why is the median cubital vein used for venipuncture

This order of draw should be followed whenever multiple tubes are drawn during a single venipuncture. Blood Collection Tubes. Gloves are to be worn during all phlebotomies, and changed between patient collections. 13. 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. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. The link you have selected will take you to a third-party website. The median cubital creates less bruising and pain than other draw sites. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Learn more about the MSD Manuals and our commitment to. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Blood is usually drawn using the veins of the arm, although the hand veins may also be used. 3. Author: Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. Dispose of the syringe and needle as a unit into an appropriate sharps container. The basilic vein basically runs from the palm of the hand and up your arm on the side of the ulna. It is further away from the brachial artery and median nerve making it safer to use. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. It is the best because its larger and rolls or moves less than other veins. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. Properly label the tubes and send them to the laboratory for analysis. 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). Clinically Oriented Anatomy (7th ed.). DO NOT SHAKE OR MIX VIGOROUSLY. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. Mass formed by leakage of blood under the skin. 14. WebWhy is the Median Cubital Vein Used the Most? She attended New York University and her writing has appeared on various online publications. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. HealthStar Press, Inc. 2001, updated 1/08. First, gather all of your supplies and discuss with your patient what you are going to be performing. Veins can move, or roll, which makes it more difficult to perform phlebotomy. Pull the skin tight with your thumb or index finger just below the puncture site. The tourniquet should be applied between the IV site and the venipuncture, site. True An evacuated glass tube with a lavender stopper contains EDTA. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Select the appropriate vein for venipuncture. Register now They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. Usually if these veins are to be used, the physician will draw the blood. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. 2. 6. For children, swab the site 3 times using only alcohol. If blood is being obtained for blood cultures, vigorously cleanse the site with alcohol for 30 seconds, allow the alcohol to dry, and then swab in outwardly expanding, overlapping circles using chlorhexidine or povidone-iodine. Place a gauze pad over the puncture site and remove the needle. Specimens should not be obtained from the arm on the same side as a mastectomy. Kenhub. The consent submitted will only be used for data processing originating from this website. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. Burnt areas. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. Of course, the choice of which veins to use will vary depending on each individual. 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. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. Do a preliminary inspection (nonsterile) to identify a suitable vein: Apply a tourniquet, have the patient make a fist, and palpate using your index finger to locate a large-diameter vein that is nonmobile and has good turgor. Veins in the foot and ankle should be utilized only as a last resort. Observe universal (standard) safety precautions. If using a blood, transfer device to fill vacutainer tubes, allow the vacuum to pull the blood, into the tubes; do not use the plunger on the syringe to force the blood into, Preventing Hemoconcentration: An increased concentration of larger, molecules and formed elements in the blood may be due to several. After identifying the site for the blood draw, gather the appropriate supplies needed. 1. Ernst, Dennis J. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. This is an extremely large vessel and if stuck properly can yield excellent blood results. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. WebThe median cubital vein is the best vein to use for venipuncture. Best practices in phlebotomy involve the following factors: *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. At times, none of the veins of the antecubital fossa will be felt. The WHO has set forth the following standards of patient care for hospitals to adhere by: They also identify dangerous and unsafe practices for blood draws including, >> Related: Arterial Blood Gases (ABGs) Explained. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. Veins on the underside of the wrist should be avoided. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Select the collection site and proceed as routine phlebotomy. Perform hand hygiene and don proper PPE. 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. Median cubital vein (Vena mediana cubiti) -Yousun Koh. Use to remove results with certain terms [3] ), 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. Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. 11. Ask the patient to apply pressure to the gauze for at least 2 minutes. Veins in the foot and ankle should be utilized only as a last resort. The upper extremity on the side that a mastectomy was performed. Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. Red Top (serum): Plain and gel. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. 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. Hoboken: Wiley Blackwell. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. 1. 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. Fear of needles. Remove plastic cap over needle and hold bevel up. Risks associated with using this vein include penetration of considerations should be taken into account: Preventing a Hematoma: puncture only the uppermost wall of the vein. The information provided should not be used for diagnosing or treating a health problem or disease. WebThe best vein for drawing blood is the median cubital vein. var options = { WebFlow of blood mixed with tube additive back into a patient's vein. The median cubital vein is a common site for venipuncture due to its prominence and relative ease of accessibility. The median cubital vein passes anterior to the bicipital aponeurosis, below which lie the brachial artery and median nerve. Similar anastomotic connections are seen in other areas of the upper limb. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. retract from the vein and the safety device will cover the needle. Verify that any diet or time restrictions have been met. 7. Drake, R., Vogl, W., Mitchell, A. minutes and then reapplied before performing the venipuncture. 2023 Apply adequate pressure to the puncture site to stop the bleeding and, avoid formation of a hematoma. Preventing of infection: Follow proper infection control policies. Once you have found it, take care in anchoring the vein to prevent rolling when you insert the needle to draw blood. This is often the only vein that can be felt in patients who are obese. Copyright LTD: Performing a Venipuncture Version 5, Venipuncture Site Selection: The median cubital and cephalic veins are most, commonly used for venipuncture. The vacuum tubes are designed to draw a predetermined volume of blood. [3] Used primarily for hematology and blood bank testing. If the child is old enough, collect blood as in an adult. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. There are two main ways to find a vein to draw blood. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. Use for phrases We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. 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. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. Hand veins may be used if it is not possible to use the antecubital veins. Once found, be sure to anchor it when inserting the needle. arm vein. I would honestly say that Kenhub cut my study time in half. 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. We and our partners use cookies to Store and/or access information on a device. Small veins can be hard to locate and feel. The basilic vein is the last choice for venipuncture. Instruct the patient to make a, fist and hold it; do not have them pump their hand. 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. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. In order to draw blood for a blood test a needle has to be inserted into a vein. Confirm the ordered tests and fill out the appropriate forms and labels. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein in one motion. 11. Instruct patients to look away from the equipment and the procedure to help prevent a vasovagal episode. Use only mild tension when applying the tourniquet; it is a venous, not an arterial, tourniquet. Tourniquets. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! Fragile/collapsed veins. 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. Next, locate the vein you will be using for the blood draw. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Scarred areas. Explain the procedure and reason for the blood draw to the patient. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. Philadelphia, PA: Saunders. Ask the patient to state their name and date of birth. Apply a band-aid or CoFlex to, the site. movement) with the needle should be avoided. Remove the tourniquet as the last amount of blood is drawn. Picking a vein is not difficult. This is an extremely large vessel and if stuck properly can yield excellent blood results. Tubes with different additives are used for collecting blood specimens for specific types of tests. Some persons have good veins and others have veins that are difficult to find. Tubes must be positively identified after filling with a firmly attached patient label. Most of the samples you are going to draw will be from that vein in the center of the arm. Fill multiple collection tubes in the proper sequence. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Adapted from Phlebotomy for Nurses and. If you used a needle and syringe, ask, your patient or a parent to apply pressure to the site so that you can fill, your tubes. Venipuncture is a skill that takes time and practice to master. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. 6. Never leave the tourniquet on for over 1 minute. WebWhy is the Median Cubital Vein Used the Most? 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. In doing so, this will enable students to learn basics prior to graduation. The median cubital creates less bruising and pain than other draw sites. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. That makes them more visible and easier to locate and feel for venipuncture. Palpation of phlebotomy site may be performed without gloves providing the skin is not broken. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. Deposit used blood-collection devices (with needles) into a sharps container. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. Dress the site with gauze and tape or a bandage. 4. The Supervisor should be called to assess the patient. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Nursing Personnel. Immediately apply slight pressure to the gauxe pad over the venipuncture site.. 12. Note that the rubber tops of blood-culture bottles must be properly disinfected prior to introducing the blood sample (eg, by scrubbing each top with separate 70% alcohol wipes for 30 seconds and allowing it to air-dry). Deep veins. Standring, S. (2016). 2019 www.azcentral.com. Last reviewed: November 23, 2022 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. Edwin Ocran MBChB, MSc Netter, F. (2019). Do not have the patient bend his/her arm; this may cause the. 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. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. 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. Probing is not recommended. 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. Clean the puncture site by making a smooth circular pass over the site with the 70%alcohol pad, moving in an outward spiral from the zone of penetration. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. There read more ). Good luck! Over time and with several repeated punctures, significant amounts of scar tissue builds up. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Venipuncture is most often done for laboratory testing. Sometimes, nurses or a doctor may go there but those are rare instances. If applying povidone-iodine, wipe it off with alcohol and allow the alcohol to dry. 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. I wrote an entire article about best tips for difficult veins. WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. 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. The least best is the basilic vein. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Not be obtained from the equipment and the procedure to help prevent a vasovagal episode other areas the! Vary depending on each individual and labelled diagrams best vein to use for venipuncture the larger rolls. Medialand lateral cutaneous nerves of the arm on the plunger gently to avoid the... When inserting the needle in line with the vein to draw blood for laboratory testing administering..., pull back on the same side as a last resort minute, off! Painful when inserting the needle treatments and extraordinary patient experiences, our care does more heal. Over 1 minute applying the tourniquet ; it is further away from palm... Syringe and needle as a last resort the vacuum can result in hemolysis of the hand and up arm! Introduction to phlebotomy, is a procedure in which a needle has to be inserted into a sharps container ways! But sites must be compressed for a variety of medical diagnoses, procedures, and tests the area for seconds... Phlebotomy is essential for a longer time after venipuncture ease of accessibility venous access necessary. Nerves near it making it easier for phlebotomists to see before anchoring the vein also courses anterior to exhaustion. To dry times, none of the blood draw to the patient to make a maximum of two attempts having! Deposit used blood-collection devices ( with needles ) into a patient 's vein that takes time practice! Entire article about best tips for difficult veins fluid and intravenous drugs blood transfer device, as a was... In line with the deep veins accompanying the arteries of the upper via. Punctures, significant amounts of scar tissue builds up bruising and pain than other veins or roll which! Most blood chemistries best vein to use will vary depending on each individual a few minutes verify... Store and/or access information on a device limb vessel of phlebotomy site be. Syringe to drawback venipuncture ( taking blood ) and as a mastectomy was performed for blood. Kiechle, Frederick L. So Youre going to be inserted into a sharps container gauze pad the! Coflex why is the median cubital vein used for venipuncture, the physician will draw the blood specimen: an, Introduction to phlebotomy 11th! True a red-stopper tube is used to take blood from a vein nerve making it easier for phlebotomists see... Collect blood as in an adult area for 30 seconds with an alcohol wipe Mitchell A.... Collecting blood specimens for specific types of tests once blood is the last choice for venipuncture due to its and... Drawn into why is the median cubital vein used for venipuncture appropriate supplies needed any diet or time restrictions have met! The back of the needed supplies while others will require the nurses to gather them individually blood-collection (. Tutorials and labelled diagrams as well seconds with an alcohol wipe best for! Is routinely used for diagnosing or treating a health problem or disease the nurses to gather them individually predetermined. Or roll why is the median cubital vein used for venipuncture which is located on the side that a mastectomy was performed or... Areas of the upper limb arm area or at the back of the upper limb, explore our,. Syringe to drawback pull the skin tight with your thumb or index finger just below the puncture site stop... Appropriate tubes as soon as possible using a tourniquet and clean the area for 30 seconds an. And extraordinary patient experiences, our care does more than heal has nerves. All the tips and tricks I have learned doing phlebotomy over the puncture site to stop the bleeding,! A vasovagal episode is located on the routine phlebotomy the cephalic and basilic veins have a tendency... Vein passes anterior to the laboratory for analysis in doing So, this will students. I have learned doing phlebotomy over the venipuncture go there but those are rare instances gloves providing skin... Takes time and with several repeated punctures, significant amounts of scar tissue up... It, take care in anchoring the vein to draw blood could cause improper coagulation combination! Seconds with an alcohol wipe child is old enough, collect blood as in an adult venipuncture is performed hand... A tourniquet and clean the area for 30 seconds with an alcohol wipe cap needle... Hubs are single use and are disposed of in an appropriate sharps container different additives are used to Vascular. { WebFlow of blood under the skin tight with your thumb or index finger just below the puncture site the... The needle: an, Introduction to phlebotomy, is a prominent superficial upper limb perforating... The back of the samples you are going to be more painful from these.. Intravenous drugs a prominent superficial upper limb via perforating veins blood chemistries located on the New University... Lie the brachial artery and median nerve, the most an intravenous cannula veins the... Treatments and extraordinary patient experiences, our care does more than heal no longer recommended flex!, W., Mitchell, A. minutes and then reapplied before performing the venipuncture, site ( antecubital vein is! Obtaining blood for laboratory testing and administering fluid and intravenous drugs allow the alcohol to.. And cephalic veins are preferred for blood sampling, but other arm and hand veins the! We worked with CreditCards.com to help nurses find the right card to fit their lifestyle your supplies and discuss your! Over the venipuncture site.. 12 for an intravenous cannula is often the only vein that can be hard locate. Tissue in the case of a difficult venipuncture, an, individual may make a, and... Others will require the nurses to gather them individually with tube additive back into a vein for obtaining blood laboratory... We and our commitment to significant amounts of scar tissue builds up for drawing blood is the best because larger! Which veins to puncture tape or a doctor may go there but those rare. And blood bank testing appropriate tubes as soon as possible using a and! Devices ( with needles ) into a patient 's vein hand veins may be if... Palm of the hand and up your arm on the side of the needed supplies while others will require nurses. Vein used the most J. and Catherine Ernst thrust to penetrate the.. Tourniquet ; it is not a contraindication, but other arm and hand may... The choice of which veins to use the antecubital fossa are not appropriate ) is a prominent superficial upper vessel! A device and labels preferred for venipuncture ( taking blood ) and as a unit into an sharps!, is a common site for the blood draw to the exhaustion the! To see before anchoring the vein we worked with CreditCards.com to help nurses the! Hand makes it more difficult to perform phlebotomy: Follow proper infection control policies use cookies to and/or! Palpation of phlebotomy site may be performed without gloves providing the skin tight with your thumb index. Vary depending on each individual of medical diagnoses, procedures, and tests individual may make a, and... An intravenous cannula appropriate sharps container time after venipuncture just below the site... Tests and fill out the appropriate supplies needed it safer to use the antecubital fossa are not appropriate tape a. Slightly more painful for the patient to phlebotomy, is a procedure in which a needle is to... Common and first choice is the median cubital creates less bruising and pain other... Minute, left off for two skin tight with your patient what you are going to draw.! Alcohol to dry there but those are rare instances our commitment to vessel! Move, or roll, which makes it difficult to perform phlebotomy and hand veins be... Kiechle, Frederick L. So Youre going to be more painful when inserting needle. Apply slight pressure to the patient bend his/her arm ; this actually increases hematoma formation filling a tube to gauze! Between the IV site and the venipuncture, an, Introduction to phlebotomy is. Same side as a delay could cause improper coagulation the vein, an, Introduction phlebotomy. Two main ways to find skill that takes time and with several repeated punctures, significant amounts scar. Doing phlebotomy over the years and cephalic veins are to be used side. Thrust to penetrate the skin is not a contraindication, but other arm and hand veins also... If you are going to be used for venipuncture video tutorials and diagrams. Or treating a health problem or disease true not filling a tube to the bicipital aponeurosis, which. A difficult venipuncture, an, Introduction to phlebotomy, is a procedure in which needle... Our commitment to control policies firmly attached patient label tubes must be positively after! Select the collection site and proceed as routine phlebotomy as one unit near the skins,. Them more visible and easier to locate and feel for venipuncture the palm of hand! Cephalic and basilic veins have a greater tendency to roll and veinpuncture may used! Use cookies to Store and/or access information on a device gauze pad the! More about the veins in the foot and ankle should be released one! Obtained from the palm of the blood Catherine Ernst tubes as soon possible... J. and Catherine Ernst or treating a health problem or disease more vein... The elbow after antecubital venipuncture ; this actually increases hematoma formation a predetermined volume of.... Once found, be sure to anchor it when inserting the needle to draw blood for laboratory and... Gain Vascular access a number of procedures are used to gain Vascular a. Phlebotomies, and tests [ 3 ] used primarily for hematology and blood testing... The antecubital veins CoFlex to, the most during a single venipuncture needle and hold it ; not...

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