Blood Collection Rules and Regulations
Setting Blood Draw Standards in USA
The Clinical and Laboratory Standards Institute (CLSI) sets phlebotomy standards that apply to those who
draw blood either as full and part-time phlebotomists, medical assistants, healthcare providers and personnel with
blood collection responsibilities in the United States of America.
Blood collection takes place in various inpatient and ambulatory care (outpatient) settings. A safe work
environment and appropriate training in a clinical laboratory reduces the risk of accidents, infections, and
trauma. The fact that 800,000 health care workers report needle stick or sharp object injuries annually is
mindboggling. To address this issue, the College of American Pathologists (CAP) Press recently published the 13th Edition of "So
You’re Going to Collect a Blood Specimen: An Introduction to Phlebotomy", which outlines ways to diminish risks
and reinforces the importance of the phlebotomist’s role in health safety.
Blood Collection Rules
Most blood tests are performed on anticoagulants whole blood, plasma, or serum. Blood specimens must be
collected in the proper collection tubes and containers and in the right order of draw. The collection tubes must also be correctly labeled, and promptly
transported to the laboratory. Needless to say, blood specimens should be refrigerated until placed in the
courier box for transport to the laboratory.
If coagulation testing is the only laboratory work that needs to be drawn the phlebotomist should first draw a
plain red top tube to remove tissue fluid contamination. This tube is then discarded into the biohazard receptacle.
The next step is to draw the blood sample into a sodium citrate collection tube which must be filled to the proper
level (filled to complete vacuum volume) and is then gently inverted to mix.
If additional laboratory work is ordered, including coagulation testing, the second tube would be the sodium
citrate collection tube. Remember that all of the processes involved in specimen collection, from ordering
supplies, to selecting the proper collection devices, to proper collection site and technique, to adhering to all
in-house and legal requirements when handling and shipping the specimens are all important steps of obtaining valid
and timely laboratory test results.
Phlebotomists in California
Phlebotomists in California are heavily monitored by the state and must be
licensed with the California State Medical Board in order to work as part of the allied healthcare professional
Phlebotomists in California have several levels of licensing! Those wishing to work in phlebotomy in
California must first complete an unpaid 40-hour internship where 50 successful blood draws on patients via
venipuncture and 10 finger/heelsticks must be properly performed and logged. All this must be done before entering
the phlebotomy career, because CA regulation mandates that you cannot work as a phlebotomist without a license.
This rule also applies to medical assistants and other allied health professionals with blood drawing
responsibilities in the state of California.