Palpate to Grade a Vein
Palpate to Grade
a Vein -
Next to locating a vein, this
is the most important function in vein access!
a vein is not enough - you must determine the integrity of that vein wall before you stick it - or you may have selected
a vein whose wall will rupture with that stick!
You must grade the vein for 4 important criteria:
1. FIRMNESS 2. SIZE
These criteria were described
in Locate a Healthy Vein, but we need to go into more detail about the first criteria - FIRMNESS.
Firmness is the most important criteria
- size, direction, and depth will not matter until you meet the FIRMNESS criteria. Locating
a vein is not enough - you must determine the integrity of that vein wall before you stick it!
1. FIRMNESS (0-10) -
Firmness is a direct correlation to the
vein wall thickness. Vein wall thickness varies throughout
the body. As veins get closer to the heart, they get bigger and the walls get thicker. The thicker the wall of the vein, the better the vein wall will tolerate a needle
stick (and the procedure, i.e. withdrawing blood, injecting contrast, infusing fluids/meds). The thinner
the wall of the vein, the more likely it will be that the vein wall will rupture upon insertion of the needle.
We grade the firmness of the vein on a scale of 0-10, with 10 being the firmest.
compare the vein wall thickness this way. Get a non-sterile latex glove. Feel the thickness of one wall of that glove. Pretty thin! Stretch
that portion of
glove over your finger, thinning it even more. What will happen
to it if you stick that stretched, thinned wall with a needle? Rupture? Yep!!!!!
HAND: The vein wall in a hand vein is about as thin as
the glove wall, and when you apply a tourniquet too tight,
the vein which will stretch the wall even thinner (like the glove). You
all know what happens,
so frequently, with those hand veins . . . . quoting a phrase commonly heard,
“blew that vein”, and now you
have a huge hematoma.
Hand veins usually score 0-2.
WRIST - As we move UP the arm, the next stop is the wrist.
Venipunctures usually go a little better here because the
vein wall is getting thicker. Feel the vein for firmness and grade it (0-10). If the firmness of the bounce
than 5 on your firmness scale, do not stick that segment of the vein. Palpate a little further UP (like
until the vein feels firmer (scoring between 5-10 on the scale), and stick it here.
Superior wrist veins usually score 5-7.
As we continue to move UP the arm, the next stop is the antecubital region. The vein wall of a
median cephalic or healthy median basilic vein is as thick and as resilient as the tourniquet.
A healthy antecubital vein typically will score 7-10.
assume that just because it is antecubital, the vein will score a 7-10. It must be a "healthy" vein
to score 7-10. Varicose veins are veins that have been unnaturally and permanently distended, and
they can occur anywhere. So, palpate and grade before you make your selection.
are feeling for FIRMNESS of the bounce when you depress the vein. We are grading
on a scale of 0-10, with 10 being the firmest. If your vein scores less than 5 on the firmness scale, DO NOT STICK IT.
That vein wall will most likely not tolerate the stick.
So, if the vein
FIRMNESS has a : Score 5-10 - Stick it.
less than 5 - DO NOT stick it.
stick a hand vein.
For information on size, direction, and depth, go to Locate
a Healthy Vein on the menu.
Get all the details
and science facts on grading a vein by reading our books - How to Locate a Healthy Vein, or
one of the profession-specific books, The Science Behind the Skill of Vein Access, or enroll in
our accelerated Vein Access Training Program.
Purchase a Book
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