Blood Draw Procedure and Techniques

Blood Draw Best Practices, Order of Draw, and Proper Procedure,

The practice of drawing blood from a vein or phlebotomy is essential for a variety of medical procedures and tests to diagnose a patient. It is a proficiency that nurses should learn, and phlebotomists should excel at.

A nurse well-versed in phlebotomy contributes to better patient care. When a lab test is ordered immediately, they should be able to draw blood even when phlebotomists are not around.

Best Practices of Blood Draw Procedure

This process is not as simple or as straightforward as it seems. There are blood draw techniques and order that nurses and phlebotomists must follow.

The World Health Organization has established the best practices in phlebotomy.

1. Planning must be done at the start of a phlebotomy session to ensure success and the comfort of a patient.
2. Blood draw must be carried out in an appropriate location whether outpatient or inpatient. The best location is an area that is quiet, clean, and well-lit.
3. Quality control in phlebotomy covers several elements:

• Education and training of the person to draw blood
• Standard operating procedures required for each step
• Correct identification of a patient
• Assurance of the quality and condition of the sample
• Safe transportation of blood or blood products
• A system in place for reporting incidents and other adverse events

4. Quality control of laboratory sampling is vital in the integrity of laboratory results. Proper collection and transportation are critical.
5. There should be provisions to ensure quality care for patients and health workers.

• Appropriate blood draw supplies and protective equipment
• Post-exposure prophylaxis
• Prevention for contamination of phlebotomy equipment
• Appropriate training in phlebotomy
• Patient involvement and cooperation

Blood Draw Order

Speaking of the quality of laboratory sampling, phlebotomy must follow a certain order when collecting samples. The colored top of blood collection tubes helps identify the order of blood draw.

1 – Blood Cultures

• Tube Color: Varies
• # of Inversions: 8 – 10

2 – Sodium Citrate

• Tube Color: Light Blue
• # of Inversions: 3 – 4

3 – Clot Activator

• Tube Color: Red
• # of Inversions: 4 – 5

4 – SST (Serum Separator Tube)

• Tube Color: Gold
• # of Inversions: 4 – 5

5 – Lithium Heparin

• Tube Color: Light Green
• # of Inversions: 8 – 10

6 – Sodium Heparin

• Tube Color: Dark Green
• # of Inversions: 8 – 10

7 – EDTA

• Tube Color: Lavender
• # of Inversions: 8 – 10

8 – Sodium Fluoride / Potassium Oxalate

• Tube Color: Gray
• # of Inversions: 8 – 10

Blood draw order is not only important to phlebotomists is but also to patients. By following the order of collection tubes, the time it takes to perform phlebotomy is decreased.

It also helps reduce patient discomfort, prevent misdiagnosis, avoid complications, and prevent cross-contamination of additives.

How to Draw Blood from a Vein

1. Identify the appropriate vein to puncture.

• Median cubital vein in antecubital fossa
• Basilic vein
• cephalic vein

The first on the list is the most common and often the first choice, especially for novice phlebotomists.

2. Gather the appropriate supplies for blood draw. Be sure to bring extras in case a second attempt for venipuncture is required.

• Appropriate blood-drawing needles
• Alcohol swabs for skin disinfection
• Adhesive bandage/tape
• Blood transfer device
• Bio-hazard leak-proof transportation bags
• Evacuated Collection Tubes (tubes specific to labs ordered)
• Gauze
• Hand Sanitizer
• Laboratory specimen labels
• Laboratory forms
• Personal Protective Equipment (i.e. gloves)
• Puncture resistant sharps container
• Tourniquet

3. Identify the patient correctly and explain the procedure.

• Use two patient identifiers identify the patient
• Confirm the order tests
• Fill out appropriate forms and labels
• Check for any allergies or sensitivities

4. Prepare the patient for a blood draw. Position them properly and hyperextend their arm.
5. Perform pre-venipuncture safety procedures. Wear appropriate PPE and perform good hand hygiene.
6. Prepare the patient for phlebotomy.

• Apply a tourniquet approximately 3 to 4 inches above the intended puncture site.
• Ask the patient to make a fist but not to pump the hand.
• Clean the venipuncture site with an alcohol pad for 30 seconds. Then, air dry for another 30 seconds.

7. Grab the patient’s lower arm, just below the puncture site, to keep the vein from rolling and to draw the skin taut and give you a clear view of the vein.
8. Insert the needle at an angle of 15 to 30 degrees. Blood should flash into the catheter if done properly.
9. Attach the syringe or tube needed to remove the right volume of blood.
10. As the last amount of blood is drawn, remove the tourniquet.
11. Remove the needle and then press down on the venipuncture site with a gauze.
12. Dispose of contaminated needles and materials in appropriate containers.
13. Label tubes at the bedside and place in transport bins or bags.
14. Deliver blood specimens without delay to prevent hemolysis that can skew the lab results.

Additional sources:

https://sciencediscoveries.degruyter.com/order-blood-draw-importance-blood-sample-collection/

https://www.phlebotomyinfo.com/phlebotomy-order-of-draw/

https://www.ncbi.nlm.nih.gov/books/NBK138665/