The venipuncture procedure is complex, requiring both knowledge and skill to perform. Each phlebotomist generally establishes a routine that is comfortable for her or him.
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Phlebotomists are considered to have occupational exposure to blood borne pathogens. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Precautions include a medical grade face mask. With risk for blood spatter a face shield provides protection. A face mask reduces risk for blood culture specimen contamination.
Laboratory coats or work smocks are not typically needed as personal protective equipment during routine venipuncture, but an employer must assess the workplace to determine whether certain tasks, workplace situations, or employee skill levels may result in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. As part of presenting a professional appearance, an institutional dress code may include wearing of a laboratory coat or smock.
Patient identification is critical for safety. At least two patient identifiers, such as name and date of birth, are needed. Label collection tubes after identification of the patient. Interruptions and distractions during medical encounters and procedures should be avoided.
Several essential steps are required for every successful collection procedure:
Patient comfort. Is the seating comfortable and has the patient been seated for at least 5 minutes to avoid being rushed or confused?
Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves.
Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" and "What is your date of birth?"
Assess the patient's physical disposition (i.e. diet, exercise, stress, basal state).
Check the requisition form for requested tests, patient information, and any special requirements.
Label the collection tubes at the bedside or drawing area.
Select a suitable site for venipuncture.
Prepare the equipment, the patient and the puncture site.
Perform the venipuncture, collecting the sample(s) in the appropriate container(s).
Recognize complications associated with the phlebotomy procedure.
Assess the need for sample recollection and/or rejection.
Safely discard potentially infectious materials.
Promptly send the specimens with the requisition to the laboratory.
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Dalal BI, Brigden ML. Factitious biochemical measurements resulting from hematologic conditions. Am J Clin Pathol. Feb;131(2):195-204.
Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Phlebotomy issues and quality improvement in results of laboratory testing. Clin Lab. ;52(5-6):217-30.
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Occupational Safety and Health Administration, United States Department of Labor. https://www.osha.gov/laws-regs/standardinterpretations/-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, ).
Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. Am J Clin Pathol. ;148(4):330-335.
Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. Use of hair nets and face masks to decrease blood culture contamination rates. Diagn Microbiol Infect Dis. ;95(1):15-19. doi: 10./j.diagmicrobio..04.001.
Uman LS, Birnie KA, Noel M, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. Oct 10;(10):CD. doi: 10./.CD.pub3.
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World Health Organization. WHO guidelines on drawing blood: best practices in phlebotomy. https://www.ncbi.nlm.nih.gov/books/NBK/pdf/Bookshelf_NBK.pdf (Accessed June 13, )
And for our furry friends:
Joslin JO. Blood Collection Techniques in Exotic Small Mammals. Journal of Exotic Pet Medicine. ;18(2):117-139.
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