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Instructor’s Manual to Accompany
THE COMPLETE TEXTBOOK OF PHLEBOTOMY
Fifth Edition

Chapter 6: Phlebotomy Technique

©2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
Table of Contents
Chapter 6: Phlebotomy Technique
Review

Part A: Chapter Overview

Part B: Resources

Part C: Student Preparation for Class

Part D: Learning Objectives and Competencies

Part E: Key Terms

Part F: After-Presentation Activity

Part G: Additional Activities That Might Be Used for In-Class Discussions

Part H: For Those Students Needing Help

Part I: For Those Students Who Are Ahead and Want to Learn More

Part J: After-Class Activities

©2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
Review
Review any previous material that learners should understand for successful completion of this chapter. The material
may come from a previous course or previous chapter.

Part A: Chapter Overview

Venipuncture is a detailed procedure requiring careful attention to each step. Little attention is often given to these
basic steps that are necessary for collecting a blood sample. Our state-of-the-art sophisticated laboratory technology
is often riddled with errors because of misidentification and poor sample collection techniques. All steps must be
followed without deviation to ensure a successful laboratory result.

This chapter covers the phlebotomy techniques of venipuncture with syringe, venipuncture with an evacuated
system, and arterial punctures. The appropriate steps to perform the procedures are discussed, and illustrations
show the proper positioning of the needle. Interferences, common mistakes, and reasons for failure are also covered.

Part B: Resources

Textbook: The Complete Textbook of Phlebotomy, Fifth Edition, Lynn B. Hoeltke. Cengage Learning ©2018
Instructor Materials: Instructor’s manual for the chapter, PowerPoint presentation slides for
the chapter, student study guides, test bank of questions, and competencies.

Internet: It is recommended that the student have access to and have a working knowledge of the
internet for further research of topics.

Part C: Student Preparation for Class

Before the class the student should have read the chapter that will be covered in the lecture. The
student should also be knowledgeable about the Key Terms at the beginning of each chapter.

Part D: Learning Objectives and Competencies

After studying this chapter, the student should be able to:

1. Explain the three skills used in collecting blood and how a phlebotomist needs to use each of
these skills.
2. Explain the importance of correct patient identification, complete sample labeling, and proper
accessioning. Discuss what happens when these rules are not followed.
3. List the components necessary for proper sample labeling. Discuss what can happen if a sample
is not labeled properly.
4. List four common venipuncture sites and the advantages and disadvantages of each site.
5. List four techniques that can make veins easier to see.
6. Describe the step-by-step procedure for drawing blood with a syringe, an evacuated tube, and a
butterfly system.

©2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
 7. Understand the effect hemolysis will have on a blood sample and how the phlebotomist can
prevent hemolysis from occurring.
8. Explain hemoconcentration, how it affects the blood sample, and how to prevent it.
9. Explain four precautions in blood collection and why the phlebotomist needs to be concerned.
10. Locate veins in the feet and ankles, and explain why they are not recommended for routine use.
11. Explain how to handle different patient reactions to venipuncture.
12. Name and explain the common causes of phlebotomy complications that result in a failed
venipuncture.
13. Discuss the three blood collection alternatives when a patient has an IV running in one arm.
14. Describe the proper technique for drawing from an indwelling line.
15. Describe the equipment used and preparation of equipment for arterial puncture.
16. Describe the Allen test.
17. Locate the four arterial sites and explain the order of preference for arterial puncture.
18. Explain the proper procedure for handling arterial blood.

NAACLS COMPETENCIES RELEVANT TO CHAPTER 6

Demonstrate understanding of the importance of sample collection and
sample integrity in the delivery of patient care.
• Describe the legal and ethical importance of proper patient/sample identification.
• Describe the types of patient samples that are analyzed in the clinical laboratory.
• Define the phlebotomist’s role in collecting and/or transporting these samples to the laboratory.
• List the general criteria for suitability of a sample for analysis and reasons for sample rejection
or recollection
Follow standard operating procedures to collect samples.
• Identify potential sites for venipuncture, capillary, and arterial punctures.
• Describe and demonstrate the steps in the preparation of a puncture site.
• List the effects of tourniquet, hand squeezing, and heating pads on capillary puncture and
venipuncture.
• Recognize proper needle insertion and withdrawal techniques, including direction, angle, depth,
and aspiration, for arterial puncture and venipuncture.
• Identify alternate collection sites for arterial puncture, capillary puncture, and venipuncture.
Describe the limitations and precautions of each.
• Name and explain common causes of phlebotomy complications. Describe signs and symptoms
of physical problems that may occur during blood collection.
• List the steps necessary to perform an arterial puncture, venipuncture, and capillary puncture in
chronological order.
• Follow standard operating procedures to perform a competent and effective venipuncture on a
patient.
Demonstrate understanding of requisitioning, sample transport, and sample processing.
• Describe the standard operating procedure for a physician requesting a laboratory analysis for a
patient. Discuss laboratory responsibility in responding to physician requests.
• Instruct patients in the proper collection and preservation for various samples, including blood,
sputum, and stool.
• Explain methods for transporting and processing samples for routine and special testing.
• Demonstrate ability to use computer information systems necessary to accomplish job
functions.

©2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
Part E: Key Terms
It is important that all health care professionals familiarize themselves with the terms used in the health care
industry. No matter which job is performed in health care, each individual is either directly or indirectly
involved in processing patient information. Therefore, understanding the terms of the profession increases the
individual’s effectiveness in this process. Stress that students review these Key Terms before the start of
class. This will help their understanding of the subject when it is discussed in class. Suggest that students
search the term on the Internet if they do not fully understand the definition listed in the textbook.

Part of the whole sample that has

Aliquot been taken off for use or storage.

Reflex condition of the artery in

Arteriospasm response to pain or anxiety.

Device used for access for dialyzing

and for blood drawing in patients
Cannula
with a kidney disorder.

Abnormal accumulation of fluid in

Edema the tissues, resulting in swelling.

Artificial shunt connection done by

surgical procedure to fuse the vein
Fistula and artery together. Used for
dialysis only.

Leakage of blood out of the vein

Hematoma during or after venipuncture that
causes a bruise.

Part F: After-Presentation Activity

Discuss the critical thinking questions at the end of the chapter. Divide the students into two groups, with
each group covering one of the two questions. After 15 minutes, bring the class back together and have
each group share their thoughts on the subject.

©2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
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Part G: Additional Activities That Might Be Used for In-Class Discussions
In-Class Discussion
1. The practice of phlebotomy does not simply rely on the ability to pull blood from a patient. The three
basic skills—social (interpersonal), administrative/clerical, and technical—help the phlebotomist with
each patient encounter. Divide the class into three sections. Assign each group a skill. Have each
section discuss how the job of delivering exceptional service to patients would be affected if their
assigned skill was lacking. Give them 10 minutes and then get the class back together.
Brainstorm with learners how the job of delivering exceptional service would be affected.
Create a list of problems that would be encountered on a whiteboard or flip chart. After
learners have created their list, discuss ways that these problems could be corrected.

In-Class Activities
Group Activity: Give each learner an evacuated tube and have the learner correctly label the tube as
both the patient and the phlebotomist.
• Discuss computerized systems.
• Discuss the benefits of computerized systems.
• Discuss why laboratory computers are linked to physicians’ offices
• Discuss computerized labels and their additional advantages.
• Discuss a bar code and its purpose in the laboratory.
• Describe computerized labels.
- The label is usually adhesive so it can be attached directly to the tube. Smaller labels can
also be printed at the same time for smaller aliquot samples. Show the proper method
of attaching the bar code so the testing instruments can read the bar code.
- The computer has multiple other advantages in timing the print of orders, sorting lists of
orders for one patient at one time, and speeding entry of draw times and test results.
- Most hospitals use some type of computer system for test ordering and result reporting.
The computer labels printed off in a roll, where one label follows the other. Having two
labels attached requires special attention. One label must be carefully compared to the
other to ensure that each label is or the same person, date, and time. Identifying
patients by the computer label and ensuring that each label used is for that patient
requires using the following procedure.
o Procedure 6-1 (in textbook): Demonstrate and allow learners to practice this
skill.
- Blood is drawn and processed by institutional policy. Do NOT label tubes before the
blood sample is drawn. Outpatient and inpatient samples are labeled after the sample
is drawn and before the phlebotomist leaves the patient. In each case there is a
potential for a clerical error. Each tube and label must be checked to ensure that proper
Identification is completed.

Group Activity: Have the students continue practicing with the anatomical arms. As their technique
improves, add the other elements needed to perform the task, such as cleaning the arm and donning
gloves.

Part H: For Those Students Needing Help

Index Cards: Create an index card for each Key Term. Place the concept on one side and the Key Term
on the other. Ask learners to match the Key Term with the term’s definition and/or concept.
©2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
Part I: For Those Students Who Are Ahead and Want to Learn More
The Internet: Using the Internet, research sites for information regarding the Key Terms or concepts
covered in Chapter 6 of the textbook (these Key Terms are found at the beginning of the chapter in the
textbook.)

Part J: After-Class Activities

The students will need to use the notes that were taken in class during the PowerPoint presentation and
complete the study guide. The textbook and Internet should also be used to complete the information.
It is up to the instructor to determine if these should be turned in during the next class period or be left
to the students’ discretion to complete them.

©2018 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly
accessible website, in whole or in part.
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