The document discusses phlebotomy-related vascular anatomy. It describes the major veins in the antecubital fossa that are commonly used for venipuncture, including the median cubital vein, cephalic vein, and basilic vein. The median cubital vein is the preferred site as it is typically the largest, closest to the surface, best anchored, and least likely to cause bruising or pain. Alternative sites include the dorsal hand veins and median antebrachial vein in the forearm, though these are smaller and less preferable. The legs, feet and femoral vein should generally not be used without physician approval due to risks of complications. Proper site selection considers vein size, stability, and avoidance of

1. PHLEBOTOMY-RELATED
VASCULAR ANATOMY
Dr Ahmed Aboamer
MD Clinical pathology

2. PHLEBOTOMY-RELATED VASCULAR ANATOMY
Antecubital Fossa
•shallow depression in the arm that is
anterior to the elbow.
•It is the first-choice location for
venipuncture because several major arm
veins lie close to the surface, making
them relatively easy to locate and
penetrate
•These major superficial veins are
referred as antecubital veins.
•The anatomical arrangement of
antecubital veins varies slightly from
person to person; however, two basic
vein arrangements, referred to as the H-
and M-shaped patterns

4. 4
median cubital vein
• The H-shaped pattern is displayed by
approximately 70% of the population
• involves the cephalic vein on the lateral side of
the arm connected to the basilic vein on the
medial side by the median cubital vein just below
the elbow crease
• Located near the center of the antecubital
area,
• it is the preferred vein for venipuncture in
the H-shaped pattern.
• It is typically larger, closer to the surface,
better anchored, and more stationary than
the others,
• It the easiest and least painful to puncture
and the least likely to bruise.

5. 5
Cephalic vein
Located in the lateral aspect of the antecubital
area,
it is the second choice vein for venipuncture in
the H-shaped pattern.
It is often harder to palpate than the median cubital
but is fairly well anchored and
often the only vein that can be palpated (felt) in
obese patients.
accessory cephalic vein is lateral branch of The
cephalic vein.

6. 6
Basilic vein
Basilic vein: A large vein located on the
medial aspect of the antecubital area,
it is the last-choice vein for venipuncture.
It is generally easy to palpate but is not as well
anchored and rolls more easily, increasing the
possibility of accidental puncture of medial
cutaneous nerve (a major nerve of the arm)
or the brachial artery.
Punctures in this area also tend to be more
painful.

7. 7
Represents about 20-30% of individuals
the median antebrachial vein passes up to
the centre of the forearm and gives 2
branches
1. the median cephalic :connecting to the
cephalic vein,
2. the median basilic: connecting to the
basilic vein

8. 8
Median vein
Median vein (antebrachial vein):
The first choice for venipuncture in the M-
shaped pattern because it is well anchored,
tends to be less painful to puncture,
Not close to major nerves or arteries as the
others, making it generally the safest one to
use.

9. 9
Median cephalic vein
Median cephalic vein
The second choice for venipuncture in the M-
shaped pattern
it is accessible and located away from major
nerves or arteries, making it generally safe to
puncture.

10. 10
Median basilic vein
Median basilic vein
The last choice for venipuncture in the M-
shaped pattern (even though it may appear
more accessible)
Because it is more painful to puncture and,
like the basilic vein, is located near the
branches of the medial cutaneous nerve and
the brachial artery.

11. 11
Forarm and Hand Veins
 The dorsal digital veins drain into dorsal
metacarpal veins, which unite to form
a dorsal venous network.
 Drains into the cephalic vein laterally, and
basilic vein medially
Median antebrachial vein
It empties into the basilic, median basilic,
or median cubital vein

12. Dorsal
venous arch
Metacarpal plexus
Hand Veins
When the antecubital veins are not accessible.
• Hand veins are smaller and less
anchored.
• can be very painful for the patient.
Forarm and Hand Veins

13. Always chose a vein that is
straight and has good
bounce

14. 14
Because of the potential for significant
medical complications such as phlebitis or
thrombosis, veins of the leg, ankle, and
foot) must not be used for venipuncture
without permission from the patient’s
physician.
Puncture of the femoral vein is performed
only by physicians or specially trained
personnel.

15. 15
Selecting the
Venipuncture Site
•Everybody will not have
veins in the exactly same
position. Some variations
may exist.
•Always examine the
antecubital area first
•Select a vein that is large
and does not roll

16. Chapter 2 16
The most commonly used
veins for venipuncture are
located in the antecubital
fossa.
1st Choice Median cubital vein
2nd Choice Cephalic vein
3rd Choice Basilic vein
Which vein is BEST for venipuncture?