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Hand position: It is best practice to position the patient's hand slightly downward with the top of the hand facing the phlebotomist. The fingers of the patient's hand should be rolled underneath and wrapped around the fingers of the phlebotomist's "anchoring" hand forming a loose fist. The phlebotomist should use his or her thumb to pull back gently on the surface of the skin, making the skin taut. The vein should be anchored adequately to proceed with venipuncture. The phlebotomist may have the patient roll his/her fingers over a pillow or a rolled up washcloth to make the hand vein more prominent.

Tourniquet Position: The tourniquet should always be applied 3 - 4 inches above the needle insertion point. Therefore, when assessing for a usable vein in a hand, apply the tourniquet 1 - 2 inches above the wrist. If the tourniquet is on longer than one minute, release and reapply prior to venipuncture to avoid hemoconcentration.

Cautions:

• Choose a straight section of the hand vein-- avoid the "intersection" or "V" where a vein branches into another vein. This juncture may contain a valve and could be damaged if punctured.
• Only use the top of a hand or thumb-side of the wrist for puncture. Avoid the fingers or the underside of the wrist. This will prevent the inadvertent puncture of hidden arteries, tendons or nerves in the area.