1

Making the Vein More Visible

1.

1
Make sure your tourniquet has been applied properly. Applying a tourniquet increases
the amount of blood in the vein to make them stand out more. The tourniquet should not
be so tight that it cuts off the circulation.[2][3]
o The tourniquet should be put on the arm about four inches above the vein.
o A blood pressure cuff that is inflated to 4060 mm Hg also works well.

2.

2
Put a warm pack or water bottle over the area. Warmth will make the patient's veins
dilate and expand, making them easier to see.[4]
3. 3
Use proper palpation techniques. Contrary to popular culture, you should palpate the
arm, rather than slapping it. Slapping the skin is poor technique that may result in a
hematoma. Use your index finger to look for a vein, which feels soft and spongy. Don't
use your thumb, as it contains its own pulse.
o The warm pack or water bottle should be put on the area before it is disinfected.
Nothing more should touch the area after it is disinfected.

o Do not apply the warm pack or water bottle directly to the skin. Wrap it in a thin
towel to prevent burns. If it hurts, it is too hot.
4.

4
Tell the patient to relax. Many people have needle phobias and nervousness and
apprehension is a normal response. Stress not only makes the veins hard to hit, but it
could also negatively affect the test results (particularly for biochemistry panels).
Reassure your patient and explain that the pain is very brief and minor.
o Tell your patient to try visualization and deep breathing.
o Observe your patient and have them lie down on their back if you think they
might faint. This will improve the blood flow to their head. It also reduces their
chances of falling and injuring themselves if they do pass out.

Part 2
Taking Blood from the Forearm
1. 1
Verify patient information. Verify the patient name, date of birth and reason for blood
draw and check the labeling to ensure no mistakes are made. Mislabeling could lead to
difficulty processing or even safety issues down the line.
2.

2
Locate the vein. The inside of the elbow is generally the preferred location because the
median cubital vein is usually easily visible. [5]

o The median cubital vein runs between the muscles and may be clearly visible as a
blue bulge in the inside of your elbow. If it cannot be seen it can usually be felt. It
is also relatively easy to access because the tissue around it prevents it from
rolling away from the needle.
o Avoid drawing blood from a place where your veins divide or join together. Doing
so increases risk of bleeding under the skin.
3.

3
Disinfect the area. A common disinfectant is 70 percent alcohol. Wipe an area that is at
least two centimeters by two centimeters for at least a half a minute. After a minute or
two it will have dried.[6]

o Alcohol is better than iodine because if the iodine gets into the blood it can alter
values that the lab may be looking for. If you do use alcohol, follow it with a 70%
alcohol swab.
o Allow the disinfectant to dry before inserting the needle. Do not blow on or fan it
with your hand as this will contaminate the area.
4.

4
Perform the venipuncture.[7]
o Anchor the vein by pulling the skin below the vein taut. This will prevent the vein
from rolling.
o Insert the needle in at a 15 to 30 degree angle and then hold it still while
collecting blood.

o Fill the collection tube with blood, following the order of draw as specified by
your laboratory.
o Release the tourniquet after 1 minute and before removing the needle. Leaving the
tourniquet on for longer than a minute will affect the concentration of red blood
cells, possibly altering the test. Withdrawing the needle while the tourniquet is
still on will result in pain.
5.

5
Apply pressure to the puncture area for 5 minutes after the needle is out to stop the
bleeding.[8]
6. 6
Dispose of the needle in a hard sided, biohazard container.

7. 7
Double check the labeling on the tube to make sure it is accurate.

Part 3
Troubleshooting
1.

1
Look for another vein if the median cubital vein is not visible. If you cannot find the
vein in the inside of the elbow in either arm, look for another one.[9]
o Move down the forearm looking for the basilic vein or cephalic vein. These veins
may also be visible through the skin. Have the patient lower their arm and make a
fist to make the veins more obvious.[10]

o The cephalic vein runs along the radial side of the forearm. The basilic vein runs
along the ulnar side. The basilic vein is less frequently used than the cephalic. It is
more likely to roll away from the needle than the cephalic vein because it is not
held as tightly in place by the tissues around it.
o If no veins can be accessed, find the metacarpal veins on the back of the hands.
They are usually very visible and can be palpated. They should not be used for
elderly patients because the skin is not as supple and does not support the veins as
well. In addition, the veins themselves become more fragile.
2.

2
Notice sites to avoid. Do not draw blood from areas that:[11]
o Are near an infection

o Have scarring
o Have a healed burn
o Are on an arm that is on the same side as where the patient had a mastectomy or
fistula placed
o Are bruised
o Are above an IV line
o Are on an arm where the patient has a cannula, fistula, or vascular graft
3.

Correct improper needle placement. Occasionally, you may encounter problems with
the needle, such as going too far into the tissues or inserting it at too low of an angle (so
the bevel is against the wall of the vein and impedes blood flow).[12]
o Pull the needle back a little bit without removing it from the skin.
o Change the angle of the needle while it is still under the skin so that it can be
inserted into the vein.
4.

4
Give up and have a colleague do the procedure if your second attempt fails. Protocol
in many laboratories dictates that phlebotomists must attempt a venipuncture two times,
and to have another person do it if both attempts are unsuccessful.[13]

Community Q&A

What needle is best for someone with a "hard stick"?

wikiHow Contributor
I prefer to use a butterfly because it is easier to redirect and you can see a flash before
inserting the tube.
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Not Helpful 0 Helpful 6

What to do if the patient is difficult to draw?

wikiHow Contributor
Use a heat pad, drop the arm and give them a cup of water while they relax, and then
reevaluate the site. If there is no one more experienced around, you can send them to
another facility that may have someone who is more experienced than yourself.
Flag as duplicate
Not Helpful 1 Helpful 10

Does blood get into the needle on a missed vein?

wikiHow Contributor
Maybe just a minute amount from the capillaries, but you will not see any enter the
vacutainer (tubes). The tubes are designed to pull the blood into them by means of
negative pressure. All the blood in your body is either in your veins, arteries and (the
smallest) capillaries which get the blood to your skin.
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Not Helpful 1 Helpful 7

Is there anything I can do to stop the veins from rolling?

wikiHow Contributor
In the examples given, the nurse puts their thumb from the hand not holding the needle
on the vein below where they are trying to insert the needle. With their thumb there, they
will be able to pull the vein tight, so that it cannot roll away.
Flag as duplicate

Not Helpful 10 Helpful 16

What should I do if my veins aren't coming up during a blood work? I'm really scared.
wikiHow Contributor
Be prepared when going to have your blood drawn by drinking plenty of water the day
before. Try some of the relaxation techniques mentioned in the article and remember that
the person drawing your blood is a trained professional. Try to relax -- your veins are
probably not as difficult to find as you think!
Flag as duplicate
Not Helpful 5 Helpful 8

How do I identify a vein for bleeding a patient?

wikiHow Contributor
Bloodletting has long been rejected as a valuable or healthy medical treatment. In other
words, you should not do it.
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Not Helpful 6 Helpful 7

The nurse was able to draw one tube of blood, but when she changed vials, no more
blood would come out. What would cause that?
Illneedasaviour
It's possible the veins collapsed. This happens when the walls of the veins suddenly
narrow, slowing the flow of blood. Repeated punctures can weaken a vein and lead to
eventual collapse. The force of the vacuum of the syringe or tube can also collapse a vein.
Flag as duplicate
Not Helpful 0 Helpful 1

How can I inject if I am dehydrated and can't hit the veins in my arm?
wikiHow Contributor
First, try to get dehydrated. If all else fails, the phlebotomist/nurse will usually draw
blood from the dorsal vein, the veins at the back of your hand. But during the procedure,
as the article suggests, drink plenty of water prior to the procedure and keep calm.

Flag as duplicate
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Warnings

Single use materials such as needles should never be reused.

All materials which have been contaminated with blood should be disposed of in a
biohazard container that is puncture resistant, such as a Sharps container.