Venipuncture - How to Position a Needle

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:

***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.

[jacob]

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.

[staceyarey]

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

[dandeleona]

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.

[shilohivy]

More people need to watch this. I have small fragile veins and have had terrible experiences with labs and iv placement my entire life.

[fbbWaddell]

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.

[aureamack]

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!

[xgametherapist]

The information in this video is higher than what nursing school teach, thanks darling

[timwood]

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!

[sendlocation]

@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?

[lorigiles]

I have look at alot of videos this is the best one. Most don’t show exactly how 30 degrees looks like.

[sushilchakrabarty]

I m also learning and getting only punctured veins

[The_doctor_is_here]

You clear all my doubts
Thank you for such an amazing video

[chris-nxnk]

Incredibly insightful and useful video.

[keegancan]

seems like a competent nurse. I would need a lot of practice if applicable.

[leonardschofield]

Thank you so much. I had 2 bad draws recently.

[MARIAGONZALEZ-vqft]

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! :)

[grahammorgan]

Great information and I have learnt something new today! Thank you

[mesterulmanole]

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

[irishrose]

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

[johnbambrough]

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