Phlebotomy Procedure Step by Step

As a phlebotomy technician, you are expected to perform a lot of things, not just in drawing blood. Although collecting blood sample is your primary function, your role extends to the social aspect of phlebotomy. Even if your training doesn’t include ideas on how to properly interact with patients, depending on the course program you enrolled in, it is important that you get extensive knowledge about this particular aspect. Just think; if you were the patient and the phlebotomy technician wasn’t the least courteous or friendly, you probably would not have anything to do with him.

What are the best practices in phlebotomy, then?

The entire procedure is simply described in the flowchart below

Phlebotomy Procedure Steps

Prepare the equipment required

Whatever you need to perform a particular procedure must be within safe and easy reach from you, but away from your patient to keep stuff from being tipped over accidentally. Ideally a phlebotomy tray must have the following:

Supply of laboratory sample tubes (sterile glass or plastic tubes) with rubber caps, vacuum-extraction tubes, or glass tubes with screw caps
Sterile glass or bleeding pack, depending on the amount of blood to be collected
Blood-sampling devices of different sizes
Tourniquet
Alcohol hand rub
Gauze to be applied over the puncture site
70% alcohol swab to disinfect the skin
Leak-proof transportation containers or bags
Puncture-resistant sharps container for used needles

On top of these, there should be laboratory forms, specimen labels and pens that you will need.

Patient identification and preparation

Now that you have the tools you need, it’s time to deal with the patient. The process differs when you are dealing with an adult (conscious) and a child.

When patient is an adult:

Make sure to introduce yourself and have the patient state their full name. For in-patients, check the arm band for verification. When working with outpatients, be sure to verify that the patient information matches what is written on the requisition form.
Ask about allergies, phobias or instances when a patient fainted during blood collection. If the patients seem afraid or anxious, reassure them, ask about what will make them comfortable and let them know that only a minimum amount of blood will be drawn for testing. That is, if this is all you need.
Make sure the patient fully understands the procedure before you proceed. Obtain verbal consent, as they have the right to refuse after they have been informed about the procedure.

When patient is a child or a baby:

Verify identification based on wrist or foot band attached to the patient.
When a parent or guardian is present, ask the person for the first and last names of the child.
Match the identity of the patient with that of the name, date of birth, and file number written on the laboratory form.

Perform hand cleansing and put on gloves

Before carrying out phlebotomy, technicians must wash their hands with soap and water and then dry with a single-use towel. An alternative would be to cleanse the hands with 3 ml of alcohol rub, starting with the palm of the hand, rubbing it into the fingertips and all over the hands until the alcohol dries out.
Put on well-fitting latex, rubber or vinyl gloves. Make sure to ask if patient if allergic to latex, before you put on one.

Select the venipuncture site

Extend the patient’s arm so that the shoulder to wrist forms a straight line.
Locate a vein that is visible, straight, clear and with a good size. The most frequently used veins are the larger median cubital, cephalic and basilica veins.

Image Credit: Pinterest/Cynthia Villareal

But once the patient clenches his fist, other veins will become prominent. Make sure that the vein you pick is already visible even before you apply the tourniquet.

Apply the tourniquet 3-4 inches above the collection site or 4-5 finger widths, and then re-examine the vein. Don’t leave the tourniquet on for more than a minute. If you need more time to locate a vein, release it after 1 minute and then re-apply after 2 minutes.

Important Note:

In choosing a collection site…

Avoid areas with extensive healed burns or scarring
When a patient has had a mastectomy, don’t obtain blood from the arm that is on the same side as the breast that has been surgically removed.
Avoid areas of hematoma
Never obtain blood samples above the IV site, it should always be below
Avoid an arm having a vascular, fistula or cannula graft
Following a transfusion, wait 10 to 15 minutes before obtaining blood samples.

Disinfect the collection site

Clean the site with a swab soaked with 70% alcohol for 30 seconds, then allow it to dry.
When applying the swab, use firm but gentle pressure and cover an area of 2 cm or more. Start from the centre and then moving downward or outwards.
Make sure the site is completely dry before performing phlebotomy to avoid contamination.

Perform venipuncture

Anchor the vein using the thumb of your opposite hand and place it about an inch below the collection site. Make sure the bevel of the needle is pointing up, and then insert the needle with a quick, small thrust to penetrate the skin at no more than 15⁰.
As soon as blood flow is established, remove the tourniquet and ask the patient to unclench or open his hand. It is also important to note how long the tourniquet should be left on. Once sufficient amount of blood has been collected, carefully remove the needle.
Have a clean gauze or cotton wool ready before you withdraw the needle. Gently withdraw the needle and then place the cotton or gauze over the puncture site with gentle pressure.
Ask the patient to hold the cotton wool in place with the arm extended and raised. Remind them not to bend the arm to avoid hematoma.

Phlebotomy Procedure Video Tutorial

Important Note:

Do not perform a venipuncture more than twice. If you don’t succeed at the first two attempts, inform a patient’s physician or your supervisor. Venipuncture should never be done on an artery and should not be performed on the feet unless specified.

Here’s a diagram for the entire Venipuncture process from Anatomical Blueprints².

Phlebotomy procedure when using a syringe is basically the same as the one outlined above, except that blood is drawn by slowly pulling back on the syringe stopper, rather than an evacuated vacutainer tube. The process is also different when done on an infant or child because of the differences in the collection site and equipment that will be used.

Collecting blood using multiple tubes

When multiple tubes are needed, the proper order of draw must be followed to avoid cross contamination and erroneous results. The recommended order of draw below is set by the Clinical and Laboratory Standards Institute™ (formerly known as United States National Committee Clinical Laboratory Standards).

Blood culture bottles, vials or sterile tubes
Coagulation tube (light blue top)
Clot activator (red top)
Serum separator tube (red-grey tiger or gold top)
- Tubes with royal blue tops are used mainly for nutritional studies, toxicology, and trace metal analysis
- Tubes with red tops are used for serology, chemistry tests and Blood Bank testing
Sodium heparin (dark green top)
PST (light green)
EDTA (purple top)
Blood tube (pale yellow top)
Oxalate/fluoride (light grey top)

Important Note:

Never shake the blood vigorously, but invert them so that additives will be mixed. For most additives, inverting 4 times will suffice, while others require 8 to 10 times, or as specified by the laboratory.

Afterwards, prepare the samples for testing or transportation, and clean up any spills of blood or other body fluids.

Closing

Mastering the phlebotomy procedure is not just a technical skill; it’s an art that combines precision, empathy, and professionalism. As you’ve delved into the various aspects of this process, you’ve gained insights into the importance of patient comfort, proper equipment usage, and accurate sample collection. By following the step-by-step guidelines outlined in this article, you’re well-equipped to navigate the complexities of venipuncture with confidence.

Remember that every successful phlebotomy procedure is a testament to your dedication to patient well-being and diagnostic accuracy. The small gestures of reassurance, the meticulous attention to hygiene, and the skillful execution of each venipuncture all contribute to creating a positive healthcare experience for your patients.

As the medical field continues to evolve, so does the practice of phlebotomy. Stay curious, remain open to learning about new techniques, tools, and safety measures, and always prioritize continuous professional development. By doing so, you’re not only elevating your own expertise but also contributing to the advancement of patient care standards.

Whether you’re an aspiring phlebotomist or a seasoned healthcare professional honing your skills, the art of phlebotomy is a cornerstone of modern medicine. With dedication, compassion, and a commitment to excellence, you’re shaping the future of healthcare, one successful venipuncture at a time.

FAQs: Phlebotomy Procedure

Q1: What is a phlebotomy procedure?
A1: A phlebotomy procedure is a medical technique involving the collection of blood from a patient’s vein for diagnostic testing, medical research, or blood donation purposes.

Q2: Who performs phlebotomy procedures?
A2: Trained healthcare professionals called phlebotomists are responsible for performing phlebotomy procedures. Nurses, medical assistants, and other healthcare providers may also be trained in phlebotomy.

Q3: What are the essential steps of a phlebotomy procedure?
A3: The key steps include:

Patient identification and verification.
Selecting the appropriate venipuncture site.
Applying a tourniquet to enhance vein visibility.
Cleansing the site with an antiseptic.
Inserting the needle into the vein and collecting blood.
Removing the tourniquet and needle, applying pressure, and securing the site.
Properly labeling and handling the collected blood samples.

Q4: Why is patient identification crucial in phlebotomy?
A4: Accurate patient identification ensures that the collected blood samples are correctly matched to the patient. Mistakes in patient identification can lead to incorrect diagnoses and treatments.

Q5: What tools are used in a phlebotomy procedure?
A5: Common tools include needles, evacuated blood collection tubes, tourniquets, antiseptics, adhesive bandages, gauze pads, and labels for sample identification.

Q6: How can I minimize patient discomfort during a phlebotomy procedure?
A6: Techniques such as using a smaller needle, selecting less sensitive venipuncture sites, and maintaining a calm and empathetic demeanor can help minimize patient discomfort.

Q7: What is the “butterfly” needle used for in phlebotomy?
A7: The “butterfly” needle is a smaller, more flexible needle often used for patients with small or fragile veins. It allows for gentler venipuncture and is preferred when obtaining smaller amounts of blood.

Q8: Can I reuse phlebotomy equipment?
A8: No, single-use disposable equipment is the standard in phlebotomy. Reusing equipment can lead to contamination, infection risk, and inaccurate test results.

Q9: What safety precautions are necessary during a phlebotomy procedure?
A9: Wearing gloves, adhering to infection control protocols, properly disposing of used needles and supplies, and following bloodborne pathogen guidelines are crucial safety measures.

Q10: How can I learn more about phlebotomy procedures?
A10: You can pursue formal training programs, workshops, online resources, and textbooks on phlebotomy. Hands-on training and supervised practice are essential for mastering the skills involved.

Q11: Are there specific patient populations that require special considerations during phlebotomy?
A11: Yes, pediatric patients, elderly individuals, patients with difficult veins, and those with specific medical conditions may require special techniques and considerations during phlebotomy to ensure their comfort and safety.