Name: Lenard S. Abo.

Course: III BMLS

Subject: Hematology 1

Order of Draw and Functions

Common Tube and Anticoagulant/additives Uses Number of
order of draw inversion
1. Yellow top SPS (Sodium Blood cultures 8-10
Polyanethole Sulfonate Microbiology
(aerobes,
anaerobes, fungi)
2. Blue top Sodium Citrate For Coagulation 3-4
studies (Pt and
APTT)
3. Red top No Anticoagulant and/or Used in Clinical Not usually
with clot activators and Chemistry, required
gel Immunology and (5 times)
Serology that
requires serum
4. Green top Heparin with or without For Blood gas 8-10
gel separator analysis
5. Lavender or EDTA Used in 8-10
purple top (Ethylenediaminetetraacet Haematology, and
ic acid) with or without Blood Bank
gel separator
6. Gray top No Anticoagulant but For Glucose test 8-10
contain additives Antiglycolytic
Sodium agent
flouride/potassium
oxalate

2. DO’s and Don’ts in Phelobotomy Procedure

DO
Observe standard precautions throughout the procedure.
Assess your patient for factors that could contraindicate venipuncture or lead to complications.
Assemble the appropriate equipment and determine whether special preparation or specimen
handling is necessary.
Wash your hands and put on clean gloves. Explain the procedure to the patient. Extend and
support his arm so it's level with his heart.
Identify the patient using two different identifiers, asking open ended questions such as, ‘’Wha is
your name’’? and “’ what is your date of birth?
Asses the patient’s physical disposition (ie. Diet, exercise, stress, basal state, allergie, fainting
or syncope). Patients may be occasionally allergic to alcohol, iodine, latex, or the glued used in
adhesive bandages. Necessary precautions must be observed by using alternate antiseptics,
paper tape or self-adhering wrap (Coban), and nonlatex prodcuts
Check he requisition form for the requested tests, patient information, and any special
requiremens. At the end of the procedures requisition for should have the essential element:

 Patients surname, first name, and middle initial

 Patient’s Id number
 Patient’s date of birth and sex
 Requesting physician’s complete name
 Source of specimen. This information must be given when requesting
microbiology, cytology, fluid analysis, or other testing where analysis and
reporting site is specific.
 Date and time of collection
 Initials of the phlebotomists
 Indicating the tests requested.
Look for an appropriate site of collection, and if no palpable veins are found such as in
antecubital area, the wrists and the hand should be examined.
Areas to be considered and be avoided:

 Damaged veins- veins that contain thrombi or have been subjected to numerous
venepuncture often feel hard sclerosed and should be avoided as they may
blocked and have impaired circulation
 Hematoma- if a vein containing hematoma must be used, blood should be
collected below the hematoma to ensure sampling of free-flowing blood
 Buns, scars and Tatoos- they are more susceptible to infections
 Mastectomy- blood should be drawn from the other arm where mastectomy site
is away. In the case of a double mastectomy, the physician should be consulted
to an appropriate site, such as the hand. It may be possible to perform the tests
from a fingerstick with physician’s permission.
 Obese patients- veins on obese patients are often deep and difficult to palpate.
Often the cephalic vein is more prominent and easier to palpate.
 IV therapy- whenever possible blood should be drawn from the other other arm. If
an arm containing IV must be used for sample collection, the site must be below
he IV insertion point and probably in different vein. CLSI recommended having
the nurse turn off the Iv infusion for 2 minutes, the phlebotomists then apply the
tourniquet between the IV and the venipucture site and perform the
venepuncture. The first 5mL of blood drawn should be discarded and a new
syringe is the used for the sample collection
 Sites with Heparin and saline locks
 Patients with Cannulas and Fistulas
For Blood collection on babies, the site is the heel. Prewarming the infant’s heel (42 degrees
celcius for 3 to 5 min).
Cleanse the site in an inward to outward spiraling motion and allow to dry for 30-60 seconds.
Apply the tourniquet 3 to 4 inches (7.5 to 10 cm) above the potential venipuncture site. Avoid
sites above an I.V. line, infected or edematous sites, and sites of hematoma or vascular injury.
Ask your patient to make a fist. Determine the best venipuncture site, clean it according to
protocol, and let it air-dry.
Follow the recommended order for drawing multiple specimens during a single venipuncture.
Use a butterfly needle when drawing patients that have small or fragile veins or when drawing
from the hand.
Attach the needle to the blood tube holder (adapter) and slide the specimen tube inside without
pushing it onto the needle.
Slowly insert the needle into the vein with the bevel up and at a 15- to 30-degree angle.
Stabilize the needle and push the collection tube forward so the back end of the needle
penetrates the stopper. Release the tourniquet and have the patient relax his fist as soon as
possible after blood flows freely into the tube.
Firmly gripping the adapter, let the tube fill, then pull it out of the adapter. If the tube contains an
additive, gently invert it 8 to 10 times without shaking it. Insert, remove, and invert additional
tubes as needed.
Place sterile gauze over the puncture site, then quickly withdraw the needle from the vein and
activate the safety device. Apply pressure to the site for 2 to 3 minutes or until bleeding stops.
Following facility policy, label and prepare the tubes for transport. Appropriately dispose of the
needle, adapter, and other soiled devices. Wash your hands. The key elements in labelling are:

 Patient’ surname, first and middle

 Patient’s Id number
 Note: both of the above MUST match the same on the requisition form
 Date, time, and initials of the phlebotomists must be on the label of Each tube
Label the collection tubes at the bedside or drawing area
Utilize the safety device on the need and dispose of in the proper sharps container.
Only two attempts should be allowed for a Phlebotomists to puncture veins if still failed refer to
another phlebotomist.
Document the procedure and the patient's response in the medical record as well as if the
patient had decided to have a refusal of the procedure.

DON'T
Don't use an arm with an arteriovenous fistula or one on the same side as a mastectomy or
axillary node removal.
Don't palpate the venipuncture site after you clean it.
Don't keep the tourniquet on for more than 1 minute, to minimize discomfort and prevent
hemoconcentration.
Don't push the needle to accelerate the blood enter the tube
Don't shake the tube which contain blood
Don't leave the tube contain with blood without doing proper inversion
Don't put the tube contain with blood to the centrifuge immediately after the blood draw
Don't Take equipment into isolation rooms that you will need to bring out again e.g. Sharps
containers (these should be available in the isolation room).
Don't re-sheath needles; discard immediately at point of use into sharps bin.
Do not reuse a needle, ever, even on same patient.
Don't label bottles before taking blood.
Never decant blood from one bottle to another.
Don't use a needle and syringe to collect blood unless there is good reason to do so. This will
require transfer of blood from the syringe into a "Vacutainer" tube. Don't inject the blood through
the rubber septum (health & safety risk and risk of haemolysis). Remove needle from syringe (!)
directly to sharps bin, remove "Vacutainer" tube cap and gently fill the tubes one at a time.
Replace the "Vacutainer" cap firmly. Vacutainer tubes filled in this way must NOT be sent via
the air tube system as the caps have a tendency to come off.
Don't be frightened to admit defeat – some patients are very difficult to bleed - and pass the
blood collection need back to medical staff.
Don't attempt venepuncture more than 3 times (refer on to more experienced phlebotomist or
medic after fewer attempts if you are sure you will not succeed in 3 attempts.
Don't use arterial lines to take blood. Care should also be taken not to disturb electrical
connections attached to patients and monitors.
Don't attempt to bleed patients from an arm with a drip set up. If patients have drips in both
arms, inform ward staff. Don't attempt to bleed until drip has been stopped for at least 30
minutes.
Don't attempt to bleed babies or children less than 16 years old. A paediatric phlebotomist is
employed specifically for this purpose and patients should be referred to the paediatric dept
where they may have to make an appointment