Different Ways Nurses Draw Blood for Labs

Most people dread getting their blood drawn, and it can be the same for nursing staff. It is true that there are special phlebotomy teams and staff that specialize in drawing blood, but taking blood cultures is a critical skill that nurses need to be able to do.

Since everyone is so different, there are a number of different ways to draw blood for labs. While one may study and practice drawing blood, it is still a tricky process to take blood specimens. Depending on the setting, the person, experience level, or volume of blood, there may be a better technique to use. To help you and your patients feel more comfortable with blood specimen collection, we break down everything you need to know about blood draws. We also take a quick glance at the different ways that nurses draw blood for labs.

What Does it Mean to Draw Blood?

Drawing blood on patients typically refers to the process of collecting a blood sample from a patient for medical testing or analysis. This is usually done by a trained healthcare professional, such as a phlebotomist or nurse, who uses a needle to puncture a vein in the patient’s arm and collect a small sample of blood.

Why Nurses Draw Blood

The collected blood sample is then sent to a laboratory for testing, and the results are used to diagnose medical conditions, monitor the progress of treatment, or evaluate overall health. Blood tests are a common diagnostic tool used in many areas of healthcare, including primary care, emergency medicine, and specialty care.

How to Learn to Draw Blood

Liability issues limit nursing schools from teaching this important skill, but there are a number of ways to learn and practice the process of blood sampling.

We discuss how labs are drawn on patients in our video course, Nursing School Clinical Prep (Drawing Labs module). If you are interested in a very in-depth explanation, check out Phlebotomy for Nurses from the IV Guy.

Different Ways to Draw Blood

1. Capillary Collection– This method is great for those that require a smaller volume of blood. This includes fingerstick sampling, puncturing the heel, or puncturing the earlobe. It is quick and easy and is less invasive than typical venous blood sampling. Keep in mind, this method is not preferred and certain labs cannot be run off of a capillary collection.

2. Through an IV start– This is a great method for those that require an IV already. For this method, you would start an IV as you normally do (no butterfly needle). After you insert the needle, get the vein, and insert the catheter and withdraw your needle… you can connect a syringe draw the appropriate volume of blood, aspirate what you need into the syringe, and then you can hook up your normal IV set up.

3. Straight Needle with a Hub– In this method, the needle is already pre-attached to the tube holder or syringe. The hub is the end of the needle that is attached to the collection device. This is often the most popular method if multiple samples are needed. 

4. Straight Needle with a Syringe– This method is similar to using a hub, but the syringe helps to reduce additional stress. This technique is often used when the blood draw is more difficult. The syringe helps to prevent vesicular collapse as well as reduce some of the pressure on the vein.

5. Butterfly Needle with a Hub– A butterfly needle is used when puncturing a superficial vein. The needles are much smaller, making them less painful for the patient. This is also a popular option for drawing blood in kids as it is smaller and less painful. This technique is not as suitable for those with multiple collection samples. 

6. Butterfly Needle with a Syringe– Like the Butterfly Needle with Hub Draw, the needle is much shallower and more suited to place precisely on fragile or smaller veins. 

7. Central Line Draw– This method is nurses draw blood from a large vein in the chest, neck, or groin. This is used mainly for larger blood draws, or used in conjunction to give fluids, or medications quickly. 

Phlebotomy Equipment That You Will Need

While most hospital settings will have everything you need to perform the procedure, it is helpful to know what tools you will need. This way you are able to practice and familiarize yourself with all the necessary equipment. Different methods that require different equipment. You may also want to have backups, just in case the blood draw does not work the first time. An important aspect of phlebotomy is to always use sterile equipment, meaning you are not able to use the same needle on a second or third attempt.

To draw blood for laboratory testing, a healthcare professional typically needs the following equipment:

1. Needle: A sterile needle, typically ranging in size from 21 to 23 gauge, is used to puncture the vein and collect the blood sample.
2. Syringe or vacuum tube holder: Once the needle is inserted into the vein, a syringe or vacuum tube holder is used to collect the blood sample.
3. Vacutainer tubes: These are sterile, color-coded tubes that come in various sizes, each designed to collect different types of blood samples. The color of the tube corresponds to the type of additive that is in the tube and the type of testing that will be performed on the blood sample.
4. Alcohol swabs: Alcohol swabs are used to clean the area where the needle will be inserted into the skin to reduce the risk of infection.
5. Bandages or gauze: A bandage or gauze is placed over the puncture site once the blood sample has been collected to prevent bleeding and protect the site from infection.
6. Gloves: Healthcare professionals must wear gloves to prevent the spread of infection and to protect themselves from blood-borne pathogens.

Other equipment that may be used during the blood draw process includes tourniquets, butterfly needles, and a biohazard container for safe disposal of used needles and other materials.

Steps to Drawing Blood on a Patient

Please note, these are general steps. Always follow your organization’s policies and procedures.

Here are the general steps for drawing blood for lab specimen collection:

1. Identify the patient: Before beginning the blood draw, the healthcare professional should confirm the patient’s identity by asking for their name and checking their ID band or other form of identification.
2. Verify the order: Blood cannot be drawn on a patient without a physician’s order.
3. Prepare the equipment: The healthcare professional should gather all the necessary equipment and ensure that everything is sterile and in appropriate condition. There are specific tubes required for specific labs.
4. Clean the site: The healthcare professional will clean the site where the blood will be drawn with an alcohol swab to reduce the risk of infection.
5. Apply a tourniquet: A tourniquet may be applied to the upper arm to make it easier to locate and access the vein. The tourniquet should be tight enough to slow the flow of blood but not so tight that it causes discomfort or pain.
6. Locate the vein: Once the tourniquet is in place, the healthcare professional will locate the vein they plan to use for the blood draw. They may use their fingers to feel for the vein or use a device that illuminates the area under the skin.
7. Insert the needle: With the vein located, the healthcare professional will insert the needle into the vein and collect the blood sample. They may use a syringe or a vacuum tube holder to collect the blood.
8. Remove the needle: Once the blood has been collected, the healthcare professional will remove the needle from the patient’s arm.
9. Apply pressure: A bandage or gauze will be applied to the puncture site to apply pressure and prevent bleeding.
10. Label the sample: The healthcare professional will label the blood sample with the patient’s identifying information, the date and time of the draw, and any other relevant information.
11. Dispose of the equipment: The used needles and other equipment will be disposed of in a biohazard container according to the appropriate protocols.

How to Draw Blood From a Hard Stick Patient

Drawing blood from a patient who is a difficult stick, meaning that they have small or hard-to-find veins, can be challenging, but there are several strategies that healthcare professionals can use to make the process easier and more successful:

1. Use a smaller needle: When working with difficult patients, it can be helpful to use a smaller-gauge needle, such as a 23-gauge needle, which may be less painful and easier to maneuver in smaller veins.
2. Warm the area: Applying a warm compress to the area where the blood will be drawn can help to dilate the blood vessels and make it easier to locate and access the vein.
3. Use gravity: Raising the patient’s arm above their heart level can help to increase blood flow and make it easier to locate and access the vein.
4. Hydrate the patient: Drinking water before the blood draw can help to increase blood volume and make it easier to find a vein.
5. Use a butterfly needle: A butterfly needle is a smaller, flexible needle that may be easier to maneuver in difficult veins.
6. Use ultrasound guidance: In some cases, healthcare professionals may use ultrasound guidance to locate veins that are difficult to see or access.
7. Seek assistance: If the healthcare professional is having difficulty finding a vein, they may seek assistance from a colleague or a specialist, such as a phlebotomy technician or an anesthesiologist.

It’s important to communicate with the patient throughout the process, explain what is happening, and address any concerns or questions they may have. For more specific techniques to optimize your skills, make sure you check out Phlebotomy for Nurses from the IV Guy. Specifically, check out Module 4 – Challenging Patient Populations, in which he discusses how to draw blood on geriatric and bariatric patients, those suffering from diabetes and end stage renal disease, those who are combative, and with a history of intravenous drug use. This course is literally the best one available for nurses and nursing students who are looking to improve their phlebotomy skills.

How to Use a Straight Needle for a Blood Draw

The main difference between drawing blood with a straight needle and a butterfly needle is the size and design of the needle. A straight needle is a rigid, straight needle that is typically used for venipuncture, or the insertion of a needle into a vein to collect blood. Straight needles connect to a vacutainer and then the blood collection tube.

A butterfly needle, also known as a winged infusion set, is a smaller, more flexible needle that has two “wings” on the sides. These wings can be held to stabilize the needle while it is inserted into the vein. Butterfly needles are often used for patients with smaller veins or for those who are difficult to stick. Butterfly needles connect to a short tube, which then connects to a vacutainer, and then finally to the blood collection tube.

There is not much difference in the actual task of drawing the blood from the vein with the needle, rather, the difference is in how you hold the blood collection tubes.

Is it Better to Use a Butterfly Needle or a Straight Needle to Draw Blood?

One of the main advantages of using a butterfly needle over a straight needle is that it can be easier to maneuver in smaller veins. The wings on the butterfly needle can help stabilize the needle while it is inserted, and the smaller size can reduce discomfort for the patient.

However, butterfly needles can be more difficult to use for larger blood draws, as they are typically used with smaller vacuum tubes. Additionally, the design of the butterfly needle can make it more prone to kinking or bending during the blood draw, which can cause the needle to become dislodged from the vein.

Ultimately, the choice of needle will depend on the specific patient’s needs and the preference of the healthcare professional performing the blood draw.

How to Practice Drawing Blood at Home

If you want specific guidance and instruction on how to complete these different processes, we recommend you check out the Phlebotomy for Nurses. He gives a detailed account of each process and helps you become more familiar with each. Blood drawing is an important medical process that you can improve on by learning more about the process and practicing on patients. 

If you would like a basic demo and explanation, check out the FreshRN Nursing School Clinical Prep course below.

Getting ready for nursing school clinicals, but feeling unprepared?

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