The ante cubital fossa or elbow pit is the triangular area on the anterior view of the elbow.
Median cubital vein connects the basilic and cephalic veins in the antecubital fossa. With cephalic and basilic veins on both sides, it usually forms a H or M pattern
Veins located in the antecubital area are larger, fuller, superficial and often visible. So, cubital veins are the first option for phlebotomy and specimen collection. Remember, nerves and arteries pass through this region. So, you need to palpate and identify the vein to prevent puncturing an artery or nerve.
You may consider superficial, large accessary veins
The dorsal digital veins pass along the sides of the fingers. Digital veins unite to form three dorsal metacarpal veins. These metacarpal veins located on the back of the hand is your 2nd choice for phlebotomy when you are not able to get blood from the antecubital veins.
Cephalic Vein runs from the lateral side of the arm from the hand to the shoulder
Basilic Vein passes along the back of the forearm on the ulnar side for a distance and then it curves to the surface below the elbow
<insert picture of Metacarpal Veins>
- Choose large, soft fuller veins to draw blood.
- If unable to draw from the cubital veins, consider metacarpal veins located on the hand. Also, consider veins on the hand for patients for planned dialysis fistula or graft
- Veins in the feet are the last option for venipuncture because of higher probability of complications. Avoid feet for diabetes patients and patients with neuropathy
Avoid the upper extremity on the side of mastectomy with lymph node resection
Avoid upper extremities with lymphedema, compromised circulation associated with radiation therapy, paralysis or hemiparesis from CVA.
Avoid areas of hematoma – Because, it may alter the test results. If another site is not available, collect the specimen distal to the hematoma
Avoid edematous extremities – tissue fluid accumulation in the collection tubes may alter test results. If an alternative site is unavailable, compress the site with your fingers and move the fluid away from the immediate venipuncture site.
Avoid areas with scars and burns.
Avoid the ventral surface of the wrist due to pain on insertion and possible damage to the radial nerves.
Generally, arms with a fistula are not used for venipuncture. Be aware of the facility’s policy.
If a patient is getting an IV infusion, perform phlebotomy on the opposite extremity. If required to draw blood from the same arm with an infusion, follow these steps:
- Turn off the IV for at least 2 minutes before the venipuncture. If you are not the patient’s nurse, it is safe practice to ask the nurse to turn off the IV.
- Apply the tourniquet below the IV site and draw below the IV site. If the IV is on the hand, the nurse may need to replace the IV site to the forearm to accommodate the phlebotomy.
- Draw and discard 5 ml blood (first tube) and then collect the specimen
