Introduction to Clinical Medicine III

Student ID:

Phlebotomy
№ Checklist Coef. 5 4 3 2 1 0
1 Student introduced self to the patient, explained the reason of
2
the visit and gave short description about the procedure
Student washed hands
2 1

3 Student collected all the necessary materials 1

4 Student wore medical no sterilized gloves 1
5 Student checked the syringe 1
Student checked the possible injection sites and put the medical
6 tourniquet on the patient’s arm about 4-5 cm proximally from 2
possible injection site
7 Student prepared the injection site for the procedure (cleaning
the site 2 times with alcohol cotton from center to periphery 2
direction)
8 Student inserted the needle (Sharp side down) on 15-30 degree
3
angle in the peripheral vein
9 Student pulled the pump to check the blood control and
3
collected the blood sample (3 ml)

10 Student removed the medical tourniquet 3

11 Student removed the needle out of the vein and pressed the vein
2
with alcohol swab
12 Student poured the blood in EDTA tube on certain level 2
13 Student eliminated the used materials and removed the gloves
1
with “sack-like” method
14 Student was careful while doing painful procedure 2
15 Student was supportive during procedure and gave maximum
2
comfort to the patient

Comment:
 Station Point: 0.0

Evaluator Signature: a.sepashvili Date: 24.02.2022.