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• Required information on a requisition


  • Patient's first and last names
  • Identification number
  • Patient's date of birth
  • Patient's location (rm no.)
  • Ordering health-care provider's name
  • Tests requested
  • Requested date and time of sample collection
  • Status of sample (stat, timed, routine)
  • Special collection information (such as fasting sample)
  • Special patient information (such as areas that should not be used for venipuncture, and latex sensitivity)
• Greeting patient


  1. Introduce themselves

  2. Say they are from the laboratory

  3. Explain they will be collecting a blood sample

  4. Explain the procedure in non-technical terms and in a manner the patient can understand
• Observe any signs on the patient's door or in the patient's room relaying special instructions, such as allergy to latex, NPO, DNR, do not draw blood from (particular) arm
• When entering a patient's room, it is polite to knock lightly on the open or closed door to make your presence known
• Phlebotomists


  • Demonstrate concern for the patient's comfort
  • Demonstrate confidence in their own ability to perform the procedure, including any nonroutine techniques
• If the patient asks for questions other than the tests to be done, the best policy is to politely suggest that they ask their physician these questions
• Blood should never be drawn from a patient who is in a standing position
• Outpatients should be seated or reclined at a drawing station
• The patient's arm should be firmly supported and extended downward in a straight line, allowing the tubes to fill from the bottom up to prevent reflux and anticoagulant carryover between tubes
• Equipment selection


  1. Collect all necessary supplies (including collection equipment, antiseptic pads, gauze, bandages, and needle disposal system)

  2. Place them close to the patient

  3. Do not place the blood collection tray on the bed or on the patient's eating table
• Tourniquet


  • Causes blood to accumulate in the veins making them more easily located
  • Provides a larger amount of blood for collection
  • Can alter some test results by increasing the ratio of cellular elements to plasma (hemoconcentration) and by causing hemolysis
  • Maximum time tourniquet should remain in place is 1 minute
• The tourniquet should be placed on the arm 3-4 inches above the venipuncture site
• Preferred site for venipuncture


  • Antecubital fossa located anterior and below the bend of the elbow
  • The three major veins: the median cubital, the cephalic and the basilic vein
  • The most often seen arrangement of veins in the antecubital fossa are referred to as the "H-shaped" and "M-shaped" patterns
• Two Routine Steps in the Venipuncture Procedure that Aid the Phlebotomist in Locating a Suitable Vein


  1. Applying a tourniquet

  2. Asking the patient to clench his or her fist
• Palpation


  Locating veins by touch, using the tip of the index finger of the non-dominant hand to probe the antecubital area with a pushing motion rather than a stroking motion
• Cleansing the site


  1. Use a 70% isopropyl alcohol pad/cotton

  2. Cleanse with a circular motion, starting at the inside of the venipuncture site and working outward in widening concentric circles about 2-3 inches
• Place assembled venipuncture equipment within easy reach; however do not place the collection tray on the patient's bed
• Examining the needle


  Immediately before entering the vein, remove the plastic cap and visually examine the point of the needle for any defects such as a non-pointed or rough end
• Anchoring the vein


  Place the thumb 1 or 2 inches below and slightly to the left of the insertion site and the four fingers on the back of the arm and pull the skin taut
• Inserting the needle


  1. Align the needle with the vein and insert it, bevel up, at an angle of 15 to 30 degrees depending on the depth of the vein

  2. After the insertion, brace the fingers against the patient's arm to provide stability while tubes are being changed or plunger of the syringe is being pulled back
• Filling the tubes


  1. Push the evacuated tube completely into the holder

  2. Use the thumb to push the tube onto the back of the evacuated tube needle, while the index and middle fingers grasp the flared ends of the holder

  3. Release the fist and tourniquet once blood begins to flow into the tube
• Removal of the needle


  1. Remove the tourniquet by pulling on the free end

  2. Tell the patient to relax his or her hand

  3. Place a folded gauze or clean dry cotton over the venipuncture site and withdraw the needle in a smooth swift motion

  4. Apply pressure to the site as soon as the needle is withdrawn
• Disposal of the needle


  Immediately dispose the contaminated needle and holder in an acceptable sharps container located near the patient
• Labeling the tubes


  Label the tubes after the sample has been collected by writing on the attached label or by applying a computer-generated label that may also contain a designated bar code
• Bandaging the patient's arm


  1. Apply a gauze pad or clean dry cotton

  2. Place a hypoallergenic tape on top

  3. Bleeding at the venipuncture site should stop within 5 minutes
• Leaving the patient


  1. Dispose all used supplies

  2. Wash hands

  3. Return the bed and bed rails to the original position
• Venipuncture procedure using the syringe


  • Obtain the test request
  • Identify the patient
  • Verify diet restrictions
  • Prepare the patient for testing
  • Assemble the equipment and supplies
  • Wash hands and put on gloves
  • Position the patient
  • Apply the tourniquet
  • Ask the patient to make a fist
  • Select the venipuncture site
  • Release the tourniquet
  • Clean the site
  • Verify equipment and tube selection
  • Reapply the tourniquet
  • Pick up and position the blood collection equipment
  • Remove the cover and inspect the needle
  • Anchor the vein
  • Insert the needle into the vein
  • Fill the syringe
  • Withdraw the needle
  • Engage safety device
  • Dispose sharps
  • Transfer blood to evacuated tubes
  • Label the tubes
  • Check the patient's arm and apply bandage or micropore tape
  • Dispose the contaminated materials
  • Thank the patient
  • Remove gloves and wash hands
  • Transport the specimens to the laboratory
• Pre-examination variables


  • Diet
  • Exercise
  • Stress
  • Smoking
  • Altitude
  • Age and gender
  • Pregnancy
• Diet


  • Ingestion of food and beverages alters the level of certain blood components, affecting tests like glucose and triglycerides
  • Alcohol consumption can cause transient elevation in glucose levels and affect liver and triglyceride tests
  • Caffeine can affect hormone levels
  • Excessive liquid intake can alter hemoglobin levels and electrolyte balance
• Exercise


  Moderate or strenuous exercise affects laboratory test results by increasing the blood levels of various components like creatinine, fatty acids, enzymes, hormones, and decreasing arterial pH and PCO2
• Stress


  Failure to calm a frightened, nervous patient before sample collection may increase adrenal hormones, WBC counts, and affect arterial blood gas results
• Smoking


  Immediate effects include increased plasma catecholamines, cortisol, glucose, BUN, cholesterol, and triglycerides
• Altitude


  RBC counts and hemoglobin (Hgb) and hematocrit (Hct) levels are increased in high-altitude areas due to reduced oxygen levels
• Age and gender


  • Laboratory results vary between infancy, childhood, adulthood, and the elderly due to gradual changes in body fluid composition
  • Hormone levels vary with age and gender
  • RBC, Hgb, and Hct values are higher for males than females
• Pregnancy


  Physiological changes affect some laboratory results, including increased plasma volume which can cause a dilutional effect on certain components
• Smoking


  Immediate effects of nicotine include increased plasma catecholamines, cortisol, glucose, blood urea nitrogen (BUN), cholesterol, and triglycerides
• Altitude


  RBC counts and hemoglobin (Hgb) and hematocrit (Hct) levels are increased in high-altitude areas such as the mountains where there are reduced oxygen levels
• Age and Gender


  • Laboratory results vary between infancy, childhood, adulthood, and the elderly because of the gradual change in the composition of body fluids
  • Hormone levels vary with age and gender
  • RBC, Hgb, and Hct values are higher for males than for females
• Pregnancy


  • Physiological changes in the body during pregnancy affects some laboratory results including increased plasma volume
  • The increased plasma volume may cause a dilutional effect and cause lower RBC counts, protein, alkaline phosphatase, estradiol, free fatty acids, and iron values
  • The ESR and coagulation factors may also be increased
• Diurnal Variation


  • The concentration of some blood constituents is affected by the time of day
  • Diurnal rhythm is the normal fluctuation in blood levels at different times of the day based on a 24-hour cycle of eating and sleeping