How To Draw Blood Properly

In a clinical setting a lot can be required of newly trained attending nurses and medical

assistants. During a shift meds are passed, vitals are taken, and tests are ordered, all of which

benefit the patient's health. One of the best diagnostic tools is to have blood drawn from a

patient, also known as 'having labs ordered.' The blood can be viewed as concordance of the

body, and through blood a primary care provider can research and study different factors

affecting the body. To obtain blood is the first step in the process of studying a sample. In the

following document the steps in preparation, the drawing of the blood, the disposal of tools, and

the proper way to send labs will be outline in an easily accessible format.

It is important to review some basic terminology and physiology of the blood system

before beginning with any procedure. As a technician using phlebotomy in the work force the

first time drawing blood can be a bit nerve wrecking to some, and cause some basic steps and

skills to be forgotten. This is completely understandable, but must be overcome in a short amount

of time to begin giving a high level of care and treatment for patients.

Each patient’s diagnosis will almost always be based upon their lab results. Lab results

give clarity due to the fact that so much of the body is made up of blood. The average person has

about 5 l of blood in them. The blood is made up of two components, plasma which is a liquid

derived from the intestines and organs of the body, and the cells that make up the solids in the

blood are originally formed by bone marrow. ( page 17)The cell part of the blood can be divided

into three main group, erythrocytes, leukocytes, and platelets or thrombocytes. Erythrocytes are

commonly known as red blood cells and leukocytes are commonly known as white blood cells.

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The white blood cells can be further divided into two main subgroups, Granulocytes, and Non

granulocytes. (page 17) The granulocytes are made up of Neutrophils, Eosinophils, and

Basophils. The non granulocytes are made up of Lymphocytes and Monocytes.(page 17) All of

these groupings of the different types of cells in the body are important to know during the

diagnosis of blood samples. Each of these components of blood can undergo changes leading to

positive or negative results on the body that could potentially cause severe damage to organs and

the body as a whole.

The damages to the body are a result of some disorder in a component of the blood.

Frances Fischbach in her manual of laboratory tests states the disorders of red blood cells,

leukocytes disorders, and platelet disorders as an introduction to the importance of the different

parts of blood needing to be in the right range of quantity. “With red blood cells a patient can

suffer from anemia which is a severe reduction in the circulation of red blood cells or

polycythemia which is an abnormal increase in the red blood cell count. The white blood cells

can suffer from a increase number of leukocytes called leuokocytosis or a decrease in the number

of leukocytes called leucopenia.”(Fischbach) Platelet count is also important. An example of a

direct result of thrombocytopenia which is a decreased number of platelets, can lead to

hemorrhaging which ultimately is a major cause of a stroke. The other example of platelet count

affecting a patient is when a person is suffering from thrombocytosis which is an increased

number of platelets. This can cause an abnormality in the way the blood clots which could lead

to abnormal bleeding or abnormal clotting. (Page 17)

The primary way to obtain blood from an individual is through venipuncture. The blood

is acquired from the preferred site of the antecubital vein. During your preparation of drawing

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blood you will need to decide what size needle if most suitable for your patient. Fischbach states,

“The size of a needle and syringe is determined by the amount of blood needed as well as the

size and integrity of the vein being used. Furthermore, many hospitals use the Vacutainer system

because it is cheaper. The Vacutainer System consists of a vacuum tube (Vacutainer tube), a

holder, and a multi sample collecting needle.” After you have chosen the proper needle you will

need to gather the vacutainer tubes with the correct colored tops. The colors of the test tubes are

correlated with the test being ordered. For example, if a primary care provider asks a technician

to obtain a CBC with DIFF, then the proper colored top would be lavender. A two columned table

will be documented later in the instructions listing the tube tops matched with the tests that can

be matched to the color.

As a technician in the form of a nurse or medical assistant one must remember that

drawing labs from a patient is to be done carefully. In Fishbach’s manual, the author gives a

clinical alert to possible problems that may arise if the venipuncture is done incorrectly. Please

review the following outlined information from Frances Fischbach’s manual of laboratory and

diagnostic tests :

Warning:

• If oozing from the puncture site is difficult to stop, elevate the area and apply a pressure

dressing. Stay with the patient until the bleeding stops.

• Never draw blood for any laboratory test from the same extremity that is being used for

intravenous medications, intravenous fluids, or blood.

• In patients with leukemia or agranulocytosis and in others with lowered resistance, the finger

stick and earlobe puncture are more likely to cause infection and bleeding than venipuncture. If

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 a capillary sample is necessary in the patients, the cleansing agent should remain in contact

with the skin for at least 7 to 10 minutes. Alcohol is bactericidal; povodoneiodine is the

cleansing agent of choice on patients with leukemia.

• If difficulty in encountered obtaining blood

• Warm the extremity (this must be done for all blood gases)

• Allow the extremity to remain in a hanging position for some time.

• Hematomas can be prevented by

• Using good technique

• Releasing the tourniquet before the needle is removed

• Applying sufficient pressure over the puncture site after completion of the procedure

Conclusion:

With the understanding of the information listed above, and the general overview of

blood physiology the instructions can now be followed with a better understanding. The blood’s

components are diminutive yet must be balanced properly for the overall health and well being

of a patient. Medical technicians are responsible for making effective decisions towards how to

draw a patient’s labs, what tools will be needed, and how to properly treat the area of the

venipuncture. Keeping all these items in the foreground of one’s mind, the following set of

instructions, tables, and pictures will be easy to follow and helpful in one’s medical career and

treatment of patients.

Outline of How to Draw Blood Properly

Part 1: Receiving Orders :

I. Receiving Orders
A. Obtaining the list of lab orders from the primary care provider

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 1. The Doctor, Nurse Practitioner, Physicianʼs Assistant are some examples of a
provider who will be giving you the orders. The orders will be give the details
of
a) Which patient is having their blood drawn
b) Why the patient is needing samples taken
c) Which tests are going to be done
B. Looking up the proper tests tubes based on the test orders
1. Each test requires a specific tube that will contain different samples of blood.
2. Different tubes contain the blood in different manners to preserve the blood in
specific way so that the lab technicians can study the different samples
properly
C. Grab the proper tubes based on the tests
1. Look up the test on the data table that will be given in the final document
2. Match the test on the data table with the proper colored tube
II. Tools that are required for obtaining Sample (See Appendix A for picture diagrams
of tools)
A. Test Tubes
1. The different colored tubes are
a) Red tops
b) Green tops
c) Blue Tops
d) Lavender Tops
e) Grey Tops
B. Bandaging
1. Grab a roll of surgical tape
2. One cotton ball is needed to cover the recently punctured area on the
patientʼs arm
C. The Needle and proper gauge size
1. When you first meet the patient you can assess wether the patient will need
either a
a) Butterfly needle (25 and 23 gauged needles)
(1) are appropriate for of small veins and hard draws
(a) children have small veins
(b) hard draws entail
i) Elderly Adults
ii) Adults with small veins
b) 22 or 21 Gauge needles
2. At the end of the document there is a table to refer to that lists the colored
tubes according the tests that can be taken from them.
D. Tourniquet
1. The tourniquet should be latex free to avoid any allergic reactions in a patient
E. Alcohol Wipe ( 70% isopropyl alcohol)
Part 2: The Steps of Venipuncture:

(See Appendix B for Visual Examples of Steps)

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III. The steps in Venipuncture
A. Locating the vein that will be punctured
1. You will do this with feeling around with your pointer finger around the area of
the median cubital vein
2. Press down lightly on the area of the skin feeling for a bounce back from a
vein
B. Placing Tourniquet
1. How to properly tie the tourniquet
a) When applying the tourniquet place it behind the arm and bring the ends
of the tourniquet to the front of the arm
b) Pull the tourniquet and begin to lace the ends into a knot about three
inches above the vein that will be punctured
c) Pull one end all the way through the knot and leave one end partially
ticked in the knot and not entirely pulled all the way
(1) this is so you can remove the tourniquet with one hand while you are
still holding the needle in the patients arm with your other hand
C. Tapping of the site or gentle flicking of site to cause veins to surface
D. Positionin the Patients arm
1. Have the arm strait without any bend in the elbow
2. Direct the forearm to be facing upwards
a) Have the patient to make a fist and hold the fist
b) The patient is not required to pump their fist
E. Wipe the area that will be punctured with alcohol wipe and allow area to dry for
about five seconds
F. Remove Needle Safety Cap
1. Gently twist the cap over the needle and set it aside
G. One hand is used to hold the area of skin taught around the vein
H. Your other hand is used to hold the needle at a forty five degree angle from the
arm
I. Insert the needle gently into the vein remaining aware of not pushing the needle
completely through the vein
1. use this hand to hold and anchor the needle
J. Grab test tubes and attach them to the needle in the proper order
1. remember to keep the needle steady with your anchor hand to avoid
excessive movement which could cause trauma
K. Remove tourniquet when
1. last tube has almost reached the proper volume or
2. after the last tube is removed from the needle
L. Grab Gauze with your free hand and place over site where the needle is in the
vein
M. Slowly Remove the needle and place pressure with cotton ball on the punctured
site
N. Have patient hold cotton ball in place maintaining pressure
O. Dispose of needle in the sharps box
P. Dispose of gloves, and other left over items in the trash
Q. Place surgical tape over cotton ball

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Part 3: Proper Disposal of Tools
(See Appendix C for Visual Aid)

IV. Proper Disposal of testing tools

A. Place needle in a sharps box
B. Items that go in the trash
1. Glove
2. Alcohol Wipe
3. Alcohol Wipe container
4. Needle Safety Cap

Part 4: Avoid:

V. Avoid
A. Leaving tourniquet too long on the patientʼs arm can cause
1. tissue damage wear the tourniquet was located
B. Excessive probing with the needle
1. This will cause trauma in the arm to the:
a) vein that was punctured
b) nerves in the area can suffer damage
c) scarring in the area
C. Passing through the entire vein
1. The blood flow will stop
2. Patient will suffer from a Hematoma
D. Removing the needle before the tourniquet has been removed
1. The pressure in the arm will force excess blood to come from the punctured
area and blood will exiting the hole rapidly
2. The patient will develop a Hematoma
Part 5: Sending the Lab Orders Out

(See Appendix See of Example of how to send out cultures)

VI. Steps in Sending the Tubes Properly to a Lab

A. Write Proper Patient information on the tube
1. Their First and Last Name
2. Depending on your PCP you may be required to put
a) The PCPʼs name
b) The PCPʼs office address and phone number
c) The patientʼs birthdate
d) The patients gender
e) The patients identification number
B. Print off lab orders that the has been filled out and place in the lab bags
separating each order into different bags.
C. Spin tubes that require it for ten minutes
1. The tubes required to be spun are the red tops

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 2. Spinning will
a) Separate the plasma from the blood
b) Prevent the blood from coagulating
D. After all samples have been spun remove from spinner remove them and place
them with the other test tubes that were drawn from the same patient
E. Place each patients test tube in the properly designated bag with each patients
own orders
F. Leave test sample in a pick up box for lab pick up

Appendixes:

The following Appendixes are divided into three sections

1) Appendix A shows pictures of the tools required for lab draws

2) Appendix B shows pictures of the procedure in order

3) Appendix C shoes pictures of how to dispose of tools and how to send out lab orders

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 Appendix A: Supplies

Test Tubes Butterfly Needle

Tourniquet Latex Free Latex Free Exam Gloves

21 Gauge Needle Surgical Tape

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 Appendix B: How to Draw Blood

1. Place Tourniquet On 2. Feel Area for Vein

3. Wipe the Desired with Alcohol wipe 4. Enter Needle at 45 degree

angle

5. Apply test tube to needle

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6. Have Patient Apply Pressure 7. Apply Surgical Tape
with cotton ball

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 Appendix C: Proper Disposal and Sending out Orders

1. Put used Needle in Sharps Box 2. Throw away all other used
tools

3. Spin Red Top Test for ten minutes 4. Place cultures in bag to send
out to lab, with lab order slip

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Most Common Test Orders and Vacutainers

Test Name Tube Type

CBC WITH DIFF LAVENDER

AMYLASE GREEN OR RED

COMPREHENSIVE GREEN OR RED

METABOLIC PANEL

LIPASE GREEN OR RED

LIVER FUNCTION TEST GREEN OR RED

LIPID PANEL GREEN OR RED

TSH RED

TOTAL 3 RED

GLUCOSE GREY

Needle Gauges and Appropriate Time for Use

Needle Gauges Proper Use

25 Gauge (Butterfly Pediatrics/ Difficult Veins

Needle)

23 Gauge (Butterfly Pediatrics/ Difficult Veins

Needle)

22 Gauge Needle Adults/Easy Draws

21 Gauge Needle Adults/Easy Draws

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 Works Cited

Fischbach, Frances. A Manual of Laboratory and Diagnostic Tests. 4th ed. Vol. 1.

Philadelphia: J.B. Lippincott Company, 1992

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