False Students should study venipuncture in books and watch licensed nurses in clinical settings perform this task. 8. The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. To access the external jugular vein, place the patient in Trendelenburg position with the head tilted slightly contralaterally. Kenhub. This is to prevent cross contamination by the tube additives that could lead to erroneous results. On others it will be just below the surface. 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. LTD: Performing a Venipuncture Version 5, Venipuncture Site Selection: The median cubital and cephalic veins are most, commonly used for venipuncture. 11. Remove the tourniquet if you did not do so earlier. If blood is being obtained for blood cultures, vigorously cleanse the site with alcohol for 30 seconds, allow the alcohol to dry, and then swab in outwardly expanding, overlapping circles using chlorhexidine or povidone-iodine. Large bruise caused by blood under the skin. It is usually there for the picking. touched before performing the venipuncture, it should be cleansed again. There are about three main areas for drawing blood: the median cubital, cephalic, and basilic veins. Clinical read more , or hyperuricemia) and also to avoid skin irritation. retract from the vein and the safety device will cover the needle. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. The tourniquet should be applied between the IV site and the venipuncture, site. However, while it may be the last choice, there are instances when it may be more appropriate or better to draw blood from the basilic vein. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. 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. Identify the patient, two forms of active identification are required. Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. Dispose of contaminated materials and needles in the designated hospital-approved containers. 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. 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. Here, I share with you all the tips and tricks I have learned doing phlebotomy over the years. It is more difficult to find and access and has more nerves near it making it Veins on the underside of the wrist should be avoided. * 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. Use a vein-finder device if a suitable vein is not readily seen or palpated. Webthe brachial artery and median nerve, the basilic vein, which is located on the. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Arteries pulsate, are, more elastic and have a thicker wall than a vein. When bleeding stops, apply a fresh bandage, gauze or tape. Median cubital vein: want to learn more about it? WebThe median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. WebWhy do we use the median cubital vein? Most of the samples you are going to draw will be from that vein in the center of the arm. 12. Obese patients. Secure patient to Papoose apparatus for stabilization if child is unable to sit upright on their own. 1. Knowing the location of each vein, go to the respective area to find it. When that happens it can be difficult to locate veins. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. (2016). If using a needle, and syringe, avoid drawing the plunger back too forcefully. 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. She attended New York University and her writing has appeared on various online publications. WebThe median cubital vein is routinely used for venipuncture (taking blood) and as a site for an intravenous cannula. o [teenager OR adolescent ]. Edinburgh: Elsevier Churchill Livingstone. Together these veins drain into the axillary vein. Excessive probing (uncalculated side-to-side. WebThe best vein for drawing blood is the median cubital vein. WebThe median cubital vein is the best vein to use for venipuncture. We and our partners use data for Personalised ads and content, ad and content measurement, audience insights and product development. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. The blood is normally drawn from a vein on the top We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. WebFlow of blood mixed with tube additive back into a patient's vein. The vacuum tubes are designed to draw a predetermined volume of blood. Fragile/collapsed veins. Needles are never recapped, removed, broken, or bent after phlebotomy procedure. NOTE: When using a winged blood collection set for venipuncture and a coagulation tube is the first tube needed, first draw a discard tube (plain red top or light blue top). It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. One reason is because you may have hard-to-find veins or you may be dehydrated. The discard tube does not need to be filled completely. If the vein is visible then you can already make a choice. Veins in the foot and ankle should be utilized only as a last resort. 3. Select the appropriate vein for venipuncture. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. Have the patient or an assistant continue to apply pressure to the site. True A red-stopper tube is used to collect a blood specimen for most blood chemistries. The median cubital and cephalic veins are preferred for blood sampling, but other arm and hand veins may be used. if (window.ClickTable) { You know all nursing jobs arent created (or paid!) Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. Refer to the specific test in the online directory for handling and storage requirements. Standring, S. (2016). together for emotional support and understanding across multiple locations to reach you in the community where you live. Confirm the ordered tests and fill out the appropriate forms and labels. 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. These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. 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. It has the tendency to roll sometimes so care must be taken to anchor it when inserting the needle. Release the tourniquet. 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. 10. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Remove the tourniquet as the last amount of blood is drawn. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Read more. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. }; For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. After this point, do not touch the skin site with any nonsterile item. Venipuncture; Approved StandardSixth Edition. 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. Philadelphia, PA: Saunders. 7. 3. An example of data being processed may be a unique identifier stored in a cookie. Ask the patient to make a fist and not pump the hand. Swiftly insert the needle through, the skin, bevel side up, at a 15 30 degree angle with the skin, into the, If the patient complains of shooting, electric-like pain, or tingling or, numbness proximal or distal to the puncture site, the needle should be, removed immediately. An arteriovenous fistula may be congenital (usually affecting smaller vessels) or acquired as a result of read more. I. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. WebThe median cubital vein is the best vein to use for venipuncture. The cephalic vein is found on the lateral, or outside, of the arm. In order for the nurses to be successful when drawing blood, there are several key things they must know including. First, gather all of your supplies and discuss with your patient what you are going to be performing. Netter, F. (2019). Yellow Top (plasma and cells): Contains ACD solution A or B. Large bruise caused by blood under the skin. Never leave the tourniquet on for over 1 minute. Manage Settings Veins deeper in the arm can be hard to feel and locate. Do not place, tightly or leave on for more than 1 minute. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. These tubes are used primarily for chemistry tests. Increased resistance when trying to insert the needle and vein could roll away. Sharps Disposal Container. Rolling veins. Wayne, PA: Clinical and Laboratory Standards Institute; 2007. Reapply the tourniquet proximal to the selected insertion site. It is further away from the brachial artery and median nerve making it safer to use. Veins of the hand and wrist are usually close to the surface, but they are prone to movement and rolling. There is no easy way to draw blood. Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. 2. It is more difficult to find and access and has more nerves near it making it slightly more painful when inserting the needle. How to find the vein? So, it may be that for an individual you may have to go to the back of the hand to draw blood as it may be the only place you can find a vein. WebSelect the appropriate vein for venipuncture. 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. [3] Abnormal caving in of the vessel walls, stopping blood flow. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. 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