Phlebotomy and Vaccinations

yellow top

yellow top

venipuncture color for:

• SPS for blood culture specimens

red OR gold/tiger top (red-grey)

venipuncture color for:

• serum chemistry studies

• blood donor screening

• infectious disease testing

green top

venipuncture color for:

• plasma determinations in chemistry

lavender top

venipuncture color for:

• whole blood hematology determinations

• routine immunohematology testing

• blood donor screening

light blue top

venipuncture color for:

• coagulation studies

invert 3-4 times

number of inversions for light blue venipuncture

invert 5 times

number of inversions for red venipuncture

invert 8-10 times

number of inversions for green, lavender, and gray venipunctures

• 5/8”, 22-25G

• vastus lateralis muscle of anterolateral thigh

IM injection for neonate (<28 days)

• 1”, 22-25G

• vastus lateralis muscle of anterolateral thigh

IM injection for infants (1-12 months)

• 1”-1.25”, 22-25G

• vastus lateralis muscle of anterolateral thigh

preferred IM injection for toddlers (1-2 years), also acceptable for children ages 3-10

• 5/8”-1”, 22-25G

• deltoid muscle of arm

preferred IM injection for children ages 3-18, also acceptable for toddlers (1-2 years)

• 1”, 22-25G (but 5/8” can also be used)

• deltoid muscle of arm

IM injection for adults (19+) weighing <130 lbs

• 1”, 22-25G

• deltoid muscle of arm

IM injection for adults (19+) weighing 130-152 lbs

• 1”-1.5”, 22-25G

• deltoid muscle of arm

IM injection for adult (19+) men weighing 153-260 lbs, women weighing 153-200 lbs

• 1.5”, 22-25G

• deltoid muscle of arm

IM injection for adult (19+) men weighing >260 lbs, women weighing >200 lbs

yellow test tube stopper

• additive: sodium polyanetholsulfonate

• test type: blood cultures

light blue test tube stopper

• additive: sodium citrate

• test type: coagulation studies

red test tube stopper

• additive: none

• test types:

  • blood chemistries

  • HIV/AIDS antibody

  • viral studies

  • serologic tests

gold/red-gray test tube topper

• additives:

  • clot activator

  • silicone serum separator

• test types:

  • tests requiring blood serum

  • routine blood donor screening

  • infectious disease testing

green test tube topper

• additive: heparin

• test types:

  • electrolyte studies

  • arterial blood gases

lavender test tube topper

• additive: ethylenediaminetetraacetic acid (EDTA) (anticoagulant)

• test types:

  • hematology

  • blood chemistries

gray test tube topper

• additive: potassium oxalate OR sodium fluoride (anticoagulant)

• test type: blood glucose

Do you have latex allergies?

If the patient answers yes, wear nonlatex gloves

Have you ever had a reaction to an adhesive bandage?

If the patient answers yes, apply a piece of cotton or gauze and secure it with paper tape.

Have you ever had a mastectomy?

If the patient answers yes, perform phlebotomy on the opposite side. If it was performed on both sides, ask the provider how to proceed.

Are you taking any blood thinners or aspirin therapy?

If the patient answers yes, be careful about moving the needle around and apply pressure for at least 2-5 minutes following the blood draw. Then, apply a pressure bandage.

Do you have a port or shunt?

If the patient answers yes, draw the sample from the opposite arm.

Do you have a history of fainting associated with having your blood drawn?

If the patient answers yes, position them in a supine or semi-Fowler’s position

• Hepatitis B (HepB)

• Diphtheria, tetanus, and acellular pertussis (DTaP)

• Diphtheria and tetanus (DT)

• Haemophilus influenzae type b (Hib)

• Pneumococcal conjugate (PCV13)

• Influenza (IIV)

• Hepatitis A (HepA)

• Human papillomavirus (9vHPV)

• Meningococcal conjugate (MenACWY)

• Tetanus, diphtheria, and acellular pertussis (Tdap)

• Tetanus and diphtheria (Td)

• Meningococcal B (MenB)

• Polio (IPV)

• Pneumococcal polysaccharide (PPSV23)

• Zoster/Shingrix (RZV)

vaccines that should be administered intramuscularly

• Measles, Mumps, Rubella (MMR)

• Varicella (VAR)

• Polio (IPV)

• Pneumococcal polysaccharide (PPSV23)

vaccines that should be administered subcutaneously

slightly rotate the bevel

proper procedure if the bevel is against the wall of the vein

slowly advance the needle until blood begins to flow

proper procedure if the bevel is partially inserted

withdraw the needle slightly

proper procedure if the needle is inserted too deep

remove the tube from the needle , withdraw and redirect the needle into the vein, and use a new tube

proper procedure if the needle is inserted beside the vein

use a smaller tourniquet and/or tube volume

proper procedure if there is a collapsed vein

try another tube that has NOT expired or been dropped

proper procedure if there is an insufficient tube volume

• 25-27G

• 1/2”-5/8”

• 5-15 degrees

proper needle used for ID injection

• 25-27G

• 3/8”-5/8”

• 45 to 90 degrees

proper needle used for SQ injection

• 25-31G

• 5/16”-1/2”

• 45-90 degrees

proper needle used for SQ insulin injection

• 18-25G

• 5/8”-1 1/2”

• 90 degrees

proper needle used for IM injection

Gently reposition the needle. If pain persists, remove the needle

14G needle

• color: olive

• outer diameter: 0.072”

15G needle

• color: amber

• outer diameter: 0.065”

16G needle

• color: gray

• outer diameter: 0.064”

18G needle

• color: green

• outer diameter: 0.050”

20G needle

• color: pink

• outer diameter: 0.036”

21G needle

• color: purple

• outer diameter: 0.033”

22G needle

• color: blue

• outer diameter: 0.027”

23G needle

• color: orange

• outer diameter: 0.025”

25G needle

• color: red

• outer diameter: 0.020”

27G needle

• color: white

• outer diameter: 0.016”