 A laboratory requisition form is needed before beginning any blood draw.  Each facility has their own form, which may be hand written or computer generated.  Lab requisition forms will normally include the patient’s information, test ordered, and the doctor who ordered it.  Phlebotomists must be able to figure out what color tubes to draw and which type of technique to use.  Phlebotomists must have a pen to write patient information on tubes after their blood draw.  They also need a watch, enabling them to record the time of draw.

 The CDC and OSHA require the use of gloves when performing a blood draw using the venipuncture, capillary, or arterial methods.  Gloves provide a protective barrier between the phlebotomist and the patient.  They can help prevent the spread of infectious agents but cannot help protect from an accidental needle stick.  A new pair of gloves must be applied for each patient and removed after the procedure is completed.

 The following gloves are recommended.  Nitrile  Latex  Neoprene  Polyethylene  Vinyl  A good fit is necessary.  Hand washing is required between each removal and donning of new gloves.  Liners are available for those with dermatitis or allergies when gloves are worn.  Barrier hand creams are also available to help hands with repeat glove use.

 Antiseptics are used to prevent or inhibit the growth and development of microorganisms.  Antiseptics are used to clean the site prior to the blood collection.  The most commonly used antiseptic is 70% isopropyl alcohol.  They come individually wrapped.  If a collection requires a more potent antiseptic, providone-iodine is used.  If a patient is allergic to iodine, chlorhexidine gluconate is used instead.

 Disinfectants are chemicals regulated by the EPA that are used to kill or remove microorganisms on surfaces and laboratory instruments.  Disinfectants are not used on human skin!  Solutions of sodium hypochlorite (bleach) can be used.  If there is a large spill of blood a 1:10 dilution of bleach is used and must spend 10 minutes on the surface for the disinfectant to be effective.

 Alcohol hand sanitizers can be used for routine hand cleaning.  Hand sanitizers can replace hand washing only when the hands are not visibly soiled.  If the hands are soiled with organic material (blood, feces, urine) hand washing is a must.  Alcohol-based hand sanitizers can come in liquid, foam, or gel forms.

 A tourniquet is an elastic strap that fits around the patient’s arm to stop the flow of blood for a small amount of time.  It should be tight enough to restrict venous blood flow but not tight enough to restrict the artery’s flow.  The tourniquet prevents venous outflow of blood from the arm causing the veins to bulge.  This enables the phlebotomist to visibly see the vein and makes it easier to palpate.  This also makes the vein’s wall thinner and easier to insert the needle into.

 The most common tourniquets used today are strips made of latex, nitrile, or vinyl.  Modern tourniquets are meant to be disposed of and are not made to be reused by multiple patients.  If necessary, a blood pressure cuff can be used as a tourniquet.  If the tourniquet is left on for longer than 1 minute, the makeup of the blood components can change, resulting in erroneous (incorrect) laboratory results.  A tourniquet must be applied so that it can be easily removed by the phlebotomist during the venipuncture.

 Gauze pads are used to hold pressure on the venipuncture site.  A common size is a 2 X 2 inch pad.  Sterile gauze should be kept in its wrapper until it is ready for use.  The gauze is placed on the arm right after the needle is removed.  Apply pressure until the bleeding has stopped.  The gauze can be folded into quarters to help increase pressure.  A bandage or piece of tape can be applied to the gauze.

 Bandages are used to cover the venipuncture site after the bleeding has stopped.  Surgical tape, paper tape, a band aid, or self adhesive gauze wraps can be used to cover the venipuncture site.  Be careful of latex allergies!  There are latex-free bandages.  Self-adhesive wraps are good for patients with bleeding disorders or patients on anticoagulant therapies.

 Collecting blood specimens for the medical laboratory is the primary duty of a phlebotomist.  Blood can be collected by using the venipuncture, capillary, and arterial methods.  The most popular method is the venipuncture method using the evacuated tube system.  Some call this the Vacutainer system since that is a common brand used.

 The evacuated tube system (ETS) is a closed system in which the patient’s blood flows through a needle and goes directly into a tube without being exposed to the air or outside contaminants.  The system includes a special blood-drawing needle, a tube holder, and different evacuated tubes.

 The multisample needle is threaded in the middle and has a beveled point on each end.  The threaded portion is used to screw on the tube holder.  The end that is intended as the needle is longer and has a longer bevel.  The shorter end penetrates the stopper of the tube during collection.  It is covered by a sleeve that retracts when the needle goes through the tube and moves back in place after.  Most needles are sold with safety devices like in the second picture.  Never recap a needle that doesn’t have a safety device!

 ETS needles are called multisample needles because multiple tubes can be used during a single venipuncture.  These needles are disposable and are only used once.  Needle sizes can differ in length and gauge.  Most needles are inches in length.  The needle gauge tells the diameter of the needle, with the smallest numbers indicating the largest diameters.  The smaller the gauge the bigger the diameter of the needle.  Example : A 20-gauge needle has a large diameter and 23-gauge needle has a smaller diameter.  The most commonly used needles are 21 – 23-gauge needles.  Needles smaller than 23-gauge are not routinely used because they can cause hemolysis (popping of the red blood cells).

 Tube holders are also known as needle adapters.  They are clear, plastic, and disposable.  One end has a small threaded opening that connects to the needle and the other end has a wide opening to hold the collection tube.  These holders are not meant to be used more than once.  NEVER reuse a tube holder!  They should be disposed of with the needle still attached after the venipuncture.

 Each tube is color coded, letting the phlebotomist know the type of anticoagulant, which type of specimen will be used for testing, and the department the tubes are used in.  Tubes are made for adults as well as children.

 Evacuated tubes can be used with the multisample needle and with a needle and syringe.  Several companies sell evacuated tubes that can come in a variety of sizes and volumes.  The sizes range from 1-15 mL.  Due to the vacuum in each tube the phlebotomist can put blood directly into the tube at the time of venipuncture.  The vacuum pressure is proportional to the amount of blood needed in the tube.  The vacuum is only guaranteed until the tube’s expiration data.

 The phlebotomist will determine the appropriate tube based on the age of the patient, the amount of blood needed for each test, the size of the patient’s vein, and the condition of the patient’s vein.

 Even though the ETS system is the most popular the syringe system is used occasionally on patients with small veins and veins that are hard to pin down.  The syringe system is made up of a sterile syringe needle (hypodermic needle) and a sterile plastic syringe.  Blood collected using this system needs to be transferred into the evacuated tubes.  Due to an increase in needle sticks during blood transfer, a syringe transfer device is now available.  This allows the phlebotomist to safely transfer the blood into the tubes without using the same needle or removing the tube’s top.  Do NOT force the blood into the evacuated tube. This can cause hemolysis.

Syringe Needles (Hypodermic Needles)  The sterile needle is for a single use.  Needles are available in different gauges.  The needles also come in different lengths.  The most common size is 1” to 1 ½”.  NEVER recap a needle without a safety device! Syringes  Sterile syringes come in various sizes.  Phlebotomists usually use sizes ranging from 2-10 mL.  The phlebotomist chooses the syringe size based on the amount of blood needed and the size and condition of the vein used.

 A butterfly infusion set, also known as a winged infusion set, is used to collect blood from children and the elderly.  They are also convenient for patients with difficult or fragile veins in the arms or hands.  A butterfly infusion set consists of a ½ in - ¾ in needle connected to tubing 5 – 12 in long.  A 23-gauge needle is the most common size for the butterfly.  A multisample adapter is available on some so that the evacuated tubes can be used with it.  The winged infusion set is known as the butterfly because of the plastic wings used for gripping the needle.

 The needle disposal container is also known as a sharps container.  All sharps should be disposed of in this container immediately.  Containers come in various shapes, color, and sizes.  They are hard, puncture-resistant, leakproof, and disposable.  All containers should have a biohazard sticker and should be sealed when full.  They must be disposed of as biohazardous waste.

 A blood drawing station is an area in the medical laboratory where phlebotomy procedures are performed.  This is normally for outpatients to come in to get their blood drawn.  The typical blood drawing station is equipped with a table or desk with phlebotomy supplies, a phlebotomy chair or reclining bed, and a padded table for infant heel sticks.

 A phlebotomy chair should be easy to access and comfortable for all patients.  This means the chair needs adjustable arms so that either arm can be used.  Chairs can have locking mechanisms so that if a patient faints, they will not fall on the floor.

 A phlebotomy cart holds all the necessary supplies for the drawing of blood.  The cart is easy to push around the hospital or doctor’s office.  A blood drawing tray is smaller and can be taken into all rooms, allowing the phlebotomist to take the blood drawing station with them anywhere.