Basic Phlebotomy Principles

If you are considering entering the field of phlebotomy, it is a good idea to learn about the underlying phlebotomy principles first. We will provide a brief overview of infection control, anatomy and physiology, puncture site selection and preparation, order of draw, and post-puncture care.

Basic Infection Control

Standard operating procedures must be followed when it comes to infection control and quality assurance. These steps should be made available to phlebotomists in a clinical environment. To effectively control and prevent infections, proper hygiene-materials must be used. Here is a list of hygienic materials to be kept in a medical environment conducting phlebotomy:

  • Soap
  • Water
  • Alcohol rub
  • Non-sterile gloves
  • Single-use disposable needles
  • Syringes/lancing devices

In the same sense, contaminated phlebotomy equipment must be discarded in an appropriate manner. Did you know that up to 25% of tourniquets are contaminated through inadequate hand-hygiene? Also, hepatitis B has been known to spread through reusing finger-prick devices. Needles, syringes, and blood sampling devices should be disposed into a puncture-resistant sharps container, in order to uphold proper phlebotomy safety standards. It is important to know which pieces of equipment can be reused, versus what should be discarded.

Basic Anatomy and Physiology

Knowledge of anatomy and physiology is one of the most crucial phlebotomy principles. Anatomy is the study of body structure, and physiology is the study of body function. This topic as it relates to phlebotomy is a major focus in phlebotomy schools—an understanding of the basics is required to be a successful phlebotomy technician.

Proper Selection and Preparation of Skin Puncture Site

Site selection can make or break a phlebotomy procedure. Generally, you want to examine a patient’s extended forearm. Locate a sizable vein that is visible, straight and clear. A good place to start is the median cubital vein, because it is the easiest to puncture successfully. It is wise to avoid the basilic vein, in order to negate the possibility of damaging the nerve or artery. It is also a considerably more painful blood withdrawal. Vein diversions should also be avoided, to decrease the chance of a hematoma.

It is important to disinfect the entry site before puncturing. Clean the site with a 70% alcohol (not povidone iodine) swab for 30 seconds while applying a gentle pressure. Allow some time for the site to dry. This decreases the contamination risks. After the site is cleaned, it is imperative that you do not touch the site with your finger, as this will commonly result in an infection.

Order of Draw      

Blood must be collected in tubes in a very specific order. This phlebotomy principle is referred to as “Order of Draw.” It can be somewhat difficult to remember. Here are the 9 elements of order of draw:

  1. Color varies-blood cultures
  2. Light blue-sodium citrate
  3. Red-clot activator
  4. Gold-SST
  5. Light green-lithium heparin
  6. Dark green-sodium heparin
  7. Lavender-EDTA
  8. Gray-Sodium Fluoride
  9. Yellow-ACD Solution

A helpful way of remembering the color order is, “Boys Love Ravishing Girls Like Dieters Love Greek Yogurt.” (blood culture, light blue, red, gold, light green, dark green, lavender, gray, yellow) Make sure to verify that your laboratory is using the same colors and descriptions.

Post-Puncture Care

After blood withdrawal has occurred, a major phlebotomy principle is cleaning contaminated surfaces and completing interactions with the patient. Double checking the phlebotomy labels and forms helps to ensure accurate standards of information. Hand hygiene should be performed once again, to protect against infections. Check if the patient is feeling satisfactory. Then, make sure that the needle insertion site is not bleeding. Once these final post-operation steps are taken, the patient is free to leave. The next step is to prepare and transport blood samples—this process is an educational focus of certified phlebotomy training programs.

Master Phlebotomy Principles at PhlebotomyU

This guide acts as a basic introduction to the principles of phlebotomy; it alone does not adequately prepare you to be a certified phlebotomist. PhlebotomyU on the other hand, has the sole purpose of educating individuals on the most up-to-date trends in blood analysis, venipuncture, and everything else related to phlebotomy. Basic and advanced phlebotomy principles will be covered in-depth. Interested in becoming a certified phlebotomist and entering a highly in-demand workforce? Contact us today, for more information on pursuing your CDLH-approved phlebotomy license.

What does Venipuncture Mean?

If you are familiar with medical terminology, then you’ve likely heard of “venipuncture.” It plays a key role in the world of phlebotomy. Let’s take a closer look at what venipuncture truly means, the basic steps in the venipuncture process, common venipuncture equipment, and the various withdrawal sites.

Defining venipuncture

What is venipuncture? It is the collection of blood from veins. It is most often performed for the purpose of laboratory testing. It is done with a needle, and typically performed by a phlebotomist. Venipuncture may also be performed in order to remove extra red blood cells from the blood, to treat various blood disorders. There are many factors at play during a venipuncture procedure. For example, “Order of Draw” is a vital concept to understand, for the purpose of avoiding cross-contamination of additives between tubes. Venipuncture is actually one of the most routinely performed invasive procedures. There are five primary reasons for performing a venipuncture:

  1. Obtaining blood for diagnostic purposes
  2. Monitoring levels of blood components
  3. Administering therapeutic treatments (medications, nutrition, chemotherapy)
  4. Removing blood due to excess levels of iron or erythrocytes (red blood cells)
  5. Collecting blood for later uses (transfusion in the donor)

Steps in the venipuncture process

Here is our master list of steps to practicing venipuncture successfully. In a phlebotomy course, these steps will be broken down and taught with hands-on training by professional educators.

1. Review the order of draw

2. Gather the supply tray and cart

3. Approach, identify, and prepare the patient for the process

4. Maintain proper hand-hygiene

5. Apply the tourniquet, ask the patient to make a fist, and assess the antecubital space

6. Select a vein, release the tourniquet, and ask the patient to relax their fist

7. Cleanse the site thoroughly

8. Put on clean gloves and prepare your equipment

9. Reapply the tourniquet, have the patient make a fist, and uncap the needle

10. Properly anchor the vein and insert the needle

11. Establish blood flow and have the patient open his or her fist, then release the tourniquet

12. Fill tubes using the correct order of draw and mix tubes

13. Place gauze, remove the needle, and apply appropriate pressure to the site

14. Discard the collection unit

15. Label the tubes

16. Implement special handling techniques

17. Check and inspect the patient’s arm, then apply a bandage

18. Dispose of the materials and clean up

19. Remove your gloves, perform hand hygiene techniques, and thank the patient

20. Securely transport specimens to the lab for testing

Venipuncture Equipment

The equipment used during the venipuncture test can vary, but the following are most commonly used for routine venipuncture:

  • Collection tubes
  • Needles
  • Tourniquet
  • Wipes/Swabs
  • Gauze
  • Bandages
  • Gloves
  • Disposal unit

Venipuncture Sites

Phlebotomists do not always draw blood from the same area and site in the human body. Venipuncture is most commonly performed on the Antecubital Fossa, which is the inside of the elbow. In this region, phlebotomists will usually decide between three veins including the median cubital vein, the cephalic vein, and the basilic vein. If all of these veins in the inside elbow area do not look promising, then the phlebotomy technician may choose a dorsal vein in the hand or worst case, a vein in the foot. Semi-common problems include improper blood flow from the vein, which causes phlebotomists to switch sites.

PhlebotomyU offers venipuncture courses

Our CPT1 5-week course emphasizes proper venipuncture training. An on-site sitting of the NCCT National Phlebotomy Certification Exam is included with the training program. Furthermore, certified radiologic technicians in California are require to take a 10-hour safe venipuncture training course in order to safely perform venipuncture for administering contrast x-rays. We have created a didactic course that allows radiologic technicians to safely and legally perform venipuncture in California. Still wondering about the topic of “what does venipuncture mean?” Or are you considering enrolling in a phlebotomy class with PhlebotomyU and have questions? Don’t hesitate to contact us today.

What are the Phlebotomist Certification Requirements?

Interested in becoming a certified phlebotomist? There are various requirements, depending on the state you plan on practicing in. This article will focus on the state of California. Let’s take a look at phlebotomist certification, training and certifying programs, and requirements for all three license types.

About Phlebotomist Certification

Phlebotomy certification is a state required standard—it is not on a single national scale. In order to become a phlebotomist in California, it is highly recommended that you fulfill CA phlebotomist certification requirements. What does this mean? Essentially, you must complete a phlebotomy training program, and then pass a phlebotomy exam.

Phlebotomy Training Programs and Requirements

There are usually program requisites for phlebotomy schools. Most phlebotomy programs require that you have a copy of your high school diploma or General Education Diploma. Background checks are a common requirement to be accepted as a phlebotomy student. Here is a list of further general requirements:

  •  Students must be a minimum of 18 years old
  • Students must hold a current American Heart Association BLS CPR card
  • Students must have proof of a negative Tuberculosis skin test or negative chest x-ray administered within three months prior to the first class
  •  Students must have proof of a current Mumps, Measles, & Rubella (MMR) and Varicella immunization
  •  Students must have proof of a Hepatitis B vaccination
  •  Students must have access to a background report and professional liability insurance
  •  Students must bring a physical exam, showing that the student is fit enough to work
  •  Students are required to possess two official sealed transcripts for admission

Once accepted, students will typically receive classroom lectures, lab training, and hands-on clinical experience. Subjects covered will range from basic anatomy, to advanced venipuncture. Non-medical techniques are also worked on in these training programs. This could include psychology, communication skills, and technology optimization. Many institutes have a phlebotomist certification requirement of participating in an externship or practicum, with an emphasis on supervised field experience.

Certifying Organizations

Completing your phlebotomy course does not mean you’ve checked off all of the certification boxes. It is still a requirement to take the National Phlebotomy Certification Examination (conducted by the NCCT). Many Phlebotomy training programs allow you to take the exam on-site. Training programs are usually not technically required to take a competency exam; however, there is typically a minimum experience level for these said test-takers. All in all, taking a phlebotomy class is the most recommended course of action for those seeking to take the NCCT National Phlebotomy Certification Exam.

The various NCCT exam fees can be found here:

https://www.ncctinc.com/Documents/Examination%20Fees.pdf

Phlebotomy Certification Requirements for the 3 License Types

How do you know which license certification to pursue? Limited Phlebotomy Technicians are only authorized to collect skin puncture blood samples. A Phlebotomy Technician I license grants permission to perform venipunctures as well as skin punctures. A Phlebotomy Technician II license grants authorization to perform venipuncture, arterial punctures, and skin punctures.

Phlebotomy Technician 1 licenses have several requirements, which are essentially identical to the Limited Phlebotomy Technician license requirements. (A few extra requirements are necessary) Phlebotomy license requirements for this certification include the completion of at least 40 hours of didactic training through a CDPH-approved program. 40 hours must also be completed in a supervised practical training—10 skin punctures and 50 venipunctures are also required to be performed under professional supervision in clinical training.

Regarding the Phlebotomy Technician II license, the main difference is that you must already have a current CDPH Phlebotomy Technician I license, along with 1040 hours of field-experience throughout the past five years. You must have completed 20 arterial punctures, as well. a CDPH-approved practitioner to write a letter for you, containing proof of these punctures.

Fulfill Phlebotomist Certification Requirements at PhlebotomyU

Your dream phlebotomy career is ready for you. After attending PhlebotomyU, you can achieve your CDPH-approved Phlebotomy certificate. PhlebotomyU prides itself in training and preparing students with the necessary skills required to succeed throughout their Phlebotomy career. Valuable assets offered include readily available career services, and a hands-on phlebotomy internship. Have questions regarding phlebotomy license requirements? Please don’t hesitate to contact us with any questions.