Basic Phlebotomy Online

Basic Phlebotomy Online Headquarters

  • Oct 31

    Needles – What’s the Point?

    Needles that are used for venipuncture are available in a variety of lengths and diameters. The diameter of the needle is referred to as the needle gauge; the larger the diameter of the needle, the smaller the gauge number. The image on this page illustrates the relative gauges of needles that are available for venipuncture.

    Needles that are routinely used for venipuncture are available in 3/4 inch, 1 inch and 1 1/2 inch lengths. The phlebotomist determines the gauge and length of the needle to use for a venipuncture after assessing the vein

  • Jul 24

    Many prospective students of phlebotomy have questions regarding their potential career. What will they do on a day to day basis? What are their employment opportunities?  How much can they expect to earn? The following article from the esteemed Mayo Clinic helps to answer some of the most frequent questions asked by phlebotomy students. It discusses the possible careers open to a certified phlebotomist, potential earnings and what it is that a phlebotomist does. The good news for those currently studying phlebotomy, or that are thinking about doing so, is that the employment opportunities are continuing to grow as well as the wages paid to a qualified phlebotomist. 2013 is a great year to enroll in an online phlebotomy course.

    Phlebotomy Technician

    Field description

    Phlebotomy technicians are primarily responsible for the collection and preparation of blood samples for laboratory testing. Phlebotomists are mainly employed in hospital and clinic settings, but sometimes work in nursing homes, private home care, the insurance industry or research institutes.

    The field of phlebotomy continues to expand and is now much more than collecting blood samples. Today’s phlebotomists must be aware of the types of tests requested, the importance of the timing of blood collections in some instances, medications that the patient is taking that could interfere with testing, and the effects of diet on the patient’s specimen.

    Some phlebotomists may be called upon to perform other duties, such as collecting donor blood, performing bleeding time tests (on occasion), performing therapeutic phlebotomies, point-of-care testing and specimen preparation.

    Career opportunities

    Phlebotomy is a rapidly expanding field with excellent career opportunities. Hospitals are the primary employer of phlebotomy technicians. Other areas that employ phlebotomists are clinics, private physicians’ offices, research centers, and other areas where invasive procedures are performed.

    Earnings potential

    According to the Bureau of Labor Statistics, the average income for phlebotomists nationally is $14.86 an hour, which is $30,910 a year. Earnings are dependent upon a candidate’s experience and work history.

    Professional organizations

    American Phlebotomy Association
    National Phlebotomy Association


    One of they key points to remember about the preceding article is that wages will vary tremendously depending on location. Different states have different costs of living and the salaries for all medical workers and workers in general reflect this. Even within a particular state wages may vary, the earnings potential listed above is a  only a nationwide average. A phlebotomist working in an advanced laboratory setting will probably make more money than one working at a free health clinic. Often times a recent graduate will need to take a lower paying job to acquire some experience before a high paying facility will consider hiring them. Higher paying positions also will want to make sure that their potential employees are familiar with the latest technologies that they will almost certainly be using which is why attending an accredited phlebotomy school with the latest technology is so important.

    Tagged as:
  • Mar 24

    phlebotomy certification onlineWould you like to get certified as a phlebotomist, but are too busy to go directly to a phlebotomy school to get the course training? In today’s modern age you can accomplish this while you’re at work, as long as you have a computer with internet connection, you can get certified.

    Now more than ever, employers such as hospitals, doctor’s offices, out-patient labs and nursing homes require medical health-care workers to perform blood draws. The state of California and many employers all over the country require employees who draw blood in the laboratory setting to be certified as a Phlebotomy Technician, you cannot work as a “Phlebotomist” in California without it.

    CCMCC’s online phlebotomy program is fully approved and accredited by the California Department of Public Health-Laboratory Field Services. Contra Costa Medical Career College’s new Phlebotomy Certification Online is not only accredited by the state of California but it takes less than five minutes to enroll. Watch the short video below to get more info.

  • Jan 3


    One very familiar scenario is delaying the dream for medical school. The most practical way around this is by enrolling in a phlebotomy school. As of late, more and more students use phlebotomy to jumpstart their medical careers.

    Enrolling in a phlebotomy school is the most practical detour towards a medical profession because it is the fastest way. Most degrees would require a minimum of two years for an associate degree. However, with phlebotomy, you can finish a course in a matter of weeks to months. Phlebotomy only requires a minimum of sixty hours of credit which translates to 60 hours of attending classes. You may be able to finish the entire lecture course in a matter of two weeks if you are lucky enough with your schedule. There is really no going wrong in phlebotomy when it comes to practicality, therefore, taking time to choose a school and the number of credit hours it offers is necessary.

    Taking up phlebotomy is practical because certification is not needed. Except for the states of California and Louisiana, one could land a job after he or she finishes their training course and practicum. While it may not be a degree per se but once you are in the employed market it is so much easier to save money and use phlebotomy simply as a stepping stone for your medical career. It is practically that one single step that introduces you to the fascinating world of medicine.

    This can be in the form of vocational school like that of phlebotomy. Being in a phlebotomy school is never a waste because it is after all a medical course too.

    To cap it all off, a practical phlebotomy school only requires you to dish out a few hundred dollars for your entire course. As compared to other courses where you pay thirty to forty thousand dollars per semester, the whole phlebotomy training can be as low as $ 2300. Just comparing these figures alone will make you understand the practicality behind enrolling in a phlebotomy program.

    A word of caution though is that you should never allow yourself to be shortchanged by your phlebotomy school. One consideration is that the school must be accredited by at least one of the 10 different government-sanctioned agencies in the US. Second is that the schools must offer up-to-date facilities that will give you a glimpse of how phlebotomy is in the real world.

    In a nutshell, a phlebotomy school is almost synonymous to the word practical. Precisely because of this reason, it comes as no surprise why more and more students take phlebotomy.

    The most practical way around this is by enrolling in a phlebotomy school. Enrolling in a phlebotomy school is the most practical detour towards a medical profession because it is the fastest way. Being in a phlebotomy school is never a waste because it is after all a medical course too. To cap it all off, a practical phlebotomy school only requires you to dish out a few hundred dollars for your entire course. In a nutshell, a phlebotomy school is almost synonymous to the word practical.

  • Oct 31

    In addition to the puncture device, additional equipment may be required when performing a successful dermal puncture.

    Plastic microcollection devices: Plastic microcollection devices are small plastic tubes designed to collect capillary blood from a dermal puncture wound. Each small collection tube is color-coded in the same manner as blood collection tubes used for venipuncture. The color of the cap of each container tube corresponds to the type of additive inside the tube, most often an anticoagulant. The additive coats the inside of the tube. Examples of microcollection devices are shown below.

    Heel warmer: It is best practice to warm the heel of an infant with a warming device known as a heel warmer. The heel warmer, when activated, is designed to warm its contents to a standardized temperature. This temperature will be hot enough to effectively warm the heel and facilitate blood flow to the area without causing heat injury to the patient. It is unacceptable to warm a cloth using a microwave. There may be “hot spots” on the cloth that could potentially burn the patient. Keep in mind, what may feel warm to you, the phlebotomist, may feel hot to your patient!

    Plastic or Mylar-wrapped capillary tube: In some facilities blood from a capillary puncture is collected directly into a capillary tube. These tubes are very delicate and must be used with great caution. As soon as the tube is two thirds to three-fourths filled, one end is sealed to prevent blood from leaking out.

    Glass microscope slides: In some facilities, the person collecting the capillary specimen may also be required to prepare a blood smear for laboratory examination. A drop of blood is placed directly on a glass slide and spread to create an area for cell examination. If you are required to prepare blood smears, remember that the slide is considered infectious until fixed or stained. It is also important to remember that glass is a sharps hazard. If not used correctly, the glass may cause injury to both the patient and the phlebotomist. Be as cautious with a glass slide containing blood as you are with a contaminated needle. Dispose of glass slides that will not be used for testing in approved sharps containers.

    Alcohol and gauze pads: Alcohol is the disinfectant of choice for dermal puncture. The alcohol must be allowed to air dry, which will prevent hemolysis of the specimen and discomfort for the patient. A piece of clean or sterile gauze is used to wipe away the first drop of blood. Gauze is also used to apply pressure to the wound after the specimen collection is complete to stop the wound from bleeding.

    Iodine or other approved cleaning agents may be used as an alternative to alcohol.

    Bandage: It may be necessary to apply a bandage to the puncture wound on a finger or heel if the site continues to bleed. However, it is NOT recommended to bandage the finger of a child who is 2-years-old or younger since the bandage may become a choking hazard if the child puts that finger in his/her mouth.

    Personal protective equipment (PPE): All healthcare professionals that may come in contact with blood and/or body fluids while performing a laboratory procedure are required to wear intact gloves. It is against safety guidelines to alter gloves in any way that may compromise the integrity of the gloves. Eye protection, such as safety goggles, is recommended if there is the possibility of a splash of blood while collecting a capillary blood specimen. In many facilities, special gowns are required in some patient areas such as special-care nurseries. Always follow the policies of your facility in regard to PPE.

  • Oct 31

    In some situations, the phlebotomist will make the decision if a blood specimen will be obtained by dermal puncture or venipuncture. The patient’s condition, the age of the patient, the amount of blood needed for testing, and the risks associated with the procedure will help the phlebotomist determine the best method for collection.

    A dermal puncture requires less precision, therefore it is less critical for the patient to be still or immobilized. However, if the puncture is not performed correctly, or an approved site is not used, the puncture may cause more discomfort, or even injury to the patient.

    The risk of accidental needlestick injury to the patient and phlebotomist is minimal since the puncture device is designed to retract the needle once the puncture is made.

    The puncture is quick and standardized for puncture depth. However, the procedure takes longer to complete. This delay in collection of the blood specimen could result in hemolysis or clotting of the blood or tissue fluid contamination of the specimen and specimen rejection by the laboratory.

    The dermal puncture minimizes the amount of blood taken from the patient. This will be important to consider, especially with infants in an intensive care nursery. However, some laboratory tests require larger amounts of blood for testing; in these cases, capillary collection is not an option.

    If a patient is dehydrated or has poor peripheral circulation, an adequate blood collection from a dermal puncture may not be possible.

  • Oct 31

    Needle holders with built-in protection devices

    • You will be required to use appropriate safety devices with your needle holder. Various options are available.
    • The Needle-Pro™ Needle protection device (Sims Portex) shown here is an example of a needle holder with a built-in safety device.
    • It is activated after venipuncture by pressing the orange protection device against any flat surface so as to engage the sheath firmly on the needle.
    • Butterfly needles with built-in safety features continued

      • Two examples of butterfly needles with built-in safety devices are shown.
      • The Punctur-Guard™ (Bioplexus), shown above, uses an internal blunt needle which is activated after blood is drawn. The activated device showing the blunt internal needle is shown in the inset on the upper right.
      • The Angel Wing ™ (Monoject), is activated by sliding a safety shield over the needle after venipuncture
  • Oct 31

    Case 101

    John Smith was a newly certified phlebotomist and had been working at Hallwood Hospital for several months. As she approached room 09, he looked on her collection list to verify this was the correct room for her first collection. Indeed it was, even though there was no patient name on the door. His collection list told her the patient in room 09 was a 45 year old male named Jay Ready. After knocking several times, John entered the room to find a middle aged man who appeared to be sleeping. John approached the patient and said, “Good day Mr. Ready. My name is John and I am from the lab. I need to draw blood for some tests ordered by your doctor.” The man awoke and seemed irritated as John repeated himself. The patient responded and told John to do whatever she needed to do so he could go back to sleep John then proceeded to do the venipuncture.

    Discussion Case 101

    A phlebotomist should never use an arm with restricted usage for the venipuncture. Even if no sign is posted, the patient may tell you not to use a particular arm for various reasons, i.e. previous mastectomy, history of phlebitis, active AV fistula, etc. Do not draw blood above an IV line. If blood is taken from a vein above an IV line it might be diluted by the IV fluid, which could cause incorrect test results. In this case, John  should choose a vein on the dorsum of Mrs. Grayson’s hand, below the IV. A butterfly needle would facilitate drawing blood from these small hand veins.Relevant topics:Alternate sites, Sites to avoid, Signs, Arms to avoid.

    Case 102

    A phlebotomist at an outpatient drawing station prepares to collect blood from a patient who is scheduled for surgery the next day. The patient tells the phlebotomist that she is afraid of needles. The phlebotomist assures the patient that everything will be fine. He seats the patient in a phlebotomy chair. He talks the patient through the beginning of the venipuncture and she seemed to be doing fine. As the second of four tubes is being drawn, the patient suddenly blurts out that she fells very dizzy and is going to faint.


    What should the phlebotomist do now?

  • Oct 29

    Before we discuss what to do if someone faints it would be best to discuss why people faint in the first place. If you are currently caring for a person who has fainted, skip on to the next section: it is important that they receive care as quickly as possible.

    The ultimate cause of most fainting cases is that the supply of blood to the brain has been reduced by a drastic amount. Without freshly oxygenated blood the brain cells cannot function properly and the person loses consciousness. Usually, upon falling the blood flow to the brain improves (since the person is lying down, the head is no longer elevated) and so the fainted person will usually quickly regain consciousness.

    Losing blood flow to the brain can be caused by a variety of conditions including physical exhaustion, hunger, dehydration, emotional stress, hyperventilation, anemia, low blood sugar and serious cardiac problems. If someone faints there is always an underlying cause and therefore they require some form of treatment.

    What to do if someone faints: The DO’s and DON’Ts of caring for a person who has fainted

    The first thing you must do if someone faints is not panic. Then run through the following checklist to properly position and care for the fainted person.

    Do check if a person is still breathing immediately after they faint. If not, administer CPR as needed

    Do immediately alert medical personnel if someone faints

    Do position the person properly. To do this lie the person face-up in a supine position. If at all possible, elevate the heart above the head and feet above the heart: this will allow for maximum blood flow to the brain. Tilt the person’s head to one side: swallowing one’s own tongue is a serious risk for an unconscious person.

    Do loosen any tight clothing that the fainted person is wearing

    Do use blankets if someone has fainted and is shivering or their lips are turning blue

    Do apply damp towels to face of the fainted person.

    What you should not do if someone faints is just as important as what you should do if someone faints. Be sure that you do not do any of DON’Ts on the following list. If someone faints and you do these things, you could put their lives in danger.

    Don’t try treating them beyond basic first aid. Leave that to professionals

    Don’t try giving them anything to eat or drink until you are sure that they are completely conscious. Even though dehydration is often a cause of fainting, you don’t want to risk them choking

    Don’t slap or shake the person. That only works in movies. If someone faints and you do this you may end up further injuring them.

    Ultimately, there is not that much that you can do if someone faints, except to properly position them and ensure that nothing happens to them while they are unconscious until medical professionals arrive. By knowing the things you can do however, you may one day save a life of someone faints in your presenc

  • Oct 29

    Complications In Blood Collection
    A. A variety of adverse complications may be encountered during the blood collection process.

    The following are the most commonly encountered.
    1. Fainting (syncope)
    a. Patient becomes dizzy and faint at the site of blood or due to fasting.
    b. ASK the patient if they have a tendency to faint, if YES, have them lie down.
    c. If during the procedure patient states they are faint or appear faint REMOVE THE
    NEEDLE immediately, have patient lower the head and breathe slowly and deeply.
    d. Signs that patient is about to faint include: blood draining from their face, rapid
    breathing, restless movement.
    e. Ask for help to move the patient.
    f. Talk to the patient calmly, apply a wet towel to the back of the neck, offer juice or water.
    g. If the patient faints, remove needle and break the fall, request help.
    h. Do not allow the patient to leave until they have recovered.
    i. Fill out incident report.
    2. Failure to draw blood may be due to needle inserted incorrectly or vacuum lost in tube
    a. If you suspect the needle is not properly inserted, gently and carefully reposition.
    DO NOT DIG FOR VEINS. Withdraw slightly, reposition, reinsert.
    b. If you suspect vacuum in tube is lost, change tubes. Always have extra tubes within reach.
    3. Hematomas occurs when area around puncture site begins to swell indicating that blood is
    leaking into the tissues which will result in a bruise.
    a. Due to partial insertion into the vein or insertion through the vein.
    b. If this happens IMMEDIATELY remove the needle, apply pressure for 2 minutes
    and recheck to ensure bleeding has stopped.
    c. Fill out incident report.
    4. Petechiae
    a. Prior to blood collection examine potential site. Small red spots on the patients
    skin may indicate rupture of minute veins below the skin.
    b. May be due to coagulation problems or abnormalities.
    c. Phlebotomist must be aware of the fact that the patient may bleed excessively after
    blood collection.
    d. Make sure bleeding stops prior to leaving the patient. Notify nurse of excessive
    bleeding if it occurs.
    5. Excessive bleeding after venipuncture
    a. Patient on anticoagulants, on aspirin containing medications or has decreased number of platelets
    b. Do not leave patient until bleeding has stopped

    6. Neurologic
    a. Patient may feel sharp, electric tingling if nerve is hit.
    1) Immediately discontinue the venipuncture.
    2) Fill out incident report and submit.
    3) Patient may need physical therapy.
    b. Seizures
    1) Rare complication, immediately stop the venipuncture.
    2) Call for help.
    3) Do not place anything in the patient’s mouth.
    c. Fill out incident report.
    7. Mastectomy
    a. Women who have had a breast removed will also have had adjacent lymph nodes
    1) This will greatly reduce lymph flow to the arm on the side of the
    2) May increase the possibilities of infection or it may result in lymphedema.
    b. Lymphedema is an accumulation of lymphatic fluid that causes swelling in the
    tissue of an arm or leg.
    1) Accumulation of this fluid can occur after lymph nodes or vessels are
    surgically removed or damaged.
    2) Lymphatic fluid is clear and collected from tissue in all parts of the body.
    c. Ask patient about arm preference.
    d. If double mastectomy confer with physician, may need to perform finger stick or
    perform venipuncture on legs or feet.
    8. Edema
    a. Abnormal accumulation of fluids in intercellular spaces of the body.
    b. Can be localized or diffuse.
    c. Avoid collection blood from these sites, usually hands and feet, but arms can be
    swollen, will contaminate specimen with tissue fluids.
    9. Obesity
    a. Obese patients generally have veins that are very deep and, thus, are difficult to
    visualize or palpate.
    b. Any puncture made may have to be made based on phlebotomist’s knowledge of
    venous anatomy.
    1) This is essentially a “blind” stick.
    2) Should only be made by the most experience personnel.
    c. If the vein is missed take care not to probe excessively as this will cause rupture of RBCs,
    increase concentration of intracellular contents and release of tissue clotting factors.
    d. Consider possibility of finger stick.

    10. IV therapy never draw above an IV site, consider the following:
    a. Try opposite arm.
    b. When there is no other option always draw from site 5 inches below IV site.
    c. If IV in both hands confer with nurse to determine if blood can be drawn from IV
    line, the IV is disconnected, syringe attached, first 6ccs discarded, and blood is
    drawn for testing.
    d. Proper protocol must be followed which involves having IV turned off
    waiting appropriate time limit, discard first tube drawn
    e. Evaluate feet or legs, however if patient has been bedridden for extended periods of
    time this may increase chance of phlebitis.
    f. Extended IV therapy may cause veins to damaged or occluded.
    11. Damaged, sclerosed or occluded veins
    a. Sclerosed or hardened veins due to inflammation or disease.
    b. Patients whose veins have been repeatedly punctured often become scarred and feel
    hard when palpated.
    c. Blood is not drawn easily, best to avoid these sites.
    12. Hemoconcentration
    a. An increase in concentration of large molecules and formed elements in the blood.
    b. Some causes are:
    1) prolonged tourniquet application
    2) massaging, squeezing or probing a site.
    3) long term IV therapy
    4) sclerosed or occluded veins
    5) dehydration
    6) certain diseases
    c. Hemoconcentration may cause false increase in: potassium, magnesium, LDH,
    phosphorous, ammonia, and total protein.
    13. Hemolysis
    a. When RBCs are ruptured hemoglobin is released and serum appears pink to red.
    b. If grossly hemolyzed will appear dark red.
    c. May be due to conditions such as: burns, snakebite or some diseases.
    d. Usually caused by improper technique:
    1) needle to small
    2) pulling to hard on plunger of syringe
    3) expelling blood vigorously into a tube
    4) shaking/mixing specimen in tube too vigorously
    5) not allowing alcohol to dry before drawing blood
    e. May cause false increase in: potassium, magnesium, iron, LDH, phosporous,
    ammonia and total protein.
    14. Collapsed veins
    a. May be caused by pulling syringe plunger back to quick or too hard, use gentle pressure.
    b. Vacutainer used on small veins.

    15. Allergies
    a. Patient may be allergic to iodine or other solutions used to disinfect the site.
    b. Prior to using iodine or betadine ask patient if they are allergic, if the answer is
    “yes”, use alternative method as directed by your site.
    c. Latex allergy
    16. Thrombosis
    a. Thrombi are solid masses derived from blood constituents in the vessels, ie, a clot.
    b. Thrombus may partially or fully occlude a vein or artery making venipuncture difficult.
    17. Burned or scarred areas should be avoided.
    a. Burned areas a very sensitive and susceptible to infection.
    b. Veins under scarred areas difficult to palpate and difficult to insert needle.
    18. Infections
    a. Patient may have transmissible disease, ie, hepatitis, which may be transmitted to phlebotomist.
    c. Special infection control measures will be posted on the patient’s door.
    B. Physical Disposition
    1. The basal state refers to the patient’s physical condition in the early morning hours
    approximately 12 hours after the last meal. Many factors can affect the basal state.
    a. Results of lab tests are more reliable because normal values are most often
    determined from specimens collected during this time.
    b. It is recommended that specimens collected for determination of concentrations of
    the following analytes be collected during this time:
    1) glucose
    2) cholesterol
    3) triglycerides
    4) electrolytes
    5) proteins
    2. Diet
    a. To ensure a basal state, overnight fasting is necessary as blood composition is
    significantly altered after a meal.
    b. Fasting refers to abstinence from food and beverages except water.
    c. Fasting time will vary according to test ordered and it is critical to ask a patient
    when they last ate.
    d. If a patient has eaten and the doctor still wants the test drawn write “non-fasting” on
    the lab requisition.

    e. Phlebotomists may need to instruct patient. It is best to give oral and written
    instructions and emphasize the importance of following these directions:
    1) Coffee/tea are not allowed, may cause fluctuation in blood glucose.
    2) Water is allowed and encouraged to prevent dehydration which will also
    alter test results.
    3) Specify the time when fasting must start.
    f. Serum is normally clear, light yellow or straw colored, turbid specimens appear
    cloudy and milky and may be due to the following:
    1) Lipemia, excess fats in the blood due to lipids present after eating fatty
    substances such as meat, butter, cream or cheese.
    2) Lipemic specimens may indicate the patient is not in a basal state.
    3) Rarely, cloudy specimens may indicate presence of bacteria.
    3. Exercise
    a. Moderate or excessive exercise has a marked effect of the following lab results:
    lactic acid, creatinine, fatty acids and some amino acids, proteins and enzymes.
    b. Most return to normal shortly after exercise except enzymes such as CK, AST and
    LDH, which will return to normal within 24 hours.
    c. Some research indicates exercise affects hemostasis.
    4. Stress
    a. Patients are often frightened, nervous and overly anxious.
    b. Anxiety can cause a transient increase in WBCs, albumin, fibrinogen, glucose,
    cholesterol and insulin, a transient decrease in serum iron, and abnormal adrenal
    hormone values.
    c. Violent crying in newborns will have WBC counts 140% above baseline counts.
    Even mild crying will cause 113% increase, but will return to normal after one
    5. Diurnal rhythms and posture
    a. Body fluids fluctuate during the day.
    b. Certain hormone levels are reduced in the afternoon, while eosinophils and serum
    iron are increased.
    c. Posture changes are well known to alter lab results.
    1) Important to consider when comparing in-patient versus out-patient results.
    2) Changing from supine to sitting or standing causes water to shift from
    intravascular or interstitial compartments.
    3) Certain large molecules are not filterable to the tissues.
    4) Enzymes, proteins, lipids, iron and calcium significantly increase with
    position changes.
    6. Tourniquet Interference and Fist Pumping
    a. May cause false increase or decrease in certain analytes in the blood.
    1) Some analytes leak from blood into the tissues causing false increase in:
    plasma cholesterol, iron, lipid, protein and potassium.
    2) Certain enzymes may be falsely increased or decreased.
    3) Tourniquets interference can occur within 3 minutes.