Patient identification is widely considered the most critical step in phlebotomy because misidentification can lead to misdiagnosis, treatment errors, or fatal transfusion reactions. The Joint Commission requires that at least two patient identifiers be used, and the patient's room number may not serve as either of them. Acceptable identifiers include the patient's full name and date of birth or medical record number, which must be verified against the requisition and, in inpatient settings, against the wristband. Active identification, in which the patient states and spells their name and date of birth, is preferred over passive identification because it avoids the risk of the patient simply agreeing to an incorrectly stated name, a phenomenon known as yes or no bias. If a patient is unconscious or unable to state their identity, verification proceeds through the wristband with confirmation from a second staff member or family member according to facility policy.
Specimen labeling must occur at the patient's bedside immediately after collection and before the phlebotomist leaves the room. A properly labeled tube must include the patient's full name, date of birth or identification number, the date and time of collection, and the phlebotomist's initials. If a specimen is collected but not labeled at the bedside, it must be discarded and recollected rather than labeled away from the patient, because labeling away from the bedside introduces an unacceptable risk of misidentification. A mislabeled or unlabeled specimen is treated as a critical or sentinel event requiring immediate correction and recollection.
Proper specimen handling after collection preserves analyte integrity. Most routine specimens are transported and stored at room temperature, typically between 20 and 25 degrees Celsius or 68 to 77 degrees Fahrenheit. Some specimens require special handling to maintain accuracy. Tests such as ammonia, lactic acid, and arterial blood gases must be immersed in an ice slurry immediately after collection to slow metabolic activity. Conversely, specimens for cold agglutinin testing must be kept warm at body temperature, approximately 37 degrees Celsius. Certain analytes, including bilirubin and vitamin B12, are light-sensitive and degrade with exposure; these specimens should be protected from light during transport. Coagulation specimens should be kept at room temperature, never chilled, and processed within a defined time window to preserve accuracy.
Serum should be separated from cells within two hours of collection per CLSI guidelines to prevent continued glycolysis and cellular metabolism, which can falsely lower glucose and falsely elevate potassium. Tubes containing clot activator, such as SST gold tubes, should be allowed to sit for at least 30 minutes before centrifugation to permit complete clot formation, and centrifugation should occur with the stoppers in place to prevent aerosol formation, evaporation, and contamination. Specimens should be transported upright in leak-proof biohazard bags, gently handled to avoid hemolysis or agitation, and accompanied by proper documentation. Laboratories will reject specimens that are hemolyzed, clotted when anticoagulated, insufficient in volume (a condition referred to as QNS or quantity not sufficient), improperly labeled, or collected in the wrong tube type. An aliquot may be prepared by transferring a measured portion of the original specimen into a secondary container for testing or storage, while preserving the primary specimen.
Specimens collected for legal or forensic purposes, such as drug or alcohol testing, require a chain of custody, which is a documented, unbroken record of specimen handling and transfer. Each person who handles the specimen must sign and initial the documentation, recording the date and time at every transfer point. If a specimen is received without a matching requisition or with any inconsistency in labeling or volume, it should be rejected or held pending clarification and never processed until identity is confirmed.