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phlebotomy

Venipuncture (Evacuated Tube System)

Venipuncture with an evacuated tube system draws blood from a vein into vacuum tubes.

16 steps6 criticalLimit 5 minAlways tested

Steps

  1. 1Critical stepVerify the provider's order, check any diet or time restrictions, and gather supplies
  2. 2Confirm the patient's identity with two identifiers (ask them to state their name and date of birth), explain the procedure, and ask about allergies and past fainting
  3. 3Perform hand hygiene and put on gloves
  4. 4Position the patient's arm and choose a visible, straight, clear vein
  5. 5Critical stepApply the tourniquet a few inches above the site, check for a pulse beyond it, and keep it on no longer than your facility's limit (about 1 to 2 minutes)
  6. 6Clean the site with a 70% alcohol swab from the center outward, let it dry completely, and do not touch it again
  7. 7Anchor the vein by holding the skin taut with your thumb just below the site
  8. 8Critical stepTell the patient you are about to stick them, then insert the needle bevel up, in line with the vein, at about 30 degrees or less
  9. 9Push the first tube into the holder once the vein is entered, and release the tourniquet when blood begins to flow
  10. 10Critical stepFill the remaining tubes in the correct order of draw, gently inverting additive tubes as your lab specifies; do not shake
  11. 11Critical stepRemove the last tube from the holder before withdrawing the needle, with the tourniquet already off and gauze over the site
  12. 12Activate the needle safety device and discard the needle and holder in the sharps container without recapping
  13. 13Critical stepApply pressure until bleeding stops, ask the patient not to bend the arm, and cover the site with a bandage
  14. 14Label every tube in the patient's presence and check the labels against the requisition
  15. 15Bag the specimens, discard used supplies, remove gloves, and perform hand hygiene
  16. 16Document the procedure, site, time, samples drawn, and anything unexpected

What graders are watching for

Tips
  • Label the tubes while you are still with the patient, never later from memory.
  • Release the tourniquet when blood starts to flow, and always before the needle comes out. Sources give a limit of 1 minute (UF Health) or 2 minutes (WHO, WTCS), so follow your facility.
  • Take the last tube off the holder before pulling the needle, then activate the safety device and use the sharps container. Never recap or bend a used needle.

Common mistakes

  • Puncturing while the antiseptic is still wet, or touching the site after cleaning it.
  • Leaving the tourniquet on longer than the limit or until the needle is withdrawn.
  • Filling tubes out of order, which lets additives carry into later tubes.
  • Shaking additive tubes instead of inverting them gently.
Practice this skill

Practise the sequence with critical-step highlighting and a rationale for each step.

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Sources and how we check them: How we verify.

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