Venipuncture is a skill that takes time and practice to master. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Observe special handling requirements. Do not inject blood into vacuum collection tubes; allow the vacuum to draw the blood into the tube. Median cubital vein: want to learn more about it? 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. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. It is usually easy to find as its near the surface of the skin and is usually larger than the basilic vein. Take care not to puncture too deeply and go through the vein. HealthStar Press, Inc. 2001, updated 1/08. The blood is normally drawn from a vein on the top Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. True An evacuated glass tube with a lavender stopper contains EDTA. Fill multiple collection tubes in the proper sequence. Do not leave the tourniquet on for > 1 minute. Adapted from Phlebotomy for Nurses and. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. retract from the vein and the safety device will cover the needle. Knowing the location of each vein, go to the respective area to find it. Ask the patient to make a fist and not pump the hand. 1. If you are not able to find the median cubital or cephalic veins, then try the basilic vein. Without proper specimens, unhelpful or even harmful medical treatment could happen. 2. Do not have the patient bend his/her arm; this may cause the. Instruct patients to look away from the equipment and the procedure to help prevent a vasovagal episode. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. Intravenous therapy/Blood Transfusions If it is not possible to draw the. Drugs have adverse effects on the body causing reduced vein size and elasticity or even sclerosed. Gloves are to be worn during all phlebotomies, and changed between patient collections. Dress the site with gauze and tape or a bandage. Tubbs, R. S., Shoja, M. M., Loukas, M., & Bergman, R. A. Extensive scarring or healed burn areas should be avoided. Go check it out here. Remove the tourniquet before removing the needle. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. Reapply the tourniquet proximal to the selected insertion site. Learning the anatomy of the main veins and arteries in the body is essential to becoming competent in phlebotomy. Among the 3 main veins, it is probably the one closest to the elbow. Phlebotomy teams generally only make rounds at specific times in hospital settings, therefore, if a lab test is ordered immediately it could be the responsibility of the nursing staff to draw the specimen. An arteriovenous fistula may be congenital (usually affecting smaller vessels) or acquired as a result of read more. WebSelect the appropriate vein for venipuncture. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. Single use, disposable, latex-free tourniquets. Reviewer: Place a gauze pad over the puncture site and remove the needle. o [ pediatric abdominal pain ] ), 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. WebWhy is the Median Cubital Vein Used the Most? 2. Veins on the underside of the wrist should be avoided. The foot is also a last resort. Prepare the patients arm using a Chlorhexadine wipe. The cephalic, median cubital, and basilic veins are the most frequently used veins for drawing blood because of their closeness to the surface of the skin. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. It is usually there for the picking. a bed. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. Position the patient with the arm extended to form a straight-line form shoulder to wrist. If an IV is in place, samples may be obtained below but NEVER above the IV site. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. Register now Nursing Personnel. Edematous extremities tissue fluid accumulation can alter test results. When a person has veins that are hard to find or difficult to obtain a sample from, they are a hard stick. 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). Tell the patient that the needlestick is about to happen. There are about three main areas for drawing blood: the median cubital, cephalic, and basilic veins. 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. Reading time: 3 minutes. 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. Author: The Supervisor should be called to assess the patient. 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. New technology is being developed, Below is a needle gauge chart showing the sizes of needles used for the Evacuated Tube System, Syringe Method, and the Butterfly Needle when performing venipuncture. Next, locate the vein you will be using for the blood draw. 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. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. In the above situations, use another site (eg, the opposite arm) for venipuncture. The upper extremity on the side that a mastectomy was performed. Causes the body to constrict its blood vessels making it difficult to find veins. The consent submitted will only be used for data processing originating from this website. This is an extremely large vessel and if stuck properly can yield excellent blood results. Drake, R., Vogl, W., Mitchell, A. There is the potential for blood clots to form when these veins are used. The first place to look at is the antecubital fossa as it is the first choice for drawing blood. You know all nursing jobs arent created (or paid!) Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. Caution must be taken to avoid arterial puncture. The following order of draw is the approved order as established by CLSI. Small veins can be hard to locate and feel. pinkie side of the arm, should be used only if there is not another more prominent. Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. WebFlow of blood mixed with tube additive back into a patient's vein. All rights reserved. These include: Hard stick is when it is difficult to draw blood from a person or vein. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Arteries pulsate, are, more elastic and have a thicker wall than a vein. Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. Increase in ratio of blood components to plasma. 14. Picking a vein is not difficult. Used for Genetics testing. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. 9. It is more difficult to find and access and has more nerves near it making it Refer to the specific test in the online directory for handling and storage requirements. Sign up to receive the latest nursing news and exclusive offers. 7. Over time and with several repeated punctures, significant amounts of scar tissue builds up. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. In doing so, this will enable students to learn basics prior to graduation. Check out our list of the top non-bedside nursing careers. A. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain. If a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. 10. Increase in ratio of blood components to plasma. These superficial veins lie within the subcutaneous tissue. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. 1. False A Supervisor or Manager should be notified and the incident. WebThe best vein for drawing blood is the median cubital 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. WebSelect the appropriate vein for venipuncture. Do not recap nonsafety needles prior to disposal unless a sharps container is not immediately available. Use another tube as vacuum may have been lost. Continue with Recommended Cookies. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. Observe universal (standard) safety precautions. regardless of how small it may be. 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. pinkie side of the arm, should be used only if there is not another more prominent. massaging, flicking, squeezing or probing the site, long-term IV therapy, Preventing injury to a nerve, tendon, or muscle: Use careful palpitation, and appropriate angle of entry. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. The antecubital fossa is the area of the arm near the elbow. When bleeding stops, apply a fresh bandage, gauze or tape. 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. The least best is the basilic vein. 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. Secure patient to Papoose apparatus for stabilization if child is unable to sit upright on their own. News and Education Editor, MSN, RN, BA, CBC. 2019 www.azcentral.com. [3] 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. 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. These superficial veins lie within the subcutaneous tissue. The median cubital vein is a common site for venipuncture due to its prominence and relative ease of accessibility. This information must match the requisition. Scarred areas. 3. (2016). Excessive probing (uncalculated side-to-side. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Never leave the tourniquet on for over 1 minute. False Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. Draw the desired amount of blood by pulling back slowly on the syringe stopper. 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