1. Drawing blood samples EHES Training Materials

2. Exclusion criteria Blood samples are not taken, if participant Has a chronic illness which restricts taking blood samples Has anemia (Hb below 10 g/l) Doubts about the blood volume to be taken Refuses

3. Equipment Blood sampling vacuum tubes Needle for vacuum tubes Needleholder/adapter Needle disposal container Stasis Disinfection solution, swabs, gauze pads, skin tape Disposable gloves

4. Blood collection tubes Serum evacuated tubes containing gel or plain serum tubes (red cap) Fluoride-citrate plasma tube (grey cap) EDTA plasma tubes (violet cap)

5. Preparing for the blood collection Check participant’s ID code Place the code label on the form Record length of time from the last meal in full hours Participant rests 10-15 minutes Use gloves or disinfect hands

6. Posture of the subject Sitting position, hand downward, palm upwards Before blood collection, ask the participant to remove tight clothes that might constrict the upper arm If participant tells that he/she easily faints, supine posture due to safety of the participant Take blood from the arm not used for BP measurement usually left arm

7. Protocol 1/8 Gently tap top of the fluoride citrate plasma tube if it contains granules Release cover from the end of the needle and connect the holder and sample needle Apply tourniquet (if needed) to search a vein Limit the use of the tourniquet to less than one minute at a time

8. Protocol 2/8 Place the arm in a downward position and disinfect the puncture site Remove the protector case from the needle Perform the venipuncture

9. Protocol 3/8 Collect blood first into the 2 plain serum tubes Press the tube to puncture the stopper and start filling Loosen the tourniquet when the bloodstream runs Support the tube during filling

10. Protocol 4/8 When the bloodstream stops, take the tube out of the holder Check that the tube is filled to the accurate volume Mix the plain serum tube 5 times by inverting the tube completely top-down immediately after taking the tube out of the holder

11. Protocol 5/8 Fill the fluoride-citrate plasma tube Immediately after taking the fluoride- citrate tube out of the holder, mix 15 times by inverting the tube completely top-down

12. Protocol 6/8 Fill the 3 EDTA tubes Mix the plain EDTA tubes 5 times by inverting the tube completely top-down immediately after taking the tube out of the holder Store all tubes in a vertical position until sample handling

13. Protocol 7/8 Remove the needle from the vein Apply pressure immediately on the puncture site with a gauze pad until bleeding stops

14. Protocol 8/8 Label the successfully filled blood sampling tubes according to the sampling chart Discard needles into a needle dispose container and all other materials contaminated with blood into a biological waste container

15. Recording Record: Deviations from the blood drawing protocol Your initials/personnel code to identify who draw the blood samples

16. Acknowledgements Slides Laura Lund, Päivikki Koponen Photographs Hanna Tolonen Measurement demonstration Saara Vallivaara, Maarit Kajosaari