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Blood Specimen Collection Guidelines

Information in this section and in the Alphabetical Test Directory has been provided to ensure the specimen is properly collected, prepared, and preserved during and after collection for transport. The integrity and quality of the result is dependent on these instructions being adhered to. Failure to do so may result in recollection.

 

Blood Collection Guideline

  • The phlebotomist (blood collector) will collect blood samples ordered by the physician provided the sample can be collected in an evacuated tube, microcollection tube or syringe.
  • The phlebotomists are limited to drawing from approved blood collection sites (see following section: Site Selection for Blood Collection).
  •  Phlebotomists DO NOT collect arterial blood.

 

Patient Identification

Inpatients

  • The phlebotomist will identify an inpatient for blood collection by use of the hospital identification bracelet on his/her person.
  • In situations where it is not feasible for a patient to have an identification bracelet on their person, for example burn patients, the phlebotomist will obtain the identification of the patient from the attending nurse or physician prior to blood collection. The identifying personnel will sign a form indicating that they identified the patient. 

Outpatients

  • The phlebotomist will identify an outpatient by asking them to state and spell their full name and state their birth date (year, month and day), as well as by obtaining two pieces of acceptable original identification
    The preferred, acceptable list of original documents includes valid provincial or territorial health care card PLUS one of the following government issued photo identification:
    • Valid driver's license
    • Valid passport (including out of country issued passports)
    • Canadian citizenship card
    • Certificate of Indian Status card
    • Valid Alberta or other government issued student identification card
    • Federal, provincial and/or territorial government issued identification with a photograph
    • Other acceptable original documents include:
      • Birth certificate
      • Marriage certificate
      • Legal change of name certificate
      • Final divorce certificate
      • Citizenship/Immigration status document (student permit, temporary resident, interim federal health certificate of eligibility)
      • Certified copy of the court order for name change
      • Court of Queens Bench Adoption Order
  • Pediatric patients may be identified by their parent or guardian.


Site Selection for Blood Collection

Approved Sites

Phlebotomists will collect blood using one of the following approved sites (listed in the order of preference):

  1. Antecubital area of the arm
  2. Back of hand or side of wrist
  3. Back of hand or side of wrist below a lock
  4. Antecubital area of arm above a lock
  5. Back of hand or side of wrist below an I.V. line. I.V. must be turned off by physician/nurse for a minimum of three minutes prior to collection.
  6. Foot or ankle only with written permission of physician/nurse.
  7. As a last resort, at the discretion of physician/nurse, a phlebotomist may collect from a site above an I.V. line.   Physician/nurse must provide written permission for this procedure and must turn off I.V. for a minimum of three minutes prior to collection.  A comment will be appended to the test results, indicating the possibility of dilutional/contamination effect.

Alternate Sites (used only in exceptional and unusual circumstances)

Phlebotomists will not collect from:

  • the arm or hand from the side of a mastectomy unless all other sites have been ruled out, and only with written physician/nurse permission.
  • limbs with indwelling artificial access devices (other than I.V./lock) unless all other sites have been ruled out, and only with  written permission of primary care physician.

Unacceptable Sites

Phlebotomists will not collect from:

  • fistulas, shunts, arterial lines, or locks.
  • arteries, femoral vein, varicose veins, or the palmar region (inside) of wrist.

Phlebotomy staff shall not collect blood specimens from deceased patients, and will only collect from human patients.

 

Specimens Drawn by Physicians or Nursing Staff

Phlebotomists will request that a blood sample be drawn by the patient’s physician/nurse if one of the following situations is encountered:

  • Two phlebotomists are unable to obtain the required blood sample after a total of four collection attempts.
  • The phlebotomist is unable to find a useable approved collection site.
  • The patient refuses to have a phlebotomist collect the blood sample
  • The patient has a shunt, port, Hickman, PICC line or arterial line (phlebotomist will check with nursing unit to see if blood can be drawn from line by nursing staff; if required, lab drawn blood may still be necessary).
     

Inpatients Absent for Scheduled Collection

  • The phlebotomists will make a reasonable effort to locate patients for collection.
  • If a patient is not on or cannot be located on the identified unit, the phlebotomist will notify the nursing unit personnel.  It is then the responsibility of the nursing personnel to contact the laboratory, on the return of the patient to the nursing unit, for blood collection. 

 

Outpatient Services

Outpatients from Hospital Clinics

  • Patients from hospital clinics must be registered through an admission process and receive a facility medical record number prior to presenting for laboratory services.

Non-Clinic Outpatients

  • Patients from community physicians’ offices who present with a requisition for laboratory work as an outpatient at an acute care facility will be collected.  However, as priority is given to hospital patients, they are encouraged to use one of the Patient Service Centers.
  • Patient MUST have their Alberta personal health card or other province's health care card for processing.

 

Pretransfusion Testing

For patient identification for pretransfusion testing, please see Transfusion Medicine - Pretransfusion Testing.