Vein Information and Courses from MediaLab, Inc.

Anticoagulant therapy is employed in a number of clinical situations Some of these clinical situations include: After an episode of thrombosis, such as deep venous thrombosis (DVT) in the veins of the legs, to prevent reoccurrence. Prophylactically after some surgeries, especially those involving vascular repair such as coronary bypass surgery to prevent clots from blocking newly formed vasculature. In heart valve and chamber disorders where there is an increased risk of thrombosis occurring.

Circulating blood enters the bone through the central artery which branches out into small arterioles. These arterioles are interspersed in the cords of hematopoietic tissue. The arterioles drain into venous sinuses (space or cavity). Sinuses have a basement membrane which is lined by endothelial cells within the sinus and surrounded by reticular (e.g. adventitial) cells on other side. Blood from several venous sinuses may combine in a collecting sinus which leads to a central vein. The venous sinuses alternate with hematopoietic cords in a spokelike pattern with the central vein as the core.

Bobby Jones, a phlebotomist at Georgetown Hospital, entered the room of Mrs. Mary Grayson with a physician's order to draw some blood work. After properly greeting Mrs. Grayson, identifying himself and checking her armband, Bobby prepared for the venipuncture. He suddenly notice a sign posted above the bed that read: “Restricted left arm usage. Previous mastectomy - Do no use left arm for venipuncture.” Bobby set up his equipment to use her right arm and noticed an IV line in Mrs. Grayson’s right arm positioned in a vein slightly above her wrist on the dorsum (top) of her forearm.

Julie Smith, a newly certified phlebotomist at Northlake Hospital, entered a patient’s room on the third floor for a routine blood draw. The patient was an elderly woman who had very small fragile veins. Julie therefore decided to use a safety butterfly needle attached to a Vacutainer tube in order to draw the blood. When Julie was finished with the venipuncture, she detached the butterfly needle from the Vacutainer, and approached the Biohazard needle disposal box. She noticed that the disposal box was full , but decided to try to fit the butterfly into the box anyway. Holding the butterfly by the tubing, she tried to push the butterfly into the box. The needle suddenly recoiled and stuck Julie’s finger. Julie left the patient’s room in a panic and headed back to the lab to report the needle stick injury.

Tourniquets wrap around the arm to increase venous pressure, and fill the veins, so that they are easier to see, feel, and puncture. They can be made of latex, Velcro, or other material.

The median cubital vein is most commonly used. It is the middle of the bend of the arm (antecubital region).

Tie the tourniquet just above the elbow.The tourniquet should be tight enough to stop venous blood flow in the superficial arm veins.

If no veins are accessible on the arm, you may try the veins on the back of the hand.Use a much smaller needle for these hand veins.

With the needle bevel up, insert the needle into the vein.

Butterfly needles (also known as a winged infusion set), are available in smaller gauges, and are used to draw venous blood from children, and adults with difficult veins.

Syringes may be used to collect blood from patients having small or delicate veins that might be collapsed by the vacuum of the evacuated tube system.Syringes may also be used to collect blood culture specimens.

Select a site on the inside of the forearm with no visible veins, scars or bruises, about 5 cm below the bend of the elbowNicking a vein will invalidate the result.

A hematoma is a blood clot which forms within the body. It is caused by leakage of blood into the tissues from an injured vein . It will resolve spontaneously.Hematomas are caused by excessive needle trauma to a vein, for example, by a needle which passed entirely through a vein and came out the other side.Apply compression to help stabilize a hematoma.

The needle may not be in a vein. Try slightly manipulating the needle. If no blood flows, withdraw the needle and repeat the venipuncture. Never probe the patient’s arm with the needle. The bevel of the needle may be compressed against the inside of the vein wall. Slightly manipulating the needle should result in blood flow.  The needle may have passed entirely through the vein. Pull it back slightly, and blood should flow.

Phlebotomy, also known as venipuncture, means collecting blood from veins.Phlebotomists, by definition, collect venous blood, but perform a variety of other important medical tasks as well.

In the capillaries, oxygen and nutrients diffuse from the blood cells into the tissues. The deoxygenated blood then returns to the veins, completing the circulatory pathway. Illustration this screen from LifeArt Collection 2000, with permission. © Lippincott Williams & Wilkins.