What angle should a needle be inserted?
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Those training to enter the field of Phlebotomy should know that one of the keys to a successful blood draw is needle positioning – an improper needle position is one of the most common causes of blood draw failure. Once trained, a Phlebotomist can use several simple visual cues to determine if the needle is positioned correctly in the vein. Show The angle of the needle can greatly affect the success of a blood draw. If the bevel of the needle is resting against the lower or upper wall of the vein, blood flow can be affected – this problem can easily be fixed by changing the needle angle. If the needle angle is too shallow, this can cause the needle to come in contact with the upper wall, resulting in an angle that is too steep, which can cause the needle to come in contact with the lower wall. To avoid this, a skilled Phlebotomist will reestablish blood flow by releasing the vacuum pull on the vein and slightly retracting the needle. Problems can occur when the needle is inserted into a bend in the vein or at a point where the vein goes deeper into the skin – both situations are unfortunately difficult to detect. Another problem that can occur is the needle being inserted too deeply, causing it to penetrate all the way through the vein. This can occur if the tube holder is less steady than the tube being pushed onto the needle, or if the angle is too steep. If the needle position isn’t quickly corrected, a hematoma can form – this can often be corrected by slightly withdrawing the needle to reestablish blood flow. While the needle being inserted too deeply can pose a problem, another common challenge is if the needle isn’t inserted deep enough. If the needle doesn’t penetrate the wall of the vein, the blood flow will be very slow. In this case, the phlebotomist should gently push the needle into the vein. If the vein is not well anchored during needle insertion, the needle can slip to the side of the vein instead of into the vein. If this occurs, the vacuum can be preserved and the needle can be redirected into the vein. It is important to note that the needle should never be moved laterally to find a vein. Lastly, if the angle of the needle can’t be determined visually, a Phlebotomist can use their finger to help relocate the vein, repositioning the needle into it. Interested in becoming a Phlebotomist? Contact Arizona College today to learn more about our Phlebotomy training program and other exciting career paths in the field of allied health. Editor’s note: This is an updated version of the article originally published in August 2014. Selecting the proper needle length when vaccinating your patients is critical — vaccine must reach the desired tissue site for optimal immune response to occur. To determine the proper needle length to use in each situation, you must consider the following factors:
Below is a summary of the guidance for choosing the proper needle length for intramuscular and subcutaneous injections based on CDC’s General Best Practice Guidelines for Immunization (Vaccine Administration). For infants, children and teensIntramuscular (IM) injections: Injection site and needle size
Subcutaneous (Subcut) injections: Injection site and needle size
For adultsIntramuscular (IM) injections The deltoid muscle is most often used as the site for IM injections in adults. Needle length is usually 1"–1½", 22–25 gauge, but a longer or shorter needle may be needed depending on the patient's weight. Note: An alternate site for IM injection in adults is the anterolateral thigh muscle. The needle length and gauge are the same as when the deltoid muscle is used, i.e., 1"–1½” length, 22–25 gauge. You should choose needle length based on the weight of your adult patients, as follows:
Subcutaneous (Subcut) injections
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What angle should a needle be inserted at?Insert needle at a 90o angle to the skin with a quick thrust. Retain pressure on skin around injection site with thumb and index finger while needle is inserted.
How should needle be inserted?Always inject towards your heart, in other words in the same direction as your blood flow. Put the needle into the vein at an angle (no more than 45 degrees) with the hole of the needle facing upwards. This helps to stop you going through the vein.
What angle should the needle be inserted for blood draws on a deeper vein?Grab the patient's lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Insert the needle at a 15 to 30-degree angle into the vessel.
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