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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure

VENIPUNCTURE PROCEDURE

PURPOSE
This procedure provides instructions for collecting venous blood samples for laboratory testing
while ensuring the following:
1. Patient Safety
2. Employee Safety
3. Correct (color) tubes are collected for tests ordered.
4. Collection is performed in a timely manner.
5. Test types and times are consolidated when appropriate to minimize unnecessarily large
blood volumes
6. All specimens are uniquely identified and labeled as per CLSI standard.
NOTE: Click Here to access Appendixes and Shortcuts to specific procedure details.
PROCEDURE
Equipment:
1. Vacutainer Safety Needles with pre-attached holder
a. 21G (green)
b. 22G (black)
2. 23G Push Button Blood Collection Set (Butterfly)
3. 21G & 22G Hypodermic Syringe Needles
4. Single use Vacutainer holder
5. 3ml, 6ml, 12ml & 20ml Syringes
6. Non-latex Tourniquet
7. 70% Isopropyl Alcohol wipes
8. Gauze
9. Paper Tape or Bandages
10. Blood Collection tubes- See Standardization of Blood Collection Tubes
11. Non-latex gloves
12. Marker or Pen

Safety Precautions:
1. Wash hands or use Quick-Care Foam and change gloves between each patient.
2. Use Standard Precautions. All patient blood specimens are to be treated as infectious.
3. Engage safety device and dispose used needle in Sharps container.
4. Follow all established isolation policies.
5. Phlebotomy carts and trays, and sharps containers must be locked or attended at all times
in accordance with Joint Commission regulations.

Quality Assurance:
1. Make no more than two attempts to collect a specimen.
2. A new, sterile needle must be used for each phlebotomy attempt.
3. Inspect gloves to assure there are no rips or tears.
4. Inspect needle tip for burrs or irregularities.
5. Take note of patient’s age and observe guidelines for Age Specific Concerns.

Procedure:
1. Locate Patient
a. All inpatient locations are listed on the tube label or requisition. Their location consists of
both a room number and a bed number.

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure

2. Evaluate Labels and Orders
a. Review all tests requested. Check for duplicate orders.
b. Check with nursing before combining TIMED and ROUTINE orders.
c. Note any patient restrictions or special drawing and handling instructions. Some tests
may require special handling prior to or during collection. Please refer to specific
test in department procedure for detailed instructions. Click here for Isolation Policy.
d. Clarify unclear or ambiguous orders to ensure proper collection.
e. In order to minimize the collection of unnecessarily large blood volumes, refer to the
following tables:
1) Volumes for Neonatal Testing
2) Maximum Draw Volumes for Pediatrics
3) Guidelines for Minimal Blood Draw Volumes

3. Greet the Patient
a. Identify yourself and the department which you represent. Explain why you are there.
b. You must obtain patient approval before drawing a sample. Consent, while it need not
be documented, can be either verbal or nonverbal communication. The patient has the
right to refuse the phlebotomy procedure.
c. Do not attempt to answer medical questions about the tests being drawn. You must
refer the patient to their physician or nurse.

4. Identify Patient
Prior to collecting a blood specimen, a minimum of two patient identifiers must be used
to verify the patient’s identity. Acceptable patient identifiers (stated by patient and / or
printed on wristband) include name, medical record number, social security number and
date of birth. Patient Identifiers must be compared with printed information on the
specimen labels or requisition and the patient wristband.

If a patient is unable to state the requested identifiers, a family member or caregiver may
be asked to provide the information, or the wristband may be used as the sole means of
identification.

a. Inpatients
1) Always ask the patient’s name.
2) Check the patient’s wristband.
3) Match collection labels or requisition to the wristband, checking both the patient
name and a second unique identifier specific to your hospital Patient Identification
Policy.

b. Outpatients
1) Use patient’s full name when addressing them.
2) Ask patient to state their first and last name as well as another unique identifier such
as date of birth prior to collection of sample.
3) Match the stated information to the collection labels or requisition, checking both
patient identifiers.

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure

c. Patient without wristband
1) If a patient is not wearing an identification wristband, and is a registered hospital
inpatient or outpatient, notify the patient’s nurse and have the patient banded prior to
collection of the sample.
2) For patients unable to state their name and an additional identifier (unconscious,
confused, young children, handicapped, or non-English speaking patients), refer to
individual hospital policy.
3) In a critical / emergency situation the patient may be identified by a physician or a
member of the nursing staff that is present in the patient’s room. A family member or
significant other may also identify the patient.
4) For emergency Blood Bank specimens, follow the Specimen Acceptability Criteria
Hospital Inpatient and Outpatient Policy

5) Emergency Armbands

See Individual Institutional Policies or contact laboratory.

5. Assemble Necessary supplies
a. Evacuated Tube System
1) Remove Vacutainer needle with pre-attached holder from packaging.
2) Pull back safety device on needle to provide an unobstructed view of the puncture
site.
3) Inspect the tip of the needle to determine that it is free of hooks or burrs at the point
and that the bevel is free of any small particles that could obstruct the flow of blood.

b. Venipuncture using Hypodermic needled and syringe
1) Remove needle from packaging.
2) Choose appropriate size syringe to match volume of blood required.
3) Thread needle onto syringe maintaining sterility of the needle.
4) The plunger must be moved within the barrel of the syringe to show syringe and
needle patency and freedom of plunger movement.
5) Inspect the tip of the needle to determine that it is free of hooks or burrs at the point
and that the bevel is free of any small particles that could obstruct the flow of blood.

c. Venipuncture with Push-Button Butterfly and syringe
1) Select largest size syringe that vein can handle.
2) The plunger must be moved within the barrel of the syringe to show syringe and
needle patency and freedom of plunger movement.
3) Inspect the tip of the needle to determine that it is free of hooks or burrs at the point
and that the bevel is free of any small particles that could obstruct the flow of blood.
4) Remove luer adapter and maintaining sterility, attach a clean syringe to the open end
of the butterfly.

d. 6.3 Venipuncture with Push-Button Butterfly and evacuated tube system
1) Thread single-use holder onto needle end until it is secure. Take care not to turn
holder forcefully as threads are easily stripped.
2) Inspect the tip of the needle to determine that it is free of hooks or burrs at the point
and that the bevel is free of any small particles that could obstruct the flow of blood.

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
6. Properly position patient.
a. Seated patients- When seated, a patient’s arm should be supported firmly and extended
downward in a straight line from the shoulder to the wrist. Make sure to observe patients
for any signs of dizziness or fainting.
b. Bedded patients- When lying down, the patient’s arm should be extended in a straight
line from shoulder to wrist. Support arm if necessary.

c. Be aware of employee ergonomic issues when positioning patient. Lowering bed rails or
raising the height of the patient’s bed may help the employee to perform the
venipuncture in a more ergonomically correct position.

7. Application of Tourniquet or Blood Pressure Cuff
a. Use of Tourniquet
1) Apply the tourniquet at least 3-4 inches above the venipuncture site. The tourniquet
should remain “flat” around the patient’s arm to avoid any discomfort. You may place
the tourniquet over the patient’s clothing or place a tissue between the skin and
tourniquet if they are sensitive to the tourniquet (excessive hair on arm or any
epidermal condition). The tourniquet should not be so tight as to restrict arterial flow.
2) After applying the tourniquet the patient may be requested to make and hold a fist.
However, the patient must not be allowed to pump hand.
3) The tourniquet should be left on the site for no longer than 1 minute due to the
possibility of hemoconcentration and / or the variation of test values.

b. Use of Blood Pressure cuff.
1) The blood pressure cuff is applied to the patient’s arm and inflated to 40 mm Hg.
2) After applying the blood pressure cuff the patient may be asked to make and hold a
fist. However, the patient must not be allowed to pump hand.
3) The blood pressure cuff should not be left on the site for longer than 1 minute due to
the possibility of hemoconcentration and / or the variation of test values.

8. Select the Vein Site
Diagram: Anatomy of the Anticubital

 Both arms should be assessed to determine if the median cubital or
cephalic vein are viable options before collecting a sample from a basilic or
hand vein.
 To locate veins it is necessary to palpate and trace the path of veins several
times with the index finger. It is often best to use the index finger of the hand that
is opposite from the hand you will draw with.
 If superficial veins are not readily apparent, blood can be forced into the vein by
massaging the arm from the wrist to elbow.
 Warming the site by applying a warm blanket, or a commercial warming device
(following manufacturer’s directions) for five minutes may dilate the vein.
 Lowering the extremity over the bedside will allow the veins to fill to capacity.

a. Median Cubital Vein- This is the first choice to draw from. It is usually larger and
anchored best. It also tends to bruise less and is the least painful.
b. Cephalic Vein (thumb side)- This is the second choice for a draw site. It does tend to
roll and can bruise easily.

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
c. Basilic Vein (little finger side)- This is the third choice for a draw site. This vein tends to
be painful when drawn and is very close to an artery. It also bruises easily.
d. Hand / Wrist- Veins of the hands and wrist are more delicate and smaller in diameter.
They bruise extremely easily. Veins of the anterior (palm side) wrist should never be
considered for a venipuncture.
e. Feet / Ankle- This site is drawn only with physician’s order. Check with the patient’s
nurse to get a physician’s order for a foot draw if there are no available sites on the
patient’s arms or hands. It is recommended that these veins be drawn with a butterfly
and syringe. Upon completion of draw, apply pressure until bleeding stops. This is to
prevent clots in patients who are prone to thrombosis.

f. Other considerations

1) Blood Draws from Peripheral IVs: Follow individual Allina institutional policy and
procedure for sample collection from peripheral IVs. If has been noted that a
decrease in sample quality may occur utilizing the collection methodology.

2) Below an IV: Current guidelines recommend that whenever possible the arm
opposite an IV should be utilized unless there is no other alternative.

a) Have the RN turn off patient IV for 2 minutes.
b) Apply the tourniquet below the IV site.
c) Perform the venipuncture.
d) Indicate on the request / label that the sample was drawn from a site below an IV.
e) Ask the RN to turn the IV back on when the draw is complete.

3) Above an IV: In general collection above an IV is not recommended and should
only be attempted when other alternatives have been exhausted.

a) Have the RN turn off patient IV for 2 minutes.
b) Select a vein other than the one with the IV.
c) Perform the venipuncture.
d) Ask the RN to turn the IV back on when the draw is complete.
e) Note: a physician order is required to perform this procedure at United Hospital

4) Indwelling Lines or Catheters: RNs are able to draw blood from lines or catheters
after complete, thorough and documented training. Refer to institutional policies and
procedures. Venipuncture should be avoided from an arm containing a PICC line.
Blood cultures should not be collected from Lines or Catheters unless specifically
ordered by a physician.

5) Saline Lock: Lab tests may be drawn above or below a saline lock with the following
protocol: Identify when lock was last flushed. Venipuncture should not be attempted
if saline lock has been used within 5 minutes.

6) Mastectomy with lymph node dissection: Do not draw from an arm on the side of
an axillary node dissection with because of lymphostasis. If there is no alternative
site or if there has been a bilateral axillary node dissection, approval of the physician
is required to draw from any site.

7) Extensive Scarring: Burned or healing areas should be avoided.

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure

8) Hematoma: Specimens collected from a hematoma may cause erroneous results. If
another site is not available the venipuncture should be performed below the
hematoma.

9) Cannula, Fistula, Shunt: These are venous access devices reserved for kidney
dialysis. The arm, which contains these devices, should not be used for blood
collection. Patients with a kidney dialysis access device that is no longer used or is
not working may request that the venipuncture be performed in the arm. It is
acceptable to do so with the physician’s approval. Place the tourniquet below the
device and obtain the blood from this area.

10) Casts, Slings and other unusual situations: Consult with patient’s nurse to obtain
permission to draw patient.

9. Cleanse the Area
The vein site should be cleansed to prevent any chemical or microbial contamination of
either the patient or the specimen.
a. Use a gauze pad with a 70% isopropyl or commercially prepared alcohol pad.
b. Cleanse the site with a circular motion from the center to the periphery.
c. Allow the area to air dry to prevent hemolysis of the specimen and to prevent the patient
from experiencing a burning sensation when the venipuncture is performed.
d. If the venipuncture proves difficult and the vein must be touched again to draw blood, the
site should be cleansed again.
e. Exceptions:
1) Blood Cultures: use ChloraPrep SEPP applicator (2% Chlorhexidine Gluconate /
70% isopropyl alcohol). Refer to the Blood Culture Collection Procedure
2) Alcohol (ETOH) levels: use Povidone Iodine swabs or soap and warm water.
3) Allergies to alcohol: use Povidone Iodine swabs or soap and warm water.
4) Allergies to both alcohol and Iodine: use soap and warm water and cleanse
thoroughly.

10. Performing the Venipuncture
a. Venipuncture with Evacuated Tube System: Equipment of choice for best quality
specimen.
1) Put on gloves. Gloves must remain intact with no visible rips or tears.
2) Grasp the patient’s arm firmly. The phlebotomists thumb should be used to draw the
skin taut. This anchors the vein. The thumb should be one or two inches below the
venipuncture site.
3) With the bevel up, line up the needle with the vein and using a forward motion guide
the needle into the skin keeping the angle of the needle less than 30.
4) After needle is in the vein, insert the blood collection tube into the holder. Engage
the collection tube. Be sure to grasp the vacutainer assembly securely when
engaging the tube to prevent the needle from advancing further into the vein.
5) To obtain additional specimens, insert the next tube into the holder. Follow the
correct order of draw listed below and all specimen-handling instructions.
a) Blood culture (sterile) collection. First anaerobic and then aerobic
b) Blue (Citrate)
c) Red (clot activator)
d) Gold (SST) / Marble Top

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
e) Dark Green (PST, sodium heparin)
f) Light Green (PST, lithium heparin)
g) Lavender (EDTA)
h) Gray
6) Fill the tube until the vacuum is exhausted and the blood flow ceases. This will
ensure that there is a correct ratio of additive to blood.
7) Immediately after drawing mix each tube that contains an additive by gently inverting
the tube 8-10 times.
8) Release the tourniquet and remove the last tube collected from the holder, prior to
withdrawing the needle from the patient’s arm.
9) A clean gauze pad should be place lightly over the venipunture site.
10) Slight pressure should be applied to the pad. The needle should be removed slowly
while keeping the bevel in an upward position. The phlebotomist must exercise care
not to scratch the patient’s arm.
11) Engage the needle safety device.
12) Slip the gauze pad over the site, continuing mild pressure until bleeding has ceased.
If bleeding continues longer than 5 minutes notify the patient’s nurse.
13) Apply an adhesive or gauze bandage over the venipuncture site. A bandage should
never be placed over a site that is still bleeding.
14) Instruct the patient to leave the bandage on for at least 15 minutes.

b. Venipuncture Hypodermic Needle and Syringe: Equipment of choice when blood
transfers are required (i.e. Blood Culture Collection)

1) Put on gloves. Gloves must remain intact with no visible rips or tears.
2) Grasp the patient’s arm firmly. The phlebotomists thumb should be used to draw the
skin taut. This anchors the vein. The thumb should be one or two inches below the
venipuncture site.
3) With the bevel up, line up the needle with the vein and using a forward motion guide
the needle into the skin keeping the angle of the needle less than 30.
4) Pull the plunger of the syringe back gently but firmly (blood will come rather slowly)
5) Release the tourniquet.
6) When enough blood is collected, place clean gauze lightly over the venipuncture site.
7) Slight pressure should be applied to the pad. The needle should be removed slowly
while keeping the bevel in an upward position. The phlebotomist must exercise care
not to scratch the patient’s arm.
8) Engage the needle safety device.
9) Slip the gauze pad over the site, continuing mild pressure until bleeding has ceased.
If bleeding continues longer than 5 minutes notify the patient’s nurse. A bandage
should never be placed over a site that is still bleeding.
10) Apply an adhesive or gauze bandage over the venipuncture site.
11) Instruct the patient to leave the bandage on for at least 15 minutes.
12) Carefully remove needle from syringe and discard needle in sharps container.
13) Fill the tube(s) using the Blood Transfer Device.
14) Blood Transfer Device
Within 30 seconds of collection attach a needleless transfer device to the syringe.
Gently invert the syringe 3-5 times to assure uniformity of the specimen. Fill your
tubes following the prescribed order of draw also taking care to follow all special
handling instructions.
1) Blood culture (sterile) collection. First anaerobic and then aerobic.
2) Blue (Citrate)

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
3) Red (clot activator)
4) Gold (SST) / Marble Top
5) Dark Green (PST, sodium heparin)
6) Light Green (PST, lithium heparin)
7) Lavendar (EDTA)
8) Gray

All transfers must be completed in an upright position. Use your thumb to slow the
syringe plunger. This controls the speed of the fill and prevents hemolysis of specimen.
Do not push blood into the tubes; the vacuum in the tubes will draw in the correct
amount. Mix each tube that contains an additive by gently inverting the tube 8-10 times.

c. Venipuncture with Push-Button Butterfly and Syringe: Equipment of choice for
small fragile veins.

1) Put on gloves. Gloves must remain intact with no visible rips or tears.
2) Grasp the patient’s arm firmly. The phlebotomists thumb should be used to draw the
skin taut. This anchors the vein. The thumb should be one or two inches below the
venipuncture site.
3) With the bevel up, line up the needle with the vein. Using a forward motion guide the
needle into the skin with the wings, keeping the angle of the needle less than 30.
Watch for a “flash" of blood to appear in the body of the butterfly.
4) When the flash appears, pull the plunger of the syringe back gently but firmly
(blood will come rather slowly, as the diameter of the needle is small.)
5) Release the tourniquet.
6) If multiple syringes are required kink butterfly tubing to stop blood flow. Remove
syringe and attach additional syringe.
7) When enough blood is collected, place clean gauze lightly over the venipuncture site.
8) The butterfly safety device is designed to be activated while the needle is still in the
patient's vein. To operate the safety device correctly:
While the needle is still in the vein, grasp the body of the butterfly with the
thumb and middle finger.
Activate the button with the tip of the index finger.
The needle will safely retract into the body of the butterfly.
9) Slip the gauze pad over the site, continuing mild pressure until bleeding has ceased.
If bleeding continues longer than 5 minutes notify the patient’s nurse. A bandage
should never be placed over a site that is still bleeding.
10) Apply an adhesive or gauze bandage over the venipuncture site.
11) Instruct the patient to leave the bandage on for at least 15 minutes.
12) Fill the tube(s) using the Blood Transfer Device.
13) Blood Transfer Device

Within 30 seconds of collection attach a needleless transfer device to the syringe.
Gently invert the syringe 3-5 times to assure uniformity of the specimen. Fill your
tubes following the prescribed order of draw also taking care to follow all special
handling instructions.
9) Blood culture (sterile) collection. First anaerobic and then aerobic.
10) Blue (Citrate)
11) Red (clot activator)
12) Gold (SST) / Marble Top
13) Dark Green (PST, sodium heparin)

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
14) Light Green (PST, lithium heparin)
15) Lavender (EDTA)
16) Gray

d. Venipuncture with Push - Button Butterfly and Evacuated Tube system:
Equipment of choice for small children, hand veins, combative patients.

1) Put on gloves. Gloves must remain intact with no visible rips or tears.
2) Grasp the patient’s arm firmly. The phlebotomists thumb should be used to draw the
skin taut. This anchors the vein. The thumb should be one or two inches below the
venipuncture site.
3) With the bevel up, line up the needle with the vein and using a forward motion guide
the needle into the skin keeping the angle of the needle less than 30. Watch for a
“flash" of blood to appear in line.
4) After needle is in the vein, insert the blood collection tube into the holder. Engage
the collection tube.
5) Release the tourniquet.
6) To obtain additional specimens, insert the next tube into the holder. Follow the
correct order of draw listed below and all specimen-handling instructions.
a) Blood culture (sterile) collection. First anaerobic and then aerobic
b) Blue (Citrate)
c) Red (clot activator)
d) Gold (SST) / Marble Top
e) Dark Green (PST, sodium heparin)
f) Light Green (PST, lithium heparin)
g) Lavender (EDTA)
h) Gray
7) Fill the tube until the vacuum is exhausted and the blood flow ceases. This will
ensure that there is a correct ratio of additive to blood.
8) Immediately after drawing, mix each tube that contains an additive by gently inverting
the tube 8-10 times.
9) A clean gauze pad should be place lightly over the venipuncture site.
10) The butterfly safety device is designed to be activated while the needle is still in the
patient's vein. To operate the safety device correctly:
While the needle is still in the vein, grasp the body of the butterfly with the
thumb and middle finger.
Activate the button with the tip of the index finger.
The needle will safely retract into the body of the butterfly.
11) Slip the gauze pad over the site, continuing mild pressure until bleeding has ceased.
If bleeding continues longer than 5 minutes notify the patient’s nurse.
12) Apply an adhesive or gauze bandage over the venipuncture site. A bandage should
never be placed over a site that is still bleeding.
13) Instruct the patient to leave the bandage on for at least 15 minutes.

11. Disposal of Sharps and used Equipment
a. Assure that all needle safety devices are engaged.

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
b. Do not remove Vacutainer holder from needle. Discard the unit as a whole.
c. If a blood transfer device has been used, do not remove the device from the syringe.
Discard the unit as a whole.
d. Dispose of all needles and syringes in a puncture resistant (Sharps) container.
e. All other used equipment that is not saturated with blood may be disposed of in regular
trash.
f. Any equipment that is saturated with blood must be disposed of in a biohazard
container.
g. Note: Tourniquets must be discarded when contamination with blood or body fluids is
obvious or suspected. Tourniquets used in an isolation room should either be left in the
patient room or discarded.

12. Labeling Tubes
a. Label the tubes at the bedside. Refer to the Specimen Acceptability Criteria Inpatient
and Outpatient Policy.
b. Place identification label over blank paper label on tube.
c. Label must be lengthwise with the patient’s last name as close to tube stopper as
possible.
d. Barcode must be straight without creases or wrinkles
e. Do not place labels on stopper.

13. Exiting Patient Room
a. Leave the patient’s room as you found it. Make sure to lower the bed and raise the rails.
Turn off or dim the lights if necessary.
b. Ask the patient if they require further assistance. Thank them for their time.

14. Transport of specimens
a. Return all specimens to the laboratory within 30 minutes of collection. STATs and
TIMED specimens should be sent immediately. Samples may be hand carried or
transported to the laboratory through the Pneumatic Tube System (PTS)
b. Each patient should be bagged individually. For routine collections 3-5 bags may be
placed in a carrier.
c. Follow the established institutional policies for the transport of specimens as indicated at
each site.
d. All sites follow standardized guidelines for Restricted Specimens

APPENDIXES
1. Order of Draw
2. Standardization of Blood Collection Tubes
3. Age Specific Concerns.
4. Maximum Draw Volumes for Pediatrics
5. Guidelines for Minimal Blood Draw Volumes
6. Volumes for Neonatal Testing
7. Other Considerations (i.e. peripheral IVs, Indwelling lines or catheters, above and below IVs
etc.)

RELATED DOCUMENTS
1. Blood Culture Collection Procedure
2. Specimen Acceptability Criteria Hospital Inpatients and Outpatients Policy

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REFERENCES
1. CLSI Procedures for the Collection of Diagnostic Blood Specimens by Skin Puncture,
Publication H4A5, Vol. 24 No.21, Wayne, PA: National Committee for Clinical Laboratory
Sciences; 2008
2. Ernst, Dennis and Ernst, Catherine, Phlebotomy for Nurses. 2001, Health Star Press
3. Garza, Diana and Becan-McBride, Kathleen, Phlebotomy Handbook. 1999, Appleton & Lange
4. CLSI Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture;
Approved Standard- Sixth Edition, H3A6, Vol. 27 No. 26, USA 2008
5. Mayo Medical Laboratories, Mayo Guidelines for Pediatric Patients, August 2006
6. Children’s Hospitals and Clinics, Laboratory SOP#SCM5.02, June 2006

DOCUMENT HISTORY
Table of Document History

APPROVAL
Author: Belinda Trudeau
Approver: Chris Chong, MD

KEY WORDS
Title: Venipuncture
Department: General Lab
Document Type: Support Procedure
Applicable Sites: ANW, BUF, CAM, COC, MCY, NEU, OWT, RFA, STF,UTD, UTY
Alternate Terms: Phlebotomy Procedure, Phlebotomy, Venipuncture, Blood Draws, Specimen
Collection
Date of Last Major Revision: 05/13/09
Document Owner: Heather Dawson

DOCUMENT HISTORY return

OnBase
Date Summary of Change
Version
5/19/09 2 Addition of hypodermic needle draw. Minor update to match recent CLSI
changes.
11/12/09 3 Add an additional applicable site.

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Allina Hospitals and Clinics Venipuncture Procedure
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Standardization of Blood Collection Tubes
Sept 2007
Allina Standardization Committee

Type of
Tube Color Collection tube BD Reorder #
tube

Red CLOT TUBES, NON GEL
4 ml Hemogard with clot activator Plastic 367812
(13x75)
15 ml rubber stopper (16x125) Glass 366432
10 ml rubber stopper (16x100) Glass 366430
7 ml rubber stopper (13x100) Glass 366431

Gold CLOT TUBES, GEL
3.5 ml (13x75 tube) SST with clot Plastic 367983
activator

Light HEPARIN, Li, GEL
Green 3 ml, PST Hemogard (13x75) Plastic 367960

Green HEPARIN, Li, NON GEL
6 ml, non-gel Hemogard (13x100) Plastic 367886

Lavender EDTA, K2
3 ml Hemogard (13x75) Plastic 367856
4 ml Hemogard (13X75) Plastic 367861

Blue SODIUM CITRATE, 3.2%
2.7 ml Hemogard (13x75) Plastic 363083
4.5 Hemogard (13x75) Glass 369714

Gray Na FLOURIDE, K OXALATE
4 ml Hemogard (13x75) Plastic 367922

Dark Green HEPARIN, Na (for cytogenetics and Plastic 367871
special testing only.)
4 ml Hemogard (13x75)

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
APPENDIX I
CONCERNS AND BEHAVIORS OF DIFFERENT PATIENT AGE
GROUPS
(Page 1 of 2)
Very Young 6 to 13 Months

 Usually trust most adults  Fear of strangers & separation contact
 Use very gentle approach  Allow parents to be in close range of child
 Keep patient warm  Use comfortable toys, pacifier, or blanket
 Introduce self to parents  Introduce self to parents
 Explain procedure carefully before  Explain procedure carefully before
beginning beginning
 Allow parent to hold child  Allow parent to hold child
 Keep supplies from within child’s reach  Keep supplies from within child’s reach
 Use pediatric sized supplies  Use pediatric sized supplies
 Encourage parent to cuddle child during  Encourage parent to cuddle child during
and after the procedure and after procedure
 Thank parents for their cooperation  Thank parents for their cooperation
1 to 3 Years 3 to 5 years

 Fear of injury, long separations  Enjoy role playing, playing doctor
 Parents nervous  Talk slowly to child, maintain eye contact
 Give child time they need to think  Fear injury, separation from parent
 Introduce self to child and parents  Child will understand simple commands
 Explain procedure carefully before and understand your requests
beginning  Introduce self to child and parents
 Allow parent to hold child  Prepare child for brief “stick”.
 Allow child to touch supplies if safe  Encourage parents to offer praise for
 Use appropriate sized supplies cooperation and bravery
 Give lots of praise after procedure  Give lots of praise after procedure
 Offer stickers as reward  Offer stickers as reward
 Thank parent & child for their cooperation  Thank parent & child for their cooperation

Date Printed: 11/26/2011 9:26 AM Page 13 of 20
Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure

CONCERNS AND BEHAVIORS OF DIFFERENT PATIENT AGE
GROUPS
(Page 2 of 2)
6 to 12 Years Teenagers
Fear of losing self control  Embarrassed to show fear, need privacy
More willing to participate  May act hostile to mask fear
Curious, explain/demonstrate procedures  Use adult language, don’t talk down to them
slowly when explaining procedure
Let them express fears without  Ask, have they done this before- ever fainted?
embarrassment  Remind them of “little hurt” but will be over
Remind them it hurts a little but will be over quickly
quickly  Ask them what might make them more
Ask them what might make them more comfortable
comfortable  Allow time for questions, offer opportunity to
Do not leave items within reach of patient recover if they have cried, assure them it is a
Have a parent nearby normal reaction
If tearful, remind them it is a normal
 Always thank them for their cooperation
reaction & how well they cooperated during
the procedure
Thank the child for cooperating with
Adult Elderly
 Introduce self, explain procedure  Fear of being unable to read, hear, or
 Allow to verbalize fears and concerns understand directions
 Ask them what might make them more  Fear pain of procedure, expense of visit
comfortable  May be frail & have trouble moving about
 Remind them of a “little stick”  May have tremors, have difficulty holding still
 With increased age, more response to & worry about tech not being able to collect
stress specimen, causing more pain
 Allow as many choices as possible  Explain each step slowly
 More attention to health concerns  Frequently ask if they have any questions
 Emotional changes with chronic illness  Pause to make sure they understand you
 Foster image of self-esteem  Offer reassurance about procedure, remind
 Thank patient for their cooperation them of a “little stick”
 Gentle approach helpful in calming fears
 Comments like “I know this isn’t the most
comfortable position but I will be finished as
soon as possible” are invaluable in giving
patient’s a sense of control.
 Always thank the patient for their cooperation.

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure

Minimum Neonatal Volumes
TEST TUBE MINIMUM VOLUME

Coag
Protime / INR 3.2% Citrate / Blue plastic 2.7 ml in 2.7 ml tube
Special Coag 3.2% Citrate / Blue glass 4.5 ml in 4.5 ml tube

Hematology EDTA / Lavender (dark) 2.5 ml in 4 ml tube
(CBC, plt, diff) EDTA / Lavender (light) 1 ml in 3 ml tube
EDTA Microtainer 0.5 ml

ESR EDTA / Lavender 2.0 ml
(sed rate)

Panel 8 and / or SST Tube / Gold 2.5 ml in 5 ml tube
Bilirubin Red/ Peach Microtainer 1 full container
PST Tube / Green 2.5 in 5 ml tube
Green Microtainer 0.5 ml

Electrolytes SST Tube / Gold 2.5 ml in 5 ml tube
Red/ Peach Microtainer 1 full container
PST Tube / Green 2.5 in 5 ml tube
Green Microtainer 0.5 ml

CRP SST Tube / Gold 2.5 ml in 5 ml tube
PST Tube / Green 2.5 in 5 ml tube
Green Microtainer 0.5 ml

Hepatic Panel SST Tube / Gold 2.5 ml in 5 ml tube
Red/ Peach Microtainer 1 full container
PST Tube / Green 2.5 in 5 ml tube
Green Microtainer 1 full container

Hepatitis B or C SST Tube / Gold 1 full 5 ml tube
Cannot be collected in
Microtainers

Blood Cultures BD Bactec bottles
* Blood cultures can be  Pediatric (pink bottle) 1-3 ml
collected in the Pediatric  Aerobic (gray/blue bottle) 3-10 ml
bottle only, in both the  Anaerobic (purple bottle) 3-10 ml
Aerobic and Anaerobic
bottles or only in the
Aerobic bottle.

Chromosomes NA Heparin Tube (dark green) 3 ml
Cannot be collected in
Microtainers

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
Table IPediatric Blood Draw Volumes

Maximum amounts of blood to be drawn on pediatric patients

Pounds Kilograms (mLs.) Volume which can
(lbs.) (kg.) safely drawn per day
6-8 2.7 - 3.6 4.6-6.1
9 – 10 4.1 – 4.6 7.0 – 7.8
11 – 14 5.0 – 6.4 8.5 – 10.8
15 – 17 6.8 – 7.7 11.6 – 13.1
18 – 20 8.2 – 9.1 13.9 – 15.5
21 – 23 9.6 – 10.5 16.3 – 17.9
24 – 26 10.9 – 11.8 18.5 – 20.1
27 – 29 12.3 – 13.2 23.2 – 24.7
30 – 32 13.6 – 14.5 23.2 – 24.7
33 – 35 15.0 – 15.9 25.5 – 27.1
36 – 38 16.4 – 17.3 27.8 – 29.4
39 – 41 17.7 – 18.6 30.1 – 31.7
42 – 44 19.1 – 20 32.5 – 34.0
45 – 47 20.5 – 21.4 34.8 – 36.3
48 – 50 21.8 – 22.7 37.1 – 38.6

lbs./2.2 = kg kg. x 1.7 = mLs

Procedure Notes:
1. The laboratory has developed procedures to minimize specimen volume requirements
whenever possible. The laboratory staff will do their best to work with the specimens that
have been collected and will notify the patient’s caregiver if testing cannot be completed.
2. This procedure is a guideline for pediatric phlebotomy. If test requests require greater
amounts of blood to be drawn than indicated in the guidelines, laboratory staff should call
the ordering provider to determine if all tests are to be drawn or to prioritize testing.
3. General Information:
a. Approximate blood volume1:
Age Total Blood Volume
Premature infants 90 – 105 ml/kg
Term newborns 78 – 86 ml/kg
>1-month 78ml/kg
> 1-year 74 – 82 ml/kg
Adult 68 – 88 ml/kg
4. For phlebotomy, observe the patient for the risk of development of physiologic signs of rapid
blood loss. Symptoms of excessive blood loss are tachycardia, decreased profusion,
bradycardia, decrease in blood pressure, and shock. Symptoms are more severe with acute
loss. If signs of acute blood loss are apparent or if the patient losses consciousness,
immediately inform the nurse.

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
Guidelines for Minimal Blood Draw Volumes
Frequently Ordered Tests TABLE III
Test # Test Name Tube Type & Special Instructions Min/Vol
908 Alk Phos Gold / Green 1 ml
17 Albumin Gold / Green 1ml
254 ALT Gold / Green 1ml
31 Amylase Gold / Green 1ml
910 AST Gold / Green 1ml
272 B 12 Vitamin Gold/ Green – protect from light 1 ml
690 BHCG, Qual Gold ONLY 1 ml
6133 Blood Type 4 ml Lavender- Verify MRN# 4 ml
46 Bilirubin. Total Gold / Green- protect from light 1 ml
47 Bilirubin, Direct Gold / Green- protect from light 1ml
52 BUN Gold / Green 1ml
400 CBC /CBC Diff 3 ml Lavender 1ml
56 Calcium Gold / Green 1ml
67 Chloride Gold / Green 1ml
71 Cholesterol Gold / Green 1ml
80 CK total Gold / Green 1ml
538 CK&CK-MB Gold / Green 1ml
82 Creatinine Gold / Green 1ml
6083 X-match & type 4 ml Lavender-Verify MRN# 4ml
92 Digoxin Pl. Red / Gold / Green 1 ml
91 Dilantin / Phenytoin 5 ml plain red ONLY 1 ml
6085 Direct Coombs Lavender 2.5 ml
945 Serum Drug Screen 5 ml Plain Red 1 ml
19 Ethanol Grey / Gold / Green 1 ml
103 Folate Gold / Green 1 ml
104 FSH Gold / Green 1 ml
832 Gentamycin Pl. Red / Gold / Green 1 ml
114 GGT Gold / Green 1 ml
109 Glucose Gold / Green 1 ml
3631 HDL Cholesterol Gold / Green 1 ml
241 Hemoglobin A1C Lavender 2.5 ml
450 Hemoglobin Lavender 2.5 ml
230 Hemo w/o plt Lavender 2.5ml
430 Hemo/plt Lavender 2.5 ml
800 Hemo/diff/no plt Lavender 2.5 ml
400 Hemo./diff/plt Lavender 2.5 ml
2283 Heparin Blue Until vacuum exhausted
100 Iron & IBC Gold / Green 1 ml
101 Fibrinogen Blue Until vacuum exhausted
149 Lactate Grey- on ice 5 ml
909 LD total Gold / Green 1ml
169 Lithium Pl. Red / Gold 1ml
175 Magnesium Gold / Green 1ml
205 Phoshorus Gold / Green 1ml
484 Platelet Lavender 2.5 ml
PFT Platelet Function Test Lavender & blue 3ml & 4.5 ml
211 Potassium Gold / Green 1ml
2455 Prealbumin Gold 1ml
7095 Pro-BNP Green 1ml
215 Prolactin Gold / Green 1ml
219 Protein-total Gold / Green 1ml
487 PT-INR Blue Until vacuum exhausted
490 APTT Blue Until vacuum exhausted
6035 Rh Immunglobulin / Rhogam Lavender – verify MRN# 2.5 ml
503 Sed Rate Lavender 2.5 ml
233 Sodium Gold / Green 1ml
952 Tegretol / Carbamazepine Pl. Red / Gold / Green 1ml
248 Theophylline Pl. Red / Gold / Green 1ml
5190 Troponin T Green- ONLY 1 ml
258 TSH Gold – ONLY 1ml
6083 Type & Screen 4 ml lavender-Verify MRN# 4 ml
262 Uric Acid Gold / Green 1ml
949 Valproic Acid / Depakote Pl. Red / Gold / Green 1ml
697 Vancomycin Pl. Red / Gold / Green 1ml
7 Basic Metabolic Panel 1 Gold / Green 1 ml
95 Comp Metabolic Panel 1 Gold / Green 2ml
94 Electrolyte Panel 1 Gold / Green 1ml
223 Hepatic Function Panel 1 Gold / Green 2ml
694 Acute Hepatitis Panel 2 Gold – need 10 ml serum 10ml
160 Lipid Panel 1 Gold / Green 2ml
751 Obstetric Panel(s) 2 Lav, 1 Gold -verify MRN# 13ml
15 Renal Function Panel 1 Gold / Green 2ml

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure

The following items MUST NEVER be transported through the
pneumatic tube system:
LABORATORY
 Empty blood product bags
 Alleged assault specimens
 Any surgical specimens (placenta, biopsies, etc.)
 Amniotic fluid
 Bone Marrow
 Cerebral spinal fluid
 Specimens for Cold agglutinins, Cryofibrinogens and Cryoglobulins
 Gastric bronchial aspirates or bronchial washings
 Plasma hemoglobin specimens
 Stones for analysis
 Stool
 Petri dishes
 24 hour urine containers
 Any irretrievable specimens
PHARMACY
 Chemotherapy agents
OTHER
 Any needles(needles MUST be removed from syringe specimens)
 Food or beverage
 Items over 10 pounds
 Original medical records / files
 Soiled instruments
 Mercury Thermometers
REMEMBER
 Ensure that container lids / covers are tightly secured and parafilm is wrapped tightly.
 Non-restricted liquids & items with the potential to leak must be in double re-sealable
plastic bags
 Include a foam liner to prevent jarring or breakage (foam liners can be obtained from
Pharmacy or Lab)
 Do not wrap any specimens in towels

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Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure

Date Printed: 11/26/2011 9:26 AM Page 19 of 20
Allina Hospitals and Clinics Venipuncture Procedure
Laboratory Services
Support Procedure
Blood Drawing Procedure for Patients that are in Isolation
1. Leave your blood drawing tray in a secured area.
2. Wash hands thoroughly.
3. Put on required barriers- gloves, gown, mask, etc. The barriers required will be
indicated on the isolation sign posted on the patient’s door.
4. Obtain a clean towel or a disposable Chux from the linen cart or isolation cart.
5. Gather all of the supplies you will need for the blood draw. Be sure to include extra
alcohol wipes. A tourniquet and tape may already be in the room. These supplies are
considered “dedicated” equipment; once this equipment has been used for this patient it
should remain in the room for the remaining time the patient is in isolation.
6. Enter the room and place the towel on the bedside stand or other convenient location.
Place your drawing supplies on the towel.
7. Obtain the blood samples- place each tube drawn on the towel as it is collected. Be
sure to draw a green top tube if a glucose meter has been ordered along with other
laboratory tests.
8. Place used needle in the Sharps container in the room.
9. Discard any used disposable supplies in the wastebasket.
10. Place the tourniquet and tape in a convenient place in the patient’s room.
11. Remove your gloves and discard them in the wastebasket.
12. Open 2 alcohol wipes. Pick up each tube with one wipe and use the other one to wipe
each tube. Place each wiped tube on a clean paper towel.
13. Place labels on each tube at the bedside.
14. Carry the tubes on the paper towel to your draw tray outside the room. (Use paper
towels to open the door when exiting.)
15. Place the towel in the dirty linen bag or in the wastebasket if disposable.
16. Wash your hands using the chlorhexidine soap provided at the hand washing stations on
the unit.

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