resort. There are also fewer nerve endings surrounding this vein making venipuncture less painful at The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. Nursing schools do not teach this skill due to legality issues. Support the supinated forearm (or other chosen site) on a comfortable surface. * After removing a tube from the holder, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. The basilic vein is the last choice for venipuncture. 5. (2016). }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. 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. The median cubital vein is used the most for its accessibility. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Increase in ratio of blood components to plasma. the venipuncture should be performed distal to (below) the hematoma. That makes them more visible and easier to locate and feel for venipuncture. WebThe best vein for drawing blood is the median cubital vein. 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. 9. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. Remove the tourniquet as the last amount of blood is drawn. opposite arm, then blood should be drawn from BELOW (distal to) the IV. However, it does BECOME easier with practice. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. o [ abdominal pain pediatric ] All surfaces are cleaned daily with bleach. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. The blood is normally drawn from a vein on the top 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. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy). 3. When that happens it can be difficult to locate veins. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein in one motion. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. 7. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. WebThe median cubital vein is the best vein to use for venipuncture. WebThe best vein for drawing blood is the median cubital vein. Avoid probing for the vein. Return to your, patient and assess the site of the puncture. 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). F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. 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). Release the tourniquet. Apply the tourniquet 3-4 inches above the collection site. Scarred areas. Risks associated with using this vein include penetration of Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. While it is important to know the best veins to access its also important to know which areas to avoid. Copyright These include: Hard stick is when it is difficult to draw blood from a person or vein. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Dimitrios Mytilinaios MD, PhD The wrist is a last resort for drawing blood. At no time may phlebotomists perform venipuncture on an artery. Causes include chronic kidney disease, hypoparathyroidism, and metabolic or respiratory acidosis. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. Test your knowledge on the main veins of the upper limb in this quiz. The median cubital creates less bruising and pain than other draw sites. [3] I am a full time phlebotomist and I enjoy my job. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Oxalate/fluoride light gray top tube, If Gases (venous no O2 reported) are drawn with a needle and syringe, the, blood must be put into the Lithium Heparin tube using a blood transfer device; do, not pop the top of the tube open to fill the tube. Causes the body to constrict its blood vessels making it difficult to find veins. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. Veins in the foot and ankle should be utilized only as a last resort. Dehydration. 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. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. minutes and then reapplied before performing the venipuncture. The median cubital vein typically arises as a collateral branch from the cephalic vein which runs on the anterolateral aspect of the upper limb. 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. False It is more difficult to find and access and has more nerves near it making it 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. Abnormal caving in of the vessel walls, stopping blood flow. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Tubes with different additives are used for collecting blood specimens for specific types of tests. We've looked at programs nationwide and determined these are our top schools. When bleeding stops, apply a fresh bandage, gauze or tape. These superficial veins lie within the subcutaneous tissue. 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. Fill multiple collection tubes in the proper sequence. Green Top (plasma): With and without gel, contains lithium heparin. This is an extremely large vessel and if stuck properly can yield excellent blood results. I hope you find my posts helpful. They are the cephalic, median cubital, and basilic veins. Fear of needles. Have appropriate back up staff as available. Furthermore, it has a low risk of damaging surrounding nerves, arteries, and tendons versus other veins in the hands. It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. 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. 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. The label must include the patient first and last names, DOB,, collection date and time and collectors initials. Confirm the ordered tests and fill out the appropriate forms and labels. Blood Collection Tubes. Subscribe for the latest nursing news, offers, education resources and so much more! After identifying a suitable cannulation site, remove the tourniquet. The tube must be labeled before leaving the patient. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. 2023 Wayne, PA: Clinical and Laboratory Standards Institute; 2007. Author: 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. Palpate and trace the path of the vein with the index finger. Continue with Recommended Cookies. When a person has veins that are hard to find or difficult to obtain a sample from, they are a hard stick. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Prepare the patients arm using a Chlorhexadine wipe. Mass formed by leakage of blood under the skin. 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. Ernst, Dennis J. There are several major veins that run through this area, close to the surface. 1. Obese patients. It does hurt more, though, when inserting the needle there than in the center of the arm. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Preventing of infection: Follow proper infection control policies. The median cubital vein is used the most for its accessibility. Do not have the patient bend his/her arm; this may cause the. Use only mild tension when applying the tourniquet; it is a venous, not an arterial, tourniquet. Loosen the tourniquet, as it may be obstructing blood, flow. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. And, on some others it will be deeper in their arm. Veins on the underside of the wrist should be avoided. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. It brings the entire family Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. 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