Hand position: When collecting blood from a hand vein, it is best practice to position the patient's hand slightly downward with the top of the hand facing you. The fingers of the patient's hand should be rolled underneath, forming a loose fist. Use your thumb to pull back gently on the surface of the skin, making the skin tight. The vein should be anchored adequately to proceed with venipuncture. The hand veins will be more prominent if the patient grips a pillow or a rolled up washcloth.
Tourniquet Position: The tourniquet should always be applied 3 - 4 inches above the needle insertion point. Therefore, when assessing for a usable vein in a hand, apply the tourniquet 1 - 2 inches above the wrist. If the tourniquet is on longer than one minute, release and reapply prior to venipuncture to avoid hemoconcentration.
Cautions:
- Choose a straight section of the hand vein-- avoid the "intersection" or "V" where a vein branches into another vein. This juncture may contain a valve and could be damaged if punctured.
- Only use the top of a hand for puncture. Veins on the palmar surface of the wrist, the fingers, and the lateral wrist above the thumb to the mid-forearm must not be used according to the 2017 CLSI standards. This will prevent the inadvertent puncture of hidden arteries, tendons, or nerves in the area.
