Medical professional drawing blood

A Step-by-Step Guide to Phlebotomy

What is phlebotomy? Learn about the procedures, steps, risks, and requirements for performing phlebotomy.

Medical professional drawing blood

Drawing a blood sample may not be the highlight of a medical worker’s day and it certainly isn’t one for the patient, either. However, phlebotomy is more than essential to patient care. Mastering this skill will lead to a much better experience for healthcare practitioners as well as their patients.

Venipuncture is a vital practice for a number of medical diagnoses, procedures, and tests. This essential skill can be exciting for new healthcare professionals. It can be very beneficial for Medical Assistants to learn the proper method of drawing blood in a healthcare environment.

This article focuses on the art and science of phlebotomy, one of the most important healthcare procedures for medical staff.

(Click here to see our full list of the most common Medical Assisting duties and responsibilities).

Phlebotomy Definition

What is Phlebotomy?

Phlebotomy is the process of drawing blood intravenously from a patient. Phlebotomy is typically conducted by inserting a hollow needle into a patient’s vein to collect blood samples for laboratory testing.

In most cases, healthcare professionals draw blood from a vein inside the patient’s forearm or the back of their hand. Phlebotomy can be performed by nurses, medical laboratory scientists, medical practitioners, phlebotomists, dialysis technicians, and other staff.

What is the Purpose of Phlebotomy?

Phlebotomy is a standard procedure that’s usually performed for one of the following reasons:

  1. To acquire blood samples for diagnostic purposes.
  2. To monitor levels of various blood components.
  3. For removing blood to combat high levels of iron or red blood cells.
  4. To collect blood for later uses, such as blood transfusions.

How Long Does it Take to Perform Phlebotomy?

According to a study conducted by the National Institutes of Medicine, it takes about 10 seconds or less to collect blood for one tube. The average time to acquire blood for three tubes was between 26 and 44 seconds.

When you consider some of the preliminary steps for phlebotomy —collecting supplies, verifying information, preparing the patient, etc.—the entire process may take anywhere from five to ten minutes.

Who Can Perform Phlebotomy?

Phlebotomy is typically performed by a variety of different healthcare professionals, including medical laboratory scientists, medical practitioners, phlebotomists, dialysis technicians, and other nursing staff.

Some EMTs and paramedics may also perform venipuncture, and in veterinary medicine, the procedure is usually performed by veterinarians or veterinary technicians.

Depending on the location (i.e. state of employment), employer, and experience level, Medical Assistants can also draw blood with the proper training. It’s important to remember that a Medical Assistant can only draw blood under a physician’s order and as permitted by state law.

(Click here to learn how to become a Medical Assistant).

Students completing admissions process

Training Requirements for Phlebotomy

Phlebotomy requirements often vary and will depend on your location and profession. For instance, in all but four states, phlebotomists aren’t required to obtain a phlebotomy certificate or license to draw blood. Don’t worry, though; most employers will only hire phlebotomists with valid certifications or diplomas. Some people have years of phlebotomy experience but have never passed a phlebotomy program.

When it comes to phlebotomy training, many programs in your chosen profession will likely include some component of phlebotomy. For example, at Unitek College, students in our Medical Assisting program must demonstrate the application of adult and pediatric phlebotomy, venipuncture, and capillary blood collection.

Phlebotomy Procedure

With these steps, you can start to learn more about the process of phlebotomy. Like any other skill, phlebotomy requires time and practice to get it right. Try not to feel disheartened if you don’t get it right the first time. And don’t hesitate to ask for help.

Phlebotomy Prep

Have your supplies ready! Once you know the blood draw site, you’ll want to gather the necessary supplies.  Some healthcare facilities have pre-made kits, while others will require you to retrieve the kit yourself. It’s a good idea to take an extra set of supplies into the exam room as you might need to perform more than one procedure.

Phlebotomy Steps

Here are some of the general guidelines you should follow when performing phlebotomy on adults or children:

  1. Ensure you have received a physician’s order to draw blood. Also, ensure you are permitted to perform phlebotomy under your state’s law.
  2. Explain the procedure and reason for the blood draw to the patient.
  3. Identify the patient using two patient identifiers as mandated by the Joint Commission (JCAHO).
  4. Confirm the ordered blood tests and fill out the appropriate forms and labels.
  5. Check for any allergies or sensitivities with the patient regarding antiseptics, adhesives, or latex.
  6. Position the patient and hyperextend the patient’s arm.
  7. Perform good hand hygiene and wear appropriate PPE (personal protective equipment).
  8. Apply a tourniquet approximately three to four inches above the selected site. Closely monitor the arm to ensure it is not applied too tight or for more than two minutes. Reasons for concern would include numbness, tingling, change of color to blue or white, and extreme pain.
  9. Ask the patient to make a fist and not pump the hand.
  10. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow it to air dry for 30 seconds.
  11. Grab the patient’s lower arm (below site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Then, insert the needle at a 15 to 30-degree angle into the vessel.
  12. If properly inserted, blood should flash into the catheter. If this does not happen, the needle has either not punctured the vein or gone through the vessel.
  13. Attach the needed tubes or syringes to remove the proper volume of blood. Only remove the tourniquet as the last amount of blood is drawn.
  14. Remove the needle from the patient’s arm and press down on the vessel with gauze.
  15. Dispose of contaminated materials and needles in the designated hospital-approved containers.
  16. Label appropriate tubes at the bedside and place them into transport bags.
  17. Deliver blood specimens to the laboratory promptly.

Female healthcare worker in orange mask

Recovery

Medical professionals can stem the blood by holding a cotton swab to the puncture site. They should also apply a bandage or secure the cotton swab with tape. After the procedure, it’s recommended that the patient drink water and eat something. If they feel dizzy or experience any other uncommon symptoms, they must tell someone right away.

Necessary Equipment for Phlebotomy

Typically, the suggested supplies for phlebotomy include the following items:

  • Evacuated collection tubes
  • Personal Protective Equipment
  • Needles and syringes
  • Tourniquets
  • Hand Sanitizer
  • Alcohol swabs
  • Laboratory specimen labels
  • Gauze
  • Blood transfer device
  • Tape or adhesive bandages
  • Laboratory forms
  • Bio-hazard leak-proof transportation bags
  • Puncture resistant sharps container

Potential Risks or Complications of Phlebotomy

The following are some of the potential risks or complications that you may face when performing Phlebotomy on patients:

  • Cellulitis – A common but potentially serious bacterial infection of the skin. The affected areas typically appear swollen and red.
  • Phlebitis – Inflammation of the vein. It can occur due to blood clot(s) in a vein that causes inflammation.
  • Diaphoresis – Perspiring from sweat glands, which is often a response to heat, exercise, or stress.
  • Hypotension – Low blood pressure. It can result in fainting or dizziness, as the brain isn’t receiving enough blood.
  • Syncope or near syncope – Fainting, or a sudden temporary loss of consciousness.
  • Seizure activity – A sudden, uncontrolled electrical disturbance in the brain. It can alter your behavior, movements, or feelings.

Close up of medical worker with stethoscope

Pro Tips for Mastering the Art of Phlebotomy

Some of the most basic phlebotomy tips involve planning ahead, using an appropriate location, and ensuring there’s quality control. Here are other pro tips that may assist you in the future.

  • Know Your Veins – A common choice for adult patients is the median cubital vein in the antecubital fossa (think crevice of the elbow). This vein is a good choice for beginners, as it’s close to the surface and tends not to roll when punctured. Some other commonly used veins are the basilic vein and the cephalic vein.
  • Take a Deep Breath – By asking the patient to take a deep breath just before the stick, you can help keep them calm and distracted. A person will often feel more in control of the situation if you give them something to do. This may work as the needle is being removed, too.
  • Anchors Away – Stretching the skin by “anchoring” the vein doesn’t just help you stick the vein on the first try. It also helps make the stick less painful. Remember, your thumb goes below the venipuncture site and give yourself plenty of room so you don’t accidentally jab your own fingers.
  • Nothing More Than Feelings – Part of selecting the vein comes down to feeling. Not a gut feeling but a literal Feeling for the vein—not slapping, despite what you see in movies—will always be the most reliable approach. Palpate for that “spongy firmness,” and feel above and below your target area for a better idea of direction.
  • The Invisible Vein – Still can’t find a place to stick?  Jabr of Florence, Oregon suggests that you “apply a warm pad to the target vein for a few minutes.” Doing so will help you dilate the vein and make it more visible. Another trick is to bend the arm upward if the veins are hiding. This sometimes makes them easier to spot.
  • Less Than Thirty – You’ve probably heard this in your training, but it never hurts to hear it again. The World Health Organization guidelines suggest keeping the angle of insertion at 30 degrees or less (15 is ideal) to avoid passing through the vein.
  • Label Immediately – There’s nothing worse than getting a great stick, drawing a great sample, then forgetting to label it right away. Actually, there is something worse… and that’s mixing up samples because they weren’t labeled at the bedside. For your sake and the patient’s sake, label all sample immediately, even if things are going a mile a minute.
  • Know When to Quit – Just can’t get that blood sample? Veins just aren’t cooperating? Here’s something else to consider—getting help. Don’t think of it as failure or defeat, think of it as making the best decision for your patient. Getting a fresh set of eyes on the situation might be all that’s needed to finally draw a good sample, and knowing when to seek help is the mark of a pro.

Why Should Medical Assistants Learn Phlebotomy?

Without the proper blood samples to accurately diagnose our health, we could all suffer from a host of dangers, including treatment errors or the lack of proper medical attention to undiagnosed illnesses or conditions.

Even though many hospitals employ phlebotomy teams, it can be very beneficial for some Medical Assistants to learn these skills. This is because phlebotomy teams typically make rounds at specific times in most hospital settings. For example, if a doctor orders an immediate lab test, the responsibility could fall to the nurses or Medical Assistants on duty.

While phlebotomy isn’t a job requirement in every doctor’s office, it is a valuable skill that leads to greater opportunities. It would be advantageous for MAs or aspiring Medical Assistants to seek phlebotomy certification. Once they are certified, an MA would likely become more indispensable to their employer and enrich their career.

Healthcare worker on a laptop

Start Your Career in Medical Assisting

Phlebotomy is truly a crucial skill that aspiring Medical Assistants should consider learning for their career. It’s also an essential medical practice for several diagnoses, tests, blood transfusions, donations, and other routine procedures.

Think about it: Without the proper blood samples to accurately diagnose our health, we could all suffer from a host of dangers, including treatment errors or the lack of proper medical attention to undiagnosed illnesses or conditions.

If you’re feeling inspired and would like to pursue a career in medicine, Unitek College offers various healthcare programs, such as our Medical Assisting program.

Contact us today to learn more about our programs and tuition assistance options. Take the first step toward a rewarding future in healthcare!