These guidelines were reviewed and approved by the CAP Executive, September 25, 1996.
Published in the January-February 1997 issue of CAP Newsletter.
These guidelines were reviewed (no changes) and approved by the CAP Executive, July 3, 2004.

The mundane phlebotomy chair is a source of problems for the phlebotomist and for patients in the clinical laboratory.

Patients may faint, collapse or fall off the chair during the phlebotomy procedure. This can occur as a result of a vasovagal attack due to the sight of needle or blood, an overnight fast for laboratory test or, rarely, events such as a heart attack. The constant bending is a source of back disorders in phlebotomy staff. Universal precautions require the chair to be easily cleaned.

For these reasons and since there are no adequate international guidelines or published standards in Canada the Section of Clinical Pathology, Canadian Association of Pathologists, has developed guidelines on the design of the phlebotomy chair. These guidelines were officially approved by the executive and council of the association on June 23, 1991. The three basic considerations are patient comfort, patient safety and phlebotomist comfort.

The phlebotomy chair should be comfortable, be easily accessible and promote a sense of security for the patient. Physical restraints should not be considered for routine phlebotomy.  Arm extensions or fixed arm positions allow for patient comfort while maximizing the visibility of the elbow region. Extension surfaces for both arms are essential, because some patients have easily accessible veins in only one arm.

The patient should not be able to fall out of the chair or tip it, even if he or she collapses during venipuncture process. Positioning the chair against the wall or using a chair with a head rest would prevent the head and chair from tipping backward.

The chair should be easily cleaned (wood and cloth materials should be avoided) and sturdy, so that it does not tip. Its height should promote accessibility. If arm extensions are used they should be readily retractable in case a patient collapses.

The chair should be adjustable so that minimal bending is required for venipuncture. A large enough arm rest to ensure ease of venipuncture is a necessity. The venipuncture apparatus should be visible and easily removed if the patient collapses.

An adjustable reclining phlebotomy chair is preferable with quick release from sitting to reclining, supine and trendelenberg position in the event of patient fainting or going into shock.

Original authors: Bhubendra Rasaiah, MD, FRCPC
Gordon Hoag, MD, FRCPC
Section of Clinical Pathology
Canadian Association of Pathologists