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Blood Collection Site Selection

When evaluating a patient for blood collection, use the following order of site preference.

To prevent medical procedures from being performed on affected limbs, use regional caution signs to improve communication between unit staff and laboratory staff performing collections. Place signs above the head of the bed. If both arms are not to be accessed use both signs. (Data Printing ordering numbers: Left arm #103257, Right arm #103258.)

1. Antecubital Area (without locks or IVs)

The three veins in this area are the first choice for blood collection

  • The median cubital vein is the first choice for blood collection. This vein is usually large, visible, well anchored and does not bruise easily.
  • The cephalic vein is the second choice for blood collection. This vein is not as well anchored and is usually more difficult to find.
  • The basilic vein is the third choice for blood collection and should only be considered if the median cubital and cephalic veins in both arms have been ruled out. It is a high risk area due to the proximity of nerves. In addition, this vein tends to roll away and bruise more easily.

2.  Hand or Wrist (without locks or IVs)

  • Use only the backside (posterior) of the hand, and the thumb side (lateral) of the wrist.

3.  Hand or Wrist Below a Lock

  • Use only the backside (posterior) of the hand, and the thumb side (lateral) of the wrist.
  • Tourniquet may be applied above collection site and below lock site provided there is a space of at least 6 cm between the tourniquet and lock site.  

4.  Antecubital Area Above a Lock

  • Tourniquet should be applied only briefly.

5.  Hand or Wrist Below IV

  • Use only the backside (posterior) of the hand, and the thumb side (lateral) of the wrist.
  • IV must be turned off by nursing staff for at least 3 minutes before blood collection begins.        

6.  Foot

  • For CLS staff, foot venipunctures are not performed unless a physician has authorized this type of collection and it is noted on the patient's chart.
  • Use the top of the foot and side of ankle. The preferred site is the great saphenous vein.

7.  Antecubital Area Above an IV

  • LAST CHOICE. Use this site only if all other potential phlebotomy sites are unacceptable.
  • IV must be turned off by nursing staff for at least 3 minutes before blood collection begins.
  • CLS staff obtain physician authorization for foot phlebotomies due to risks associated with diabetic patients or patients with risks of thrombosis.

Safety and Notes



  • CLS staff do not perform collections on limbs adjacent to certain known surgeries such as mastectomies unless requested to do so by physician or nurse, with a signed form.
  • CLS staff do not perform collections on limbs with indwelling access devices other than IV and locks without physician nurse approval, and will never collect directly from an indwelling access device.
  • CLS staff do not perform femoral artery collections.