Of the three veins in the antecubital area that are acceptable for venipuncture, the median cubital vein (in the middle) is considered ideal for four reasons:
1. It’s a comparably stationary vein;
2. Inflicts less pain to the patient;
3. Easier to find because it’s closer to the skin; and
4. It isn’t surrounded by nerves or arteries.
When surveying the antecubital area, check both arms for the medial vein before considering any of the alternatives. If it’s not prominent enough to instill confidence on either side, the second choice is the cephalic vein on the lateral or thumb side of the arm. The basilic vein (located on the medial or inside aspect of the antecubital area) is a last resort.
Underlying nerves and the brachial artery make punctures in this area highly risky. Most misguided punctures into this vein cause permanent nerve injuries and arterial nicks. You have to be able to draw blood from all of these sites as a phlebotomist.
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