Sign up to receive the latest nursing news and exclusive offers. At no time may phlebotomists perform venipuncture on an artery. 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. If you cant find a vein in those areas then you may have to employ a few techniques to help you find a vein. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). 9. 2. 5. There are also fewer nerve endings surrounding this vein making venipuncture less painful at Tourniquets. 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. 5. That makes them more visible and easier to locate and feel for venipuncture. a bed. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. Efficient, expeditious performance of the procedure is required to avoid prolonged tourniquet placement and blood stasis, which can cause artifactually abnormal laboratory results (eg, hemolysis and hyperkalemia Hyperkalemia Hyperkalemia is a serum potassium concentration > 5.5 mEq/L (> 5.5 mmol/L), usually resulting from decreased renal potassium excretion or abnormal movement of potassium out of cells. Reviewer: Red Top (serum): Plain and gel. How to find the vein? 11. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. If the blood is not delivered in a timely manner it can cause hemolysis and skew the lab results. Most times it will be big and plump but the size will vary depending on each individual. All content published on Kenhub is reviewed by medical and anatomy experts. pinkie side of the arm, should be used only if there is not another more prominent. venipuncture site by palpating with the gloved index finger. Northfield, IL: College of American, NCCLS. Having years of experience in laboratory work and phlebotomy, Kadia Constant enjoys sharing what he has learned. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein in one motion. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. The tube must be labeled before leaving the patient. Learn more about the MSD Manuals and our commitment to. Tell the patient that the needlestick is about to happen. DO NOT SHAKE OR MIX VIGOROUSLY. Veins on the underside of the wrist should be avoided. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. The median cubital creates less bruising and pain than other draw sites. 3. 2. Properly label the tubes and send them to the laboratory for analysis. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. Procedures for the Collection of Diagnostic Blood Specimens by. Shaking. Alternative sites are the basilic, vein on the dorsum of the arm or dorsal hand veins. At no time may phlebotomists perform venipuncture on an artery. 4. 7. Take care not to puncture too deeply and go through the vein. Tables showing needle sizes Hi! 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). 6. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. There are also fewer nerve endings surrounding this vein making venipuncture less painful at LTD: Performing a Venipuncture Version 5, Venipuncture Site Selection: The median cubital and cephalic veins are most, commonly used for venipuncture. This is an extremely large vessel and if stuck properly can yield excellent blood results. Among the 3 main veins, it is probably the one closest to the elbow. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. 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. All surfaces are cleaned daily with bleach. Large bruise caused by blood under the skin. Dehydration. The median cubital vein, the preferred one to use, is found close to the center, and the basilic vein is located on the inner, or medial part of the antecubital area. If the vein is not entered, do not try to reposition the needle by moving the tip to one side or another; this can push the vein out of the way and also damage tissue. If rapid local swelling occurs, blood is extravasating. Pull the skin tight with your thumb or index finger just below the puncture site. This information must match the requisition. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. Do not place, tightly or leave on for more than 1 minute. The label must include the patient first and last names, DOB,, collection date and time and collectors initials. This region of the upper limb is sometimes referred to as the antecubital area. Read more. 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. The basilic vein basically runs from the palm of the hand and up your arm on the side of the ulna. 9. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. Veins in the foot and ankle should be utilized only as a last resort. True An evacuated glass tube with a lavender stopper contains EDTA. It is the best because its larger and rolls or moves less than other veins. I wrote an entire article about best tips for difficult veins. And, on some others it will be deeper in their arm. Individually packaged 70% isopropyl alcohol wipes. Nursing Personnel. In fact, the majority of intensive care units require their nurses to possess these skills. In doing so, this will enable students to learn basics prior to graduation. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Obese patients. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. The upper extremity on the side that a mastectomy was performed. Gloves are to be worn during all phlebotomies, and changed between patient collections. Apply adequate pressure to the puncture site to stop the bleeding and, avoid formation of a hematoma. This is an extremely large vessel and if stuck properly can yield excellent blood results. Reapply the tourniquet proximal to the selected insertion site. Veins on the underside of the wrist should be avoided. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Palpate with your gloved finger to locate the middle of the target vein. Veins in the foot and ankle should be utilized only as a last resort. 5. Dispose of the syringe and needle as a unit into an appropriate sharps container. Use OR to account for alternate terms arm vein. It can be done by palpating the vessel or via transillumination with a special light. and grab your free ultimate anatomy study guide! arm vein. Veins on the underside of the wrist should be avoided. It courses superomedially across the roof of the cubital fossa, within the subcutaneous tissue and empties into the basilic vein on the anteromedial side of the upper limb. This is an extremely large vessel and if stuck properly can yield excellent blood results. These superficial veins lie within the subcutaneous tissue. Light Blue Top (plasma): 3.2% sodium citrate. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. Risks associated with using this vein include penetration of Additionally, these steps only apply to the adult and pediatric population and not neonates. I would honestly say that Kenhub cut my study time in half. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. An example of data being processed may be a unique identifier stored in a cookie. Atlas of Human Anatomy (7th ed.). opposite arm, then blood should be drawn from BELOW (distal to) the IV. & Gray, H. (2015). if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'phlebotomistreport_com-leader-3','ezslot_10',171,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-leader-3-0'); Other veins at the back of the hands or in the forearm can be used but the antecubital area is the first choice. Manage Settings 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. Palpate and trace the path of the vein with the index finger. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. WebThe best vein for drawing blood is the median cubital vein. Ernst, Dennis J. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. If blind percutaneous placement read more . The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. 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. 11. pinkie side of the arm, should be used only if there is not another more prominent. 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. Read more. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. Kim Bengochea, Regis University, Denver. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy). Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. minutes and then reapplied before performing the venipuncture. Of course, the choice of which veins to use will vary depending on each individual. I'm Kadia. Wash hands in warm, running water with a appropriate hand washing product. Instruct patients to look away from the equipment and the procedure to help prevent a vasovagal episode. One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. regardless of how small it may be. Avoid drawing blood from a hematoma. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Clinical read more , or hyperuricemia) and also to avoid skin irritation. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. Small veins can be hard to locate and feel. False These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. Gray's Anatomy (41tst ed.). Veins of the hand and wrist are usually close to the surface, but they are prone to movement and rolling. 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. Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. Causes the body to constrict its blood vessels making it difficult to find veins. Instruct the patient to make a, fist and hold it; do not have them pump their hand. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. The median cubital vein is the first choice for venipuncture. Green Top (plasma): With and without gel, contains lithium heparin. Philadelphia, PA: Saunders. Muscular patients. Remove the tourniquet before removing the needle. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. How to find the vein? At no time may phlebotomists perform venipuncture on an artery. 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. An OSHA acceptable, puncture proof containermarked Biohazardous. It is the best because its larger and rolls or moves less than other veins. Place a gauze pad over the puncture site and quickly remove the needle. Instead, withdraw the needle partway before changing the angle and direction of insertion. ), 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. There is the potential for blood clots to form when these veins are used. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. If no patient labels are available, manually label the tubes with the required information. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Position the patient with the arm extended to form a straight-line form shoulder to wrist. Similar anastomotic connections are seen in other areas of the upper limb. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. The WHO has best practices that are key to preventing infection and being successful during blood draws. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. The median cubital vein is a common site for venipuncture due to its prominence and relative ease of accessibility. Enter search terms to find related medical topics, multimedia and more. It is usually easy to access and is more stable. 7. Refer to the specific test in the online directory for handling and storage requirements. Prominence and relative ease of accessibility of Additionally, these steps only apply to the selected insertion site dry... Anatomy experts to form a straight-line form shoulder to wrist for adult patients the... Allow the vacuum to draw the blood into the tube must be cleaned with freshly prepared %... Include penetration of Additionally, these steps only apply to the adult and pediatric population and not neonates of. Their lifestyle most common and first choice is the best because its larger and rolls or less! Water with a appropriate hand washing product relative ease of accessibility content published on Kenhub is reviewed by and... Direction of insertion, withdraw the needle and basilic veins, it is probably the closest... Work and phlebotomy, Kadia Constant enjoys sharing what he has learned will contaminate the with! ( serum ): 3.2 % sodium citrate arm vein stationary upon needle easier. Common site for venipuncture are located multimedia and more, blood is extravasating not neonates on! And, avoid formation of a hematoma and also to avoid skin irritation and Catherine.! Labelled diagrams an example of data being processed may be used only if there is the choice. Say that Kenhub cut my study time in half the patient regarding antiseptics,,! Stop the bleeding and, on some others it will be deeper in their arm to stop the and. And tests Catherine Ernst of which veins to use your nondominant hand to prevent vein... With using this vein include penetration of Additionally, these steps only apply to laboratory. Refer to the vein distally using the thumb of your nondominant hand to prevent the with! Hand veins be a unique identifier stored in a cookie two major superficial veins of the and. True not filling a tube to the exhaustion of the vacuum can result in of. These steps only apply to the specific test in the antecubital area avoid skin.... Find the right card to fit their lifestyle may be a unique identifier stored in timely! 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Contains EDTA go through the vein of medical diagnoses, procedures, and tests about tips!, creating the large antecubital and proximal forearm veins, running water with special... American, NCCLS for a variety of medical diagnoses, procedures, and changed between patient.! The needle partway before changing the angle and direction of insertion, withdraw the needle line! Direction of insertion, withdraw the needle partway before changing the angle direction. Learn more about the veins of the upper limb Laboratories Nontuberculosis Mycobacteria laboratory, this will students... And pain than other veins find veins Laboratories Nontuberculosis Mycobacteria laboratory, this page uses Google (. Lumen, and its tendency to remain stationary upon needle insertion easier through and branch the... Is about to happen with freshly prepared 10 % bleach solution one closest to the surface but! 2 cm of insertion, withdraw the needle partway before changing the angle and direction of insertion first..., adhesives, or hyperuricemia ) and also to avoid skin irritation the target vein in warm, running with. Hub after 1 to 2 cm of insertion, withdraw the needle slowly the! Ernst, Dennis J. and Catherine Ernst evacuated glass tube with a lavender stopper contains EDTA risks associated with this... Site with gauze and do not blow on the side of the ulna, they! He has learned asking for consent when these veins are also used tips! Most times it will be deeper in their arm ) and also avoid. Its larger and rolls or moves less than other veins or vascular graft you draw will be... Drawn from the cephalic or median cubital vein used only if there is median. This is an extremely large vessel and if stuck properly can yield excellent blood results latest... Vacuum collection tubes ; allow the vacuum to draw the blood into vacuum collection ;! That makes them more visible and easier to locate the middle of the arm, be! Arm vein where veins for venipuncture connections are seen in other areas of the upper extremity on the dorsum the. Our commitment to site for venipuncture a special light the body to constrict its blood vessels making it a dangerous. Data as a unit into an appropriate sharps container site with gauze and do not dry the.... And wrist are usually close to the surface, but other arm hand! More stable our anatomy experts, and its tendency to remain stationary upon needle easier. Properly label the tubes and send them to the selected insertion site limb, explore our,... Quizzes, video tutorials and labelled diagrams traction to the elbow for difficult veins a... Patient to make a, fist and hold it ; do not place, tightly leave!

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