Venipuncture is the process of puncturing the vein in order to extract blood for medical testing transfusions or to start an IV (intravenous) line. Venipuncture is preformed in a variety of settings including hospitals, blood donor clinics, community healthcare centers, medical labs and more. In order to work in this field, one must be trained in both the theoretical and practical side of this practice as well as passing a certification exam.  Trained professionals in venipuncture are known as phlebotomists. Although not all states require venipuncturists to have their certification, most medical facilities will not consider hiring anyone who has not passed their certification exam. For this reason, it is extremely important to ensure that your venipuncture course is designed to prepare you for certification.

Venipuncture or phlebotomy involves much more than simply learning to draw blood from patients. There are standard steps that must be taken prior to, during and after each procedure. Experienced phlebotomists do, in time, establish their own personal routine that includes these essential elements for every extraction:

  • Patient identification
  • Patient assessment for such things as stress, diet, medications, etc.
  • Review requisition order to confirm required tests, special requirements, etc.
  • Venipuncture site selection
  • Prepare patient, site and all required equipment
  • Perform the blood draw in appropriate container(s)
  • Understand and recognize possible complications
  • Evaluate whether or not rejection or recollection is necessary
  • Collection tube labeling
  • Procedures for sending specimens to laboratory

Each step of this procedure is vital for a proper diagnosis to be made. Doctors depend on accurate blood draws and analysis in order to treat their patients. Understanding requisition requirements and proper administrative tasks are essential elements that must be studied in any venipuncture course. All equipment and their proper use must also be thoroughly covered and should include the following:

  • Evacuated collection tubes – understanding the color coding that represents specific additives each tube contains
  • Needles – which needles to use with a syringe and which ones for evacuated systems, butterfly or single draw including gauge numbers denoting bore size
  • Holder or adapter for use in evacuated collection system
  • Proper handling of tourniquets
  • Needle disposal units
  • Protective gloves
  • Syringes

Another vital aspect phlebotomists are trained in is the order of the draw that must be followed for patients that require multiple tube extractions. A specific draw order is necessary to prevent cross-contamination of the additives contained within each tube. The proper order for multiple draws is as follows:

  1. Yellow or yellow-black top – blood culture bottle
  2. Light blue top – coagulation tube. It must also be noted that if a simple coagulation assay only is requested, then the single light blue top maybe preformed. In cases where there may be a concern in terms of contamination due to thromboplastins or tissue fluids, a venipuncturist may draw a non-additive tube first followed by a light blue top tube.
  3. Red top – non-additive tube
  4. The last draw are additive tubes and must be drawn in the following order:
    1. Red-gray or gold top – gel separator and clot activator
    2. Dark green top – sodium heparin
    3. Light green top – PST – lithium heparin anticoagulant and gel separator
    4. Lavender top – EDTA
    5. Pale yellow top – CDA acid citrate dextrose
    6. Light gray top – oxalate/fluoride

Phlebotomists must also take care to thoroughly mix any tubes that have additives in order to ensure accurate test results.

Patient relations is another area that a phlebotomy or venipuncture course must cover. It is extremely important that all patients be treated professionally with courtesy and understanding. Many patients, especially young children and the elderly can feel a lot of stress when they arrive for blood draws. Positive communication skills (verbal and nonverbal) are essential characteristics of professional venipuncturists.

Most accredited venipuncture courses also cover the Patient Bill of Rights as set out by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Since many hospitals and healthcare facilities have adopted these rights, it is important to ensure that your course covers this important topic. For more information, you can visit the JCAHO website at http://www.jointcommission.org/

There is no question that a trained and certified phlebotomist or venipuncturist can enjoy an exciting and lucrative career. The important things to remember when looking for the right venipuncture courses are that they be through an accredited learning institute and that they adequately prepare you for your certification exam.

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