Question: One of our phlebotomists always uses a 20ml syringe to draw patients requiring many tests. It seems to me she needs to be trained to use tube holders instead. According to the standards, are there any circumstances in which a syringe would be preferred over a tube holder system?

Our Response: The CLSI standards don't address device selection with one exception: it states syringes with needles should be avoided whenever possible due to the increased risk of needlesticks.

That's because syringes are the device in use when most healthcare professionals sustain accidental needlesticks. So the phlebotomist's choice is pretty much a matter of personal preference unless it is established in the facility's policy. We agree syringe use should be minimized. Besides the safety concern, a 20cc syringe adds to the cost of the procedure and should only be used when the vein selected requires it, i.e., is fragile or anticipated to collapse when the full vacuum of the tube is applied.

Perhaps the person feels more comfortable with syringes, and uses them on every patient. That, then, becomes a matter of retraining for versatility. Sarstedt (Newton, North Carolina) offers a blood collection product that incorporates the evacuated tube method and syringe-draw process into one system where the tube itself can be filled via aspiration, similar to a syringe draw.

If one-on-one coaching won't decrease use and changing systems is not possible, you should put it into your policies and procedures so that syringe overuse is easier to discipline.