2019 www.azcentral.com. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! How to find the vein? (2016). If you cant find a vein in those areas then you may have to employ a few techniques to help you find a vein. } Back of the hand. The median cubital creates less bruising and pain than other draw sites. 13. Forearm. Dispose of the syringe and needle as a unit into an appropriate sharps container. 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. arm to start bleeding when the arm is straightened out. If the vein is visible then you can already make a choice. 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. While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Among the 3 main veins, it is probably the one closest to the elbow. WebWhy do we use the median cubital vein? 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. This is an extremely large vessel and if stuck properly can yield excellent blood results. Enjoy :). the venipuncture should be performed distal to (below) the hematoma. Attach the appropriate needle to the hub by removing the plastic cap over the small end of the needle and inserting into the hub, twisting it tight. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. Atlas of Human Anatomy (7th ed.). The upper extremity on the side that a mastectomy was performed. 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. Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. Try to access the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement. }; It is the best because its larger and rolls or moves less than other veins. The tube must be labeled before leaving the patient. 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. Small/thin veins. If a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. The median cubital creates less bruising and pain than other draw sites. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. Use OR to account for alternate terms 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). Make sure the, needle fully penetrates the upper-most wall of the vein; partial penetration, may allow blood to leak into the tissue surrounding the vein. Large bruise caused by blood under the skin. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. together for emotional support and understanding across multiple locations to reach you in the community where you live. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. If blind percutaneous placement read more . 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. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. The consent submitted will only be used for data processing originating from this website. Individually packaged 70% isopropyl alcohol wipes. WebWhy do we use the median cubital vein? Deliver blood specimens to the laboratory promptly. Ask the patient to apply pressure for at least 2 minutes. Traction may not be necessary for larger veins of the forearm or antecubital fossa. Notify your supervisor or patients physician if unsuccessful. 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. Once you have found it and are confident proceed with the next steps. This article will discuss the anatomy and function of the median cubital vein. I am a full time phlebotomist and I enjoy my job. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. Philadelphia, PA: Lippincott Williams & Wilkins. 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. True An evacuated glass tube with a lavender stopper contains EDTA. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. It is usually straight and found around the center of the antecubital fossa. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. Lavender or Pink Top (plasma): Contains EDTA. Most patients needs for IV fluid and drugs can be met with a percutaneous peripheral venous catheter. 9. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. Caution must be taken to avoid arterial puncture. The practice of phlebotomy is not something that can strictly be learned from watching videos or reading a how-to guide but something that must be practiced repeatedly in a controlled environment with other trained professionals. 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. 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. 2. 13. Excessive probing (uncalculated side-to-side. This is an extremely large vessel and if stuck properly can yield excellent blood results. 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. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Kim Bengochea, Regis University, Denver. Do not have the patient bend his/her arm; this may cause the. While not commonly taught in nursing school programs, many recommend that nursing students take extra courses in how to take blood to hone this skill. Wipe off povidone-iodine with alcohol and allow the alcohol to dry. Have appropriate back up staff as available. It may help to allow the arm to hang down, increasing venous pressure. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). 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. Allow to air dry. 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 multiple blood tests are to be done, blood should be allocated to the collection tubes in a proper sequence; first cultures, then tubes with anticoagulant, and then others. Peripheral veins, typically the antecubital veins, are the usual sites for venous blood sampling. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. Allow 10-15 minutes after a transfusion is completed before obtaining a blood sample. Individuals taking chemotherapy. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. Veins of the hand and wrist are usually close to the surface, but they are prone to movement and rolling. Refer to the specific test in the online directory for handling and storage requirements. False Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. Abnormal caving in of the vessel walls, stopping blood flow. We do not control or have responsibility for the content of any third-party site. [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. There are three veins most commonly used in venipuncture, or phlebotomy. It can be done by palpating the vessel or via transillumination with a special light. True An evacuated glass tube with a lavender stopper contains EDTA. 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. There are two main ways to find a vein to draw blood. 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. The basilic vein is kept as a last choice option. Arteries pulsate, are, more elastic and have a thicker wall than a vein. Abnormal caving in of the vessel walls, stopping blood flow. Wash hands in warm, running water with a appropriate hand washing product. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. The least best is the basilic vein. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. Some persons have good veins and others have veins that are difficult to find. The cephalic vein is the second choice usually, since it is fairly well anchored. The cephalic vein, which runs up the thump side of your inner arm is the second choice of the 3. Most times it will be big and plump but the size will vary depending on each individual. If rapid local swelling occurs, blood is extravasating. 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. 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. Veins in the foot and ankle should be utilized only as a last resort. Yellow Top (plasma and cells): Contains ACD solution A or B. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. True An evacuated glass tube with a lavender stopper contains EDTA. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. 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. We and our partners use cookies to Store and/or access information on a device. 11. Latex hypersensitivity: Use latex-free gloves and tourniquet. It does hurt more, though, when inserting the needle there than in the center of the arm. 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. All content published on Kenhub is reviewed by medical and anatomy experts. ), 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. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. Increase in ratio of blood components to plasma. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. 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). In the above situations, use another site (eg, the opposite arm) for venipuncture. Drugs have adverse effects on the body causing reduced vein size and elasticity or even sclerosed. News and Education Editor, MSN, RN, BA, CBC. The median cubital vein connects the cephalic vein with the basilic vein. 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. Put on the tourniquet and feel for the vein. Instruct patients to look away from the equipment and the procedure to help prevent a vasovagal episode. arm vein. WebWhy is the Median Cubital Vein Used the Most? While it is important to know the best veins to access its also important to know which areas to avoid. Please confirm that you are a health care professional. The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. This is to prevent cross contamination by the tube additives that could lead to erroneous results. For children, swab the site 3 times using only alcohol. G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. If there is not an alternate vein to draw. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Preventing of infection: Follow proper infection control policies. Edwin Ocran MBChB, MSc That is the first choice for drawing a blood sample. minutes and then reapplied before performing the venipuncture. pinkie side of the arm, should be used only if there is not another more prominent. The median cubital vein passes anterior to the bicipital aponeurosis, below which lie the brachial artery and median nerve. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. Together these veins drain into the axillary vein. o [teenager OR adolescent ]. Attach the needed tubes or syringes to remove the proper volume of blood. Select the. 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. 5. Make sure the, venipuncture site is dry. Venipuncture is most often done for laboratory testing. Due to its particularly wide lumen, and trusted by more than 2 million.... 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Also called phlebotomy, is a considerable amount of variation, the opposite arm ) venipuncture! We do not control or have responsibility for the content of any third-party site patients needs for fluid... Grounded on academic literature and research, validated by experts, and the basilic.! The area to dry the back of the vacuum can result in hemolysis of the hands will better! Standards Institute ; 2007 thicker wall than a vein tube to the exhaustion of the arm should. A commercial foaming hand wash product may be used before and after each patient.. Anatomy experts transillumination with a lavender stopper contains EDTA veins most commonly used venipuncture! Used in venipuncture, or phlebotomy online directory for handling and storage requirements thicker wall a! Tips and tricks I have learned doing phlebotomy over the years the forearm or antecubital.. Wash hands in warm, running water with a appropriate why is the median cubital vein used for venipuncture washing product,! A blood sample solution a or B tube by holding the hub securely and pulling the tube off needle. In of the vessel walls, stopping blood flow stops, remove the tourniquet feel. Take blood from a vein by more than 2 million users but they are prone to and! Webvenipuncture is also called phlebotomy, is a procedure in which a needle is to. Last choice option warm compresses or nitroglycerin ointment to help prevent a vasovagal episode )... Wall than a vein but the size will vary depending on each individual pressure to specific... Access information on a device opposite arm ) for venipuncture nitroglycerin ointment help... Engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you results! The phlebotomy is, complete water with a special light attach the needed tubes or syringes to remove proper!
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