Name: __________________________________________
Phlebotomy Skills Verification Each venipuncture must be observed by an RN and evaluated according to the following performance criteria. A
minimum of 3 successful venipunctures is required.
Preceptor #1 _________________________ Date ___________ Preceptor #2 _________________________ Date ___________ Preceptor #3 _________________________ Date ___________
Skill: #1 #2 #3 1. Accurately Collects Blood Specimen following VUMC policy:
a. Verifies order. Gathers all venipuncture supplies prior to entering room. b. Washes hands properly observing all isolation protocols. Greets patient and introduces self. c. Verifies patient identity using any two of the following identifiers: Patient name, date of birth, medical record number,
last four digits of SS#, driver’s license, Polaroid photograph (Vanderbilt Psychiatric Hospital). Verify that the lab requisition and label information matches correctly.
d. Assess patient for an acceptable site to perform venipuncture i. Median cubital and cephalic veins are the optimal choices and provide the least risk of nerve damage; if
unacceptable the wrist or hand veins may be used. ii. If unable to find site, applies tourniquet to select site, then removes tourniquet.
e. Verbalizes sites that should be avoided i. Areas with extensive scar tissue
ii. Hematomas iii. Edematous areas iv. Extremities with dialysis shunts, PICC lines, and/or IVs
f. Positions patient, extending upper extremity comfortably. g. Verifies tubes to be collected correspond to tests requested. h. Applies tourniquet 3-4 inches above the selected puncture site. Does not leave tourniquet on more than 2 minutes. i. Asks the patient to make a fist without pumping their hand. j. Cleanses puncture site with alcohol in circular pattern, beginning at site, working outward. Allows to air dry. k. Dons gloves. Connects vacutainer to butterfly. Removes needle cap and inspects needle. l. Draws skin taut to anchor the vein. m. Inserts the needle (bevel up) at a 15-30 degree angle, avoiding trauma and excessive probing. n. Holds butterfly completely still while inserting tubes onto vacutainer. Fills vacutainer tubes in correct order.
i. Blood Culture tube (yellow-black stopper) ii. Non Additive tube (red stopper or SST)
iii. Coagulation tube (light blue stopper). A light blue stopper (sodium citrate) tube is NEVER the first tube drawn. If a coagulation assay is the only test ordered, draw a non-additive (discard) tube (red stopper or SST) first, and then draw the light blue stopper tube.
iv. Last draw – additive tubes in this order; note tubes with additives must be thoroughly mixed. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive.
a. Heparin (dark green stopper) b. EDTA (lavender stopper)
o. Removes the tourniquet as the last tube is filling and asks patient to open fist.
Name: __________________________________________
Phlebotomy Skills Verification Each venipuncture must be observed by an RN and evaluated according to the following performance criteria. A
minimum of 3 successful venipunctures is required.
Preceptor #1 _________________________ Date ___________ Preceptor #2 _________________________ Date ___________ Preceptor #3 _________________________ Date ___________
Skills/Theory #1 #2 #3 p. Removes the vacutainer tube. q. Removes the needle from the patient’s arm using a swift backward motion. While withdrawing the needle from the
patient’s skin, engages the safety mechanism. Presses down on the gauze over the puncture site with adequate pressure to avoid hematoma formation or asks competent patient to apply direct pressure over site keeping arm straight.
r. Places the needle into the sharps container. s. Gently inverts the tubes 5-10 times and correctly labels all tubes while at the bedside. Records own initials, date and
time of venipuncture on each tube label.
t. Records puncture site, full name with title, date and time on the requisition. u. Note that tubes labeled for the blood bank must have a full signature on them. v. Places properly labeled specimens into biohazard bag and seals completely. Places the requisition in the front non
sealable pouch of the biohazard bag.
w. Assures that puncture site bleeding has stopped. Applies Band-Aid after checking for allergy or a piece of tape with gauze.
x. Removes gloves and discards properly. y. Washes hands properly. z. Leaves patient settled comfortably. aa. Sends specimens to laboratory and documents procedure.
2. Note that if they feel the need to feel the vein after cleansing with alcohol, they may do so with sterile gloves only. 3. Verbalize no staff member should attempt phlebotomy on the same patient more than twice. 4. Verbalize methods to avoid hemolysis:
a. Mix tubes with anticoagulant additives gently 5-10 times b. Avoid drawing blood from a hematoma c. Make sure the Venipuncture site is dry d. Avoid a probing, traumatic venipuncture
5. Verbalizes and demonstrates proper procedure for drawing blood cultures: a. Peripheral venipuncture is the preferred method b. When multiple blood cultures are ordered, separate venipunctures are required for each culture set. c. Cleanses skin thoroughly with 70% isopropyl alcohol and allows site to dry. d. Swabs the site concentrically with Chlora Prep. e. Allow solution to completely dry before attempting venipuncture. This allows disinfection of the site to take place. f. Once disinfected the venipuncture site should not be probed with your finger unless you are wearing a sterile glove. g. Verbalizes appropriate sample volumes: 20ml sample (10 ml in each bottle) h. Label bottles with source and time
6. All venipunctures should be documented in HED as a procedure.
Name: __________________________________________
Phlebotomy Skills Verification Each venipuncture must be observed by an RN and evaluated according to the following performance criteria. A
minimum of 3 successful venipunctures is required.
Preceptor #1 _________________________ Date ___________ Preceptor #2 _________________________ Date ___________ Preceptor #3 _________________________ Date ___________
