OUR LADY OF FATIMA UNIVERSITY

COLLEGE OF MEDICAL LABORATORY SCIENCE

JAMES L. GORDON MEMORIAL HOSPITAL

INTERNSHIP ACTIVITY
PHLEBOTOMY
Students will explore the different manual hematology testing procedures
COURSE
that are essential in the diagnosis of diseases using blood as the specimen.
OUTCOMES:
To achieve this unit a learner must:
1. Properly identification of patient.
2. Demonstrate the proper preparation of all the materials to be used.
3. Apply the tourniquet properly.
UNIT 4. Demonstrate the proper selection of the puncture site.
OUTCOMES 5. Demonstrate the proper disinfection of the puncture site.
6. Demonstrate venipuncture properly and accurately.
7. Collect blood with the right order of draw.
8. Label the tubes properly.
PREANALYTICAL PHASE: Larger amount of blood for chemistry and other hematological analyses are
obtained by venipuncture from the median basilic or median cephalic veins of the antecubital fossa and from the
dorsal surface of the hand or foot in adults or the external jugular vein or femoral veins in infants.

ANALYTICAL PHASE:
MATERIALS:
Sterile syringe 70% Alcohol
Sterile needle (gauge 21) Tourniquet
ETS Adapter Evacuated Tubes
Two-way needle (gauge 21) Micropore tape
Cotton Yellow bag

PROCEDURE:
1. Identify the patient by having the patient verbally state his/her full name and confirm with the
patient’s identification number (ID band or any valid ID).
2. Verify any diet restrictions.
3. Prepare all materials so that they are within your reach at the time of blood extraction.
4. Position the patient.
5. Apply the tourniquet 2 to 4 inches above the selected puncture site for no longer than 1 minute.
6. Ask the patient to make a fist. This makes the vein more easily palpable.
7. Select a suitable vein for puncture.
NOTE: Palpate the site using the tip of the index finger to find the best vein. Even if the vein is
visible, palpate to determine the vein location and path.
8. Cleanse the area with 70% alcohol using concentric circles, working from the inside to outside.
9. Allow the area to dry.
10. Inspect the needle. Check if the needle is not clogged by moving the plunger of the syringe up
and down forcing air through the needle.
PRECAUTION: Make sure that there is no column of air in the barrel of the syringe by pushing
the plunger all the way towards the needle). Precautions should always be taken against pumping
air into the vein at the time of the extraction. A few cubic centimeters of air pump into a vein could
cause death.
11. Grasp the patient’s arm 1 to 2 inches below the puncture site. This anchors the vein and prevents
it from rolling.
12. Align the needle in the same direction as the vein. The needle should be in the bevel up position
(needle opening facing upward).
13. Using one deliberate, smooth motion, insert the needle in the same direction as the vein at
approximately 15⁰- 30⁰ angle with the skin.

Syringe – pull back gently on the plunger and release to allow blood to fill syringe. Do not alter
the position of the needle in the vein.
 Evacuated tube system – push vacutainer tube into holder. Place first and second fingers of left
hand against the top of the base of the holder and the thumb against the bottom of the tube.
Hold tightly to holder to prevent movement. Do not push holder – may force needle through the
vein.

14. Withdraw the desired volume of blood for the examination to be performed when the needle enters
the vein. Pull the plunger gently during aspiration.
15. Remove the tourniquet and ask the patient to open his fist.
16. Apply dry cotton lightly over the punctured site and withdraw the needle.
17. Instruct the patient to apply pressure in the punctured site.
18. Remove the needle from the syringe and fill the tubes.
19. Label the tubes properly. (Patient’s full name, age, gender, date & time of collection and collector’s
initials.
20. Dispose the puncture equipment and other biohazardous wastes.

POST-ANALYTICAL PHASE:
Before leaving, the medical technologist must do all of the following:
l Disposal of wastes and disinfection with liquid Lysol or 10% sodium hypochlorite of the area.
l The PPE of each individual should be removed properly. These cannot be exposed outside the
laboratory premises.
CRITICAL THINKING:
1. What are the different blood collection methods? (3pts)

2. What are the proper sites of collection in venipuncture? (5pts)

1.
2.
3.
4.
5.
6.
7. foot (STEININGER)
3. What is the order of draw in venipuncture? (6pts)
1.
2.
3.
4.
5.
6. tubes (Gray) (RODAK)
4. If at the time of extraction, blood fails to enter the syringe, what are you supposed to do? (2pts)
Use your free index finger to locate the vein. It may be that the needle has not gone deeply

5. What is the effect of prolonging tourniquet application? (1pt)

6. What are the causes of hematoma? (3pts)

 VENIPUNCTURE: SYRINGE METHOD
NAME: _____________________________________________________ SCORE:________________

Critical 1 2 3 4 5
Dimensions
REFER BEGINNER COMPETENT PROFICIENT EXEMPLARY SCORE
(NO CONTENT) (LIMITED (ADEQUATE (REMARKABLE (PROFESSIONAL
CONTENT) CONTENT) CONTENT) CONTENT)

Pre-analytical Phase:
PPE (lab gown, No PPE is worn. Only 1-2 out of 5 Only 3 out of 5 PPEs Only 4 out of 5 PPEs Complete PPEs are
mask, gloves, PPEs are worn. are worn. are worn. worn.
hair cap
&goggles)
(Factor: 2
Materials (Factor: No materials. 1 out of 4 materials 2 out of 4 materials 3 out of 4 materials Complete materials.
1) is available. are available. are available.

Cleaning the work Did not clean the Did not clean the Neither clean nor Cleaned but did not Cleaned and
area (Factor: 1) working area working area disinfect the working disinfect the working disinfect the working
before starting. before starting. area before starting. area before starting. area before starting.

Proper storage of Bag and other Materials are found Bags and other Few materials are Bag and other
bag and other materials that will on the working materials are found found in the working materials are
materials (Factor: not be used are area. neither on the working area. properly stored in the
1) located above the area nor the designated area.
table. designated area.

Analytical Phase:
Proper Failure to identify Improper patient Identified the patient Proper identification
Identification of the patient. identification. but did not confirm of the patient.
the Patient with the patient’s ID.
(Factor: 2)

Verification of Failure to verify Performed Verified any diet

any diet any diet improperly. restrictions.
restriction restrictions.
(Factor: 1)

Preparation of the No materials. Performed Incomplete materials. Prepared all the

materials (Factor: improperly. necessary materials.
1)

Positioning the Failure to position Performed Positioned the patient

patient (Factor: 1) the patient. improperly. properly.

Application of the Failure to apply the Performed Applied the tourniquet

tourniquet tourniquet. improperly. 2-4 inches above the
(Factor: 1) puncture site.
Asking the Failure to ask the Performed Asked the patient to
patient to make a patient to make a improperly. make a fist.
fist (Factor: 1) fist.

Selection of the Failure to select Wrong choice of Selected the best

vein (Factor: 1) vein. vein. vein.

Palpating the vein Failure to palpate Did not use the Used the index finger
(Factor: 1) the vein. index finger to in palpating the vein.
palpate the vein.

Disinfection of Failure to disinfect Did not disinfect Disinfect the site in

the site (Factor: the site. the site in circular circular motion.
1) motion.

Drying of the site Failure to allow Performed Allowed the area to

(Factor: 1) drying of the site. improperly. dry.

Inspecting the Failure to inspect Performed Inspected the

needle (Factor: the needle. improperly. needle.
1)

Assembling the Failure to push the Performed Pushed the plunger

syringe (Factor: plunger all the way improperly. all the way towards
1) towards the the needle.
needle.
Anchoring the Failure to anchor Performed Anchored the vein.
vein (Factor: 1) the vein. improperly.

Positioning of the Failure to align the Performed Aligned the needle in

needle (Factor: 1) needle in the same improperly. the same direction as
direction as the the vein.
vein.

Bevel up position The needled is not The needle was in

of the needle in the bevel-up the bevel-up position.
(Factor: 1) position.

Insertion of the Failure to insert the Performed Inserted the needle

needle (Factor: 1) needle in the improperly. in one deliberate and
desired angle. smooth motion
approx. 15-30⁰ angle.

Aspiration of the Failure to pull the Failure to pull the Failure to pull the Pulled the plunger Pulled the plunger
blood (Factor: 1) plunger. plunger gently, plunger gently, gently but with gently during
with bubbles. without bubbles. bubbles. aspiration. No
bubbles.
Collection of the Failure to collect Blood only enters Withdrawn only ¼ of Withdrawn only half of Withdrawn the
desired amount blood. the hub. the desired amount of the desired amount of desired amount of
of blood blood. blood. blood.
(Factor: 4)
Application of the Failure to apply the Applied the Applied the
tourniquet tourniquet. tourniquet for more tourniquet for less
(Factor: 1) than 1 minute. than 1 minute.

Removal of the Failure to remove Performed Removed the

tourniquet the tourniquet improperly. tourniquet before
(Factor: 1) before withdrawing withdrawing the
the syringe. syringe.

Application of Failure to apply Applied wet cotton Applied the cotton Applied dry cotton
cotton (Factor: 1) cotton to the to the punctured hardly to the lightly to the
punctured site. site. punctured site. punctured site.

Withdrawal of the Failure to remove Removed the needle

needle (Factor: 1) the needle in a in a swift motion.
swift motion.

Applying Failure to ask the Performed Asked the patient to

pressure to the patient to apply improperly. apply pressure to the
punctured site pressure to the puncture site.
(Factor: 1) punctured site.

Filling of tubes Failure to fill the Performed Filled the tubes Removed the needle
(Factor: 1) tubes. improperly. improperly (less than from the syringe and
or more than the filled the tubes with
indicated volume of the right amount of
blood). blood.
Order of Draw Incorrect order of Filled the tubes in the
(Factor: 2) draw. right order of draw.

Labeling of the Failure to label the Incorrect labeling Incomplete label of Labeled the tubes
tubes (Factor: 2) tubes. of tubes. tubes. properly (Full name,
age & gender, date &
time of collection,
collector’s initials).
Post-analytical Phase:

Cleaning of work Left the working Disposed the Disposed the wastes Disposed all the Properly cleaned and
area (Factor: 3) area dirty. waste in an in an inappropriate waste in proper disinfect the working
inappropriate container, disinfect container, did not area.
container, did not the working area. disinfect the working
disinfect. area.

Returning of Left materials on Left some Left some materials Returned all Returned all
materials and the working area, materials on the on the working area, materials, no materials, no
glass wares with breakages, working area, with no breakage, did not breakages, did not breakages, dried
(Factor: 2) did not dry glass breakages, did not dry glass wares. dry glass wares. glass wares.
wares. dry glass wares.

TOTAL:
 VENIPUNCTURE: EVACUATED TUBE SYSTEM METHOD
NAME: _____________________________________________________ SCORE:________________

Critical 1 2 3 4 5
Dimensions
REFER BEGINNER COMPETENT PROFICIENT EXEMPLARY SCORE
(NO CONTENT) (LIMITED (ADEQUATE (REMARKABLE (PROFESSIONAL
CONTENT) CONTENT) CONTENT) CONTENT)

Pre-analytical Phase:
PPE (lab gown, No PPE is worn. Only 1-2 out of 5 Only 3 out of 5 PPEs Only 4 out of 5 PPEs Complete PPEs are
mask, gloves, PPEs are worn. are worn. are worn. worn.
hair cap
&goggles)
(Factor: 2
Materials (Factor: No materials. 1 out of 4 materials 2 out of 4 materials 3 out of 4 materials Complete materials.
1) is available. are available. are available.

Cleaning the work Did not clean the Did not clean the Neither clean nor Cleaned but did not Cleaned and disinfect
area (Factor: 1) working area working area disinfect the working disinfect the working the working area
before starting. before starting. area before starting. area before starting. before starting.

Proper storage of Bag and other Materials are found Bags and other Few materials are Bag and other
bag and other materials that will on the working materials are found found in the working materials are
materials (Factor: not be used are area. neither on the working area. properly stored in the
1) located above the area nor the designated area.
table. designated area.

Analytical Phase:
Proper Failure to identify Improper patient Identified the patient Proper identification
Identification of the patient. identification. but did not confirm of the patient.
the Patient with the patient’s ID.
(Factor: 2)

Verification of Failure to verify Performed Verified any diet

any diet any diet improperly. restrictions.
restriction restrictions.
(Factor: 1)

Preparation of the No materials. Performed Incomplete materials. Prepared all the

materials (Factor: improperly. necessary materials.
1)

Positioning the Failure to position Performed Positioned the patient

patient (Factor: 1) the patient. improperly. properly.

Application of the Failure to apply the Performed Applied the tourniquet

tourniquet tourniquet. improperly. 2-4 inches above the
(Factor: 1) puncture site.
Asking the Failure to ask the Performed Asked the patient to
patient to make a patient to make a improperly. make a fist.
fist (Factor: 1) fist.

Selection of the Failure to select Wrong choice of Selected the best

vein (Factor: 1) vein. vein. vein.

Palpating the vein Failure to palpate Did not use the Used the index finger
(Factor: 1) the vein. index finger to in palpating the vein.
palpate the vein.

Disinfection of Failure to disinfect Did not disinfect Disinfect the site in

the site (Factor: the site. the site in circular circular motion.
1) motion.

Drying of the site Failure to allow Performed Allowed the area to

(Factor: 1) drying of the site. improperly. dry.

Inspecting the Failure to inspect Performed Inspected the

needle (Factor: the needle. improperly. needle.
1)

Assembling the Failure to push the Performed Pushed the plunger

syringe (Factor: plunger all the way improperly. all the way towards
1) towards the the needle.
needle.
Anchoring the Failure to anchor Performed Anchored the vein.
vein (Factor: 1) the vein. improperly.

Positioning of the Failure to align the Performed Aligned the needle in

needle (Factor: 1) needle in the same improperly. the same direction as
direction as the the vein.
vein.

Bevel up position The needled is not The needle was in

of the needle in the bevel-up the bevel-up position.
(Factor: 1) position.

Insertion of the Failure to insert the Performed Inserted the needle in

needle (Factor: 1) needle in the improperly. one deliberate and
desired angle. smooth motion
approx. 15-30⁰ angle.

Aspiration of the Failure to insert the Failure to insert the Failure to insert the Inserted the tube Inserted the tube
blood (Factor: 1) tube. tube gently, with tube gently, without gently but with during aspiration. No
bubbles. bubbles. bubbles. bubbles.

Collection of the Failure to collect Blood only enters Withdrawn only ¼ of Withdrawn only half of Withdrawn the
desired amount blood. the hub. the desired amount of the desired amount of desired amount of
of blood blood. blood. blood.
(Factor: 4)
Application of the Failure to apply the Applied the Applied the
tourniquet tourniquet. tourniquet for more tourniquet for less
(Factor: 1) than 1 minute. than 1 minute.

Removal of the Failure to remove Performed Removed the

tourniquet the tourniquet improperly. tourniquet before
(Factor: 1) before withdrawing withdrawing the
the syringe. syringe.

Application of Failure to apply Applied wet cotton Applied the cotton Applied dry cotton
cotton (Factor: 1) cotton to the to the punctured hardly to the lightly to the
punctured site. site. punctured site. punctured site.

Withdrawal of the Failure to remove Removed the needle

needle (Factor: 1) the needle in a in a swift motion.
swift motion.

Applying Failure to ask the Performed Asked the patient to

pressure to the patient to apply improperly. apply pressure to the
punctured site pressure to the puncture site.
(Factor: 1) punctured site.

Filling of tubes Failure to fill the Performed Filled the tubes Removed the needle
(Factor: 1) tubes. improperly. improperly (less than from the syringe and
or more than the filled the tubes with
indicated volume of the right amount of
blood). blood.
Order of Draw Incorrect order of Filled the tubes in the
(Factor: 2) draw. right order of draw.

Labeling of the Failure to label the Incorrect labeling Incomplete label of Labeled the tubes
tubes (Factor: 2) tubes. of tubes. tubes. properly (Full name,
age & gender, date &
time of collection,
collector’s initials).

Post-analytical Phase:
Cleaning of work Left the working Disposed the Disposed the wastes Disposed all the Properly cleaned and
area (Factor: 3) area dirty. waste in an in an inappropriate waste in proper disinfect the working
inappropriate container, disinfect container, did not area.
container, did not the working area. disinfect the working
disinfect. area.

Returning of Left materials on Left some Left some materials Returned all Returned all
materials and the working area, materials on the on the working area, materials, no materials, no
glass wares with breakages, did working area, with no breakage, did not breakages, did not dry breakages, dried
(Factor: 2) not dry glass breakages, did not dry glass wares. glass wares. glass wares.
wares. dry glass wares.

TOTAL: