Phlebotomy 🩸
Guide for phlebotomy and venepuncture. Technique, tube selection, order of draw, and troubleshooting for blood sampling.
🧠 Indications
- Routine blood tests (e.g. FBC, U&E, LFTs, CRP)
- Drug levels (e.g. vancomycin, digoxin)
- Crossmatch or group and save
- Blood cultures in suspected infection
- Monitoring response to treatment
⚠️ Contraindications / Cautions
- Lymphoedema or previous mastectomy on that side → avoid arm
- Existing IV lines → avoid drawing above line
- Active cellulitis or skin infection at the site
- Severe bleeding disorders (discuss with senior)
📞 What to Ask / Confirm
- What bloods are required?
- Any timing considerations (e.g. fasting, drug levels)?
- Is this a difficult access patient?
- Check for allergy to alcohol swab or dressing
- Label tubes before/after depending on local policy
🧰 Equipment
- Vacutainer system (needle + holder)
- Appropriate blood tubes (check order of draw)
- Alcohol swab / chlorhexidine
- Tourniquet, gloves, gauze, tape/plaster
- Sharps bin
- Labels and request forms / ICE printout
📝 Procedure
- Wash hands, gather equipment, and don gloves
- Apply tourniquet and identify a suitable vein
- Clean site and allow to dry
- Anchor vein, insert needle bevel up at 30°
- Attach vacutainer tubes in correct order
- Once complete, release tourniquet and remove needle
- Apply pressure and dress site
- Dispose of needle safely and label tubes
🔍 Common Tube Colours (Ireland)
- 🔴 Red – Plain/Serum: Drug levels, serum biochemistry
- 🔵 Blue – Citrate: Coagulation screen (INR, PT, APTT) – fill to line!
- 🟣 Purple – EDTA: FBC, ESR, HbA1c
- 🌸 Pink – EDTA: Group & Save / Crossmatch – transfusion lab
- ⚪️ Grey – Fluoride Oxalate: Glucose, lactate – inhibits glycolysis
- 🧪 Blood cultures – Always before antibiotics; strict aseptic technique
- 🟡 Yellow – SST (if used): U&E, LFTs, CRP, bone profile, TFTs
🧾 Documentation
- Time, date, and site of sample
- Any difficulties or failed attempts
- Any patient reactions (e.g. faint, pain)
- Who took the sample