Resistance when inserting the needle. Burnt areas. Avoid probing for the vein. Coagulopathy is not a contraindication, but sites must be compressed for a longer time after venipuncture. There read more ). o [teenager OR adolescent ]. WebThe median cubital vein is the best vein to use for venipuncture. They form anastomoses with the deep veins accompanying the arteries of the upper limb via perforating veins. Get the latest on all things nursing by joining our email newsletter. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Looking for a change beyond the bedside? It is more difficult to find and access and has more nerves near it making it Manage Settings pinkie side of the arm, should be used only if there is not another more prominent. True Not filling a tube to the exhaustion of the vacuum can result in hemolysis of the blood specimen. The median cubital vein is not critical to life, but it does help facilitate venous return from the arms back to the pulmonary system. Phlebotomy is the act of taking a blood sample from the vein of a patient for laboratory examination and analysis. 14. In the case of an accidental needlestick, immediately wash the area with an antibacterial soap, express blood from the wound, and contact your supervisor. I wrote an entire article about best tips for difficult veins. (function() { Once you have found it, take care in anchoring the vein to prevent rolling when you insert the needle to draw blood. Gloves are to be worn during all phlebotomies, and changed between patient collections. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. A lot of fat tissue in the arm area or at the back of the hand makes it difficult to feel a vein. I'm Kadia. This is a common misconception - pumping the hand does not increase venous circulation. If no patient labels are available, manually label the tubes with the required information. It may help to allow the arm to hang down, increasing venous pressure. Foot. All other tubes containing an additive should be gently inverted 8-10 times. Blood is usually drawn using the veins of the arm, although the hand veins may also be used. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. Reassure the patient that the minimum amount of blood required for testing will be drawn. Venipuncture is typically performed at the antecubital fossa (on the median cubital, cephalic, and basilic veins), or on the dorsum of the hand. In venous blood sampling, a needle is inserted into a vein to collect a sample of blood for testing. Return to your, patient and assess the site of the puncture. When using vacuum tubes, push each tube fully into the tube holder, use care to avoid dislodging the needle from the vein. Latex hypersensitivity: Use latex-free gloves and tourniquet. It is no longer recommended to flex the elbow after antecubital venipuncture; this actually increases hematoma formation. Make sure the, venipuncture site is dry. The foot is also a last resort. 13. The median cubital vein connects the cephalic vein with the basilic vein. 4. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. 7. If rapid local swelling occurs, blood is extravasating. Reapply the tourniquet proximal to the selected insertion site. Best practices in phlebotomy involve the following factors: *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. Ensure that the collection tube is completely pushed onto the back of the needle in the hub. Do not place, tightly or leave on for more than 1 minute. The link you have selected will take you to a third-party website. WebThe median cubital vein is the best vein to use for venipuncture. Sign up to receive the latest nursing news and exclusive offers. The label must include the patient first and last names, DOB,, collection date and time and collectors initials. Ernst, Dennis J. WebSelect the appropriate vein for venipuncture. Phlebotomists are specially trained in this technique and are able to procure blood from several different veins in the body. Procedures for the Collection of Diagnostic Blood Specimens by. There are three veins most commonly used in venipuncture, or phlebotomy. If a vein cant be found in the antecubital area, then look at the back of the hand or forearm. Apply a tourniquet approximately 3-4 inches above the selected site. Large bruise caused by blood under the skin. Small/thin veins. 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. Clinical Significance. For children, swab the site 3 times using only alcohol. Mass formed by leakage of blood under the skin. On many persons arm it will be slightly rising above the skin surface. All rights reserved. The wrist is a last resort for drawing blood. WebFlow of blood mixed with tube additive back into a patient's vein. 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. Apply adequate pressure to the puncture site to stop the bleeding and, avoid formation of a hematoma. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. 3. Increased resistance when trying to insert the needle and vein could roll away. The best vein for drawing blood is the median cubital vein. * After removing a tube from the holder, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. 11. The vacuum tubes are designed to draw a predetermined volume of blood. Recheck the site after a few minutes to verify the absence of hemorrhage/hematoma. WebSelect the appropriate vein for venipuncture. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. 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. WebWhy is the Median Cubital Vein Used the Most? Increase in ratio of blood components to plasma. Bergman's comprehensive encyclopedia of human anatomic variation. Once found, be sure to anchor it when inserting the needle. 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. the venipuncture should be performed distal to (below) the hematoma. HealthStar Press, Inc. 2001, updated 1/08. The basilic vein is the last choice for venipuncture. Most times it will be big and plump but the size will vary depending on each individual. 1. The cephalic and basilic veins have a greater tendency to roll and veinpuncture may be more painful from these sites. It is usually there for the picking. The least best is the basilic vein. See below. If an IV is in place, samples may be obtained below but NEVER above the IV site. 10. Without proper specimens, unhelpful or even harmful medical treatment could happen. The least best is the basilic vein. Skin-cleansing materials: Alcohol, chlorhexidine, or povidone-iodine swabs or wipes, Nonsterile gloves (sterile gloves if blood cultures are being obtained), Needle system (eg, needle and syringe, or needle and vacuum tube, typically 21-gauge needles for adults; 22- or 23-gauge for neonates, small children, and sometimes older patients), Blood-collection tubes and blood-culture bottles, as appropriate, Dressing materials (eg, tape, gauze, bandages), Vein-finder device (eg, infrared vein viewer, ultrasonography device), Topical anesthetic (standard for children): Needle-free lidocaine gas-injector, lidocaine-epinephrine-tetracaine mixture, or lidocaine-prilocaine cream. Deploy safety cover over the exposed needle. Pull the skin tight with your thumb or index finger just below the puncture site. If it is deeper in the arm it may take a little longer to feel and find it. 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. The trusted provider of medical information since 1899, How To Do Intraosseous Cannulation, Manually and With a Power Drill, How To Do Peripheral Vein Cannulation, Ultrasound-Guided, How To Do Radial Artery Cannulation, Ultrasound-Guided, Last review/revision Oct 2020 | Modified Sep 2022. Position the patient and hyperextend the patients arm. 8. 8. Identify the patient using two patient identifiers as mandated by JCAHO. Phlebotomy is essential for a variety of medical diagnoses, procedures, and tests. [3] Gently invert tubes containing an additive 5-8 times. Read more. A. Tubes with different additives are used for collecting blood specimens for specific types of tests. Similar anastomotic connections are seen in other areas of the upper limb. Veins in the foot and ankle should be utilized only as a last resort. Wait for the antiseptic solution to dry completely. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. It is more difficult to find and access and has more nerves near it making it These tubes are used primarily for chemistry tests. 5. At no time may phlebotomists perform venipuncture on an artery. News and Education Editor, MSN, RN, BA, CBC. To help distend and locate veins, tap a potential site with your fingertips. Some test specimens require special handling for accurate results. Use another tube as vacuum may have been lost. Do a preliminary inspection (nonsterile) to identify a suitable vein: Apply a tourniquet, have the patient make a fist, and palpate using your index finger to locate a large-diameter vein that is nonmobile and has good turgor. Needles and hubs are single use and are disposed of in an appropriate sharps container as one unit. 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