How to Draw Blood

I have been a phlebotomist for the past year and a half and I love my job. The purpose of this is to have greater confidence and show correct methods of drawing blood to those who are new to the profession. There are many correct ways, but there are also many incorrect ways to draw blood (i.e. positioning of your hands, what to say to the donor/patient, how not to miss the vein, etc.) and I will show you how I have had good experiences drawing blood on people. Needles cause a great deal of anxiety to people, but if you show confidence in your abilities and know what to say, you will be able to ease those who are terrified of needles. There is no greater feeling as a phlebotomist when a donor/patient requests you to draw their blood because they had a good pain-free experience. This will help you get those 'requests'.

*All images were from Google images*

Step 1: Make Sure You Have All Your Supplies

Though it may not seem as a step, it is; and it's an important one. Having all your supplies all at once and knowing where they are shows you know what you are doing; this has a domino effect to the donor/patient and starts to put trust in you. You shouldn't be taking no more than 15 minutes drawing blood and out of the patients room.

List of supplies (refer to picture (minus gloves)):

*keep in mind this list may vary*

-needle (straight or butterfly)

-tourniquet

-alcohol wipe

-gloves

-bandaid

-tube to put blood in

-bag to put blood filled tube

-If needed, a transfer device and syringe if using butterfly needle

Step 2: Introduce Yourself

Tell the person you're drawing the blood from that you've been doing it for awhile. If you haven't, let them know you're still confident. For example, when I first started I would say, " I won't stick you if I don't feel confident". The purpose of this is so the patient knows that you know what you are doing. If you notice the donor/patient still anxious keep talking with them about anything. This puts their mind somewhere else that isn't a needle.

Step 3: Apply Tourniquet

Put on gloves. Ask the patient if they prefer their left or right arm. If they don't care, apply where it looks like the best donor vein. Tourniquet should be applied mid-upper arm. Feel free to go to the other arm to check for better veins if necessary. Apply the tourniquet so it's tight to restrict blood flow but not too tight. Ask the patient if it is too tight, if so, re-apply but looser. Ask the donor to make a fist. The purpose of the tourniquet and the fist makes pressure build up in the veins which makes them "pop" better and more visible.

Step 4: Check for the Veins

Check for the veins in the pressurized arm. The vein will feel like a "trampoline" feeling, bouncing back at you when you put pressure on it. Check for the elbow area first in the first arm, then check the same in the second arm. If you don't feel a vein in either elbow area (needles stick in the elbow usually hurt less) , start checking in the hands (usually hurts more so ask permission from the patient). Just because you may not see a vein pop out doesn't mean you won't feel the vein. Phlebotomy is more by touch than by sight.

Step 5: Clean Puncture Area

Clean the puncture area with your alcohol pad. Clean area for 15-20 seconds with pad. Apply alcohol to finger, ( the finger that feels for the vein) just in case you may have to re-feel for the vein and won't get the cleaned puncture site dirty.

Step 6: Use Needle to Puncture Vein

Make sure skin is tight before applying the needle. Pull the skin with your non-dominant hand ( dominant hand holds the needle). Applying the needle with skin that isn't taunt causes greater pain. Tighter the skin, less painful the puncture will be. Puncture the skin and vein with the needle. When using a butterfly with a syringe, a "flash" of blood will appear in the tubing. When using a straight needle, not until you apply the tube, will you see the "flash" of blood. SUCCESS!

Troubleshooting:

If there isn't a flash after applying the needle, pull back ( but make sure the needle doesn't leave the skin, if it does the needle is dirty and you need a new one), re-feel for the vein and redirect. Don't start to "fish around" and blindly poke for the vein, if you no longer feel the vein, pull it out, and look for another donor site. Fishing around causes the most pain for the patient.

Step 7: Remove Needle

Remove needle. Immediately cap the needle. Apply bandaid to puncture site. Bandaid should be left on for 15-20 mins or till blood has clotted.

Step 8: Apply Labels to Tubes

Take off the tourniquet. People who run tests on the blood can't do anything without a label on the blood filled tube. If you are using a butterfly needle with a syringe, this is when you use the transfer device to transfer the syringe filled with blood to the tube.

Step 9: Clean Up Used Materials

Clean up the used materials. Put needle in sharps container and bloody materials in biowaste.

Step 10: Send Blood

Make sure patient is okay for you to leave. Thank them. Send blood to where it needs to go.