Sometimes the phlebotomist may decide that the antecubital area is not the best site for venipuncture. Reasons for this decision may include:
- Extensive bruising (hematomas) in the antecubital area
- Inability to "feel" a vein suitable for puncture
- Presence of an intravascular line (IV) or vascular access device
- Physical condition of the patient
When the veins in the antecubital area cannot be used, the phlebotomist may choose to use a vein on the top of a hand. The veins in the hand are very near the surface and often very small and thin so the procedure must be performed carefully and cautiously.