Venipuncture - How to Position a Needle
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- Опубліковано 4 лют 2025
- This video covers appropriate depth, angle and speed at which to insert a needle during a venipuncture.
We also discuss what happens if you insert too slowly, make hesitation pokes, or accidentally pull the needle out too early.
You can see a pdf version of these notes here:
drive.google.c...
***Disclaimer: This material is designed for studying purposes for the North Seattle College Medical Assisting Program. This video has been prepared by a tutor, and is not a phlebotomist or medical assistant.
If any one here is starting phlebotomy and is worried… don’t be. Go into it knowing you’re going to blow some veins. You are going to miss and people will cry/complain. Don’t let it bother you. 80% of phlebotomy is hands on and with that comes mistakes. I’ve blown probably 100+ veines. But I’ve stuck 1000s. It gets better over time. So don’t beat yourself up or be worried.
Thank you , really needed that
Me too
Needed this thank you ❤
I can’t express how much I needed to hear or read this 😭🫶🏼 Thank you!
Thank you so much Jacob ❤❤❤
Thank you so much for this video! Thank you, thank you, thank you! I'm a nurse at a skilled nursing facility, been a nurse for 6 months, and I was practically at the point where I just want to quit nursing because I cannot get venipuncture down! I have told my colleagues I just need someone to watch me do it, that I'm not even asking others to do my job, I just need someone to watch me and tell me what I'm doing wrong.. your video has helped me so much to realize my mistakes, and I'm actually excited for my next chance to try and get this right! Like I'm literally almost in tears, I'm so happy I found this video
I'm having trouble getting a vein
Same here
I want to quit because i also feel Iam not good at this
Stacey Arey, venupuncture is a skill and it takes practice to learn. The more you do it, the better you will get. What helped me was making it a practice to feel the vein not just looking for it. You can do this by applying a tourniquet on your own arm and feeling the difference between the vein and non vein spaces. Watch for the ones that move and do not use those this is called the roll test. What you can do is ask to follow an er nurse or emt for a day or more and do all of their iv insertions most facilities will allow you to schedule this in. Practice makes perfect! DO NOT beat your self up, REMEMBER it takes a year to learn how to be a nurse. You’re going to get this!!
It made me kind of happy to see this bc so many nurses don't know how to do it and I go home with 4-5 marks on my arms and some trauma tbh it hikes my anxiety through the roof to go get any blood work and I wish more nurses were like you and took steps to actually learn how to do it better... 😊😊🎉
More people need to watch this. I have small fragile veins and have had terrible experiences with labs and iv placement my entire life.
----- me too ....they said they have scarred my veins with so many blood tests. They said my veins are small and deep and they can't even find them on my right arm
Even the best phlebotomists have came across veins they cannot draw from.
@@julianadamico4702 I don’t know anything about your health problems, but if you are able bodied in your upper body, doing some rowing or weight lifting exercises might help enlarge your veins.we as women are more prone to difficult veins because our subcutaneous tissue is thicker.
Thank you so much for making this video. I'm already trained in venipuncture, but no one explained any of this to me before. They just taught me how to do it, but not why a hematoma happens or why I was too deep.
The information in this video is higher than what nursing school teach, thanks darling
I drew blood for a living and 10 degrees was right for blood vessels that could be seen and felt through the skin, because the vessel was sitting high enough over muscle with a thin veneer of skin over it. 30 degrees was right for blood vessels that could be felt but not seen, due to fat pad over it.
Most errors I've seen is a 45 degree entry that goes right through an oval shaped vessel. When I had surgery, there were four attempts to start my IV while I watched that 45 degree angle push into my hand. The anxiety level of the staff was escalating, and I was worried he would ruin all access points with bad technique, so I said calmly, "I draw blood all the time, so let me talk you through it. The blood vessel is just under the skin, no more than 1/8 of an inch for lean people like myself, and variably deeper for obese, but not so deep it's embedded in muscle. First, when you pull the skin taut, don't put your thumb over the vessel feeding your access site because even with the tourniquet, you're inadvertently shutting off the flow to the vein with your thumb. Instead, pull the skin from either side of the feeding vein. Next, when you push the needle down on it, the blood vessel will go from round to slightly oval because it's pliable. If your angle is too steep you'll pass right through the vessel to the other side. Come in shallow until you get a flash, then level out." To his immense relief (and mine), he got it during the tutorial and I was wheeled away to la-la land.
But we all know this isn't a measurement game where we use a protractor to do what we do. Experience and touch tells us angle and depth, and repeated success tells us we're doing it right every time.
Very helpful thanks
This is a wonderful breakdown. Thank you!
Thank you so much!
I’m a MAT student and we just went over phlebotomy. When I anchor my vein should I use my finger and anchor on the side instead of on the vein below where I’m going to stick?
@@andreabautista53 Finger placement alongside anchors the vein by using fascia under the skin without compressing the source of flow that can collapse the vein. It accomplishes the same thing without hindering the whole point of a tourniquet.
While I appreciate this video very much as I am going into the Hemodialysis field, what I appreciate more is your schedule in the background at end of video. Specifically, Wednesdays 'POO BRAIN'. Thank you very much for sharing your skill set and awesomeness!
You are some thank you. I am not a phlebotomist but a person having blood drawn for test and red cross platelet donation and though going through some of these phlebotomy videos and info might help me understand and feel more comfortable. Excellent video!
I have look at alot of videos this is the best one. Most don’t show exactly how 30 degrees looks like.
It's ok to take out your protractor if need be. No one will judge you. Ok maybe just a bit.
@ALEX BURY @IV’ERS
I am new to IV drugs and have issues with needle depth. If I go in at 30 degrees. How deep do I put the needle in before I start pulling back to check if I am drawing blood? I am using a 29G U100 needle with a 1/2inch tip. I am also injecting into the arm crook or forearm.
Another thing is when injecting myself should I have needle tip on the skin or 1/2 inch away from skin when going to penetrate?
Thank you so much. I had 2 bad draws recently.
You clear all my doubts
Thank you for such an amazing video
I m also learning and getting only punctured veins
Incredibly insightful and useful video.
Its very help full for me. THANKS A LOT.
Why are you watching she has no hijab? It’s haram
thank you, i missed so much of my veins till now, and i didn't even filter the tablets till now, i will never again not filter te tabslets i inject
thank you so much for the video explaining the do's and don't's, i"m a visual learner and this was very helpful! :)
Great information and I have learnt something new today! Thank you
seems like a competent nurse. I would need a lot of practice if applicable.
I've got two lumps where I just tried to inject so looking for tips and going to try again. But the needles are rubbish so might empty the naloxone kit and use that needle instead
How do u know if your less or in or in to deep
You have to use the needle gently, when u access the vein, blood will start flowing to your tubes immediately. That's when you stop introducing the needle. If you apply unnecessary power while introducing the needle you might pierce the opposite wall of the vein and the blood flow will suddenly stop, causing hematoma. Always be delicate handling a needle 👍
@@crisbioyou don't put the tubes in until you know there's blood. So how do you know there's blood
@@cr.-lb1hj It all depends on the type of collection material you are using. many materials indicate that you have access ready (you're right in the vein). True, if you are using an adapter cannon it can be problematic, because if you are not in the vein, the flow will not come. Now, either you messed up the access or you need to gently introduce more. I wish you success in your collections!
@@crisbio I'm talking about the BD vacutainers
@@crisbio BD vacutainer eclipse
I will say my nurses had fun as well as labtechs last month while. I was in hospital. I went in for catheter ablation got my pre-op two IVs in both hands. Then they put an ALine after I was asleep. I ended up going into cardiac arrest CPR intubated etc. I ended up with lots of lab work and medical intervention. I had shots of heparin in my belly. I'm normally on a blood thinner -Eliquis ( held day of surgery of course per Dr orders). I was black and blue everywhere lots of black bruising on arms groin belly.
Is that from technique or my taking blood thinners pre op and or from heparin shots over my 4 days in ICU and CCU. I wish I could post photos
Thank you for sharing your ideas.
Thank you sooooooo much I really needed this I draw blood the other day the blood sample was rejected by the Lab due to Hemolyzed I really need to avoid this from happening again. My name is Lorescia how can I get a one one one class with you
Ex heroin addict and I only injected a few times I was terrified of all the variables problems that could occur just wasn’t worth the even greater high at the time great informative video though
Is there any way to tell once your completely in...as blood when you draw back not enough as demonstrated?
Thanks for good reminder. I made up 25~30 angle insert needle and barrel model on my desk to remind myself what to be done.
well explained. Thank you.
That explains why my arm looks like a battle scene I've been doing it all wrong. When you stabbed it quick go again how do you know how deep to put the needle that's what I'm concerned about how deep?
Is it normal for a nurse to adjust the needle after plunging it into my vein? A nurse was moving the needle in and out of my vein... the needle was still inside but she was going back and forth in my vein with the needle ( I thought it was weird ) now when i move my arms, i can feel a little snap in the are
She punctured me
If she had done it gently then there should be no issue but if it's one where she kept pulling out and then trying again it might be an issue referred to as "fishing". I'm still practicing Phlebotomy so I'm not the best reference so I suggest speaking to your nurses for your next checkup and ask if there is anything wrong.
Thank you mam🙏
What about redirecting? Shouldn’t you pull the needle to the surface to redirect? My daughter just had her blood attempted to be drawn and I felt that the phlebotomist put the needle too deep then was dramatically redirecting with the needle all the way inside. Please let me know if I am correct in thinking that this is wrong. Thanks.
You don't want to fully withdraw the needle to reposition because that will contaminate the tip of the needle, so you wouldn't want to reinsert it. The contamination can lead to injection or alter test results. Instead, you can try repositioning a bit, but not too much, or the vein can be injured. If in doubt, I find it's best to withdraw the needle, bandage the puncture site, and try again with a whole new needle at a different site.
Thanks for the comment though, it's a good question!
I'm a nurse, sometimes I have to take blood from geriatric patients. I haven't been able to do that lately. I think I use too small an angle, so a hematoma forms and the blood first goes into the tube, and then it stopped, I don't know why
Mam , Why we do insert needle upper postion not below position in arm
I'm a nurse student and with experience I wish I can find out the vein so fast and appropriate so I don't hurt people . It happens to my dad they make him bruised like crazy because of a student 😭
If I stick a needle in there is usually bleeding but just above the skin, so no hematoma. Does it mean I was to shallow and completely missed or did I still hit the vein? Also how can I follow a vein inside the skin if it becomes invisible after the needle is in?
I've drawn blood nearly 40 years and this is my take, not seeing your patient: If you have bleeding you did hit a vein, hopefully the one you were aiming at. If you have no flash in the needle you went through to the backside, and may be able to recover by slowly pulling back to flash, then angle parallel to the skin. When you push on a vein, the thin walls are deformed with the pressure, forming a dimple on the vessel wall, and making the lumen oval. When it's punctured, the vessel pops back up to round, but if you advance too quickly, you're already at the back wall by the time the vessel recovered its shape. Glide slowly, paying attention to show of blood.
If a vessel 'disappears' during insertion, chances are good your thumb or hand is sitting on the vein and shutting it off. Remember, vein blood is traveling UP from the hand to the elbow, and your support hand for the needle is usually between the wrist and the insertion hole. If you're not careful, you'll find yourself leaning on the wrist to steady your hand and accidentally shutting off the vein flow just when you need it most.
Take note of the length of needle you're using. If you're using a 1 1/2 inch and half is not visible, you know how much of that needle is already in play under the skin. If half is not visible to you, you're too deep for superficial veins on average people. Half is not unusual for obese arms, but you have to take greater care when advancing because even that can be too much needle in action.
TIP: Practice on family members. No, not with needles, but with the tourniquet. Then close your eyes and run your fingertips over the skin to feel for elevated veins. You'll feel them without seeing them. One of the problems with students is they depend on their eyes looking for blue. What they NEED to do is FEEL for the elevation changes of engorged veins without seeing them. THOSE veins are the good ones to cannulate. Without needles, practice feeling for veins on everyone willing to submit to it, because variety will make you better as your intuition is honed. Eventually, on the job you'll feel before you see, and your strikes will be far more accurate with fewer hematomas.
@@dandeleona4760 can you please make a video? Your info is excellent. I lost my confidence with drawing labs as a nursing student and graduate in May. Bc of Covid we have not really had chances to do IV starts either and it seems so basic but between Covid and confidence I feel like a moron no matter how much I tell myself I got this! I am literally pretty great at other nursing things and critical thinking etc but gosh darn I cannot get this. 😢
@@dandeleona4760 thanks a lot🙌🏼
@@dandeleona4760 tq
Can this information be used with dogs
Thank you dear. Please we need more,im so new without expercence so this is very helpfull! ❤
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Sir,Im just going to start blood drawing .It seems yu told the best
Have you stated your class ? how is it going. ?
a few of my only working veins are superficial meaning the vein is basically right under the skin so I tell all nurses before hand so they don't poke shit outta me
all my other veins don't register at all. twice they had to get a radiologist to guide the needle into vein with help of ultrasound. yea I'm definitely a hard stick
How do u know if your in just right
i went for my typhoid injection today and the nurse did it in wrong way the syringe was filled with blood as well as there were lot of blood on skin i’m not the person who is afraid of injections so i was calm but man it hurts a lot 😢 and the head nurse was telling her assistant you should have put it little deeper as if i was a subject of experiment 😢
Where can I get a fake arm to practice at home?
Amazon
Dan Y. -----Practice on your friends and family members
i’ve read about people practicing on fruits at home, like oranges and bananas!
@@julianadamico4702 like seriously -?
BRUH be more sensible
She/he said "practice"
While practicing you might have lot's of mistakes as most of us are new to learning it
If the needle get into uper or lower the vessels it will occur a lot of problems
@@fake_in_world2635 my friends were really happy that i asked to practice on them, dont know what the issue is.
if they trust you and know you arent fully confident, theyre prepared for anything...
Thanks ma"am now i will do fast my always too slow and bleeding out.
This happened with me few days ago, Poor phlebotomists.
After application of Ice, it was cured.
great explanation.....🇮🇩
super helpful
I did a blood culture today and they were trying to figure out how to use the bottle AFTER they put the needle in. 2 min later they take it out and come back with different bottles. They do the blood test again on a different vein and once it’s done the person forgot the cotton bandaid thing in the drawer and had to ask my mom to get it. 😑
Ugh. It's already a high tension moment under needle. The LAST thing a patient needs is chaos adding to anxiety.
The worker needs to get his/her act together. Needles ain't no joke.
Blood cultures are done from two different sites to ensure accurate results. 2 bottles for each draw, two different veins. So two pokes and four bottles.
My friend injected him with crystalmeth and got blood under his skin what can he do to inject beter and what can he do to get rid of the blood under his skin
Are you really asking this 👎
Thank you
Everytime I get my blood drawn ,they say they can only get blood out of my left arm .I don't think they try hard enough to find the vein in the bend of my right elbow. now they've got my veins scarred in the bend of my left elbow from so many blood draws. 😠
What is the safety device?
Depends on the type of catheter, some retract, some like the Brauns have a sheet/covering that cover the end of needle. I use the BD Insyte BC blood control caths since you don’t have to worry about holding tamponade, and they retract into themselves.
Thanks
Hello Alex. I have a question. What if the needle moves while inside the vein because it hasn’t been stabilized it with a micropore (I used a butterfly needle and it can be quite challenging to self inject specially when I’m injecting my dominant hand/arm). Will the vein be damaged in any way? Or is the vein flexible enough to handle it?
A little of both. There's some flexibility of the vessel along the shaft but the tip can scratch the inner surface. Mostly the damage is minor, and heals quickly once the needle is taped down.
Self butterfly in a dominant arm is difficult for anyone so don't be too hard on yourself. Just be careful you aren't resting the butt of your nondominant hand holding the needle right on top of the vein feeding the insertion site. The weight of your hand can reduce backpressure and change the shape of the vessel to oval. You want to keep it round if possible. To keep the skin taut so it doesn't dimple under the point you could try a piece of tape to pull the skin alongside tight, leaving your nondominant hand free to concentrate on insertion, not stretching. Come in shallow, being careful not to rest your wrist on the blood vessel but beside it, and then level out after you get a flash. Tape as soon as expedient.
You cant re use needles bro, old blood is dangerous and you need to use a mutch thinner needle bro
I have heard that with fragile veins is better an angle lower that 25 degree. How do you manage fragile veins ? Any tips?
I've drawn blood for nearly 40 years and I nearly always insert at roughly 10 degrees for lean people with visible vessels that I could feel on the surface. This vessel is riding on top of muscle and has a thin veneer of skin over it, less than 1/16 inch. People with more fatty tissue just under the skin (i.e. the dermis layer containing fat) can still have veins you can feel but can't see. Then a 30 degree was the way to go, leveling out after flashback.
One of the biggest errors I see when teaching, is 45 degree angle approach, and the student putting their THUMB on the vein to pull the skin taut. Of course, what they're doing is shutting off the blood flow to the insertion which is why the vein suddenly 'disappears' . Pull skin BESIDE and in line to the vessel, so flow can keep the vein puffed up long enough for puncture.
@@dandeleona4760 I was taught to stabilize the vein with a thumb while pulling skin taut, so the opposite of what you're saying. How do you avoid the vein rolling if you don't anchor it with a thumb?
@@TessaAvonlea In this technique you ARE stabilizing the vein with your thumb. You're just not putting your thumb ON the vein (your source of flow) but BESIDE the vein instead. It's not the opposite of what we're taught, but a more efficient variation.
And on most patients that are not elderly, veins are secured by fascia or embedded in fat so rolling isn't that much of a problem anyway. We SAY their veins rolled to explain how we missed an obvious stick by going right through it to the other side. Elderly and some physiological conditions do allow veins to be pushed one side or the other ... particularly in the back of the hand ... so pinning the vein without occluding it is win-win. If the vein is visible it's probably less than 1/8 of an inch below the skin, so a 45 degree angle will not be successful. The needle will be at the back wall of the vessel before the top wall pops back, and we wind up stabbing a vessel double wall 'sandwich', not a lumen. This is why NOT occluding with our thumb is the way to go. It keeps back and top walls from touching at the time of insertion.
I hope that helps.
I have this problem where I insert the needle, get a flashback of blood, start advancing the cannual, and then loose the flashback. What could be the problem? The needle being too shallow? Any tips would be appreciated!
The vein can vacuum on the bevel and pulling it back a little could remove this vacuum, might be also an issue with the tubes, as with air bubbles and movements, the tube can lose it's vacuum
Usually you're too shallow and the cannula is not in the vein, this the "tissues" the cannula. Try advancing 1-2mm more after the flashback then slide the cannula in. The cannula will glide in smoothly if it is in the vein, it will buckle and be tough to advance if it is not or if its only partially in..
After you get the flashback of blood you want to insert it a little more, to make sure you’re in the vein. Otherwise more likely, soon as you see the flashback of blood, it will not be enough to advance the cannula.
I just had a successful insertion following your tips and also reducing the angle of the needle more. Yay!
I get this problem too 😞
Most nurses don't know how to do when i wanna test my blood. I have to do it myself to give my blood for the test. Drug users are better than nurses at injection
So how much money will I make if I become a venopuncturist ?
lmao 😂
What a pleasant and sensual voice... besides the nice explanations!
What's safety device do actually
Your video is fantastic and very informative.
Unrelated to the factual information in the video, on the schedule board for Wednesday it says poo brain. What is poo brain?
Great video.
Its helpful thanks
Nice video.
Thanks mam🙏
Thanks 😊
Hello I'm really bad at this. Please help me with a one on one
I had 5 punctures and she still miss my vein and I had to swarp arms to get my blood taken. Amerture! Bruised the next day. 😮 There will always be good and bad skill workers what ever the trade. With medical your life is in their hands if they mess up.
That was helpful
Great video 👍
the bleeding is danger??? should do surgery?
You will stop bleeding after a few minutes. No surgery needed.
Nah, I bleed after I have needles in my veins, but it stops after a few minutes. It’s nothing serious.
needle size is too big in the picture
5:55... If not getting blood wants the needles there...
Well explained
Thx ..
Discouraging
This is so fucking hard I cannot find the damn vein!!!!
Just be patient!
Sometimes it helps to have the person dangle their arm with a tourniquet on for a few moment to help the blood flow into the veins and engorge them. You can also use a second tourniquet if necessary. Sometimes a NIBP cuff can do the trick too, but this can be more uncomfortable.
Make sure to take into account your patient's physiology before you stick them. A very obese person will usually have more subcutaneous fat covering their veins, so their veins will be deeper. An elderly person usually has very shallow veins that aren't anchored well due to the deterioration of collagen - so make sure to stretch the skin and vein before you poke to ensure nothing rolls!
Practice makes perfect, and it's okay to miss your veins as long as you do your best and learn from your mistakes.
@@CaseyCorrupted Aww that was some excellent experience advice there.
You can be teacher or an instructor or something cuz Iam still blown on how u gave out good advice. A lot of people don't do that as much often as they should I guess cause they don't want to see the next person to advance in life which is wrong and because I was gonna give advice but nothing like what u just said that was freaking awesome once again nice job on that. 💯👏🏼💣✌
First of all stop using that disgusting language!! Instead learn and practice!!
Say a million of us junkies every fookin day lol!
Calm down and heat up your arm or wherever with a hot compress.Youll find it.Unfortunately it takes years of abuse to get good at it.Good luck.
@@joannaluca8495fuck 😂 you had me going for a second. I love how all these phlebotomy video comments are junkies and nurses, but you can’t always tell who is who
I ll be rite back had to get groceries
You look like monalisa in painting
I'm a drug addict 25+ years. Now i can finally use it through injection. Thanks a lot. I hope i won't die. Its on you!
Oh no!! Just kidding. Thanks for the tip
На русском языке можно говорить ?
🙏🙏🙏🙏🙏🙏🙏
😍😍😍😍😍
Hi
It's a shame. I thought there'd be actual tips and directions rather than being told what is wrong..
She’s doing a great job explaining, not quite sure what more tips and directions you need!!?
@@joannaluca8495errr actual examples rather than just some diagrams!!???
Its so scary
Some people skin pop
Disco biscuits
Abbas
The hospital ruptured my vein and caused a blood clot 🤦♀️
The lopsided tongue extragingivally puncture because advice proximally puncture during a available pest. quick, oval club
re 0:00 This is a stupid illustration (Explained by the Disclaimer, but not justified.)! No usable vein tunnels up and down like this. It runs parallel to the skin, and would much more clearly illustrate the problems often encountered in venipuncture. This also limits the students ability to recognize the need for adjusting the angle during the insertion.
A fucking animation; really!?
How easy is it to accidentally cut the vein in half?
This Video has completely changed my life, Thank You sooooo much Yes this was Very Helpful ❤ 🩸