Should nurses or phlebotomists (phlebotomy specialists) perform blood draws in an emergency department?

Dedicated Phlebotomists Should Perform Blood Draws in the Emergency Department

Dedicated phlebotomy teams should be used for blood draws in emergency departments rather than nurses, as this approach reduces blood culture contamination rates by 41% and significantly improves patient outcomes through more accurate diagnostic results. 1

Evidence Supporting Dedicated Phlebotomists

Reduced Blood Culture Contamination

• The American Society for Microbiology's 2024 evidence-based guidelines strongly recommend having specially trained phlebotomists perform blood draws in clinical settings 1
• Blood cultures obtained by trained phlebotomists result in a 41% decrease in contamination rates compared to those drawn by nurses or other providers 1
• Contaminated blood cultures can lead to:
  • Unnecessary antibiotic treatment
  • Extended hospital stays
  • Increased healthcare costs
  • Delayed appropriate treatment for actual infections

Improved Technical Outcomes

• Phlebotomists demonstrate superior technique in blood collection:
  • Use of proper sterile technique (56% reduction in contamination) 1
  • Better venipuncture skills with difficult access patients
  • Lower rates of hemolyzed samples (2.7% with butterfly needles used by phlebotomists vs. 14.6% with IV catheters often used by nurses) 2

Operational Benefits

• Dedicated phlebotomists significantly reduce left-before-treatment-completion (LBTC) rates:
  • 48% relative reduction in patients leaving before treatment completion 3
  • Greater impact as door-to-room times increase
• Phlebotomists collect larger blood volumes (5.6 ± 1.3 mL vs. 2.1 ± 0.7 mL), improving test sensitivity 1

Potential Concerns and Solutions

Training Requirements

• High-intensity training programs for phlebotomists show 56% reduction in blood culture contamination rates 1
• Training should include:
  • Proper sterile technique
  • Venipuncture skills
  • Patient positioning and comfort
  • Specimen handling protocols
  • Regular feedback on performance metrics

Cost Considerations

• While maintaining a trained phlebotomy team has costs, these are offset by:
  • Fewer false-positive results requiring unnecessary treatment
  • Reduced repeat testing due to hemolyzed samples
  • Improved ED throughput with fewer patients leaving before treatment completion
  • Lower rates of hospital-acquired conditions from inappropriate antibiotic use

Implementation Strategy

1. Establish a dedicated phlebotomy team with specialized training
2. Implement standardized sterile protocols for blood draws
3. Create regular quality monitoring of contamination rates
4. Provide continuous feedback and retraining when necessary
5. Ensure 24/7 coverage in the ED setting

Special Considerations

High-Volume/Critical Situations

• During mass casualty events or high-volume periods, having dedicated phlebotomists allows nurses to focus on critical patient care tasks
• For patients with fibrodysplasia ossificans progressiva or other complex conditions, experienced phlebotomists with vein finders/ultrasound guidance are critical for successful blood draws 1

Pediatric Patients

• Specialized pediatric phlebotomists should be available for children to minimize trauma and anxiety 1
• Child Life Services should be engaged when available for pediatric patients

Conclusion

The evidence strongly supports using dedicated phlebotomists rather than nurses for blood draws in the emergency department. This approach leads to better specimen quality, reduced contamination rates, improved ED throughput, and ultimately better patient outcomes through more accurate and timely diagnostic results.