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The page below is a sample from the LabCE course Routine Venipuncture. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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The antecubital area of the arm is usually the first choice for routine venipuncture. This area contains the three vessels primarily used by the phlebotomist to obtain venous blood specimens: the median cubital, the cephalic and the basilic veins.
Although the veins located in the antecubital area should be considered first for vein selection, there are alternate sites available for venipuncture such as the veins on the top of the hand (Table 2). These sites should only be considered after determining that the veins of the antecubital area cannot be accessed or cannot be used.
Table 2. Choosing the Best Vein.
VeinLocationReason for Choice
PlacementDirection
Median Cubital Mid antecubital fossa Vertical to diagonal Musculature assists in stabilizing vein; very often largest; ease of access
Cephalic Thumb side of antecubital fossa Vertical Ease of access; few nerves and tendons in area
Basilic Body side of antecubital fossa Vertical to diagonal More difficult to access; proximity of artery, nerves and tendons. Use this vein only as the final alternative.

H Pattern Forearm Veins
M Pattern Forearm Veins