Selecting the Right Veins for Procedures

Hey everyone, it's Sarah with RegisteredNurseAriene.com and in this video I want to go over the veins that I love to use whenever I'm drawing blood or starting IVs. So in order to be successful whenever you're drawing blood or starting IVs, you really have to know a couple things. Number one, You need to know the name of the vein that you're going to use and its location along with what can that vein actually handle. For instance, some veins can only handle about a 20 or a 22 gauge IV cannula versus some of them can handle 18 gauges, 16 gauges. So you really want to know which veins can do that. Now what veins do I love to use whenever I'm drawing blood or starting IVs? Okay, number one, which I think the consensus is probably the same for this is the median cubital vein. This is here in a moment you're going to see. to see a large vein right in the bend of the arm and it's perfect for drawing blood I also like to use the accessory cephalic vein along with the median vein of the forearm and of course those hand veins the dorsal venous network so we have our tourniquet on up here on the top of the arm and I want to show you these veins so first I'm going to show you the media cubital vein and it is located right here and as you can see it's nice and large perfect for those blood draws and it arises out of your cephalic vein, which is right here. Now this is our patient's left arm. So on the right arm, it's going to be the opposite, but we have the cephalic vein right here. And then over through here, you can't see it as well as the basilic and where the cephalic and the basilic start to connect is here at this median cubital vein. Now this vein, like I said, great for blood draws. You can use it for IVs. The problem with it though, is that it's in the bend of this arm. So as the patient is eating, eating, moving around, getting up. It's going to cause them a lot of pain and it can infiltrate and mess up the vein. So unless it's like last resort, you can't find any other veins on this arm or the patient needs like a CTPE protocol with an 18 gauge and one of those large veins, you can go there, use it, and then just take it out and go somewhere else. But I like to keep that available for blood. Next is the accessory cephalic vein, hence its name. It's coming. off of that cephalic vein up through here. Now this is really one of my favorite veins to start IVs in. Number one, it doesn't really roll. It's easy to stabilize. You're not going to stick the needle in there and it rolls to the side. Don't you just love when that happens? No, not really. And it's a relatively large vein so it can easily hold an 18 gauge. Now the thing is whenever you do use this for IVs, because it starts up in here, don't go in this bend of this arm. Go down because it comes down and you can just stick your IV. right there and the patient can move their arm, bend it, they're not going to have problems. So this is really a good vein. Another vein I like to use is located on the forearm. So we don't have a bend of an arm causing the patient issues. And it is the median vein of the forearm, also called the antebrachial vein. And it is this vein right here. It comes out of the palm of the hand. Now, as you can tell, this vein is not as big as that accessory cephalic and that media cubital vein. So whenever you go go to stick this for like an IV, you want to probably pick like a 20 or 22 gauge instead of an 18 gauge. I have seen a limited amount of 18 gauges in this vein because you know everyone's anatomy is different. Some people have bigger veins there. So you want to think about that. Another thing is that these veins can run deep on patients who have a lot of sub-Q fat on their forearms. So you might be able to see the vein, but whenever you go to stick it, you don't immediately... get that blood draw because the veins a little bit deeper so keep that in mind and that also is true for these veins up here on the bend of the arm as well and lastly the veins of the hand the dorsal venous network and these veins are great for drawing blood starting IVs but some things you want to remember okay first of all these veins like how this patient has their hand open if you go to stick a needle in this vein with the hand in this position this vein is just going to roll see how that rolls like that what you'd want to do is you want to stabilize it so have them make like this lot fist and look that keeps that vein nice and still while you go with the needle and try to draw blood or advance a cannula now I have a whole video on how to prevent rolling veins if you need some more tips on that another thing to remember is that these veins sometimes are really superficial on people like here they're nice and engorged and healthy looking so they'll be great for an IV or drawing blood. However, on some patients who have a lot of sub-Q fat on the hands, they're hard to get to, they're super small or like very fragile and they blow easy. So always look at that. Look at the health of the vein before you try to. Stick it with a needle. Now when choosing a vein when you're starting an IV there are some things you want to keep in mind. Number one you want to ask yourself okay what's this patient here for? Are they just here for like a short stay because they need a quick procedure or they're just here for observation? or they're going to be hospitalized because they need treatment. Maybe they need some blood products or they're going to have to get some vesicant type drugs like potassium, vancomycin, just to name a few. So you want to select your site and your size of your needle appropriate. really because for instance vancomycin is really hard on the veins and you want to use a large vein rather than a small vein. Next ask the patient where they prefer that you draw blood or start an IV because patients tend to be experts on where they know that you're going to be successful at getting that IV or drawing blood and some patients love to have IVs or blood draws in their hands while some prefer that media cubital vein. That's the only place they want blood drawn and that's the only place they want an IV. always ask your patient. And lastly, sometimes you're just going to have to draw blood or start an IV where you can, because if you're working with patients who have severe cardiac disease or renal disease, they really don't have much to stick. They're very, very limited in where you can even get IV access. And I've seen IVs in creative places, like in the feet and the little fingers, on the arms, up in the neck, anywhere you can get them. So always... Always keep that in mind and if that does happen and your patient is needing lots of fluids, IV drugs, things like that, you want to get with the physician and you want to ask, hey, is this patient a candidate for a central line because that may benefit the patient a little bit better. Okay, so those are some tips on choosing veins when starting IVs or drawing blood. Thank you so much for watching and don't forget to subscribe to our channel for more videos.

For instance, some veins can only handle about a 20 or a 22 gauge IV cannula versus some of them can handle 18 gauges, 16 gauges. So you really want to know which veins can do that. Now what veins do I love to use whenever I'm drawing blood or starting IVs?

Okay, number one, which I think the consensus is probably the same for this is the median cubital vein. This is here in a moment you're going to see. to see a large vein right in the bend of the arm and it's perfect for drawing blood I also like to use the accessory cephalic vein along with the median vein of the forearm and of course those hand veins the dorsal venous network so we have our tourniquet on up here on the top of the arm and I want to show you these veins so first I'm going to show you the media cubital vein and it is located right here and as you can see it's nice and large perfect for those blood draws and it arises out of your cephalic vein, which is right here.

Now this is our patient's left arm. So on the right arm, it's going to be the opposite, but we have the cephalic vein right here. And then over through here, you can't see it as well as the basilic and where the cephalic and the basilic start to connect is here at this median cubital vein. Now this vein, like I said, great for blood draws.

You can use it for IVs. The problem with it though, is that it's in the bend of this arm. So as the patient is eating, eating, moving around, getting up. It's going to cause them a lot of pain and it can infiltrate and mess up the vein. So unless it's like last resort, you can't find any other veins on this arm or the patient needs like a CTPE protocol with an 18 gauge and one of those large veins, you can go there, use it, and then just take it out and go somewhere else.

But I like to keep that available for blood. Next is the accessory cephalic vein, hence its name. It's coming.

off of that cephalic vein up through here. Now this is really one of my favorite veins to start IVs in. Number one, it doesn't really roll. It's easy to stabilize.

You're not going to stick the needle in there and it rolls to the side. Don't you just love when that happens? No, not really.

And it's a relatively large vein so it can easily hold an 18 gauge. Now the thing is whenever you do use this for IVs, because it starts up in here, don't go in this bend of this arm. Go down because it comes down and you can just stick your IV.

right there and the patient can move their arm, bend it, they're not going to have problems. So this is really a good vein. Another vein I like to use is located on the forearm.

So we don't have a bend of an arm causing the patient issues. And it is the median vein of the forearm, also called the antebrachial vein. And it is this vein right here.

It comes out of the palm of the hand. Now, as you can tell, this vein is not as big as that accessory cephalic and that media cubital vein. So whenever you go go to stick this for like an IV, you want to probably pick like a 20 or 22 gauge instead of an 18 gauge. I have seen a limited amount of 18 gauges in this vein because you know everyone's anatomy is different. Some people have bigger veins there.

So you want to think about that. Another thing is that these veins can run deep on patients who have a lot of sub-Q fat on their forearms. So you might be able to see the vein, but whenever you go to stick it, you don't immediately... get that blood draw because the veins a little bit deeper so keep that in mind and that also is true for these veins up here on the bend of the arm as well and lastly the veins of the hand the dorsal venous network and these veins are great for drawing blood starting IVs but some things you want to remember okay first of all these veins like how this patient has their hand open if you go to stick a needle in this vein with the hand in this position this vein is just going to roll see how that rolls like that what you'd want to do is you want to stabilize it so have them make like this lot fist and look that keeps that vein nice and still while you go with the needle and try to draw blood or advance a cannula now I have a whole video on how to prevent rolling veins if you need some more tips on that another thing to remember is that these veins sometimes are really superficial on people like here they're nice and engorged and healthy looking so they'll be great for an IV or drawing blood. However, on some patients who have a lot of sub-Q fat on the hands, they're hard to get to, they're super small or like very fragile and they blow easy.

So always look at that. Look at the health of the vein before you try to. Stick it with a needle.

Now when choosing a vein when you're starting an IV there are some things you want to keep in mind. Number one you want to ask yourself okay what's this patient here for? Are they just here for like a short stay because they need a quick procedure or they're just here for observation? or they're going to be hospitalized because they need treatment. Maybe they need some blood products or they're going to have to get some vesicant type drugs like potassium, vancomycin, just to name a few.

So you want to select your site and your size of your needle appropriate. really because for instance vancomycin is really hard on the veins and you want to use a large vein rather than a small vein. Next ask the patient where they prefer that you draw blood or start an IV because patients tend to be experts on where they know that you're going to be successful at getting that IV or drawing blood and some patients love to have IVs or blood draws in their hands while some prefer that media cubital vein. That's the only place they want blood drawn and that's the only place they want an IV.

always ask your patient. And lastly, sometimes you're just going to have to draw blood or start an IV where you can, because if you're working with patients who have severe cardiac disease or renal disease, they really don't have much to stick. They're very, very limited in where you can even get IV access. And I've seen IVs in creative places, like in the feet and the little fingers, on the arms, up in the neck, anywhere you can get them. So always...

Always keep that in mind and if that does happen and your patient is needing lots of fluids, IV drugs, things like that, you want to get with the physician and you want to ask, hey, is this patient a candidate for a central line because that may benefit the patient a little bit better. Okay, so those are some tips on choosing veins when starting IVs or drawing blood. Thank you so much for watching and don't forget to subscribe to our channel for more videos.

Transcript for:Selecting the Right Veins for Procedures

Transcript for:
Selecting the Right Veins for Procedures