Phlebotomy cheat sheet

Standard precautions apply to every patient: all blood, body fluids, and contaminated items are treated as potentially infectious regardless of diagnosis.

Hand hygiene: soap and water for at least 20 seconds; alcohol-based rub for 15-20 seconds, rubbed until completely dry.

Sharps containers are closed and replaced when filled to the manufacturer's fill line (commonly three-quarters full); needles are never recapped by hand.

Post-exposure needlestick: wash the site with soap and water, do not squeeze or apply bleach, report immediately, and document the source patient's status.

PPE decision rule: gloves for every venipuncture; add gown, mask, and eye protection whenever splash or spray of blood is anticipated.

A Safety Data Sheet (SDS) with 16 standardized sections must be accessible for every hazardous chemical or reagent in the work area.

Biohazard labels are required on containers, bags, and refrigerators holding blood or other potentially infectious material.

HIV post-exposure prophylaxis is most effective when started as soon as possible after exposure, ideally within hours and generally no later than 72 hours.

Employers must document bloodborne pathogen training and offer hepatitis B vaccination to staff with occupational exposure.

Two independent identifiers are required: full name plus date of birth or medical record number. Room or bed number is never an identifier.

Identity is confirmed by matching the requisition to the ID band and to the patient's own verbal statement before any tube is labeled.

Basal state for fasting tests: 8-12 hours without food, water permitted; commonly required for fasting glucose and lipid panels.

For an unconscious or confused patient, verify identity through the ID band and a caregiver or nurse; never infer identity from the situation.

Screen for allergies to latex, adhesive, iodine, and chlorhexidine before selecting tourniquet, tape, and skin antiseptic.

A patient with a fainting history is drawn seated or reclining, and is never left unattended after a vasovagal episode.

Tourniquet application longer than 1 minute produces hemoconcentration; release and allow a 2-minute rest before reapplying.

A patient extending the arm and cooperating gives implied consent; minors and incapacitated adults require consent from a parent or guardian.

Document any refusal to be drawn, record the stated reason, and notify the ordering provider or supervisor rather than proceeding.

CLSI order of draw: blood culture, light blue citrate, serum red/gold, green heparin, lavender EDTA, gray fluoride-oxalate.

Needle gauge rule: 21 G for average adult veins, 23 G for small or fragile veins, 23-25 G winged set for hand veins.

Insert with the bevel up at a 15-30 degree angle; push the evacuated tube onto the holder only after the vein is entered and flash is seen.

Site preference: median cubital first, cephalic second, basilic last because of the adjacent brachial artery and median nerve.

Avoid hematoma, edema, scarring, burns, an arm with IV fluids, an AV fistula, and the side of a mastectomy or lymph node dissection.

Invert gently by additive: light blue 3-4 times, serum 5, heparin 8, EDTA 8-10; never shake a tube.

With a winged set, draw a non-additive discard tube first when collecting coagulation tests to clear air from the tubing.

Capillary puncture: side of the distal phalanx of the ring or middle finger; infant heel stick at the medial or lateral plantar surface.

Blood culture bottles: cleanse with chlorhexidine and allow to dry, inoculate the aerobic bottle first, and do not repalpate the site afterward.

Label tubes at the patient's side immediately after collection with identifiers, date, time, and collector initials; pre-labeling is never acceptable.

Allow serum tubes 30 minutes to clot, then centrifuge; serum or plasma is separated within 2 hours of collection under most policies.

Centrifuge at the manufacturer's specified g-force and time, typically 10-15 minutes at roughly 1000-1200 RCF.

Coagulation (light blue) specimens are kept at room temperature, never refrigerated, and tested within 4 hours of collection.

Protect bilirubin and other light-sensitive analytes from light; transport ammonia on ice and keep cold agglutinin samples at 37 degrees C.

Hemolysis falsely elevates potassium, LDH, AST, and ALT and falsely lowers glucose and bilirubin; causes include small needles, strong suction, and shaking.

Recentrifuging a serum separator tube after gel barrier formation can produce falsely elevated potassium and other cellular analytes.

Point-of-care glucose meters: run both low and high controls before patient testing and verify strip expiration and meter coding.

Capillary hematocrit tubes are filled two-thirds to three-quarters, sealed, centrifuged, and read as the packed cell column.

Opening sequence: state your name and role, verify two identifiers, explain the procedure in plain language, and give an estimated time.

Teach-back, asking the patient to restate instructions, is the standard method for confirming comprehension of fasting or aftercare instructions.

HIPAA minimum necessary rule: disclose only the protected health information needed for the task and discuss it only in a private area.

Use a trained medical interpreter for limited-English-proficiency patients; family members are not used for consent or sensitive results.

De-escalation sequence: lower voice volume and pace, keep open posture, acknowledge the concern, then offer concrete options.

When a draw cannot be completed or is refused, document the attempt, notify the provider, and follow facility policy rather than persisting.

Service recovery steps: listen without interrupting, apologize for the experience, resolve what is within your control, and arrange follow-up.

Pediatric communication uses age-appropriate words and simple choices, such as which finger to use or which bandage color.