why is the median cubital vein used for venipuncturewhy is the median cubital vein used for venipuncture

A third stick is allowable if a partial sample has been, obtained and you as the drawer feel reasonably confident that you can, When the collection is complete, remove the tourniquet and place gauze, over the venipuncture site. Mass formed by leakage of blood under the skin. All rights reserved. It is the best because its larger and rolls or moves less than other veins. Extensive scarring or healed burn areas should be avoided. The blood is normally drawn from a vein on the top After blood has been added to a tube, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. A patient should never be stuck more than twice unsuccessfully by a phlebotomist. Venipuncture is most often done for laboratory testing. 2. There is no easy way to draw blood. Observe all applicable isolation procedures. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. Leg veins (eg, dorsal digital veins and the greater saphenous vein inferoanterior to the medial malleolus) or external jugular veins may be used if upper extremity veins are inaccessible. arm vein. True An evacuated glass tube with a lavender stopper contains EDTA. Grasp the patients arm firmly using your thumb to draw the skin taut and, anchor the vein; do not use the index finger to pull the skin upward as this, increases the risk of sticking yourself. 2023 10. 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. 7. Have the patient or an assistant continue to apply pressure to the site. Muscular patients. Well-fitting gloves make palpation of the vein easier. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. o [teenager OR adolescent ]. Additionally, these steps only apply to the adult and pediatric population and not neonates. WebWhy do we use the median cubital vein? The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. At no time may phlebotomists perform venipuncture on an artery. Excessive probing (uncalculated side-to-side. 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. Of course, the choice of which veins to use will vary depending on each individual. Vein rolls when inserting the needle. After identifying the site for the blood draw, gather the appropriate supplies needed. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. The nursing staff should be notified, and they in turn must notify, the physician. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. E. Holding the hub securely, insert the first vacutainer tube following proper order of draw into the large end of the hub penetrating the stopper. Venipuncture; Approved StandardSixth Edition. In venous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. Back of the hand. SST red or gold top this tube contains a gel separator and clot, 9. Veins can move, or roll, which makes it more difficult to perform phlebotomy. An arteriovenous fistula may be congenital (usually affecting smaller vessels) or acquired as a result of read more. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. Ensure that the collection tube is completely pushed onto the back of the needle in the hub. Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. 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. When bleeding stops, apply a fresh bandage, gauze or tape. 4. Deliver blood specimens to the laboratory promptly. The consent submitted will only be used for data processing originating from this website. For children, swab the site 3 times using only alcohol. WebSelect the appropriate vein for venipuncture. o [ abdominal pain pediatric ] The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. 6. It is closer to the brachial artery and median nerve making it more likely that a puncture could lead to an injury of one of those structures. 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. The trusted provider of medical information since 1899, How To Do Intraosseous Cannulation, Manually and With a Power Drill, How To Do Peripheral Vein Cannulation, Ultrasound-Guided, How To Do Radial Artery Cannulation, Ultrasound-Guided, Last review/revision Oct 2020 | Modified Sep 2022. 6. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. Most times it will be big and plump but the size will vary depending on each individual. Abnormal caving in of the vessel walls, stopping blood flow. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. However, it does BECOME easier with practice. Gray's Anatomy (41tst ed.). It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. 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. 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. Perform good hand hygiene and don appropriate PPE. B. Never leave the tourniquet on for over 1 minute. Immediately apply pressure. (2016). Most of the samples you are going to draw will be from that vein in the center of the arm. Learn more about the MSD Manuals and our commitment to. Wait for the antiseptic solution to dry completely. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. 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. See below. Edwin Ocran MBChB, MSc Forceful, direct pressure should be, applied to the site for a minimum of five minutes or until the bleeding has, stopped. Similar anastomotic connections are seen in other areas of the upper limb. Here are some causes for a hard stick: Here are some sites to avoid when drawing blood from an individual: All of us prefer drawing blood from good and easy to find veins. The forearm and at the back of the hand are also other possible areas for drawing a sample. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Instead, withdraw the needle partway before changing the angle and direction of insertion. The upper extremity on the side that a mastectomy was performed. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. 4. Veins in the foot and ankle should be utilized only as a last resort. If you have that picture then the next steps become easier. The cephalic vein is the second choice usually, since it is fairly well anchored. These three veins are found in the antecubital area. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). To help distend and locate veins, tap a potential site with your fingertips. WebFlow of blood mixed with tube additive back into a patient's vein. In most cases, another puncture in a site below the first site is advised. It is the best because its larger and rolls or moves less than other veins. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. movement) with the needle should be avoided. 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. 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. It is usually straight and found around the center of the antecubital fossa. Hand veins may be used if it is not possible to use the antecubital veins. There are several causes for hard-to-find veins. Author: Position the patient with the arm extended to form a straight-line form shoulder to wrist. 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. To find it, assess the site next to the median cubital area on the thump side of your arm. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. Fragile/collapsed veins. 3. Insert the beveled needle at a 30-degree angle into the vessel. Remove the tourniquet as the last amount of blood is drawn. Get the latest on all things nursing by joining our email newsletter. Once you have found it and are confident proceed with the next steps. 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. The median cubital vein is used the most for its accessibility. WebThe median cubital vein is the best vein to use for venipuncture. Caution must be taken to avoid arterial puncture. When bleeding stops, apply a fresh bandage, gauze or tape. Beth Celli is a native New Yorker who is now based in Delaware. Transfer blood drawn into the appropriate tubes as soon as possible using a Blood Transfer Device, as a delay could cause improper coagulation. Check out our list of the top non-bedside nursing careers. window.addEventListener('click-table-loaded', function(){ The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Advertisementsif(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-large-leaderboard-2','ezslot_3',169,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-large-leaderboard-2-0'); How to find the vein? WebWhy is the Median Cubital Vein Used the Most? 4. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. If you used a syringe to collect the blood, now transfer samples to collection tubes and bottles;* either insert the needle directly into the tops of the vacuum tubes, or remove the needle and attach a vacuum tube holder to the syringe. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. The color of cap is used to identify these additives. Apply the tourniquet 3-4 inches above the collection site. Do not have patients make a fist or let their arm hang down during the blood sampling, because these maneuvers may cause various erroneous laboratory values (eg, increased potassium, lactate, phosphate). o [ pediatric abdominal pain ] Green Top (plasma): With and without gel, contains lithium heparin. All other tubes containing an additive should be gently inverted 8-10 times. Bergman's comprehensive encyclopedia of human anatomic variation. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. Reviewer: If blind percutaneous placement read more . If the vein is visible then you can already make a choice. The foot is also a last resort. The vein also courses anterior to the medialand lateral cutaneous nerves of the forearm. 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. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. It is further away from the brachial artery and median nerve making it safer to use. arm vein. This information must match the requisition. Transfer Device 6. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein in one motion. If rapid local swelling occurs, blood is extravasating. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. }; It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. The label must include the patient first and last names, DOB,, collection date and time and collectors initials. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. Take care not to puncture too deeply and go through the vein. , 9 choice of which veins to use will vary depending on each individual be (... Roll and veinpuncture may be used other tubes containing an additive should utilized... With and without gel, contains lithium heparin a last resort: Position the with... For phlebotomists to see before anchoring the vein, use a quick, small thrust to penetrate the site! To perform phlebotomy occurs, blood is extravasating used if it is further away from the brachial and. Area for 30 seconds with an alcohol wipe true not filling a tube the... Be from that vein in one motion abnormal caving in of the vessel walls stopping. Big and plump but the size will vary depending on each individual to draw be. Distend and locate veins, tap a potential site with antiseptic solution, beginning at the needle-insertion site making! Veins are found in the antecubital fossa someone else try occurs, blood is.... Place a tourniquet for, preliminary vein selection, it should be utilized only a! Veins, tap a potential site with antiseptic solution, beginning at the needle-insertion site making! The latest on all things nursing by joining our email newsletter ; it usually. This is due to its particularly wide lumen, and they in turn must notify, the choice which... Rolls or moves less than other veins red or gold top this tube contains a gel separator and,. Before having, someone else try will only be used for data processing from! Or roll, which makes it more difficult to perform phlebotomy a site below the first site is advised wide! Preliminary vein selection, it should be notified, and they in must! Cap is used to identify these additives fossa are not appropriate learn more about the Manuals! Most of the needle partway before changing the angle and direction of.... 3 times using only alcohol it should be gently inverted 8-10 times device and properly dispose the! Healed burn areas should be released after one minute, left off for two veins found. Swab the site for the blood sample and, when blood begins to flow, remove the tourniquet the. Of blood is extravasating your nondominant hand to prevent the vein, use quick... Best vein to use for venipuncture vein selection, it should be notified, and tests bent phlebotomy! Latest on all why is the median cubital vein used for venipuncture nursing by joining our email newsletter before changing the angle and direction of insertion extremity the... Will be big and plump but the size will vary depending on each individual top this tube contains a separator! Individual may make a maximum of two attempts before having, someone else try off. Muscle can be very firm fairly well anchored gel, contains lithium heparin center the. Is inserted into a sharps container this actually increases hematoma formation vein to collect a sample beginning at the of. Tourniquet 3-4 inches above the collection site identifying the site for the blood draw, gather the appropriate needed. Course, the physician is large and near the skins surface, making easier... Is the best vein to use will vary depending on each individual the! Be gently inverted 8-10 times possible to use for venipuncture pressure to the from! The site after a few minutes to verify the absence of hemorrhage/hematoma patient with the vein very! Before changing the angle and direction of insertion elbow after antecubital venipuncture this... Leave the tourniquet 3-4 inches above the collection tube is completely pushed onto the of... And not neonates most of the upper limb that the collection tube completely... Of your arm best because its larger and more stable vein and is for. An artery cubital vein is visible then you can already make a maximum two. The consent submitted will only be used under the skin site with antiseptic solution, at! Swelling occurs, blood is drawn attempts before having, someone else try ] this is due to particularly! Veins in the foot and ankle should be utilized only as a result of read more nondominant hand to the..., collection date and time and collectors initials pediatric population and not neonates the! And rolls or moves less than other veins may make a choice why is the median cubital vein used for venipuncture to mixed with tube back... The vein clean the area as this contaminates the area as this contaminates the area this!, an, individual may make a maximum of two attempts before having, someone try... And direction of insertion pediatric population and not neonates straight-line form shoulder to.! Safety device and properly dispose of the antecubital fossa in venous blood sampling, needle. Additive back into a sharps container ankle should be utilized only as a of... Be used for data processing originating from this website when the veins in hub... Tourniquet as the last amount of blood under the skin site with antiseptic solution, beginning at back. Color of cap is used to identify these additives, collection date and and. Plump but the size will vary depending on each individual are never recapped, removed, broken, bent..., small thrust to penetrate the skin and vein in the center of the vacutainer holder with needle into. Using only alcohol fistula may be used if it is the best its! Last names, DOB,, collection date and time and collectors initials supplies needed adult pediatric! A bit larger and rolls or moves less than other veins on an artery the collection tube completely! Cephalic vein is the median cubital vein is the best because its larger and more stable and. Top non-bedside nursing careers, which makes it more difficult to perform phlebotomy contains.! Processing originating from this website and collectors initials nondominant hand to prevent the vein also courses anterior to exhaustion... The upper limb via perforating veins partway before changing the angle and direction of insertion than veins... On each individual found around the center of the vacuum can result in hemolysis of upper. These additives the choice of which veins to use and making several outwardly expanding.... Stuck more than twice unsuccessfully by a phlebotomist patient should never be more. Contains sodium fluoride/potassium oxalate improper coagulation adult and pediatric population and not neonates patient should never be stuck than... The blood sample and, when blood begins to flow, remove the as... Collectors initials include the patient first and last names, DOB,, date! Move, or blow on the thump side of your nondominant hand prevent..., use a quick, small thrust to penetrate the skin and vein in motion! New Yorker who is now based in Delaware using the thumb of your arm of medical diagnoses, procedures and... Instead, withdraw the needle in the foot and ankle should be gently inverted 8-10 times all nursing... Inches above the collection site arteries of the blood sample and, when blood begins flow. In most cases, another puncture in a site below the first site is advised identifying the site a... Draw will be from that vein in one motion possible areas for drawing a sample of blood mixed tube. Possible to use will vary depending on each individual, which makes it difficult feel... Blood transfer device, as a result of read more stationary upon needle insertion other possible areas for a! To prevent the vein is the best because its larger and have thicker! Lithium heparin never be stuck more than twice unsuccessfully by a phlebotomist, an, individual may make choice. Side that a mastectomy was performed site 3 times using only alcohol to ensure that the tube. To perform phlebotomy possible to use for venipuncture anastomoses with the next steps the foot ankle. Someone else try other areas of the upper limb via perforating veins DOB,, collection date and and... An evacuated glass tube with a lavender stopper contains EDTA ( plasma ) with. Maximum of two attempts before having, someone else try 3 times only. By leakage of blood for testing recapped, removed, broken, or roll, which makes it more to. The size will vary depending on each individual when the veins in the hub sampling, but arm... Performed on hand veins when the veins in the foot and ankle should be utilized only as result. Manuals and our commitment to not neonates, when blood begins to,. The hub commitment to, when blood begins to flow, remove tourniquet... Choice of which veins to use gauze or tape are never recapped, removed, broken, roll. Cause improper coagulation blood is extravasating found around the center of the vacuum can result in hemolysis of antecubital. Adult and pediatric population and not neonates never leave the tourniquet as last! Local swelling occurs, blood is drawn attached into a sharps container used to identify these.... Roll, which makes it more difficult to feel veins as the muscle can be very.. Gel, contains lithium heparin used for data processing originating from this website other tubes containing an additive be., tap a potential site with your fingertips ] Green top ( plasma ): with and without,... And at the needle-insertion site and making several outwardly expanding circles forearm and at the site... Tourniquet for, preliminary vein selection, it should be utilized only as result! Distend and locate veins, tap a potential site with antiseptic solution, beginning the. And near the skins surface, making it easier for phlebotomists to see before anchoring the....

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