Name: ________________________________________Date: ____________ Score: ______
Competency Checklist
Procedure 6-2 Venipuncture by Syringe
Task: Withdraw a venous blood sample for laboratory testing as requested by the
provider. (This method is most often used for fragile or weak veins and those
that could collapse when using the vacuum tube method.)
Supplies and Conditions: Gloves Personal protective equipment (PPE) Alcohol wipes Gauze squares
(sterile or clean depending on facility guidelines) Syringe (10 to 20 mL) Syringe
needle (21 to 22 G) Transfer device Tourniquet Vacuum tubes Adhesive bandage
Sharps container Patient’s chart/HER
Standards: One Attempt with a score of 70% or higher is needed for this lesson. The time
limit for each attempt is 10 minutes. If student requires more than 3 attempts to
reach 3 passing scores, please print off a 2nd checklist. Scoring: Determine
student’s score by dividing points awarded by total points possible and
multiplying results by 100
EVALUATION
Evaluator Signature: _______________________________________________ Date: _____________________
Evaluator Comments:
Name: ________________________________________Date: ____________ Score: ______
Procedure 6-2 Steps
Start Time: ______________ End Time: ______________ Total Time: _____________
Procedure Steps & Criteria Possible Student Attempt
Points
1. Incorporating critical thinking skills 10
when performing patient care, check
the provider’s order and complete the
laboratory requisition form.
2. Wash your hands and apply PPE 10
3. Assemble all the necessary equipment, 10
and loosen the plunger by pulling it all the
way back and pushing it all the way in at
least one time. Label all tubes.
4. Identify the patient using at least two 10
identifiers and identify yourself.
5. Explain the rationale for the procedure, 10
showing awareness of the patient’s
concerns related to the procedure being
performed.
6. Verify compliance of fasting 10
instructions and other restrictions (for
instance, the need to draw blood from
one side or another due to a mastectomy
or the presence of a shunt).
7. Visually inspect the patient’s skin and 10
veins in both arms, incorporating critical
thinking skills when performing patient
assessment. Always ask if the patient has
a preference. Patients usually know which
veins produce the best results.
8. Select the potential site and apply the 10
tourniquet 3 to 4 inches above the elbow.
The tourniquet should not remain in place
longer than one minute.
9. Palpate the vein using your index 10
finger, moving in an upward and
downward direction and side to side
10. Straighten and place the arm and hand in 10
a downward position.
11. Ask the patient to make a slight fist and 10
hold. (Do not pump the fist, as this can
cause erroneous results.)
12. Cleanse the site with alcohol using a 10
circular motion.
13. Allow the area to air dry, or dry wipe the 10
area with a clean/sterile gauze square.
14. To keep the vein from rolling, Pull the 10
skin taut to anchor the vein
Name: ________________________________________Date: ____________ Score: ______
15. Insert the needle using a 15-to-30-degree 10
angle and make certain that the bevel is
upward.
16. When blood appears in the hub of needle, 10
pull back on the plunger at a slow steady
rate using the opposite hand
17. Allow the syringe to fill completely. 10
18. When the syringe is full, instruct the 10
patient to open the hand.
19. Release the tourniquet. 10
20. Place a dry piece of (clean or sterile) 10
gauze above the site, withdraw the needle,
and ask the patient to apply firm pressure
to the site for two to three minutes (or
until the bleeding has stopped).
21. Push the sheath over the needle and 10
carefully remove it from the syringe.
Discard the needle into the sharps
container.
22. Carefully transfer the blood from the 10
syringe to vacuum tubes using a safety
transfer device.
23. Immediately mix each filled tube 10
according to the manufacturer’s
instructions.
24. Discard used equipment according to 10
OSHA standards.
25. Check the puncture site and apply a 10
pressure bandage
26. Dismiss the patient. 10
27. Clean the work area and process the 10
specimen.
28. Remove gloves and wash your hands. 10
29. Document the procedure in the patient’s 10
chart and in the lab log.
Points Awarded/Points Possible 290
Name: ________________________________________Date: ____________ Score: ______
Sample Patient Chart Documentation:
Name: ________________________________________Date: ____________ Score: ______
