Basic Phlebotomy Principles

If you are considering entering the field of phlebotomy, it is a good idea to learn about the underlying phlebotomy principles first. We will provide a brief overview of infection control, anatomy and physiology, puncture site selection and preparation, order of draw, and post-puncture care.

Basic Infection Control

Standard operating procedures must be followed when it comes to infection control and quality assurance. These steps should be made available to phlebotomists in a clinical environment. To effectively control and prevent infections, proper hygiene-materials must be used. Here is a list of hygienic materials to be kept in a medical environment conducting phlebotomy:

  • Soap
  • Water
  • Alcohol rub
  • Non-sterile gloves
  • Single-use disposable needles
  • Syringes/lancing devices

In the same sense, contaminated phlebotomy equipment must be discarded in an appropriate manner. Did you know that up to 25% of tourniquets are contaminated through inadequate hand-hygiene? Also, hepatitis B has been known to spread through reusing finger-prick devices. Needles, syringes, and blood sampling devices should be disposed into a puncture-resistant sharps container, in order to uphold proper phlebotomy safety standards. It is important to know which pieces of equipment can be reused, versus what should be discarded.

Basic Anatomy and Physiology

Knowledge of anatomy and physiology is one of the most crucial phlebotomy principles. Anatomy is the study of body structure, and physiology is the study of body function. This topic as it relates to phlebotomy is a major focus in phlebotomy schools—an understanding of the basics is required to be a successful phlebotomy technician.

Proper Selection and Preparation of Skin Puncture Site

Site selection can make or break a phlebotomy procedure. Generally, you want to examine a patient’s extended forearm. Locate a sizable vein that is visible, straight and clear. A good place to start is the median cubital vein, because it is the easiest to puncture successfully. It is wise to avoid the basilic vein, in order to negate the possibility of damaging the nerve or artery. It is also a considerably more painful blood withdrawal. Vein diversions should also be avoided, to decrease the chance of a hematoma.

It is important to disinfect the entry site before puncturing. Clean the site with a 70% alcohol (not povidone iodine) swab for 30 seconds while applying a gentle pressure. Allow some time for the site to dry. This decreases the contamination risks. After the site is cleaned, it is imperative that you do not touch the site with your finger, as this will commonly result in an infection.

Order of Draw      

Blood must be collected in tubes in a very specific order. This phlebotomy principle is referred to as “Order of Draw.” It can be somewhat difficult to remember. Here are the 9 elements of order of draw:

  1. Color varies-blood cultures
  2. Light blue-sodium citrate
  3. Red-clot activator
  4. Gold-SST
  5. Light green-lithium heparin
  6. Dark green-sodium heparin
  7. Lavender-EDTA
  8. Gray-Sodium Fluoride
  9. Yellow-ACD Solution

A helpful way of remembering the color order is, “Boys Love Ravishing Girls Like Dieters Love Greek Yogurt.” (blood culture, light blue, red, gold, light green, dark green, lavender, gray, yellow) Make sure to verify that your laboratory is using the same colors and descriptions.

Post-Puncture Care

After blood withdrawal has occurred, a major phlebotomy principle is cleaning contaminated surfaces and completing interactions with the patient. Double checking the phlebotomy labels and forms helps to ensure accurate standards of information. Hand hygiene should be performed once again, to protect against infections. Check if the patient is feeling satisfactory. Then, make sure that the needle insertion site is not bleeding. Once these final post-operation steps are taken, the patient is free to leave. The next step is to prepare and transport blood samples—this process is an educational focus of certified phlebotomy training programs.

Master Phlebotomy Principles at PhlebotomyU

This guide acts as a basic introduction to the principles of phlebotomy; it alone does not adequately prepare you to be a certified phlebotomist. PhlebotomyU on the other hand, has the sole purpose of educating individuals on the most up-to-date trends in blood analysis, venipuncture, and everything else related to phlebotomy. Basic and advanced phlebotomy principles will be covered in-depth. Interested in becoming a certified phlebotomist and entering a highly in-demand workforce? Contact us today, for more information on pursuing your CDLH-approved phlebotomy license.

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Order of Draw for Phlebotomy

Let’s break down the order by tube and color as well as explore some ways to easily memorize and retain for life! Here’s a useful study guide, mnemonic and color coded cheat sheet. Master the order of draw!