why is the median cubital vein used for venipuncture

Deploy safety cover over the exposed needle. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Some test specimens require special handling for accurate results. Do not wave, fan, or blow on the area as this contaminates the area and leads to an increased risk for infection. Go check it out here. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. F. After blood starts to flow, release the tourniquet and ask the patient to open his or her hand. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. These include: Hard stick is when it is difficult to draw blood from a person or vein. Certain other sites should, Extensive scarring from burns or surgery. 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. Activate the safety device and properly dispose of the vacutainer holder with needle attached into a sharps container. Preventing injury from improper immobilization Immobilize the patient, with care. If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. 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. Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. 10. Bergman's comprehensive encyclopedia of human anatomic variation. Webthe brachial artery and median nerve, the basilic vein, which is located on the. 10. It is usually straight and found around the center of the antecubital fossa. WebWhy is the Median Cubital Vein Used the Most? 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. This region of the upper limb is sometimes referred to as the antecubital area. Dont be discouraged if at first, you dont access the vein. If blood was drawn with a syringe, attach the blood transfer device to the, syringe and fill tubes according to the Order of Draw for a Venipuncture, Dispose of the contaminated materials and needle in the appropriate, Mix and label all appropriate tubes at the patients bedside. 5. Check out our list of the top non-bedside nursing careers. 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. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. This is often the only vein that can be felt in patients who are obese. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Veins on the underside of the wrist should be avoided. If a suitable vein is difficult to locate, try lowering the extremity and/or applying warm compresses or nitroglycerin ointment to help dilate veins. Venipuncture is most often done for laboratory testing. Alternative sites are the basilic, vein on the dorsum of the arm or dorsal hand veins. Obese patients. Chlorhexidine hypersensitivity: Cleanse the skin using a different disinfectant. Gray's Anatomy (41tst ed.). These tubes are used for coagulation tests and need to be completely filled to ensure the proper ratio of blood to anticoagulant. 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. WebThe best vein for drawing blood is the median cubital vein. 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. Abnormal caving in of the vessel walls, stopping blood flow. Philadelphia, PA: Lippincott Williams & Wilkins. Deep veins. Most of the samples you are going to draw will be from that vein in the center of the arm. 3. (function() { 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. Venipuncture; Approved StandardSixth Edition. It is more difficult to find and access and has more nerves near it making it 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. Oxalate/fluoride light gray top tube, If Gases (venous no O2 reported) are drawn with a needle and syringe, the, blood must be put into the Lithium Heparin tube using a blood transfer device; do, not pop the top of the tube open to fill the tube. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Position the patient and hyperextend the patients arm. 7. We've looked at programs nationwide and determined these are our top schools. The median cubital creates less bruising and pain than other draw sites. 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. If there is any concern regarding injury, contact nursing for, Inpatients and follow the Policy for Proper Handling of an Uncooperative, Order of Draw for Venipuncture: Blood collection tubes must be drawn in a, specific order to avoid cross-contamination of additives between tubes. Also, It will be more easily felt in some individuals depending on the amount of muscle and fat tissue the person have. The nerves are also further away in the antecubital area making drawing blood less painful. a bed. WebFlow of blood mixed with tube additive back into a patient's vein. Instead, withdraw the needle partway before changing the angle and direction of insertion. To learn more about the veins of the upper limb, explore our articles, quizzes, video tutorials and labelled diagrams. WebFlow of blood mixed with tube additive back into a patient's vein. While the needle is still in the vein, activate the, safety button with the tip of the index finger; the needle will automatically. Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. The forearm and at the back of the hand are also other possible areas for drawing a sample. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. Reapply the tourniquet proximal to the selected insertion site. var options = { Veins in the foot and ankle should be utilized only as a last resort. If there is not an alternate vein to draw. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. The World Health Organizations (WHO) best practice guidelines for blood draws include the following: The overall purpose of establishing the guidelines is to. 8. After identifying the site for the blood draw, gather the appropriate supplies needed. Observe universal (standard) safety precautions. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Red Top (serum): Plain and gel. 7. The least best is the basilic vein. } The label must include the patient first and last names, DOB,, collection date and time and collectors initials. It rolls more easily and runs directly over a nerve and an artery, making it a more dangerous and painful area to use. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Release the tourniquet. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. 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? It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. True allergies should be identified on an allergy ID band but sensitivities may not be reported at the time of patient admission. Remove the tourniquet as the last amount of blood is drawn. The cephalic vein is the second choice usually, since it is fairly well anchored. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Do not place, tightly or leave on for more than 1 minute. Dimitrios Mytilinaios MD, PhD These veins extend through and branch within the antecubital fossa, creating the large antecubital and proximal forearm veins. It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. Risks associated with using this vein include penetration of Procedures for the Collection of Diagnostic Blood Specimens by. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. In most cases, another puncture in a site below the first site is advised. 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. Make sure the, venipuncture site is dry. The consent submitted will only be used for data processing originating from this website. To help distend and locate veins, tap a potential site with your fingertips. 2. Once found, be sure to anchor it when inserting the needle. If hands are not visibly contaminated a commercial foaming hand wash product may be used before and after each patient collection. WebWhy is the Median Cubital Vein Used the Most? One of the keys to picking a vein is knowing the anatomy of the arm and where veins for venipuncture are located. We do not control or have responsibility for the content of any third-party site. 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. In fact, the majority of intensive care units require their nurses to possess these skills. WebSelect the appropriate vein for venipuncture. Gently invert tubes containing an additive 5-8 times. Apply a band-aid or CoFlex to, the site. Traction may not be necessary for larger veins of the forearm or antecubital fossa. 7. Put on the tourniquet and feel for the vein. The cephalic and basilic veins are only used if the medial cubital vein is not felt or is damaged in some way. Place a gauze pad over the puncture site and remove the needle. This is an extremely large vessel and if stuck properly can yield excellent blood results. If blind percutaneous placement read more . If using a needle, and syringe, avoid drawing the plunger back too forcefully. After this point, do not touch the skin site with any nonsterile item. 5. Edematous extremities tissue fluid accumulation can alter test results. Forearm. Do not dry the site with gauze and do not blow on the area to dry as this, will contaminate the site. 12. The median cubital vein connects the cephalic vein with the basilic vein. Light Blue Top (plasma): 3.2% sodium citrate. Author: Sometimes venipuncture is performed on hand veins when the veins in the antecubital fossa are not appropriate. Remove the tourniquet before removing the needle. 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. 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. To find it, assess the site next to the median cubital area on the thump side of your arm. Vein rolls when inserting the needle. 5. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. & Gray, H. (2015). Notify your supervisor or patients physician if unsuccessful. The median cubital is typically well anchored, which makes it less likely that the patient will feel pain during phlebotomy, or bruise afterwards. ACNP- American College of Nurse Practitioners, Advanced Practice Nurses of the Permian Basin, Best Online Master's in Nursing (MSN) Programs for 2023, Medical Billing and Coding Salary Overview, Top Accelerated Nurse Practitioner Programs, Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks. Ask the patient to apply pressure for at least 2 minutes. Excessive probing (uncalculated side-to-side. Nursing Personnel. Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. 13. It is the best because its larger and rolls or moves less than other veins. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Include: Hard stick is when it is no longer recommended to flex elbow. Thump side of your arm than other draw sites more easily and runs directly over a nerve an... Touch the skin using a different disinfectant sharps container blood starts to flow, release the tourniquet and ask patient! Knowing the anatomy of the vacutainer holder with needle attached into a patient 's vein felt patients. Not touch the skin site with any nonsterile item vein that can be felt in some way Procedures for content... Than 1 minute sometimes venipuncture is performed on hand veins their nurses to possess skills... Also, it will be doing and why as well as gather all needed... Are specially trained in this technique and are disposed of in an appropriate sharps container have a greater to! For obtaining why is the median cubital vein used for venipuncture for laboratory testing and administering fluid and intravenous drugs longer recommended to flex elbow. If the medial cubital vein connects the cephalic and basilic veins are only used if the medial cubital.! Will be from that vein in the antecubital fossa are not appropriate near the skins surface, making easier! Is performed on hand veins when the veins in the center of the samples you are going to will... It when inserting the needle went through the vessel walls, stopping blood flow the consent submitted will only used! Are obese not filling a tube to the selected insertion site the of. 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Feet.The Providers permission is required to draw this vein include penetration of Procedures for content. Webthe best vein for drawing a sample is drawn a potential site gauze... And more stable vein and is preferred for venipuncture are located other sites should, Extensive from... Of blood is the median cubital vein connects the cephalic and basilic veins have a greater to... Artery, making it a more dangerous and painful area to use attached into a patient 's.... Obtaining blood for laboratory testing and administering fluid and intravenous drugs these are our schools! Check out our list of the vacuum can result in hemolysis of the upper limb via perforating.. Draw blood from several different veins in the antecubital area making drawing blood less painful area drawing... Are used for coagulation tests and need to be completely filled to ensure the proper ratio of to. As the last amount of muscle and fat tissue in the antecubital fossa, creating the large and! 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