Veins In The Antecubital Fossa
Phlebotomists typically draw blood from veins in the antecubital fossa, the pitted area of the inner arm on the opposite side of the elbow.
There are three main veins that run through this region: the median cubital, basilic and cephalic veins. Phlebotomists like using these veins because they are visible in most patients. They also do not roll during the blood drawing process, and tend to produce blood quickly.
The Median Cubital Vein
The median cubital vein is a superficial vein running close to the surface of the skin. It lays over the top of the bicipital aponeurosis at the roof of the cubital fossa.
Different people have differently-shaped median cubital veins. Some form a H-type pattern, while others exhibit a more M-like shape. The vein joins with other veins in the region, including the antebrachial, basilic and cephalic, depending on the patient.
Generally, phlebotomists will attempt to use the median cubital vein first if the option is available. That’s because it is stable when drawing blood and generally easy to locate. It also produces less bruising, which means that patients are more comfortable after a blood draw. Furthermore, it is some distance from major arteries and veins, meaning that patients are at much lower risk of internal bleeding.
However, it isn’t always the perfect choice. The median cubital can be hard to find in obese patients and those with low blood pressure.
PhlebotomyU offers several courses. In our CPT I classes, students will receive hands on experience and practice this procedure in clinical and classroom settings. Contact PhlebotomyU today to learn which course is best for you.
The Cephalic Vein
The cephalic vein is another superficial vein found in the arm. It connects to the basilic vein via the median cubital vein in the antecubital fossa. The cephalic vein typically runs along the outside edge of the biceps and is one of the largest veins in the arm. It is often visible through the skin, particularly after physical activity.
Like the median cubital vein, it is a good site for venous access. Phlebotomists will usually attempt to draw blood from it if they can’t locate or use the median cubital. The cephalic vein is quite large, making it suitable for large-bore cannulas. However, since the vein runs close to the radial nerve, medics must be careful to avoid inducing numbness.
The Basilic Vein
The basilic vein is a “vein of last resort” for blood draws. Usually, phlebotomists use it if other drawing sites are blocked.
The basilic vein runs down the inside of the upper arm and then branches into the median cubital and lower arm segment of the basilic. The precise layout of the veins in the lower arm varies considerably from person to person. It is a very large superficial vein and helps drain blood from most of the forearm and the arm.
Unfortunately, the basilic vein is not as close to the skin’s surface as the other two veins discussed so far. Consequently, it can be harder to draw from it. There is also a greater risk of damage to the brachial artery and medial nerve.
Other Veins Used In Phlebotomy
Some phlebotomists will attempt to draw blood from the dorsal venous network. This refers to the veins that run from the hand and, again, is highly variable from person to person. Dorsal veins appear on the backside of the hands and then drain into the cephalic and basilic veins. In some cases, medics also use these veins for infusions (such as providing a patient with a sedative before a procedure).
Drawing blood from the hands, however, is associated with a higher degree of pain. As such, phlebotomists will usually anchor veins in their hands to stabilize them for blood draw.
Choosing A Suitable Vein
How phlebotomists choose a suitable draw site depends very much on the specific circumstances of the patient. Mostly, the choice of vein will depend on the needle gauge. The larger the needle, the larger the vein will need to be.
Phlebotomists will often ask patients whether they have had any blood draws in the past. They will then ask them to indicate the location of previous draw sites on their bodies. This can serve as a guide for where they will draw the blood on this occasion.
During vein selection, the phlebotomist will seek out a suitable vein. Usually, they will feel around the antecubital fossa area, attempting to find the median cubital vein. If they can’t find that, they will move onto the cephalic and basilic veins.
There are other draw sites below the waist. However, phlebotomists will usually only use these in special circumstances. For infusions, medics may use veins in the hands.
RELATED: “Top Vein Sites Used in Phlebotomy”
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