Venipuncture Sites, Veins and Sites to Avoid
Use the median cubital vein first, then the cephalic, and the basilic only last; the back of the hand is the usual alternative, and some arms or sites must never be used.
Veins in order of choice
| choice | vein or site | why | source |
|---|---|---|---|
| 1 | Median cubital (centre of the antecubital fossa) | Lies between muscles; usually the easiest to puncture | WHO 2010, 2.2.3 Step 3; Croatian recommendations 2013 |
| 2 | Cephalic (thumb side, lateral) | Next choice when the median cubital cannot be used | Croatian recommendations 2013; Merck Manual |
| 3 (last) | Basilic (little-finger side, medial) | The brachial artery and median nerve lie close: more risk of nerve or artery injury and more pain | WHO 2010, 2.2.3 Step 3; Croatian recommendations 2013; Korean guideline 2025 |
| Alternative | Back of the hand (dorsal hand veins) | Acceptable site in the CLSI venipuncture standard; a winged set suits these small veins | CAP TODAY (summary of CLSI H3-A6); Merck Manual |
| Only with physician permission | Ankle, foot or other lower-extremity veins | Allowed only with physician permission and facility policy | CAP TODAY (summary of CLSI H3-A6 and the CAP phlebotomy manual) |
| Never | Underside (palm side) of the wrist | Forbidden by the CLSI standard and the CAP phlebotomy manual | CAP TODAY (summary of CLSI H3-A6) |
| Never as a substitute | An artery, for a difficult venipuncture | Not without consulting the physician first | Croatian recommendations 2013 |
Preview only. The full sheet also covers: Finding the vein (observation and palpation); Sites and arms to avoid; Special considerations that change the site or device.
Sources
- WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy (2010); official WHO IRIS PDF, also published as NCBI Bookshelf NBK138650 · World Health Organization
- Nikolac N, Supak-Smolcic V, Simundic AM, Celap I. Croatian Society of Medical Biochemistry and Laboratory Medicine: national recommendations for venous blood sampling (based on CLSI H3-A6). Biochem Med 2013;23(3):242-254 (PMC3900082) · Biochemia Medica via PubMed Central
- Chang J, et al. Standards and Practice Guidelines for Venous Blood Collection: Consensus Recommendations from the Korean Society for Laboratory Medicine. Ann Lab Med 2025;45(4):343-357 (PMC12187494) · Annals of Laboratory Medicine via PubMed Central
- How To Do Venous Blood Sampling (Merck Manual Professional Edition, procedure page) · Merck & Co., Inc. (Merck Manuals)
- Ernst DJ. Q&A: acceptable venipuncture sites (summary of the CLSI H3-A6 venipuncture standard and the CAP phlebotomy manual). CAP TODAY, May 2011 · College of American Pathologists (CAP TODAY)
- Collection of Blood Culture Specimens, SOP 6972 v4.0 (effective 2021-05-13), including the paediatric maximum blood draw chart; Eastern Health Laboratory Medicine, Newfoundland and Labrador (institutional procedure, used as an example) · Eastern Health Laboratory Medicine
- Lab Guide, Adult Venous Blood Collection: Techniques to avoid (institutional procedure, used as an example) · Hamad Medical Corporation
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