Rolling veins. Dress the site with gauze and tape or a bandage. Fear of needles. It is a critical part of the health care world. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Clinical Significance. Try to access the vein efficiently and collect the blood sample within 30 seconds after tourniquet placement. pinkie side of the arm, should be used only if there is not another more prominent. The median cubital vein is the first choice for venipuncture. After identifying a suitable cannulation site, remove the tourniquet. Without proper specimens, unhelpful or even harmful medical treatment could happen. Enjoy :). 1. Edinburgh: Elsevier Churchill Livingstone. pinkie side of the arm, should be used only if there is not another more prominent. Antiseptic. She attended New York University and her writing has appeared on various online publications. Wash hands in warm, running water with a appropriate hand washing product. CLSI document H3-A6. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Veins on the underside of the wrist should be avoided. Philadelphia, PA: Lippincott Williams & Wilkins. 6. Ask the patient to state their name and date of birth. together for emotional support and understanding across multiple locations to reach you in the community where you live. Increase in ratio of blood components to plasma. Ask the patient to make a fist and not pump the hand. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. 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. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. 12. The basilic vein basically runs from the palm of the hand and up your arm on the side of the ulna. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. The cephalic vein is found on the lateral, or outside, of the arm. 5. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Standring, S. (2016). Caution must be taken to avoid arterial puncture. Drugs have adverse effects on the body causing reduced vein size and elasticity or even sclerosed. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Median cubital vein: want to learn more about it? UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy). In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. Among the 3 main veins, it is probably the one closest to the elbow. Perform hand hygiene and don proper PPE. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. 9. Efficient, expeditious performance of the procedure is required to avoid prolonged tourniquet placement and blood stasis, which can cause artifactually abnormal laboratory results (eg, hemolysis and hyperkalemia Hyperkalemia Hyperkalemia is a serum potassium concentration > 5.5 mEq/L (> 5.5 mmol/L), usually resulting from decreased renal potassium excretion or abnormal movement of potassium out of cells. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. It is more difficult to find and access and has more nerves near it making it 6. [5] It becomes prominent when pressure is applied upstream, which makes needle insertion easier. 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. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. Have the patient or an assistant continue to apply pressure to the site. WebWhy do we use the median cubital vein? Place a gauze pad over the puncture site and quickly remove the needle. Gloves are to be discarded in the appropriate container immediately after the phlebotomy procedure. Obese patients. In order to draw blood for a blood test a needle has to be inserted into a vein. 11. Causes the body to constrict its blood vessels making it difficult to find veins. Gray's Anatomy (41tst ed.). Cleanse the skin site with antiseptic solution, beginning at the needle-insertion site and making several outwardly expanding circles. Draw the desired amount of blood by pulling back slowly on the syringe stopper. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. After this point, do not touch the skin site with any nonsterile item. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. Wrist. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. a bed. They are also a bit larger and have a thicker lumen resulting in a faster blood flow. The cephalic vein is the second choice usually, since it is fairly well anchored. instance: "61c9f514f13d4400095de3de", Test your knowledge on the main veins of the upper limb in this quiz. Insert the beveled needle at a 30-degree angle into the vessel. 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. } Risks associated with using this vein include penetration of Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. This vein penetrates the fascial roof of the cubital fossa to anastomose with a brachial vein, forming a connection between the superficial and deep venous systems of the upper limb. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Tables showing needle sizes Hi! This is to prevent cross contamination by the tube additives that could lead to erroneous results. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. The Supervisor should be called to assess the patient. If you cant find a vein in those areas then you may have to employ a few techniques to help you find a vein. Large bruise caused by blood under the skin. There are two main ways to find a vein to draw blood. 8. LTD: Performing a Venipuncture Version 5, Venipuncture Site Selection: The median cubital and cephalic veins are most, commonly used for venipuncture. Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. 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. 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. They also may not be able to be used due to intravenous placement or injury. A hematoma can cause a post-phlebotomy compression injury, Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times do not, shake them. Single use, disposable, latex-free tourniquets. An example of data being processed may be a unique identifier stored in a cookie. This is an extremely large vessel and if stuck properly can yield excellent blood results. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. Attach the needed tubes or syringes to remove the proper volume of blood. Observe all applicable isolation procedures. False Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. Insert the beveled needle at a 30-degree angle into the vessel. Na Citrate Coagulation tubes light blue top tube, 4. The median cubital vein is the preferred vein for phlebotomy because it is usually larger than the other veins and more stationary. G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. 13. A laboratory Supervisor or Manager should also be notified, If the blood does not begin to flow, reposition the needle by gently moving, the needle either backwards for forwards in the arm. The least best is the basilic vein. 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. Remove the needle from the patients arm and press down on the vessel with gauze. The most common vein is the antecubital fossa; however, the median cephalic and median basilic veins are also used. False I'm Kadia. Remove the tourniquet if you did not do so earlier. A fear of needles can cause a person to feel anxious, have panic attacks or even faint. Preventing of infection: Follow proper infection control policies. Its location is in the cubital fossa, on the anterior/flexor aspect of the elbow joint. 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. WebWhy do we use the median cubital vein? They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Clinically Oriented Anatomy (7th ed.). That makes them more visible and easier to locate and feel for venipuncture. At no time may phlebotomists perform venipuncture on an artery. After cleansing the area, if it is accidentally. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. 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? Perform good hand hygiene and don appropriate PPE. Make sure the, venipuncture site is dry. To find it, assess the site next to the median cubital area on the thump side of your arm. o [ abdominal pain pediatric ] It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. Veins on the underside of the wrist should be avoided. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. Edwin Ocran MBChB, MSc The more venipunctures you successfully obtain, the more successful you will become. First, gather all of your supplies and discuss with your patient what you are going to be performing. Some persons have good veins and others have veins that are difficult to find. 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.