Blood Collection Equipment, and Order of Draw

• NAACLS Entry Level Competencies

  • Demonstrate knowledge of collection equipment, various types of additives used, special precautions necessary, and substances that can interfere in clinical analysis of blood constituents
• NAACLS Entry Level Competencies

  1. Identify the various types of additives used in blood collection, and explain the reasons for their use

  2. Identify the evacuated tube color codes associated with the additives

  3. Describe the proper order of draw for specimen collections

  4. Describe substances that can interfere in clinical analysis of blood constituents and ways in which the phlebotomist can help to avoid these occurrences

  5. List and select the types of equipment needed to collect blood by venipuncture and capillary (dermal) puncture

  6. Identify special precautions necessary during blood collections by venipuncture and capillary (dermal) puncture
• Key Terms

  • ACD
  • additive
  • anticoagulants
  • antiglycolytic agent
  • antiseptics
  • bevel
  • biocide
  • blood collection sets
  • carryover/cross-contamination
  • clear/discard tube
  • clot activator
  • CPD
  • disinfectants
  • EDTA
  • ETS
  • evacuated tubes
  • gauge
  • glycolysis
  • heparin
  • hypodermic needle
  • lumen
  • multisample needles
  • order of draw
  • potassium oxalate
  • PPTs
  • PSTs
  • RST
  • SESIP
  • sharps containers
  • sodium citrate
  • sodium fluoride
  • SPS
  • SSTs
  • syringe transfer device
  • thixotropic gel
  • trace element-free tubes
  • winged infusion set
• Objectives

  1. List, describe, and explain the purpose of the equipment and supplies needed to collect blood specimens by venipuncture, and define associated terms and abbreviations

  2. List and describe evacuated tube system (ETS) and syringe system components, explain how each system works, and tell how to determine which system and components to use

  3. Demonstrate knowledge of the types of blood collection additives, identify the chemical composition of the specific additives within each type, and describe how each additive works

  4. Describe ETS tube stopper color coding used to identify the presence or absence of an additive, connect additives and stopper colors with laboratory departments and tests, and list the order of draw and explain its importance
• The primary duty of the phlebotomist is to collect blood specimens for laboratory testing
• Choosing the appropriate tools and using them correctly helps assure the safe collection of high-quality blood specimens
• Several Methods in Collecting Blood

  1. Arterial Puncture

  2. Capillary Puncture

  3. Venipuncture
• Blood Collection Equipment

  • A variety of equipment is used in blood collection. Some equipment can be used with any method of blood collection and some is specific to the method used
• General Blood Collection Equipment and Supplies

  • The following sections describe the equipment and supplies commonly needed for all methods of collecting blood specimens
• Blood-Drawing Station

  • A blood-drawing station is a dedicated area of a medical laboratory or clinic equipped for performing phlebotomy procedures on patients, primarily outpatients sent by their physicians for laboratory testing. A typical blood-drawing station includes a table for supplies, a special chair where the patient sits during the blood collection procedure, and a bed or reclining chair for patients with a history of fainting, persons donating blood, and other special situations. A bed or padded table is also needed if heel sticks or other procedures will be performed on infants and small children
• Phlebotomy Chairs


  • Patients who have their blood drawn while in a seated position must be seated in a commercial phlebotomy chair
• Equipment needed for heel sticks or other procedures on infants and small children

  • Bed
  • Padded Table
• Commercial Phlebotomy Chairs features

  • Adjustable Arm Rest
  • Hydraulic Height Adjustment
  • Chairs that decline
• Caution: In the absence of a commercial phlebotomy chair, precautions must be taken to prevent falls and ensure client safety
• Equipment Carriers

  • Handheld Carriers
  • Phlebotomy Carts
• Handheld Carriers features

  • Designed to be easily carried by the phlebotomist
  • Contain enough equipment for numerous blood draws
• Phlebotomy Carts features

  • Made of stainless steel or strong synthetic material
  • Have swivel wheels for smooth movement
  • Have several shelves to carry supplies for obtaining blood specimens from many patients
• Keeping carts and trays adequately stocked with supplies is an important duty of the phlebotomist
• Gloves acceptable for most phlebotomy procedures

  • Nitrile
  • Neoprene
  • Polyethylene
  • Vinyl
• Latex gloves are not recommended due to the prevalence of latex allergies
• The U.S. Food and Drug Administration (FDA) has banned the use of powdered gloves in medicine due to health risks
• Health risks associated with powdered gloves

  • Airway and lung Inflammation
  • Hypersensitivity
  • Allergic reactions
  • Granulomas (nodular inflammation)
  • Peritoneal Adhesions (fibrous bands)
• Special glove liners available for individuals with allergies or dermatitis

  • Barrier hand creams that help prevent skin irritation and are compatible with most gloves
• The FDA regulates glove quality
• Types of gloves

  • Nitrile
  • Neoprene
  • Polyethylene
  • Vinyl
• Acceptable for Phlebotomy procedures
• Powdered Gloves in Human Health
• Airway and lung Inflammation
• Hypersensitivity
• Allergic reactions
• Granulomas (nodular inflammation)
• Peritoneal Adhesions (fibrous bands of scar tissue)
• Special Glove Liner (Carpenter Gloves)
• Develop Allergies / Dermatitis
• Barrier Hand Creams
• Caution: Decontamination of hands after glove removal is essential. Any type of glove may contain defects that result in contamination of the hands that might not be visible. In addition, some studies suggest that vinyl gloves may not provide an adequate barrier to viruses
• Misconception Alert: Do not make the mistake some students made in answering the following question from the Jones & Bartlett Learning TestPrep: Decontamination of hands after glove removal is essential because: Decontamination is needed to quickly restore normal flora Gloves cause pathogens to multiply on the surface of the skin Hand decontamination might not be visible to the naked eye All of the choices are correct 34% of the students that answered this question incorrectly chose “All of the choices are correct.” Read all the choices carefully. Decontamination of hands is needed to remove possible pathogens, not restore normal flora. Gloves do not cause pathogens to multiply on the surface of the skin, they protect the skin from exposure to pathogens. One reason hands must be decontaminated after glove removal is that gloves can have defects that allow the hands to become contaminated. However, the contamination might not be visible with the naked eye, which is the correct answer to the question
• Antiseptics are substances used to prevent sepsis, which is the presence of microorganisms or their toxic products within the bloodstream. They prevent or inhibit the growth and development of microorganisms but do not necessarily kill them. They are considered safe to use on human skin and are used to clean the site prior to blood collection
• The antiseptic most commonly used for routine blood collection is 70% isopropyl alcohol (isopropanol) in individually wrapped prep pads
• For a higher degree of antisepsis, the traditional antiseptic has been povidone-iodine in the form of swab sticks or sponge pads for blood culture collection and prep pads for blood gas collection. However, the use of alcohol-based preparations for these procedures is increasing because many patients are allergic to povidone-iodine