Phlebotomy Guide

Order of draw

Take extra care when bleeding patients on anticoagulant therapy. They can bleed for a longer period after venepuncture and it is important to ensure that the venepuncture site has stopped bleeding.

Apply the tourniquet 2-3 inches above the cubital fossa and palpate the area to find a suitable vein. Be aware of the brachial artery in the arm and never attempt to puncture an artery. An artery is usually deeper in the arm and has a pulse (a vein is closer to the surface and does not have a pulse, so feel carefully). Choose a vein that is 'bouncy' and that does not feel thready or fragile.

Once the vein has been located, clean the area with a Chloraprep swab. This should be applied for 30secs before being allowed to dry.

	Blood Culture - always first
	Citrate
	SST
	Lithium Heparin
	Lithium Heparin PST
	EDTA
	EDTA - cross match
	EDTA for trace elements
	Fluoride oxalate

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Order of draw poster

Assemble needle and barrel-holder. Make sure all the tubes and sharps container are in easy reach.

Warn patient that they are about to feel a scratch.

Insert the needle smoothly at a 30 - 45° angle, with the bevel of the needle uppermost. Only insert in the direction of blood flow in the vein. Maintain the needle and barrel in a steady position in the vein by bracing against the arm.

Introduce the 1st bottle into the barrel smoothly taking care not to shift the needle position. Allow it to fill under vacuum. Remove 1st tube carefully again minimising movement of the needle in the vein, and continue for all other tubes in the correct order.

Each bottle must be gently inverted several times to mix the anti-coagulants etc. thoroughly. Do not shake the tubes as this will damage the blood cells and invalidate test results.

If you feel the vein will sustain the procedure (i.e. not collapse) you should release the tourniquet whilst the tubes are filling. Never leave the tourniquet on longer than 2 minutes. Tourniquets should not be used for some tests (e.g. calcium).

During the procedure keep assessing your patient for signs of pallor, sweating, pain. If this should happen do not panic. Discontinue the procedure; make the patient comfortable and safe. Obtain support if necessary.

Once all bottles have been filled, release the tourniquet if not already done, carefully remove needle with a smooth, quick backward action. Apply dry cotton wool to the site, and apply firm pressure – patient may assist with this. Apply pressure for at least 2 – 3 minutes. Ask them to keep their arm straight. Put a little bit of tape over the cotton ball. If the patient is disorientated/confused or disabled always hold the cotton wool in place yourself until bleeding has stopped.

Immediately after removing needle from vein discard into sharps container at point of use. DO NOT RESHEATH NEEDLE.

See Blood Borne Infection Policy (12:0)