Venipuncture is a procedure that removes blood from a vein in the body, usually for testing but occasionally for treatment—for example, in the disease of iron overload called hemochromotasis. Venipuncture is also commonly used to place an intravenous line, or IV, to administer fluids, blood products and certain medications. Some veins are more accessible than others for venipuncture or the placement of an IV line.
Upper Extremity
The upper extremity refers to the arm. It is readily accessible for the placement of an IV or the removal of blood. A health care provider can place an IV at any point on the upper extremity where a vein can be seen or felt, as long as a patient has no contraindications for venipuncture in that area. An example of a contraindication, or a reason that a patient should not receive the procedure, is an arm in which a patient has a blood vessel graft, such as a connection between blood vessels created for dialysis.
A common site for drawing blood is at the hinge of the arm, opposite the side of the point of the elbow. Three veins in this location are called the median cubital vein, the cephalic vein and the basilic vein. These sites are appropriate for IV line placement as well, although the back of the hand is a common place for these lines.
Neck and Upper Thorax
Health care workers typically use the neck and upper thorax, or upper chest, under the clavicle for placement of a central line, which is a large IV line that can stay in place longer than a small, or peripheral, line and may have multiple ports for drawing blood and giving fluids and medications. The vein in the neck that is used for central line placement is the internal jugular vein, which runs down the sides of the neck near where the pulse of the carotid artery can be felt. The vein under the clavicle is called the subclavian vein. Health care providers also occasionally use the external jugular vein in the neck for placement of a peripheral IV if they cannot access a vein elsewhere.
Lower Extremity
The lower extremity, or leg, is another possible site for IV placement. In emergencies, the femoral vein near the groin at the top of the leg is accessible for central line placement. The great saphenous vein and its branches in the foot and leg are often accessible for placement of a peripheral IV in children, although the scalp is also appropriate in infants.
References
- Becton, Dickinson and Company: Best Sites for Venipuncture
- "Journal of the American Medical Association"; Femoral vs Jugular Venous Catheterization and Risk of Nosocomial Events in Adults Requiring Acute Renal Replacement Therapy: A Randomized Controlled Trial; Jean-Jacques Parienti, Marina Thirion and Bruno Mégarbane; May 2008
- Family Practice Notebook: Peripheral IV Access
- Family Practice Notebook: Central IV Access
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