1. Reviews the physician’s order to determine the patient and type of test for which blood is to be drawn. 2. Obtains the requisition and compares it to the physician’s order. 3. Determines whether special conditions, such as fasting or specific times, are required and have been met. 4. Assesses the patient’s veins to determine which type of phlebotomy equipment will be best to use: evacuated tube system or needle and syringe. 5. Screws the needle or winged infusion set onto the plastic tube holder or syringe. 6. If more than one test is ordered, determines the order in which the tubes should be drawn. 7. Follows the “Initial Implementation Steps.” 8. Washes hands to prevent cross-contamination. This is particularly important due to the invasive nature of this skill. 9. Verifies patient identity by checking the patient’s identification band and using a second method. 10. Arranges supplies within arm’s reach, positioned so you do not have to turn around or lean to pick up the tubes once the needle is positioned in the vein. 11. Dons gloves. 12. Applies the tourniquet 3 to 4 inches above the intended puncture site, with the tails of the tourniquet extending from the top side 13. Palpates the intended vein. 14. With left hand, grasps the tourniquet where it crosses over itself and grasps the lower tubing end with right hand. 15. Pulls the end in right hand until it is taut and uses left hand to maintain the tension where the two ends cross. 16. Cleans the site with 70% alcohol, chlorhexidine, or as designated by facility policy. 17. Allows the site to dry for 30 seconds: Evacuated tube system: places the first tube loosely into the plastic tube holder. Needle and syringe system: pulls back and forth on the syringe plunger two or three times to make certain it is not stuck.
18. Uncaps the needle, maintaining sterile technique. Positions the needle so that the bevel is up. If Using an Evacuated Tube System: 19. Holds the plastic tube holder so that it rests on fingertips and thumb is on top of the holder, letting the tube lay loosely in the holder. 20. Uses an angle between 15 and 30 degrees, piercing the skin in a swift, continuous motion. 21. Once in the vein, braces hand that is holding the phlebotomy device firmly against the patient’s arm and pushes the tube onto the needle carefully. 22. When the tube stops filling, gently removes the tube from the holder with nondominant hand without pulling needle out of the vein. 23. Inverts the tube of blood two to three times and put it aside. Picks up the next tube to be filled and repeats the process. 24. When tube stops filling, removes it from holder. 25. Releases the tourniquet before removing needle from vein. 26. Uses nondominant hand to place a 2 × 2-inch gauze pad over the needle insertion site while removing the needle from the patient’s arm, applying firm pressure to the site immediately after the needle is withdrawn. 27. Holds pressure over site long enough to prevent bleeding. Places a piece of tape over the gauze. May elevate the outstretched arm above the heart. Does not allow the patient to bend arm. If Using a Needle and Syringe System: 19. Holds the syringe so that it rests on fingertips with thumb on top of the syringe, needle bevel up. 20. Uses an angle between 15 and 30 degrees and pierces the skin in a swift, continuous motion. 21. Once in the vein, braces hand that is holding the syringe firmly against the patient’s arm. 22. Pulls the plunger back slowly and gently begins drawing blood into the syringe without pulling needle from vein. Avoids pulling the plunger back too quickly, as this can collapse fragile veins. Fills the syringe to the required volume to fill all needed tubes. 23. Releases the tourniquet before removing needle from vein. 24. Uses nondominant hand to place a 2 × 2-inch gauze pad over the needle insertion site while removing the needle from the patient’s arm, applying firm pressure to the site immediately after the needle is withdrawn.
25. Holds pressure over site long enough to prevent bleeding. Places a piece of tape over the gauze. May elevate the outstretched arm above the heart. Does not allow the patient to bend arm. 26. Applies a clean 18- to 20-gauge needle to the syringe. 27. Punctures the rubber stopper of the first tube to be filled. Enters the stopper at an angle, placing the tip of the needle against the inside of the tube to allow the blood to trickle down the side of the tube. Continues to fill the tubes in the correct order of draw. For either system: 28. Disposes of the contaminated needle, syringe, and disposable plastic tube holder in the sharps container. 29. Labels each tube of blood according to facility policy before leaving the patient’s bedside. 30. Places specimens in a plastic bag or specified container, along with the requisition. 31. Removes gloves and washes hands. 32. Reassesses the puncture site to ensure that bleeding has stopped before leaving the room. 33. Follows the “Ending Steps.” 34. Documents the procedure in the patient’s chart. 35. Delivers the specimens to the laboratory per facility policy.
Recommendation: Pass _____ Needs more practice _____