Phlebotomy · Special Collections · 6 min read
Blood Alcohol and Drug Screen Collections
- Identify proper site preparation techniques, additives, and handling procedures for blood alcohol specimen collections.
- Describe the required protocols for legal chain-of-custody documentation, patient consent, and refusal reporting.
- Explain the environmental controls, inspection steps, and temperature verification criteria for workplace urine drug screen collections.
Blood Alcohol Skin Preparation and Collection Supplies
Preparing a patient for a blood alcohol collection requires strict adherence to antiseptic selection guidelines. Phlebotomists must never use standard 70% isopropyl alcohol wipes to clean the venipuncture site for this test. Alcohol-based skin prep is avoided for blood alcohol collections because it may contaminate the specimen and could falsely elevate the result, particularly if the site is still wet. For this reason, collectors must completely avoid any antiseptic prep containing ethanol, isopropanol, or tincture solutions.
Instead of alcohol-based wipes, phlebotomists must select an approved non-alcohol alternative. A non-alcohol benzalkonium chloride preparation may be used if permitted by laboratory policy, or the phlebotomist may choose aqueous povidone-iodine as an acceptable alternative. Soap and water may also be used to cleanse the venipuncture site when permitted by facility policy. If aqueous povidone-iodine is selected, ask the patient about any prior reaction to it before application, and follow facility policy if a reaction is reported.
Once applied, the non-alcohol antiseptic must be allowed to air-dry completely before the venipuncture is initiated. The phlebotomist must not blow on, fan, or wipe the antiseptic site to speed up the drying process, as doing so introduces environmental contaminants. Additionally, all gauze pads used during the collection must be dry and entirely free of alcohol contamination.
Blood alcohol specimens are routinely collected in a gray-top evacuation tube. These tubes commonly contain sodium fluoride, an additive that works by inhibiting glycolysis and microbial fermentation. Inhibiting microbial fermentation is critical because it helps prevent bacteria and yeast from producing alcohol inside the collection tube after the draw. Many gray-top blood alcohol tubes also contain potassium oxalate as an anticoagulant, so the phlebotomist should always check the tube label for its specific additives.
| Antiseptic Type | Status for Blood Alcohol Prep | Special Instructions |
|---|---|---|
| 70% Isopropyl Alcohol or Tincture Solutions | Strictly Prohibited | Can cause specimen contamination and falsely elevated test results. |
| Benzalkonium Chloride (Non-alcohol) | Acceptable | Use if permitted by laboratory policy; allow to air-dry completely. |
| Aqueous Povidone-Iodine | Acceptable | Ask about prior reactions first; follow facility policy if a reaction is reported. |
| Soap and Water | Acceptable | Use when permitted by facility policy; ensure the area is clean and dry. |
Common mistakes
- Using an isopropyl alcohol wipe before a blood alcohol collection may contaminate the specimen and could falsely elevate the result.
- Blowing on, fanning, or wiping the venipuncture site to speed up drying instead of allowing the non-alcohol antiseptic to air-dry completely.
- Accusing a donor of tampering when a urine specimen's temperature is out of range, rather than documenting the objective fact, retaining the sample, and notifying the supervisor.
- Leaving an unsealed urine specimen unattended or out of the donor's view before applying tamper-evident seals.
Key points
- Blood alcohol draws require non-alcohol skin preparations, such as aqueous povidone-iodine, benzalkonium chloride, or soap and water, which must air-dry completely without fanning or wiping.
- Gray-top tubes containing sodium fluoride inhibit glycolysis and microbial fermentation to prevent yeast or bacteria from generating alcohol in the tube.
- Forensic and legal collections require strict chain of custody, patient identification, confirmation of consent or other applicable authorization, prompt reporting of refusals, and tamper-evident sealing.
- Workplace urine drug collections require securing the restroom, including adding bluing agent to the toilet bowl or tank as applicable, securing water sources, and removing or securing chemicals that could be used to alter a specimen.
- Donors must empty pockets, remove unnecessary outer garments, leave personal bags outside, and wash hands without subsequent access to running water prior to unobserved collection.
- For a federal split-specimen urine collection requiring at least 45 mL, the collector checks whether the temperature is 90°F to 100°F within 4 minutes after the donor gives the specimen to the collector and records the finding.
- Urine specimens must remain in view of both donor and collector until sealed; for federal workplace collections, the donor must initial and date the seals, and the collector must document unusual findings, shy bladder events, and refusals and make the notifications required by the collection protocol.
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