An elderly female outpatient arrives for a blood draw. The test requested include ESR and estrogen levels. The patient walks in very slowly, as if her joints are stiff or sore. She has an oxygen tank with her. By the time she sits down in the chair, she is out of breath. When the phlebotomist attempts to locate a vein for the blood draw, the patient can only partly straighten her right arm and indicates that it is too painful to straighten it any further. The patient says that she cannot be drawn in the other arm because she has had a mastectomy on that side. The phlebotomist chooses a prominent vein on the medial aspect of the ventral surface of the arm slightly distal to the bend of the elbow to perform the blood draw.