Phlebotomy Policies

Phlebotomists work in hospitals, labs, and physician's offices collecting blood samples from patients. They are a part of a clinical lab team. Phlebotomists need a high school diploma or GED and first-aid training. Different states have different requirements for phlebotomists, but many receive on-the-job training. Some may pursue a certificate program lasting several months to a year.

Patient Policies

It is important for a phlebotomist to properly identify the patient, asking the patient's full name, and checking against the armband. For an outpatient, ask for date of birth. The phlebotomist should speak to the patient during the blood-collection process to keep the individual at ease.

Preparation for Venipuncture

Phlebotomists should have all necessary equipment and supplies with them when entering the patient's room. This would include collection tubes, needles, tourniquet, alcohol wipes, gauze sponges, adhesive bandages and medical tape, needle disposal unit and gloves.

The phlebotomist must choose the venipuncture site. Typically, the median cubital and cephalic veins of the arm are first choice. The basilic vein on the dorsum of the arm or the dorsal hand vein are frequently chosen alternative sites. The foot is avoided if possible because of the higher likelihood of complications. Certain other areas are avoided for venipuncture, such as scarred areas of skin, areas of hematoma or on the site of a previous mastectomy, and whenever possible, avoid the arm where an IV is placed.

Phlebotomists should trace the vein with the index finger, making sure to avoid arteries, which pulsate, have thick walls and are elastic.The patient's condition should be observed and allergies to adhesives, antiseptics or latex noted.

Collection Procedure

The patient should be properly positioned, either sitting up in bed, lying down or sitting in a chair, with arm hyperextended. The tourniquet should be applied a few inches above the venipuncture site, not applied too tightly or left on longer than two minutes. The patient should be instructed to make a fist, without pumping the hand. Clean the site with an alcohol wipe, letting the area dry before the needle "stick."

The phlebotomist should grasp the patient's arm, pulling the skin taut with the the thumb and keeping the vein stable. The needle should be inserted at a 15-to-30-degree angle to the surface of the skin, and swiftly plunged into the vein. It's recommended that the phlebotomist speak to the patient during the blood-collection process to keep the person at ease.

After filling the last blood-collection tube, the phlebotomist removes the tourniquet and then the needle, with a swift backward motion. A gauze pad should be pressed down on the siteonce the needle is out, with sufficient pressure applied to avoid hematoma. Used items should be disposed of in appropriate containers, and label and tubes delivered to the lab promptly.

After two unsuccessful attempts at collecting blood, the phlebotomist should request a patient's permission for any further tries. Often after a couple of unsuccessful sticks, another lab worker, nurse or physician may be called in to collect the blood.