Sally brings really good grease and leaves the gravy.

Patient Identification
Prior to any patient procedure, proper identification is a priority.
Proper identification is a three-step process.
1. Ask the patient to state his/her full name.
2. Compare the name on the test requisition with the patient
response.
3. Validate patient identification by either checking the armband
from hospitalized patients, or by checking some valid form of
ID (driver’s license, military ID, etc.) from ambulatory patients.

Patient Preparation
Patient should be asked to remove any candy, gum or lozenges from
their mouth before proceeding to avoid inhalation during draw.

Specimen Collection
Equipment Preparation
4. Blood drawing chair (if patient is ambulatory)
5. Blood collection needle & holder (or syringe)
6. Proper evacuated tubes
7. Tourniquet
8. Antiseptics: alcohol, iodine, or surgical soap
9. Cotton/gauze/bandages
10. Sharps disposal container
11. Permanent marking pen or labels
12. Gloves
What is the recommended Order of Draw?
The most commonly accepted Order of Draw includes the following
sequence:
• Sterile blood culture tubes or bottles
• Coagulation tubes (e.g., citrate tubes)
• Serum tubes with or without clot activator or gel separator
• Heparin tubes with or without gel separator
• EDTA tubes (for hematology tests)
• Glycolytic inhibitor tubes (e.g., fluoride tubes for glucose testing)

FROM CLSI
1) Blood culture tube or bottle
2) Sodium citrate tube (eg, blue closure)
3) Serum tubes, including those with clot activator and gels (eg, red,
red-speckled, gold closures)
4) Heparin tube with or without gel (eg, dark green, light green,
speckled green closures)
5) EDTA tube with or without gel separator (eg, lavender, pearl, pink
closures)
6) Sodium fluoride/potassium oxalate glycolytic inhibitor (eg, gray
closure)
Routine venipuncture procedures follow:
1) Acquire and examine requisition. A written order is required for each test performed
unless the testing falls under Direct Access Testing guidelines. Check for special
specimen handling instructions before drawing, such as cooling in ice or wrapping in
foil. Have all special equipment ready before beginning, including ordering labs prior
to phlebotomy.
2) Introduce yourself to the patient
3) Identify the patient by asking their name and comparing it to the requisition and
printed labels. Visual recognition can be used as a secondary identifier, but not as a
primary
4) State the procedure you are to perform and answer any questions they may have.
5) Informed consent is necessary before drawing in all cases. Patients who refuse to be
drawn have the right of refusal and cannot be forced or constrained. This right extends
to children, even at the insistence of their parents. At times it may be necessary to ask
the parents to leave the room or have the physician or provider talk to the child. A
phlebotomist can be legally charged with assault and battery if blood is obtained
without permission of the patient. Inform the licensed provider of the patient’s refusal
and note on the requisition “Patient refused to be drawn”, date and time provider was
contacted and your initials. If blood must be drawn, the provider may make the
decision to restrain. Special informed consent forms may be required for certain drug
tests as well as HIV testing.]
6) Verify diet restrictions (such as fasting state for IR panels or lipid studies) and time of
last dose for medication checks.
7) Prepare the venipuncture equipment
8) Select a venipuncture site, preferably the median cubital vein within the antecubital
fossa, or if veins in arm are not accessible the dorsal venous arch in the hand can be
used.
9) Apply the tourniquet (tourniquet cannot be kept on for longer than 2 minutes – release
it while preparing equipment & re-tighten when ready to perform phlebotomy)
10) Palpate the venipuncture site
11) Clean the site with alcohol (please check specific cleansing requirements when
drawing blood culture tubes or blood alcohol levels)
12) Put on gloves
13) Allow the site to air dry, do not blow or fan to facilitate drying, as this may introduce
contaminants. Un-dry alcohol can cause a stinging sensation which is uncomfortable
to the patient.
14) Insert the needle
15) Engage evacuated tube onto needle holder & allow tubes to fill. See proper draw
order protocol.
16) Release tourniquet
17) Remove the needle from the arm
18) Apply pressure to venipuncture site, have patient maintain pressure for 3-5 minutes
with the arm in a straight position, not bent at the elbow. If bleeding has not yet
stopped, have the patient raise their arm and maintain pressure. Use of coumadin or
other anticoagulants may cause the patient to bleed considerably longer than usual.
19) Engage needle safety device.
20) Dispose of needle in sharps container
21) Label specimen – patient name, patient number, time, date, & phlebotomist initials
22) Check venipuncture site for clotting. If still bleeding, have patient continue to hold
until all bleeding has stopped, not just on the surface but at the vein level. Apply a
bandage, coflex, or piece of tape to the cotton ball or gauze and instruct the patient to
leave in place and not bend the elbow unnecessarily for about 15 minutes.
23) Properly put away and dispose of all other supplies and equipment that were used.
24) Thank the patient and ask if they have any questions.
 NOTES
• Veins in the legs and feet should only be used with physician
approval and can only be drawn by a RN or appropriately
trained personnel; training must be documented…
• These sites are more susceptible to infection and
formation of clots, particularly in patients with diabetes,
coagulation disorders and cardiac problems.
• Never apply a tourniquet to an arm located on the same side
of the body as a mastectomy or stroke
• If the arm contains an IV drip, it is preferable to draw from
the other arm. If this is not possible, blood may be drawn
below the IV site, preferably from a different vein, but IV must
be turned off for at least 1 hour prior. Note on the report and
requisition the site of draw.
• Arterial blood for routine testing should only be obtained in a
clinical setting by a licensed medical provider. It is outside
the scope of practice of a phlebotomist to perform an arterial
puncture and should not be attempted without proper
training. If performed improperly a patient could lose the
function of a hand or many complications can occur, such as
hematoma, thrombosis (blood clot), hemorrhage, infection
and permanent nerve damage.
• Avoid drawing through moles, scars, or any other skin
irregularities.
• Do not go through the same hole twice unless previous
puncture has had appropriate time to heal.
Fecalysis pdf
STOOL
COLOR
 URINALYSIS – TEST STRIP

1. Leukocytes (for possible inflammation)

2. Nitrites (for bacteria in urine)
3. Urobilinogen (for liver health)
4. Protein (for kidney and urinary tract health)
5. pH (for acidity and alkalinity of the urine sample)
6. Blood (for visible and non-visible blood in urine)
7. Specific Gravity (for hydration status and the body's ability to
conserve water)
8. Ketones (for diabetes and high-fat/low-carb diets)
9. Bilirubin (for liver health)
10. Glucose (for diabetes)

Reading times
The reading time refers to the time at which the color of the pad should be
compared with the color key. The reading time varies for each parameter,
ranging from 30 seconds (for the glucose pad) to 120 seconds (for the
Leukocyte pad).
How to conduct a urinalysis test?
You can easily conduct a urinalysis test with a urine dipstick at home
or in professional settings by following these steps:
1. ‍Immerse
• Immerse the strip into the urine sample and remove it
immediately by dragging the edge of the strip against the
container rim to remove excess urine. If reading the strip
visually, start timing.
• It is essential that you always use a fresh urine specimen in a
clean, dry container.

2. Wait
• Place the strip horizontally on a paper towel or tissue to
remove excess and wait until the results are ready to be read.
The reading time for different tests is provided on the
product packaging or package insert.

3. Compare
• Compare each test pad to the corresponding row of the color
chart on the package insert (or packaging) to find the closest
match (see an example color chart below). It is essential to
read the results carefully in a good light. Usually, changes in
color that appear after 2 minutes are of no diagnostic
significance – therefore, try to read results as soon as they
are ready.

Interpretation of results
• Leukocytes in urine signify inflammation in the urinary tract.
• Nitrites in urine may be a sign of a urinary tract infection (UTI).
Normal urine contains chemicals called nitrates.
• Urobilinogen - Normal urine contains some urobilinogen (up to
1.0 mg/dL). If there is little or no urobilinogen in urine, it can
mean the liver isn't working correctly. Too much urobilinogen (>
2 mg/dL) in urine may indicate liver diseases such as hepatitis or
cirrhosis.
• Protein is normally found in the blood. large amount of protein
in the urine may indicate kidney disease
• PH - Normal urine is slightly acidic, with pH values ranging from
5 to 8. A high urine pH (>8) indicates alkaline urine and may be
due to kidneys that do not properly remove acids from the body
or due to kidney failure, stomach pumping (gastric suction),
urinary tract infection, or vomiting. Urinary pH is a vital indicator
of kidney, gastrointestinal, respiratory, and metabolic health.
• Blood in the urine is also known as hematuria and may be a sign
of possible kidney damage, infection, kidney or bladder stones,
kidney or bladder cancer, or blood disorders. Blood is often, but
not always, found in the urine of menstruating females.
• Urine specific gravity is a measure of the concentration of all
chemical particles in the urine. Healthy adults have urine specific
gravity ranging from 1.003 to 1.030. A higher-than-normal
concentration often is a result of not drinking enough fluids.
Reduced specific gravity may indicate diabetes and other renal
disorders, while elevated levels indicate liver disease, excessive
loss of free water, or congestive heart failure.
• Ketones are not normally found in the urine. They can form
when a person does not eat enough carbohydrates (for example, in
cases of fasting, starvation, or high-protein diets) or when a
person's body cannot use carbohydrates properly
• Bilirubin - Increased bilirubin levels ((Bilirubinuria) indicate
different forms of liver disease, e.g., cirrhosis, hepatitis, gallstone,
biliary tract disease, and is an early indicator of jaundice
development. Even trace amounts of bilirubin are sufficiently
abnormal to require further investigation.
• Glucose is normally not present in urine. When glucose is
present, the condition is called glucosuria. This often happens if
there is an abnormally high level of glucose present in the blood.
The normal glucose range in urine is 0 to 0.8 mmol/l (0 to 15
mg/dL). Higher values may occur with diabetes, renal glycosuria,
or during pregnancy (due to gestational diabetes).