Standard Protocol for Phlebotomy Procedure
Institutions should implement a standardized sterile technique protocol for phlebotomy, utilizing specially trained phlebotomists who follow strict order of draw guidelines and employ safety-engineered devices to minimize contamination and needle-stick injuries. 1
Personnel Requirements
- Specially trained phlebotomy teams should perform all peripheral venipunctures, as this reduces blood culture contamination rates by 41% compared to procedures performed by nurses, physicians, or medical interns 1
- Training programs must include skills training, continuous monitoring, and integration into quality management initiatives, which together reduce contamination rates by 56% 1
- Healthcare workers performing phlebotomy must be aware of potential complications including nerve injury, vasovagal reactions, infections, hematoma, and thrombosis 2
Sterile Technique Protocol
The following sterile technique components are essential (reduces contamination by 56%): 1
- Sterile gloves must be worn for every venipuncture 1
- Sterile field creation using fenestrated drapes 1
- Chlorhexidine-based skin antisepsis (2% chlorhexidine/70% isopropyl alcohol preferred), which reduces contamination by 57% 1
- Sterile gauze and equipment 1
- Use of procedural checklists 1
Critical Caveat
Avoid chlorhexidine in patients with known sensitivity; alternative antiseptics must be used in these cases 1
Order of Draw
Strict adherence to order of draw is mandatory to prevent cross-contamination between tubes: 3, 4
- Blood culture/sterile tubes (first) 4
- Plain tubes/gel separator tubes 4
- Tubes containing additives (last) 4
Failure to follow this sequence results in significant sample contamination, particularly under non-ideal phlebotomy conditions, directly compromising patient safety 4
Blood Culture-Specific Recommendations
For blood culture collection specifically, implement these additional measures:
- Diversion devices should be used, reducing contamination by 64% 1
- Label diversion tubes with patient information to prevent processing errors 1
- Be aware that diversion may contribute to iatrogenic anemia in patients requiring frequent phlebotomy 1
Safety Equipment
- Safety-engineered devices must be used for both intravenous and phlebotomy procedures 5
- These devices reduce needle-stick injury rates: relative risk 0.28 for IV devices and 0.57 for phlebotomy devices 5
- Single-use holders and internally sterilized collection tubes are mandatory to prevent backflow contamination 2
Patient Identification and Labeling
- Every tube must be labeled with patient's full name, hospital number, date of birth, date/time of collection, and phlebotomist's name 1
- Pre-infusion identity checks are mandatory and must follow hospital standard procedures 1
- The identification procedure is a critical safety point requiring particular attention 6
Vein Selection and Technique
- Appropriate vein selection is crucial to avoid nerve injury, which can cause permanent motor/sensory dysfunction 2
- Careful venipuncture technique prevents the most serious complication—nerve damage 2
Monitoring During Procedure
- Monitor for vasovagal reactions (hypotension, pallor, syncope), which are relatively common 2
- Emergency equipment must be available: bed for positioning, oxygen, and emergency drug cart 2
- Maintain normovolemia if performing acute normovolemic hemodilution 1
Storage and Handling
- Blood collected during procedures must remain with the patient 1
- May be stored at room temperature for up to 6 hours in insulated containers 1
- All containers must be clearly labeled "UNTESTED BLOOD: FOR AUTOLOGOUS USE ONLY" if applicable 1
Environmental Considerations
- Minimize distractions in the phlebotomy environment, as these contribute to errors 6
- Ensure proper transfer of information between healthcare team members 6
- Follow universal precautions for disposal of hazardous waste 1