Steps to Draw Blood

Drawing blood is an art; the specimen must be properly handled and cared for concerning laboratory testing or analysis. The specimen mustn't become contaminated or compromised during collection or thereafter. The quality and accuracy of the sample being drawn must be precise. Even the slightest error could cause inaccurate results or cross-contamination. Steps must be followed to avoid inaccuracies, and the order of each draw must be followed. There are specific additives within each tube; therefore, drawing a sample in the wrong order could cause cross-contamination within the tubes; this destroys the sample. Standard operating procedures to reduce these risks include: 

• Non-Sterile Gloves -
• rubber, latex, vinyl, etc. Verify patient has no allergies.
• Needles -
• correct gauge number must be used.
• The Hub -
• holder/adapter used with the evacuated tube collection system.
• Evacuated Collection Tubes -
• tubes with a vacuum system designed to obtain a set volume of blood. The rubberized topper has specified colors; each determines the additive within the tube.
• Alcohol Wipes -
• Isopropyl alcohol - at least 70% to sanitize the puncture site.
• Syringes -
• Butterfly or "straight stick," depending on the vein location.
• Bandages/Adhesive Tape -
• protection after sample collection.
• Gauze -
• applied directly to the site of puncture after needle removal.
• Tourniquet -
• applies pressure and slows circulation to make veins more visible and easier to puncture.
• Sharps Container/Needle Disposal Unit -
• dispose of needles immediately after the needle is withdrawn in a specified container for proper disposal.
• Povidone/Iodine Swabs/Wipes -
• utilized to draw blood cultures and test alcohol levels within the blood.
• Laboratory Specimen Labels -
• the identifies whom the blood was drawn from.
• Requisition/Order Form -
• required for each sample transported to the lab and must be filled out properly before the process of the sample.

• Wash hands thoroughly with soap and water for no less than 20 seconds. This can be timed by singing Happy Birthday twice.
• Apply well-fitting, non-sterile gloves (be sure the patient is not allergic to the glove's material).

• Introduce yourself to the patient, who you are, your title, and the procedure that will be conducted.
• Check the name, D.O.B (date of birth), sex, etc. The patient's identity and the forms from the lab should match.
• Be cautious and ask if fainting has happened before; some patients are prone to fainting during blood draws. When possible, allow the patient to be in a supine position (lying flat on the back).
• Obtain verbal consent beforehand - the patient does have the right to refuse the test; be sure the patient understands the procedure.

• The patient's arm should be fully extended and inspected for an already visible vein. The vein should be a decent size, clear of crossing veins, and straight.
• Needles should never enter where veins divert; this increases the risk of hematoma (blood pooling/collecting under the skin, i.e., bruising).

• Clean the site with a 70% alcohol swab for 30 seconds and allow it to dry completely before the following steps; usually, this takes another 30 seconds.
• Alcohol should be used instead of povidone-iodine (leaves a dark orange, almost brown residue), which can contaminate the test results. Povidone-iodine has been known to increase potassium, phosphorus, and/or uric acid levels, resulting in false readings.
• From the center of the puncture site, rub the alcohol swab downward and outward, in a circular motion, approximately 2cm or more, around the area. Again, allow this to dry, and NEVER touch the cleaned site. If this occurs, the area must be disinfected again.

• As stated in the introduction, always draw blood in the correct order. Directly above is a visual to use for guidance. Also, identify the tube type; there are glass and plastic tube types.

• Apply the tourniquet 3 or 4 inches above the site, the patient's arm is held, and a thumb is placed BELOW the puncture site; the thumb will be used as an anchor.
• Ask the patient to form a fist for better visibility if needed.
• When multiple tubes are being obtained, use evacuated tubes to fill the tubes directly. If not available, a syringe or winged needle could be used. One hand will hold the tube to prevent needle sticks or a needle shield will be utilized.
• Enter the vein at a 30-degree or less angle, allowing the needle to follow along the vein.
• Applying direct and steady pressure, pierce the colored stopper on the top of the tube with the needle. The stopper will NEVER be removed; this will release the vacuum seal and pressure.
• Invert the tubes containing additives per protocol before sending them to the lab (usually eight times). The local lab can specify the number of inverts.
• Release the tourniquet BEFORE withdrawing the needle and while filling the last tube.
• Withdraw the needle, and with gauze, apply gentle pressure to the site.
• Inform the patient that the procedure has been completed.
• Ask the patient to hold the gauze with their arm extended - NEVER allow them to bend their arm, as this will cause bruising.
• Apply a bandage after inquiring if the patient has any known allergies.
• Label all tubes while the patient is present.

• Discard all contaminated equipment - gauze, needles, syringes, alcohol swabs, etc.
• Dispose of needles into a puncture-resistant sharps container.
• Ensure there are no spills or droplets.
• Wipe/disinfect all surfaces, remove gloves, and perform hand hygiene.

• Verify all labels and forms are accurate.
• Labels are legible and contain the patient's first/last name, file number, D.O.B., and date/time when the blood was drawn.
• Re-verify that all information is corrected and satisfied for the lab.
• Check the site of insertion for excessive bleeding.
• Ask the patient how they feel and provide whatever they need; water, a snack, etc.
• Thank the patient and provide reassurance or encouragement as they are leaving.

• Load laboratory samples carefully in a plastic leak-proof bag with the laboratory request form. Place the requisition on the outside of the bag, as this helps avoid contamination.
• Place multiple tubes in a rack or padded holder to avoid breakage during transportation.

Happy Sticking! And here's to getting it on the first try!