Phlebotomy Guidelines for Human Subjects Used

in Teaching and Research

University of Regina Phlebotomy Guidelines for Teaching and Research, 2015 Page 1
Table of Contents
Phlebotomy Guidelines for Human Subjects Used in Teaching and Research ............................................. 1
Introduction .............................................................................................................................................. 3
Definitions ................................................................................................................................................. 4
Training Requirements.............................................................................................................................. 5
Venipucture........................................................................................................................................... 5
Capillary Source..................................................................................................................................... 5
Ethics ......................................................................................................................................................... 6
Biosafety/ Exposure Control Considerations ............................................................................................ 7
Universal Precautions ........................................................................................................................... 7
Phlebotomy Hazards ............................................................................................................................. 7
Immunizations....................................................................................................................................... 7
Personal Protective Equipment ............................................................................................................ 8
Protective and Personal Clothing Decontamination............................................................................. 8
Phlebotomy Equipment and Materials ..................................................................................................... 9
Phlebotomy Procedures.......................................................................................................................... 10
Venipuncture Procedures ................................................................................................................... 10
General Capillary Source (Fingerprick) Procedures ............................................................................ 10
Sharps Disposal (i.e. needles, razor blade, scalpels, etc.) ................................................................... 11
Incidents .................................................................................................................................................. 13
Exposure.............................................................................................................................................. 13
Spills .................................................................................................................................................... 14
References .............................................................................................................................................. 16

University of Regina Phlebotomy Guidelines for Teaching and Research, 2015 Page 2
Introduction
These Phlebotomy Guidelines outline the recommended health and safety program for only performing
fingerprick (capillary) phlebotomy on human subjects for teaching and research purposes at the
University of Regina (U of R).

These Phlebotomy Guidelines apply to all U of R Faculty, Staff, Students, Contractors, and Visitors
engaged in capillary source phlebotomy on humans. These Phlebotomy Guidelines do not apply to
phlebotomy for animals or for venous source activities, contact health.safety@uregina.ca for more
information.

The U of R Biosafety for Education, Research, and Community Health Program and Health and Safety
Policy (GOV-100-005) provides the guidance and authority to the Phlebotomy Guidelines and forms part
of the Health and Safety Management System.

University of Regina Phlebotomy Guidelines for Teaching and Research, 2015 Page 3
Definitions
Canadian Society for Exercise Physiology (CSEP): The CSEP is a voluntary organization composed of
professionals interested and involved in the scientific study of exercise physiology, exercise
biochemistry, fitness and health.

Immunization: The process by which an individuals immune system becomes fortified against an agent.

Phlebotomy: The practice of drawing or collecting blood from a venous (venipucture) or capillary blood
source.

Universal Precautions: Are a set of strategies developed to prevent transmission of blood and body fluid
pathogens.

Venipuncture: The drawing or puncture of a vein through the skin in order to withdraw blood.

University of Regina Phlebotomy Guidelines for Teaching and Research, 2015 Page 4
Training Requirements
Venipucture
Only trained health care professionals (physician, registered nurse, phlebotomist) are permitted to draw
human blood for a venous source for teaching and research purposes. This Phlebotomy Guide does not
address venipuncture activities, contact health.safety@uregina.ca for more information.

Capillary Source
Individuals intending to draw blood from a capillary source (fingerprick) must be appropriately trained
on the procedure, the associated hazards, and protective measures.

The U of R Phlebotmoy Training Program has been designed by Saskatchewan PolyTechnic

(http://saskpolytech.ca). Records of training, theoretical and practical, must be maintained by the
supervising researcher overseeing the work. Contact health.safety@uregina.ca for training information.

CSEP-CEP
Hands-on demonstration must be re-certified annually, as per the Canadian Society of Exercise
Physiology (CSEP) position statement, see http://www.csep.ca/english/view.asp?x=956. The U of R
Training Program successfully meets this requirement.

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Ethics
Researchers intending to perform phlebotomy must ensure that all required ethics approvals from the
Research Ethics Board (REB) are in place prior to engaging in phlebotomy on humans. The REB is
responsible for the review of all ethics applications involving human subjects. For more information on
the human ethics approval process and requirements, please refer to the U of R REB website,
http://www.uregina.ca/research/REB/main.shtml.

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Biosafety/ Exposure Control Considerations
Universal Precautions
All individuals shall adhere to universal precaution strategies when performing phlebotomy. For
information, please see: http://www.ccohs.ca/oshanswers/prevention/universa.html.

Phlebotomy Hazards
By its nature, phlebotomy has the potential to expose personnel to blood from other people, putting
them at risk from bloodborne pathogens. These pathogens include human immunodeficiency virus,
Hepatitis B virus, Hepatitis C virus, those causing vial haemorrhagic fevers (e.g. Ebola, etc.), and dengue.
Diseases such as malaria and syphilis may also be transmitted via contaminated blood. Poor infection/
exposure control practices may lead to bacterial infections.

Immunizations
It is the responsibility of the supervising researcher who has been granted authorization to perform
phlebotomy procedures to ensure that all Faculty, Staff, and Students are offered recommended
immunizations when performing phlebotomy (see Table 1 below). Personnel may formally decline
immunization. Copies of all immunization records must be maintained by the supervising researcher.
Contact health.safety@uregina.ca for more information.

Table 1
Recommended immunizations for U of R lab faculty and staff working with human/ primary
specimens
Vaccine Recommendation(s)
All Researchers or lab staff should be immune. Primary series if no previous immunization.
Diphtheria Booster doses of Td vaccine every 10 years. (Available as Td or Tdap or Tdap-IPV. Tdap is
Tetanus indicated if an adult pertussis dose is needed. Tdap-IPV is indicated if both pertussis and
polio vaccinations are needed.)
Hepatitis A If no evidence of immunity. (Post-immunization serologic testing within 1 to 6 months of
&B completion of primary series.)
Measles If no evidence of immunity, regardless of age - 2 doses.
Mumps If no evidence of immunity, regardless of age - 2 doses.
Pertussis A single dose of Tdap vaccine if not previously received in adulthood.
Primary series if no previous immunization 3 doses. Unvaccinated Researchers and Lab
Polio staff at highest risk of exposure should be particularly targeted for primary immunization.
A single lifetime booster dose for Researchers and Lab staff at highest risk of exposure.
Rubella If no evidence of immunity 1 dose.
If no evidence of immunity - 2 doses. (Self-reported history of varicella or herpes zoster is
Varicella
not reliable for a Researcher or Lab staff to be considered immune.)
For more information, please see PHACs Canadian Immunization Guideline, (7th Edition, 2006).

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Personal Protective Equipment
The minimum personal protective equipment (PPE) required when performing phlebotomy and when
handling human blood are:

Clean lab coat;

Safety glasses;
Disposal non-latex gloves (e.g. nitrile gloves);
Pants; and
Closed toe/heel shoes.

Protective and Personal Clothing Decontamination

All contaminated personal clothing items and non-disposable gowns, coveralls, and coats should be
properly decontaminated to reduce risk of transmission and exposure. The risk of disease transmission
from soiled linen is low, but soiled linens may carry organisms that may contaminate the air and
immediate environment. It is recommended that decontamination via the U of R Laundry Service
(Science Stores) be performed every 6 months, but this will vary with the type and intensity of research
activity. Contact health.safety@uregina.ca for more information.
1. Do not walk into public areas with contaminated clothing.
2. Promptly don the appropriate PPE for removing contaminated clothing (i.e. gloves).
3. If soiled clothing cleaning and disinfecting procedures cannot be completed in the room that the
clothing was soiled, the items must be removed and transported in strong biohazard/plastic
bags.
4. Soiled clothing should be handled as little as possible and with minimum agitation.
5. Hold the soiled clothing away from your unsoiled clothing.
6. Bring the soiled clothing sealed in strong biohazard/plastic bag down to Science Stores for
Laundry Servicing.

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Phlebotomy Equipment and Materials
Areas designated for capillary phlebotomy are to include the following equipment and materials:
Sink for hand washing;
Soap and/or hand sanitizer;
Impervious work surface;
Emergency eye wash station;
Chair or suitable seating;
Prepackaged alcohol wipes;
Clean cotton balls;
Safety-engineered lancets;
Absorbent waterproof paper with plastic backing/ bench-coat;
Test strip and/or capillary tubes;
Sterile gauze and bandages;
Disinfectant (i.e. 70% ethanol, fresh 10% bleach, or pre-diluted Oxivir Tb) and supplies for
decontamination;
Blood & Body Fluid Spill Clean Up Kit;
Paper towels;
Sharps disposal container (available for purchase at Science Stores);
First Aid Kit.

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Phlebotomy Procedures
Venipuncture Procedures
Only health care professional shall be permitted to draw human blood from a venous source for
teaching and research purposes. Contact health.safety@uregina.ca for more information.

General Capillary Source (Fingerprick) Procedures

The following is a general procedure when performing human capillary source phlebotomy on fingertips.
1. Prepare all necessary materials prior to performing the procedures so that they are easily
assessable. Keep work area organized and clean.
2. Wash hands thoroughly:
Hand Washing Steps:
1. Remove all rings and wet your hands with warm
running water.
2. Use soap and produce lather, rubbing your
hands for 20 seconds.
3. Scrub all surfaces of hands including backs of
hands, wrists, between fingers, and under
fingernails (with a nail brush if available).
4. Rinse hands in clean, warm running water for at
least 10 seconds.
5. Dry hands with a clean towel.
3. Don lab coat, safety glasses, and nitrile gloves. Set
aside a second pair of gloves for cleanup
procedures. If gloves have to be removed for any
reason, a new pair should be used. If gloves are damaged, replace them before proceeding.
Wash hands before putting on new gloves.
4. Work over an absorbent waterproof pad (bench-coat/ absorbent paper with plastic backing).
5. Select the non-dominant hand and ring finger tip of the volunteer. Hold the finger nail down
firmly on the table surface. Select a site that is about 1/3 of the nail length from the end of the
finger, slightly off centre.
6. Wipe the fingertip with a new alcohol wipe. Allow to air dry thoroughly.
7. Retrieve a new safety-engineering lancet. Never use a surgical blade to perform capillary source
phlebotomy.
8. Puncture the disinfected finger tip with one quick, continuous and deliberate stroke, to achieve
a good low of blood and to prevent the need to repeat the puncture. Safety-engineered lancets
require only gentle pressure on the side of the end of the finger. Do not puncture the skin more
than once with the same lancet or sued the same site more than once. This can lead to bacterial
contamination or infection.
9. Disposal of the used lancet in the sharps disposal container.
10. Wipe away the first drop of blood because it may be contaminated with tissue fluid or debris
(sloughing skin).
11. Squeeze out a single blood drop and transfer it to the test strip or capillary tube.

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 12. Wipe off finger with a new cotton ball. Discard cotton ball in the sharps waste disposal
container.
13. If bleeding has not completely stopped, cover wound with cotton ball, sterile gauze, or a
bandage.
14. Dispose of all test strips or capillary tubes when finished in the sharps container. Once
containers are full contact health.safety@uregina.ca for waste removal.
15. Disinfect the work areas with Oxivir Tb (pre-diluted solution with a contact time of 1-5 minutes)
or bleach (e.g. fresh daily dilution of 10% bleach with a contact time of 15 minutes) or ethanol
(dilution of 70% ethanol with a contact time of 5 minutes). Wipe area thoroughly with paper
towel.
16. Remove all PPE and wash hands thoroughly. PPE may not be worn outside of phlebotomy area.
The laboratory coat should be placed in plastic bags for transfer to laundry service every three
months (see above).

Sharps Disposal (i.e. needles, razor blade, scalpels, etc.)

1. Wear gloves, laboratory coat, closed-toe shoes, and other appropriate personal protective
equipment, including face and eye protection.
2. No other items (i.e. liquids, solids) should be mixed with sharps waste.
3. Place waste in a biohazard sharps waste container available from Science Stores. Fill container no
more than 75% full.
4. If applicable, put on chemical waste label and label all chemicals.
5. Contact health.safety@uregina.ca for disposal.

Steps for Removing Laboratory Coat:

1. With gloves 2. Pull off one arm, 3. Pull off second arm, 4. Once coat is off, 5. Dispose of coat in
still on, keep coat away keeping coat away hold away from garbage receptacle
unbutton coat. from body. from body. body and slowly roll or placed in plastic
coat. bag for laundry
service.

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Steps for Removing Goggles:

1. Without touching face, 2. Pull goggle upward away and 3. Dispose of goggle in the
grasp goggle with one off of head. garbage receptacle.
gloved-hand.

Steps for Removing Gloves:

1. Grasp one glove 2. Pull down glove, 3. Insert fingers of 4. Pull down glove until it 5. Dispose of gloves in
on the inside of turning it inside ungloved hand is inside out, drawing it the garbage
wrist at inch out, and pull under the cuff of over the first glove. receptacle.
below band of hand. Hold the the glove on the
dirty side of glove glove with the other hand (on
without touching still-gloved hand. inside of cuff).
the skin.

6. Wash your hands well with hand anti-septic and/or soap and water at the nearest clean location.

17. Ensure all samples collected are stored in appropriate storage units such a refrigerator or
freezer. Ensure confidentiality.

_______________________________________________________________
Physician Name and Signature

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Incidents
Exposure
If an individual performing phlebotomy has been injured or exposed to human blood (e.g. cut, pucture,
exposure to eyes of mucous membranes), the following steps are to be followed by the individual.

Emergency Contact Information

24 Hour Emergency (Fire, Police, Medical): 911
24 Hour Saskatchewan Health Hotline: 811
Campus Security: 306-585-4999

Biosafety Officer (BSO): 306-585-5198/ 306-527-4320

Health, Safety & Environment, Human Resources: 306-585-4776 /306-585-5487

Medical Emergency
1. Phone 911 Direct them to the scene of the occurrence.
2. Call Campus Security: 585-4999
3. Give First Aid, if you are qualified to do so, or get help from trained Emergency Wardens and/or
Campus Security.
4. Stay with victim.

Needle Stick Poke, Puncture Wound, or Percutaneous Injury

1. Remove gloves and allow the wound to bleed.
2. Immediately wash the affected area for 15 minutes with soap and warm water.
3. Notify Supervisor (if available) to obtain assistance.
4. Seek medical assistance immediately (within 1-2 hours) from a health care professional. The cause
of the wound and organisms involved should be reported.
5. Details of the incident must be documented using the Incident Report Form and forwarded to
Health, Safety & Environment within 24 hours. Forms can be found online atwww.uregina.ca/hr/hse
or by contacting health.safety@uregina.ca or 306-585-4776. Please include the following details:
a) What was the method of contact (e.g. needle stick, splash)?
b) How did the exposure occur?
c) What known biological agents or body fluids were you in contact with?
d) What action was taken in response to the exposure to remove the contamination (e.g. hand
washing)?
e) What personal protective equipment was being used at the time of exposure?
f) What is your immune status (e.g. Tetanus, Hepatitis A or B Virus)?

Eyes or Mucous Membrane Exposure (e.g. Splash)

1. Immediately flush the affected area for 15 minutes using an eyewash or shower.
2. Notify Supervisor (if available) to obtain assistance.
3. Seek medical assistance immediately (within 1-2 hours) from a health care professional. The
organisms involved should be reported.

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4. Details of the incident must be documented using the Incident Report Form and forwarded to
Health, Safety & Environment within 24 hours. Forms can be found online www.uregina.ca/hr/hse
or by contacting health.safety@uregina.ca or 306-585-4776. Please include details as listed above.

Ingestion
1. Protective clothing should be removed.
2. Notify Supervisor (if available) to obtain assistance.
3. Seek medical assistance immediately (within 1-2 hours) from a health care professional.
4. Identification of the material ingested and circumstances of the incident should be reported.
5. Details of the incident must be documented using the Incident Report Form and forwarded to
Health, Safety & Environment within 24 hours. Forms can be found online www.uregina.ca/hr/hse
or by contacting health.safety@uregina.ca or 306-585-4776. Please include details as listed above.

Spills
1. If you need to clean up a spill, obtain the Blood & Body Fluid Spill Clean Up Kit from your area.
2. The person performing the spill cleanup must first put on personal protective
equipment provided in the Blood & Body Fluid Spill Clean Up Kit: nitrile
gloves, safety goggles, and disposable laboratory coat.
3. Care must be taken to avoid splashing or generating aerosols during the clean
up.
4. Prepare a garbage bag inside a leak-proof, puncture-resistant waste disposal
container (e.g. garbage receptacle, plastic pail, etc.) for disposal of supplies,
gloves, mask, and equipment.
5. Place the garbage receptacle close to the area of spill cleanup to minimize
splashes.
6. Cover all contaminated areas, equipment, and/or broken glass with paper towels to avoid splashing
and to reduce generation of aerosols.
7. Spray or pour disinfectant from the outside of the contaminated area and move inwards.
8. Leave disinfectant on areas and equipment for at least 5 minute contact time.
**If area is heavily contaminated with organic material (fecal material, thick secretions, vomit, etc.)
allow for 10 minute contact time.
9. Collect any sharp objects or broken glass with forceps, tongs, or broom/dust-pan and place in
biohazard sharps container. Never use your hands.
10. The spill area must be cleaned of obvious organic material (fecal matter, thick secretions, vomit,
etc.) before applying a 2nd round of disinfectant. Place material and paper towels in the garbage
receptacle.
11. Absorb excess blood and body fluids with paper towels and place in garbage receptacle.
12. Again lay paper towels over the remaining spill.
13. Spray or pour disinfectant over the paper towels and the immediate surrounding area. Allow for a
5-minute contact time.
14. Before exiting room, properly remove laboratory coat, goggles, and then gloves, (see above).
15. Place disposable items into the garbage receptacle.
16. Close bag immediately and dispose of waste by contacting Health, Safety & Environment (306-585-
4776) or health.safety@uregina.ca.

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17. If you contaminate your personal clothing items with blood and body fluids:
a. Put on clean nitrile gloves.
b. Remove contaminated items slowly and transport in separate, closed garbage bag. Hold
the contaminated clothing away from your unsoiled clothing. Contaminated clothing
should be handled as little as possible.
c. Wash contaminated clothing separately in hot soapy water and dry in a hot dryer. Or
have items dry-cleaned.
18. Wash your hands very well with hand anti-septic and/or soap and water at the nearest clean
location.
19. Notify your supervisor and Health, Safety & Environment within 24 hours of incident.
20. Complete an Incident Report Form detailing your response and forward to Health & Safety.
Incident Report Forms can be found in the Blood & Body Fluid Spill Clean Up Kit.
21. Replace Blood & Body Fluid Spill Clean Up Kit contents by contacting Health, Safety &
Environment.

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References
Canadian Centre for Occuptional Health and Safety (CCOHS). Routine Practices. Retrieved from
http://www.coohs.ca/oshansweres/prevention/universa.html

Canadian Society for Exercise Physiology. 2015. Blood Sampling Position Statement. Retrieved from
http://www.csep.ca/english/view.asp?x=956

Public Health Agency of Canada. 2007. Canadian Immunization Guideline, 7th Edition.

University of Saskatchewan, Workplace Safety and Environmental Protection. 2011. Phlebotomy

Guidelines for Human Subjects Used in Research. Retrieved from
http://safetyresources.usask.ca/procedures_forms/documents/Phlebotomy%20Guidelines%20October
%2014,%202011.pdf

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