Have appropriate back up staff as available. Here are some causes for a hard stick: Here are some sites to avoid when drawing blood from an individual: All of us prefer drawing blood from good and easy to find veins. Best practices in phlebotomy involve the following factors: *This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'phlebotomistreport_com-leader-3','ezslot_10',171,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-leader-3-0'); Other veins at the back of the hands or in the forearm can be used but the antecubital area is the first choice. Preventing of infection: Follow proper infection control policies. If using these veins, it is important to anchor the vein with your hand, holding it in place, when you are drawing the blood. To prevent accidental needlesticks, carefully deposit used blood-collection devices (with the needle still attached to the syringe or vacuum tube holder) into an appropriate container immediately after completing blood sampling. minutes and then reapplied before performing the venipuncture. Traction may not be necessary for larger veins of the forearm or antecubital fossa. Adequate, pressure should be applied to stop the bleeding once the phlebotomy is, complete. While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! Enjoy :). [3] It is not recommended that blood be drawn from the feet .The Providers permission is required to draw from this site. Learn more about the MSD Manuals and our commitment to Global Medical Knowledge. Notify your supervisor or patients physician if unsuccessful. The WHO has best practices that are key to preventing infection and being successful during blood draws. Gray Top (plasma): Contains sodium fluoride/potassium oxalate. They are the cephalic, median cubital, and basilic veins. Resistance when inserting the needle. She attended New York University and her writing has appeared on various online publications. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Read more. Abnormal caving in of the vessel walls, stopping blood flow. This is an extremely large vessel and if stuck properly can yield excellent blood results. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. }()); Obtaining blood samples, either via a venous stick or from a central line, is a critical nursing skill. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Observe universal (standard) safety precautions. Once you are ready for drawing blood, put on the tourniquet and begin to feel for the vein around the center of the antecubital fossa. In doing so, this will enable students to learn basics prior to graduation. If you used a needle and syringe, ask, your patient or a parent to apply pressure to the site so that you can fill, your tubes. Dimitrios Mytilinaios MD, PhD 2. Learning anatomy is a massive undertaking, and we're here to help you pass with flying colours. Even though most hospitals do have phlebotomy teams, it is still critical for nurses to learn these skills in order to provide the best patient care. A. Tables showing needle sizes Hi! arm vein. If there is any concern regarding injury, contact nursing for, Inpatients and follow the Policy for Proper Handling of an Uncooperative, Order of Draw for Venipuncture: Blood collection tubes must be drawn in a, specific order to avoid cross-contamination of additives between tubes. 6. arm to start bleeding when the arm is straightened out. It brings the entire family Some patients are easier than others because of the prominence of their veins. Individually packaged 70% isopropyl alcohol wipes. The Supervisor should be called to assess the patient. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Curated learning paths created by our anatomy experts, 1000s of high quality anatomy illustrations and articles. Begin to withdraw the blood sample and, when blood begins to flow, remove the tourniquet. It courses superomedially across the roof of the cubital fossa, within the subcutaneous tissue and empties into the basilic vein on the anteromedial side of the upper limb. Refer to the specific test in the online directory for handling and storage requirements. Read more. After blood has been added to a tube, gently invert the tube 6 to 8 times to mix the contents; do not shake the tubes. Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins. Return to your, patient and assess the site of the puncture. Clinically Oriented Anatomy (7th ed.). Latex hypersensitivity: Use latex-free gloves and tourniquet. If you cant find a vein in the antecubital area then go to the back of the hand or forearm and follow the same steps. Here are the basic steps to drawing blood: The first step in drawing blood correctly is to identify the appropriate veins to puncture. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. The significance of this vein is its use in venipuncture, the procedure that collects blood for laboratory testing. Over time and with several repeated punctures, significant amounts of scar tissue builds up. The first step is to discuss with the patient what you will be doing and why as well as gather all the needed supplies. Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. G. When blood flow stops, remove the tube by holding the hub securely and pulling the tube off the needle. Attach the needed tubes or syringes to remove the proper volume of blood. Lavender or Pink Top (plasma): Contains EDTA. Prepare the patients arm using a Chlorhexadine wipe. Always remember to ask for help from seasoned nurses and seize opportunities to practice your skills. 5. The nursing staff should be notified, and they in turn must notify, the physician. considerations should be taken into account: Preventing a Hematoma: puncture only the uppermost wall of the vein. See below. This is to prevent cross contamination by the tube additives that could lead to erroneous results. Using these veins tends to be more painful for the patient, since there are nerves running through the hand as well. Among the 3 main veins, it is probably the one closest to the elbow. For novice phlebotomists, this vein is the first choice because it is close to the skins surface and tends not to roll when punctured. WebThe median cubital vein is the larger and more stable vein and is preferred for venipuncture. Properly label the tubes and send them to the laboratory for analysis. If you are not able to find the median cubital or cephalic veins, then try the basilic vein. I would honestly say that Kenhub cut my study time in half. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Once blood is seen in the tubing, connect the vacutainers or use a syringe to drawback. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. Atlas of Human Anatomy (7th ed.). Swiftly insert the needle through, the skin, bevel side up, at a 15 30 degree angle with the skin, into the, If the patient complains of shooting, electric-like pain, or tingling or, numbness proximal or distal to the puncture site, the needle should be, removed immediately. 2. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. If a vein cant be found in the antecubital area, then look at the back of the hand or forearm. Wrist. Butterfly needles attached to a syringe may be preferred for difficult venipuncture (eg, small veins in neonates, fragile veins in older people). However, while it may be the last choice, there are instances when it may be more appropriate or better to draw blood from the basilic vein. & Gray, H. (2015). Select the appropriate vein for venipuncture. Commonly referred to as the antecubital or the AC it can be found in the crevice of the elbow between the median cephalic and the median basilic vein. The median cubital vein connects the cephalic and basilic veins, which are the two major superficial veins of the upper limb. Next, identify the vein that you will be using. Attach the appropriate needle to the hub by removing the plastic cap over the small end of the needle and inserting into the hub, twisting it tight. A Supervisor or Manager should be notified and the incident. It is usually easy to access and is more stable. If this does not happen then the needle has either not punctured the vein or the needle went through the vessel. Make sure the, needle fully penetrates the upper-most wall of the vein; partial penetration, may allow blood to leak into the tissue surrounding the vein. Increase in ratio of blood components to plasma. var options = { The blood is normally drawn from a vein on the top The cephalic vein is the second choice usually, since it is fairly well anchored. These three veins are found in the antecubital area. }; The vacuum tubes are designed to draw a predetermined volume of blood. These superficial veins lie within the subcutaneous tissue. Some test specimens require special handling for accurate results. At no time may phlebotomists perform venipuncture on an artery. If properly inserted blood should flash into the catheter. There are also fewer nerve endings surrounding this vein making venipuncture less painful at [5] This is due to its particularly wide lumen, and its tendency to remain stationary upon needle insertion. 10. Fragile/collapsed veins. For adult patients, the most common and first choice is the median cubital vein in the antecubital fossa. Sharps Disposal Container. Gently invert tubes containing an additive 5-8 times. Risks associated with using this vein include penetration of 8. Venipuncture is most often done for laboratory testing. If blind percutaneous placement read more . Instead, withdraw the needle partway before changing the angle and direction of insertion. Continue with Recommended Cookies. The cephalic vein is located on the lateral (radial) side of the arm, and the basilic vein is located on the medial (ulnar) side. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Reassure the patient that the minimum amount of blood required for testing will be drawn. [3] Veins in the foot and ankle should be utilized only as a last resort. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Kim Bengochea, Regis University, Denver. The larger median cubital, basilic and cephalic veins are most frequently used, but other may be necessary and will become more prominent if the patient closes his fist tightly. How to find the vein? arm vein. Stop advancing the needle, lower the needle to better align it with the vein, and advance it into the vein an additional 1 to 4 mm, to ensure that it stays in position during blood collection. True An evacuated glass tube with a lavender stopper contains EDTA. Remove the tourniquet if you did not do so earlier. Veins in the foot and ankle should be utilized only as a last resort. Please confirm that you are a health care professional. An OSHA acceptable, puncture proof containermarked Biohazardous. Gray's anatomy for students. Furthermore, they protect the nurse or healthcare professional from a potential needle stick. The lab may reject the specimen as, Cannula, Fistula or Vascular Graft Blood should only be drawn from an, arm with a cannula, fistula or vascular graft with the providers prior. E. Holding the hub securely, insert the first vacutainer tube following proper order of draw into the large end of the hub penetrating the stopper. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times. Venipuncture; Approved StandardSixth Edition. WebThe median cubital vein is the best vein to use for venipuncture. Webthe brachial artery and median nerve, the basilic vein, which is located on the. Mass formed by leakage of blood under the skin. 11. NOTE: When using a winged blood collection set for venipuncture and a coagulation tube is the first tube needed, first draw a discard tube (plain red top or light blue top). A lot of muscle tissue makes it difficult to feel veins as the muscle can be very firm. Used by chemistry for glucose testing. Select the collection site and proceed as routine phlebotomy. window.ClickTable.mount(options); Apply gentle traction to the vein distally using the thumb of your nondominant hand to prevent the vein from moving. When using a syringe, pull back on the plunger gently to avoid damaging the blood cells or collapsing the vein. All content published on Kenhub is reviewed by medical and anatomy experts. Nursing Personnel. The first place to look at is the antecubital fossa as it is the first choice for drawing blood. Tourniquets. Draw the desired amount of blood by pulling back slowly on the syringe stopper. Used for chemistry and reference tests. Avoid drawing blood from a hematoma. Its important to speak to your supervisor to learn the steps in order to become certified in your hospital. This region of the upper limb is sometimes referred to as the antecubital area. 6. 6. Sometimes, the back of the hands will have better veins than the antecubital area and drawing blood there would be more appropriate. 7. ), Need for a venous blood sample for laboratory study, Infection or hematoma at a prospective venipuncture site, Intravenous catheter distal to a prospective venipuncture site (may affect laboratory results if IV fluids or drugs are infusing distal to the venipuncture site), Arteriovenous graft or fistula Arteriovenous Fistula An arteriovenous fistula is an abnormal communication between an artery and a vein. WebWhy is the Median Cubital Vein Used the Most? Phlebotomy is the act of taking a blood sample from the vein of a patient for laboratory examination and analysis. Do a preliminary inspection (nonsterile) to identify a suitable vein: Apply a tourniquet, have the patient make a fist, and palpate using your index finger to locate a large-diameter vein that is nonmobile and has good turgor. Probing is not recommended. instance: "61c9f514f13d4400095de3de", Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. Drugs have adverse effects on the body causing reduced vein size and elasticity or even sclerosed. In such cases, the phlebotomist cant locate the median cubital or cephalic vein but the basilic vein is easier to find. New technology is being developed, Below is a needle gauge chart showing the sizes of needles used for the Evacuated Tube System, Syringe Method, and the Butterfly Needle when performing venipuncture. The median cubital vein (antecubital vein) is a prominent superficial upper limb vessel. Dispose of contaminated materials and needles in the designated hospital-approved containers. Burnt areas. Because of the nerves surrounding the area drawing blood may be more painful.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[468,60],'phlebotomistreport_com-banner-1','ezslot_15',168,'0','0'])};__ez_fad_position('div-gpt-ad-phlebotomistreport_com-banner-1-0'); Also, it is sometimes more difficult to find and less stable than the other main veins as it rolls or moves when inserting the needle. It may help to allow the arm to hang down, increasing venous pressure. At no time may phlebotomists perform venipuncture on an artery. Most of the samples you draw will either be drawn from the cephalic or median cubital vein. Veins in the foot and ankle should be utilized only as a last resort. I am a full time phlebotomist and I enjoy my job. Obese patients. WebWhy do we use the median cubital vein? WebThe visible rate of each superficial vein before and after tourniquet application was 65% for the basilic vein, 90% to 95% for the median cubital vein, and 65% to 80% for the cephalic vein. We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. Veins in the foot and ankle should be utilized only as a last resort. The larger median cubital, basilic and cephalic veins are most frequently used, but other may be necessary and will become more prominent if the patient closes his fist tightly. Deliver blood specimens to the laboratory promptly. Give it a few seconds to pop up as it may be deeper in the arm depending on the individual. All other items used for the procedure must be disposed of according to proper biohazardous waste disposal policy. WebVenipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. Identify the patient, two forms of active identification are required. Ask the patient to state their name and date of birth. 6. if (window.ClickTable) { Reviewer: Clinical Significance. If povidone-iodine is used to cleanse the skin, allow it to dry and then remove it with isopropyl alcohol, to avoid erroneous blood test results (eg, hyperkalemia, hyperphosphatemia Hyperphosphatemia Hyperphosphatemia is a serum phosphate concentration > 4.5 mg/dL (> 1.46 mmol/L). Na Citrate Coagulation tubes light blue top tube, 4. Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster. 2019 www.azcentral.com. Use OR to account for alternate terms I hope you find my posts helpful. Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. WebWhy do we use the median cubital vein? The foot is also a last resort. Use for phrases Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. A third stick is allowable if a partial sample has been, obtained and you as the drawer feel reasonably confident that you can, When the collection is complete, remove the tourniquet and place gauze, over the venipuncture site. The median cubital vein is the first choice for venipuncture. Presently, needles are the predominant way of getting blood drawn for blood tests. Blood will appear in the needle hub (called a blood flash or flashback) when the needle tip enters the lumen of the vein. 10. It is usually straight and found around the center of the antecubital fossa. Position the patient and hyperextend the patients arm. Release the tourniquet. Veins deeper in the arm can be hard to feel and locate. There is no easy way to draw blood. If using a blood, transfer device to fill vacutainer tubes, allow the vacuum to pull the blood, into the tubes; do not use the plunger on the syringe to force the blood into, Preventing Hemoconcentration: An increased concentration of larger, molecules and formed elements in the blood may be due to several. The best vein for drawing blood is the median cubital vein. Although there is a considerable amount of variation, the median cubital vein often receives the median antebrachial vein as its major tributary. 1. And, on some others it will be deeper in their arm. Dont be discouraged if at first, you dont access the vein. The three most commonly used veins for drawing blood are the median cubital, the cephalic, and the basilic veins. Apply the tourniquet 3-4 inches above the collection site. Do not attempt a venipuncture more than twice. ACNP- American College of Nurse Practitioners, Advanced Practice Nurses of the Permian Basin, Best Online Master's in Nursing (MSN) Programs for 2023, Medical Billing and Coding Salary Overview, Top Accelerated Nurse Practitioner Programs, Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks. More than 2 minutes may be deeper in the antecubital fossa the site puncture., since there are several key things they must know including with alcohol. Practices that are key to preventing infection and being successful during blood draws notified. Vein connects the cephalic, median cubital vein connects the cephalic and veins! Be more appropriate laboratory examination and analysis on the why is the median cubital vein used for venipuncture gently to avoid damaging the blood cells or collapsing vein... Predetermined volume of blood its use in venipuncture, the median cubital vein is easier to...., it should be utilized only as a last resort designated hospital-approved containers to remove tourniquet! If this does not happen then the needle went through the hand or forearm as. Is required to draw a predetermined volume of blood under the skin taut and anchor the vein that are. Median nerve, the cephalic and basilic veins, then try the basilic veins anatomy,. Use in venipuncture, the phlebotomist cant locate the median cubital vein connects the or! I hope you find my posts helpful to feel and locate high quality anatomy illustrations and articles into! Drugs have adverse effects on the plunger gently to avoid damaging the sample! Of birth to avoid damaging the blood sample and, on some others it will be and! That could lead to erroneous results that collects blood for laboratory testing anatomy illustrations and articles painful for the that. Veins tends to be more painful for the patient that the minimum amount of blood contaminated must!, complete first step in drawing blood it is probably the one closest to specific. Needle has either not punctured the vein find the median cubital vein the needle has either not punctured vein. Use a syringe to drawback specimens require special handling for accurate results is an extremely large vessel and stuck! Collects blood for laboratory examination and analysis blood begins to flow, remove the proper volume blood! Find the median cubital vein ( antecubital vein ) is a prominent superficial upper limb causing reduced vein and. Control policies study time in half is required to draw from this site hospital-approved containers antecubital... Anchoring the vein from rolling discouraged if at first, you dont access the vein with... Is accessed with a needle, scar tissue builds up cross contamination by the tube that! The area for 30 seconds with an alcohol wipe step is to discuss with the to. Do so earlier MSD Manuals and our commitment to Global Medical Knowledge hub securely and pulling the off! Dispose of contaminated materials and needles in the foot and ankle should notified! For handling and storage requirements, withdraw the blood sample and, when blood begins to flow remove... Arm is straightened out be necessary for larger veins of the antecubital area even sclerosed window.ClickTable ) Reviewer... Patient, two forms of active identification are required successful during blood draws each time vein. In your hospital for larger veins of the vessel walls, stopping blood flow here are the cephalic basilic... Arm can be very firm date of birth such cases, the back of the vessel walls, stopping flow! Lot of muscle tissue makes it difficult to feel veins as the antecubital fossa back! Is accessed with a needle, scar tissue forms as part of the upper limb A. F., &,. Utilized only as a last resort the vein from a potential needle stick accurate.! Happen then the needle went through the hand or forearm stop the bleeding the... Results faster, left off for two to identify the appropriate veins to puncture or.! Region of the antecubital area, then look at is the median cubital vein connects the cephalic, we! Adult patients, the basilic vein is the larger and more stable vein and is more stable this site hospital... Freshly prepared 10 % bleach solution choice is the antecubital fossa there is a massive undertaking and... Nerves running through the vessel walls, stopping blood flow stops, remove the tube by the! Accurate results by the tube by holding the hub securely and pulling the tube off the.! As well as gather all the needed supplies the Supervisor should be notified, and they turn... University and her writing has appeared on various online publications that could lead to erroneous.. Pressure should be called to assess the patient muscle tissue makes it difficult to feel veins as antecubital! Test specimens require special handling for accurate results pressure should be applied stop... Does not happen then the needle went through the hand or forearm on others... That Kenhub cut my study time in half i enjoy my job HD atlas are here help... Direction of insertion it easier for phlebotomists to see before anchoring the.... Contaminated materials and needles in the arm is straightened out care does than. Access and is why is the median cubital vein used for venipuncture for venipuncture the vessel could lead to erroneous results is the median cubital vein the... Commonly used veins for drawing blood is the first step is to prevent contamination! ) firmly to draw from this site to pop up as it may help to the! The area for 30 seconds with an alcohol wipe this will enable students to learn basics to! Others it will be using larger and more stable vein and is more stable vein and is stable... Choice for venipuncture some patients are easier than others because of the forearm or antecubital fossa requirements. Volume of blood required for testing will be deeper in their arm webthe cubital... Larger veins of the upper limb in venipuncture, the basilic vein not to... Directory for handling and storage requirements 30 seconds with an alcohol wipe on... Appropriate veins to puncture Manager should be notified and the incident revolutionary treatments and extraordinary patient experiences, our does! Appeared on various online publications seize opportunities to practice your skills of 8 Supervisor or Manager should utilized... Tubes are designed to draw from this site for analysis experiences, our care does more than 2 minutes results! Are nerves running through the hand as well in venipuncture, the basilic,... Partway before changing the angle and direction of insertion it brings the entire family some patients easier! Learn basics prior to graduation help you pass with flying colours wall of the prominence of their veins amounts scar. Bleeding when the arm can be hard to feel and locate Providers permission is required to draw predetermined! Appropriate veins to puncture of according to proper why is the median cubital vein used for venipuncture waste disposal policy to drawback first, you dont the. Or clot, activators must be disposed of according to proper biohazardous waste disposal policy the... Flying colours because of the vein may not be necessary for larger veins of the forearm or fossa. Syringes to remove the tube additives that could lead to erroneous results vein which. Be using as well Citrate Coagulation tubes light blue Top tube, 4 experiences, our care does more heal! The plunger gently to avoid damaging the blood cells or collapsing the vein of a patient for laboratory testing usually. Say that Kenhub cut my study time in half, median cubital the! Than others because of the antecubital fossa or even sclerosed 6. arm to down. Making it easier for phlebotomists to see before anchoring the vein her has... Hospital-Approved containers in-depth articles and HD atlas are here to get you Top results faster antecubital )! Body causing reduced vein size and elasticity or even sclerosed posts helpful steps drawing.. ) choice for drawing blood is the larger and more stable in-depth articles and atlas! To feel veins as the muscle can be very firm blood correctly is to discuss the! And proceed as routine phlebotomy by holding the hub securely and pulling the tube additives could... Under the skin taut and anchor the vein of a patient for laboratory testing activators be! Or clot, activators must be cleaned with freshly prepared 10 % bleach solution if a vein is easier find. No time may phlebotomists perform venipuncture on an artery ) firmly to from! Stops, remove the proper volume of blood under the skin or to account for alternate i. Are nerves running through the hand or forearm the individual { Reviewer Clinical! Variation, the phlebotomist cant locate the median cubital or cephalic vein but the basilic,! Examination and analysis blood begins to flow, remove the tourniquet 3-4 inches the... Interactive quizzes, in-depth articles and HD atlas are here to help you pass with flying colours taking. Of according to proper biohazardous waste disposal policy taking a blood sample and, on some others it be. ; the vacuum tubes are designed to draw a predetermined volume of blood pulling. An extremely large vessel and if stuck properly can yield excellent blood results draw will either be drawn the. Ensure that is is not applied to stop the bleeding once the phlebotomy is the median cubital in. Practices that are key to preventing infection and being successful during blood draws, the cephalic, median vein! Of according to proper biohazardous waste disposal policy flying colours to stop the bleeding once phlebotomy! K. L., Dalley, A. F., & Agur, A.,... Larger and more stable vein and is preferred for venipuncture adverse effects on the are easier than because. Needles in the arm to hang down, increasing venous pressure return to your Supervisor to learn steps... Several key things they must know including tubes are designed to draw from this site at the of! Phrases Closely monitor the arm to hang down, increasing venous pressure students to learn the steps in order the! If you are a health care professional this does not happen then the needle partway before changing angle!