PRE-PHLEBOTOMY PROCEDURES

LTD: Pre-Phlebotomy Guidelines Version 7

PRE-PHLEBOTOMY GUIDELINES

Preparation for the Phlebotomy:

 Before performing any phlebotomy procedure, carefully review the orders

to calculate the volume of blood to draw and select the necessary blood

tubes. See specific information below.

 Carefully and fully follow hospital Patient Identification Policy requiring the

use of two identifiers, generally name and medical record number on

Inpatients and name and date of birth on Outpatients.

 The patient should be lying down, sitting on their bed or sitting in a chair

with arms so they don’t injure themselves if they lose consciousness and

fall.

 The patient should not be eating, drinking or chewing gum while the

phlebotomy procedure is performed.

Volume of Blood: The amount of blood drawn from any patient should be kept to

a minimum. The guidelines at Akron Children’s are to determine the amount of

serum/plasma required and draw approximately 2.5 times that amount. For

example, if 1.0 ml of plasma is needed, then 2.5 ml of blood should be drawn.

Extra blood should not be drawn on a routine basis. Particular care should be

taken in the Neonate population where the overall blood volume is minimal. See

the “Maximum Allowable Blood Draw Volumes for Pediatric Patients” policy for

maximum volumes of blood that can safely be drawn from a pediatric patient

based on their weight. The Lab Test Directory (located as on icon on many desk

tops or available on myKidsnet under “Departments – Lab”) lists many of the

available tests along with the volume of blood and type of tube needed to

perform each test and how it should be stored for transport to the lab (room

temperature, on ice, etc.). It also contains further information including the

availability of the test, turn-around times, normal ranges, special instructions

(fasting specimen required, timing for peak and trough drug levels, etc.), and

causes for rejection of the specimen.

Choosing the best method for phlebotomy: The following should be kept in mind

when deciding whether to perform a venipuncture, arterial stick or capillary

puncture:

 The size of the patient – heel sticks are generally done on patients less

than six months of age.

 The volume of blood needed – capillary punctures yield smaller volumes

of blood.

 The tests ordered – some tests, such as ammonia, cannot be drawn by

capillary puncture. An arterial gas must be drawn by an arterial stick.

 The condition of the patient – if a patient is “crashing” and a volume of

blood is needed quickly, an arterial stick should be considered. Capillary

punctures may be easier on a patient with burns over a large portion of

their body.

 The training level of the person performing the phlebotomy – not all staff is

trained to perform arterial sticks.

References

Ernst, Dennis J. “Pediatric Pointers.” Center for Phlebotomy Education, Inc.

2004-2008, edited for accuracy 1/08.

Ernst, Dennis J. and Catherine Ernst. “Mastering Pediatric Phlebotomy.” Center

for Phlebotomy Education, Inc. Adapted from Phlebotomy for Nurses and

Nursing Personnel. HealthStar Press, Inc. 2001, updated 1/08.

Kiechle, Frederick L. So You’re Going to Collect a Blood Specimen: An

Introduction to Phlebotomy, 11th Edition. Northfield, IL: College of American

Pathologists, 2005.

NCCLS. Procedures and Devices for the Collection of Diagnostic Capillary Blood

Specimens; Approved Standard—Sixth Edition. CLSI document H04-A6.

Wayne, PA: Clinical and Laboratory Standards Institute; 2008.

NCCLS. Procedures for the Collection of Arterial Blood Specimens; Approved

Standard—Fourth Edition. CLSI document H11-A4. Wayne, PA: Clinical and

Laboratory Standards Institute; 2004.

NCCLS. Procedures for the Collection of Diagnostic Blood Specimens by

Venipuncture; Approved Standard—Fifth Edition. CLSI document H3-A5.

Wayne, PA: Clinical and Laboratory Standards Institute; 2003.

Akron Children’s Policy - Maximum Allowable Blood Volumes for

Pediatric Patients. Policy # 1122