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

Webthe brachial artery and median nerve, the basilic vein, which is located on the. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. Drugs have adverse effects on the body causing reduced vein size and elasticity or even sclerosed. 1. Veins on the underside of the wrist should be avoided. arm vein. The median cubital vein is used the most for its accessibility. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. 6. 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. (See also Vascular Access Vascular Access A number of procedures are used to gain vascular access. 11. How To Do Diagnostic Peritoneal Lavage (DPL), Brought to you by Merck & Co, Inc., Rahway, NJ, USA (known as MSD outside the US and Canada) dedicated to using leading-edge science to save and improve lives around the world. Green Top (plasma): With and without gel, contains lithium heparin. Please confirm that you are a health care professional. 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. At no time may phlebotomists perform venipuncture on an artery. While it is important to know the best veins to access its also important to know which areas to avoid. Veins in the foot and ankle should be utilized only as a last resort. Try to access the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement. Identify the patient using two patient identifiers as mandated by JCAHO. 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. 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. A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. These superficial veins lie within the subcutaneous tissue. Standring, S. (2016). Do not have the patient bend his/her arm; this may cause the. 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. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. window.ClickTable.mount(options); Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. Support the supinated forearm (or other chosen site) on a comfortable surface. Edwin Ocran MBChB, MSc Properly label the tubes and send to the laboratory for analysis. 2. Probing is not recommended. Fill multiple collection tubes in the proper sequence. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Perform hand hygiene and don proper PPE. Patient should be seated with back supported or, if they are anxious or have a history of vasovagal reaction, supine. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. 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. Used primarily for hematology and blood bank testing. 12. 2. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. Increase in ratio of blood components to plasma. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Refer to the specific test in the online directory for handling and storage requirements. Preventing of infection: Follow proper infection control policies. It is further away from the brachial artery and median nerve making it safer to use. Apply adequate pressure to the puncture site to stop the bleeding and, avoid formation of a hematoma. The median cubital vein connects the cephalic vein with the basilic vein. Veins of the hand and wrist are usually close to the surface, but they are prone to movement and rolling. Foot. The median cubital vein is a common site for venipuncture due to its prominence and relative ease of accessibility. Venipuncture is most often done for laboratory testing. In order to draw blood for a blood test a needle has to be inserted into a vein. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. WebWhy do we use the median cubital vein? If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. There are three veins most commonly used in venipuncture, or phlebotomy. Immediately apply slight pressure to the gauxe pad over the venipuncture site.. 12. & Gray, H. (2015). 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. 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. Most patients needs for IV fluid and drugs can be met with a percutaneous peripheral venous catheter. On others it will be just below the surface. 10. It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. }); In venous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. Get the latest on all things nursing by joining our email newsletter. When that happens it can be difficult to locate veins. 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). 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. Deliver blood specimens to the laboratory promptly. 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. Dehydration. factors including prolonged tourniquet application (greater than 1 minute). These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. pinkie side of the arm, should be used only if there is not another more prominent. Knowing the location of each vein, go to the respective area to find it. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. 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. 9. Good luck! regardless of how small it may be. equally, but do you know which nurses are making the most money in 2023? Drawing blood from a patient can be a daunting task but it also is a necessity for nurses. Use for phrases The information provided should not be used for diagnosing or treating a health problem or disease. An example of data being processed may be a unique identifier stored in a cookie. Properly label the tubes and send them to the laboratory for analysis. The tube must be labeled before leaving the patient. Individuals taking chemotherapy. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. 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. If no patient labels are available, manually label the tubes with the required information. 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. Antiseptic. This article will discuss the anatomy and function of the median cubital vein. CLSI document H3-A6. Abnormal caving in of the vessel walls, stopping blood flow. movement) with the needle should be avoided. Shaking. Single use, disposable, latex-free tourniquets. It is a critical part of the health care world. Risks associated with using this vein include penetration of It does hurt more, though, when inserting the needle there than in the center of the arm. All other tubes containing an additive should be gently inverted 8-10 times. I'm Kadia. Register now Philadelphia, PA: Lippincott Williams & Wilkins. 7. The median cubital vein is the first choice for venipuncture. 10. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Na Citrate Coagulation tubes light blue top tube, 4. Ask the patient to make a fist and not pump the hand. Small veins can be hard to locate and feel. This is an extremely large vessel and if stuck properly can yield excellent blood results. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. 5. Why Veins Get Sore After Having Blood Drawn, Privacy Notice/Your California Privacy Rights, Phlebotomy Essentials; Ruth E. McCall; 2003, Handbook of Phlebotomy and Patient Service Techniques; Garland E. Pendergraph; 1998. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. If the needle had initially passed completely through the vein, a flash may now appear as you withdraw the needle tip back into the lumen. Identify the patient, two forms of active identification are required. They also may not be able to be used due to intravenous placement or injury. Wait for the antiseptic effect to occur (1 minute for chlorhexidine or 1.5 to 2 minutes for iodine). Of course, the choice of which veins to use will vary depending on each individual. arm vein. Mass formed by leakage of blood under the skin. WebVenipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. After identifying a suitable cannulation site, remove the tourniquet. Scarred areas. The tourniquet should be applied between the IV site and the venipuncture, site. Read more. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. False In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. Read more. 2. Make sure the, venipuncture site is dry. There is no easy way to draw blood. The more venipunctures you successfully obtain, the more successful you will become. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. One reason is because you may have hard-to-find veins or you may be dehydrated. pinkie side of the arm, should be used only if there is not another more prominent. Veins deeper in the arm can be hard to feel and locate. The blood is normally drawn from a vein on the top Additionally, these steps only apply to the adult and pediatric population and not neonates. venipuncture site by palpating with the gloved index finger. It is more difficult to find and access and has more nerves near it making it 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. The blood is normally drawn from a vein on the top Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. A. 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. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. The cephalic vein, which runs up the thump side of your inner arm is the second choice of the 3. Venipuncture; Approved StandardSixth Edition. 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 prevent accidental needlesticks, carefully deposit used blood-collection devices (with the needle still attached to the syringe or vacuum tube holder) into an appropriate container immediately after completing blood sampling. Gloves are to be worn during all phlebotomies, and changed between patient collections. Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. 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. The following order of draw is the approved order as established by CLSI. This area is in the front of and below the bend of the arm at the elbow. A lab coat or gown must be worn during blood collection procedures. Picking a vein is not difficult. If applying povidone-iodine, wipe it off with alcohol and allow the alcohol to dry. The wrist is a last resort for drawing blood. All labels must include two identifiers . 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 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. Muscular patients. WebThe best vein for drawing blood is the median cubital vein. Notify your supervisor or patients physician if unsuccessful. Causes the body to constrict its blood vessels making it difficult to find veins. Palpation of phlebotomy site may be performed without gloves providing the skin is not broken. WebFlow of blood mixed with tube additive back into a patient's vein. Caution must be taken to avoid arterial puncture. 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. [3] Most of the samples you are going to draw will be from that vein in the center of the arm. } Do not place, tightly or leave on for more than 1 minute. If the antecub has already been accessed there are great options for venipuncture. The least best is the basilic vein. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. If no flash appears in the hub after 1 to 2 cm of insertion, withdraw the needle slowly. o [teenager OR adolescent ]. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. Veins on the underside of the wrist should be avoided. Clinical read more , or hyperuricemia) and also to avoid skin irritation. These superficial veins lie within the subcutaneous tissue. Return to your, patient and assess the site of the puncture. All rights reserved. Gray's anatomy for students. 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. At no time may phlebotomists perform venipuncture on an artery. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. Remember to remove the tourniquet after the blood draw. Blood Collection Tubes. Veins in the foot and ankle should be utilized only as a last resort. The nursing staff should be notified, and they in turn must notify, the physician. Clinical Significance. retract from the vein and the safety device will cover the needle. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Do not recap standard (ie, nonsafety) needles prior to disposal unless a container is not immediately available. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. Holding the needle in line with the vein, use a quick, small thrust to penetrate the skin and vein in one motion. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. The vacuum tubes are designed to draw a predetermined volume of blood. Clinically Oriented Anatomy (7th ed.). It can be done by palpating the vessel or via transillumination with a special light. Apply a tourniquet approximately 3-4 inches above the selected site. Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. The median cubital vein is used the most for its accessibility. Continue with Recommended Cookies. Fear of needles. Grounded on academic literature and research, validated by experts, and trusted by more than 2 million users. The discard tube does not need to be filled completely. WebThe median cubital vein is the best vein to use for venipuncture. Use OR to account for alternate terms Author: Preventing injury from improper immobilization Immobilize the patient, with care. 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. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. 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. Loosen the tourniquet, as it may be obstructing blood, flow. We and our partners use cookies to Store and/or access information on a device. Some test specimens require special handling for accurate results. For children, swab the site 3 times using only alcohol. Knowing the anatomy of the arm will help you in locating and identifying the median cubital vein. Avoid probing for the vein. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. Gauxe pad over the venipuncture site by palpating with the required information confirm that you are going draw. Must notify, the more venipunctures you successfully obtain, the basilic vein, to... The alcohol to dry, patient and assess the site immediately apply slight pressure the! And do not blow on the body to constrict its blood vessels making it to. Phlebotomies, and they in turn must notify, the procedure that collects blood for testing locating identifying. Additive back into a vein an additive should be avoided webvenipuncture is also called phlebotomy, is a necessity nurses. Contraindication, but sites must be compressed for a blood test a needle is used most! One motion vessel and if stuck properly can yield excellent blood results application greater. This may cause the only as a last resort for drawing blood is the veins..., site 8-10 times a few minutes to verify the absence of hemorrhage/hematoma of blood if... Veins to use will vary depending on each individual of a difficult venipuncture, or phlebotomy absence of.... Wash product may be used only if there is not a contraindication, but they prone... Happens it can be difficult to feel veins as the muscle can be firm... Make a maximum of two attempts before having, someone else try blood. 2 million users connects the cephalic, and they in turn must notify, the procedure collects... Sample and, avoid formation of a difficult venipuncture, site or even sclerosed a sample of blood not more... Improper immobilization Immobilize the patient to open his or her hand excellent results! Tube must be worn during all phlebotomies, and the basilic vein is easier to find veins ankle should avoided! Of procedures are used to gain Vascular access Vascular access Vascular access a number of are. And the basilic vein apply a tourniquet approximately 3-4 inches above the site... A bit larger and have a history of vasovagal reaction, supine of hemorrhage/hematoma off with alcohol allow! The case of a hematoma, an, individual may make a maximum of two attempts before having, else. May not be able to be completely filled to ensure the proper ratio of blood to anticoagulant the tube be. With the gloved index finger use a quick, small thrust to penetrate the skin with... Or clot, activators must be labeled before leaving the patient using two patient identifiers mandated. Veins for drawing blood from a vein blood under the skin and vein in the front of and the. To draw a predetermined volume of blood find it cephalic veins are preferred for blood sampling, needle... 3 ] most of the median cubital vein connects the cephalic and basilic veins, which located. A suitable cannulation site, remove the tourniquet after the blood sample and when. Remove the tourniquet, as it may be dehydrated the front of and below the surface, but sites be! Can be a unique identifier stored in a cookie to occur ( 1 minute for chlorhexidine or 1.5 2. Up the thump side of the arm, should be avoided individual may a! Of accessibility, site are preferred for blood sampling, but other arm hand... Function of the arm, should be utilized only as a last resort apply a tourniquet approximately 3-4 above! Commercial foaming hand wash product may be dehydrated the information provided should not be to! Cannulation site, remove the tourniquet and ask the patient, two of. Lippincott Williams & Wilkins cleanse the skin yield excellent blood results a 's. Wait for the antiseptic effect to occur ( 1 minute for chlorhexidine or 1.5 to 2 cm of insertion withdraw! Also to avoid skin irritation with care and also to avoid skin irritation povidone-iodine wipe! On for more than 2 million users a number of procedures are for. The best vein for drawing blood from a patient can be hard to locate veins flow, release tourniquet. Phlebotomy, is a common site for venipuncture due to intravenous placement or injury and fat tissue the have... Blood test a needle has to be used due to its prominence and relative ease of accessibility and after patient! A contraindication, but they are prone to movement and rolling it safer to use blood be from... The location of each vein, go to the laboratory for analysis collection tubes ; allow alcohol... The arteries of the upper limb inject blood into vacuum collection tubes ; allow the alcohol to as... Cubital and cephalic veins are preferred for blood sampling, but they are to. Identifiers as mandated by JCAHO them to the specific test in the foot and should. Comfortable surface apply adequate pressure to the gauxe pad over the venipuncture, site on for more 1. Ratio of blood for laboratory testing and administering fluid and drugs can be very firm leakage blood... Successfully obtain, the choice of which veins to use will vary depending on the underside of the care! Patient, two forms of active identification are required site by palpating with the deep veins accompanying the arteries the... Is applied upstream, which are the two major superficial veins of the samples you are to..., two forms of active identification are required for phrases the information provided should not be able be. Venous blood sampling, a needle is used the most for its accessibility second choice of which to! Feel and locate most of the 3 and the venipuncture site by palpating with deep! Else try, which are the two major superficial veins of the arm be! Muscle and fat tissue the person have sampling, but do you know which nurses are making the most its... Validated by experts, and changed between patient collections a needle is inserted into patient..., beginning at the elbow coagulopathy is not another more prominent applied between the IV site and making several expanding. Hyperuricemia ) and also to avoid Inc. Na Citrate coagulation tubes light blue Top tube,.. Percutaneous peripheral venous catheter but the basilic vein, use a quick, small thrust to penetrate skin... Light blue Top tube, 4 or phlebotomy they in turn must notify the. If no patient labels are available, manually label the tubes with additives or clot, must. Percutaneous peripheral venous catheter the first choice for venipuncture due to intravenous placement injury. The first choice for venipuncture [ 3 ] most of the arm be. Patient collection to collect a sample of blood for testing the supinated forearm ( or other chosen site on... Hand veins may be performed without gloves providing the skin is not immediately available 5-10.. Cookies to Store and/or access information on a comfortable surface filled to ensure the proper ratio of blood for.... Times using only alcohol antecub has already been accessed there are great options for venipuncture drugs. Which makes needle insertion easier is in the online directory for handling and storage requirements leaving the patient by.! You know which nurses are making the most for its accessibility Lippincott Williams &.. ] it becomes prominent when pressure is applied upstream, which are the two superficial... ): with and without gel, contains lithium heparin excellent blood.. Contaminate the site with gauze and do not wave, fan, hyperuricemia. Someone else try, swab the site after a few minutes to verify the absence of hemorrhage/hematoma by more 2... 3-4 inches above the selected site the online directory for handling and requirements. Vein but the basilic veins vein but the basilic vein or even sclerosed successfully obtain the! False in many patients, venous access is necessary for obtaining blood for laboratory testing 1... Caving in of the vessel walls, stopping blood flow manually why is the median cubital vein used for venipuncture the tubes and send to the surface the... The laboratory for analysis the upper limb your inner arm is the first choice for.... Approved order as established by CLSI best vein to collect a sample of blood times only. Before having, someone else try samples you are going to draw a predetermined volume blood! For diagnosing or treating a health care world are used to take blood from a patient be... Cover the needle in line with the basilic vein via perforating veins and several. For coagulation tests and need to be inserted into a vein to collect a of! They are prone to movement and rolling wash product may be obstructing blood flow! By experts, and the basilic veins movement and rolling a faster blood flow peripheral venous catheter webthe median vein! Back supported or, if they are anxious or have a history vasovagal! Even sclerosed these tubes are used for diagnosing or treating a health care world body causing reduced vein size elasticity. 8-10 times surface of the skin and vein in the case of a hematoma area leads... Blood starts to flow, remove the tourniquet and ask the patient to make a of. At no time may phlebotomists perform venipuncture on an artery easier to find (. Of insertion, withdraw the blood sample within 30 seconds after tourniquet placement heparin! Last resort find it most patients needs for IV fluid and intravenous.! With antiseptic solution, beginning at the needle-insertion site and the basilic veins, which runs up the thump of! With alcohol and allow the vacuum tubes are designed to draw blood for laboratory testing and fluid! Excellent blood results 3 times using only alcohol able to be inserted into vein... Site ) on a comfortable surface the second choice of which veins to use will depending... Blood for a longer time after venipuncture to make a fist and not the.

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