As a nurse, one of my favourite clinical skills to perform is phlebotomy. And as a clinical trainer, one of my favourite subjects to teach also happens to be phlebotomy. What a skill! It’s one of the most important diagnostic tools in medicine. I love seeing people have their first go and realise they can actually do it. I love seeing them blossom and become more proficient with performing phlebotomy over time. But it can be a little tricky to begin with. If you are starting out with phlebotomy, I promise it gets easier over time. And hopefully these tips will help you learn what to expect in the early days. So, here are 8 rookie phlebotomy mistakes I have observed regularly when people are learning how to perform phlebotomy. Also, more importantly, how to avoid them too. Hope it helps!
Phlebotomy mistake number one: Not anchoring the needle.
Not having a firm and confident hold on the needle device while in the arm can lead to one of three things happening:
- Accidentally withdrawing the needle while looking away to grab sample tubes or when retracting the tubes from the hub. This can be a bit of a blood bath as often the tourniquet will still be in situ at this point too.
- Accidentally pushing the needle in too far when going to grab a tube, or when inserting blood tubes into the hub. This risks transfixation (coming out of the other side of the vein) and also risks possible damage to underlying structures if too deep, such as nerves or tendons.
- Accidentally moving the needle around under the skin and causing more trauma to the vein walls in the process, possibly even causing transfixation while doing so. Micro movements can make a big difference!
How to avoid this phlebotomy mistake – TIPS:
Use a firm and confident hold on the needle. Practice first holding them and stabbing something that doesn’t mind being stabbed (e.g. fruit) and holding it steady. I get the delegates to practice this many times on the training pads we provide for our virtual phlebotomy course.
Use your whole hand, rest it on the patient‘s arm. Ensure the patients arm is anchored and not unstable too. When inserting the needle, have your hand resting on the skin already and use your fingers to do the insertion motion.
If your workplace, doesn’t have phlebotomy training pads for you to practice on, have a look at our phlebotomy training kits here.
Mistake number two: Being too distracted to use distraction
One of the most important skills in phlebotomy is the ability to put someone at ease. The physiology behind being at ease impacts directly on veins and circulation (for example vasodilation). But if you are new to a skill it is really hard to concentrate on both the new skill itself, and also the skill of distracting a nervous individual. Over time, you will develop better dual tasking methodology. However, until you have perfected and refined your phlebotomy practice you might find it hard to find this balance.
How to avoid this phlebotomy mistake – TIPS:
Training arms are a good place to start. They don’t require distracting and don’t get nervous!
For your first few goes on a real person have someone else in the room (also recommended for many other reasons!). The role of a supervisor isn’t just to check your skills. They will also be great at talking to the patient and offering up a bit of distraction while you are concentrating. As you become more skilled, this rule still applies. You will meet a lot of anxious people as part of this role. So, encourage them to bring a friend, watch something on their phone, close their eyes (or even look as some people find this is actually better for them). Get used to a bit of small talk – it will certainly help your blood taking practice and reduce the stress for everyone.
Mistake number three: Getting the order mixed up – especially when it comes to removing the tourniquet after removing needle (instead of before)
I’ve seen people make this mistake a lot. It is tricky to remember the order of everything isn’t it? However, I expect this is usually a mistake people only make the once! It gets a bit messy and serves as a good reminder as to why we remove the tourniquet first and not at the very end.
How to avoid this phlebotomy mistake – TIPS:
- The clue is in the title, obviously try to remember the order of things – again, practice the procedure on something that isn’t a person many times to gain a more automatic feel for things.
- Another tip here is don’t be too quick to remove the needle after the tourniquet is off. Let the blood recirculate and disperse from the area it has built up in first before you remove the needle. Your patient will thank you for less bruising!
Mistake number four: Positioning – putting everything on the wrong side or out of reach
When you commence any new skill, it’s always tricky putting everything where you need it and getting the hang of where it’s all best placed. I always struggled with wound care as a nurse and all the ‘clean hand’ ‘dirty hand’ principles and what I could touch and what I couldn’t. It’s hard when lots of equipment is needed. Often, I’ve seen people forget to bring the sharps bin over to the patient and then end up having to put the needle back in the tray (which we should not be doing).
How to avoid this phlebotomy mistake – TIPS:
- Again, take your equipment home, improvise and practice with where you would want everything.
- Ensure you have the set up you want at work. Do you have a trolley to put everything on? How close is your desk / table / sharps disposal…?
- Are you left or right-handed? Have you been learning from someone who is right-handed and now it’s really confusing if you’re a left-handed person?
- Practice practice practice.
Mistake number five: Rushing for fear of looking inadequate
When you are new you want to look as competent as possible don’t you? You might feel like if you are being ‘slow’ the patient will loose confidence in you. Therefore, sometimes I have seen people rushing and probably going faster than they need to on their initial attempts when performing phlebotomy. I personally feel that one of the most important parts of the process is to have a good feel of both arms first and really gauge where is the best place to go. However, I see some not checking both arms or just having a quick visual inspection and rapidly deciding to try there. In practice this sounds efficient but actually can be counterproductive. You could miss the vein and then later realise there may have been a better option. Then you are back to square one with a second attempt, and having to start again wasting both time and resources, along with compromising patient safety.
How to avoid this phlebotomy mistake – TIPS:
- Take your time, especially with palpating and searching for veins.
- Pause for moment to allow time for the veins dilate after you have applied your tourniquet.
- Take time to let the veins drain after removing the tourniquet (see point 3).
- Explain why you are taking your time – to get the best shot at doing it first time.
- Ultimately you will do a better job than if you rush. I think this probably applies to most things in life really!
Mistake number six: Getting the wrong patient
How many times have you called a patient in from the waiting room and it’s not actually your patient who comes in? If you are new to clinical practice in general – be prepared for this! Sometimes the wrong bit of eye contact or a similar sounding name can lead to mistaken identity. Check and double check the identity of your patient. A mistaken diagnosis on the back of that blood result can lead to disastrous and dangerous consequences for patients.
How to avoid this phlebotomy mistake – TIPS:
- Never tell them their name!
- Always ask them for names along with some other identifiers as per your local policy. But always check. You want details!
- Never ask for yes or no answers. You will be suprised how many people want to answer ‘positively’ to health care professionals and they will often nod along, even when the answer is no!
Mistake number seven: Getting the tension wrong with your tourniquet
When you start out in phlebotomy you may be naturally worried about hurting someone. After all, you are about to stab them in the arm. So, often when I’m teaching ‘tourniquet skills’ I notice people tending to be a little too gentle with their tension. I can totally understand this reluctance. However, your tourniquet is your best friend in phlebotomy practice. It can increase the volume of blood in the vein by a considerable amount if used correctly. You don’t want to have it too tight so that it is uncomfortable, but these things are designed to be firmly applied. Increase your chance of success by getting your tourniquet use just right.
How to avoid this phlebotomy mistake – TIPS:
- Get an experienced colleague to apply a tourniquet on you so you can get a feel for the tension.
- If it is one without fastenings, practice tying them without losing tension.
- If you have willing friends and relatives, ask if you can practice applying tourniquets and palpating veins. Observe what difference it makes when altering the tension.
- Again, it’s just a matter of practice as much as you can and put yourself in the patients position too by trying a tourniquet on yourself.
Mistake number eight: Beating yourself up when you miss
The final rookie error (and one that still affects the most experienced of phlebotomists) is losing confidence or getting annoyed at yourself if you miss a vein and don’t get the blood. Lots of people miss occasionally while performing phlebotomy, or can’t find a decent vein. You do occasionally get that annoying bloods whizz in practice who has done a thousand bloods and ‘never missed yet’. But in my experience, these phlebotomy prodigies are few and far between.
How to avoid this phlebotomy mistake – TIPS:
I don’t want to sound negative, but expect to miss sometimes. You win some, you lose some. Performing phlebotomy is a tricky skill and every arm is different. Don’t get mad at yourself for the ones you miss. Instead, be proud of the ones you get. And after some practice I can guarantee that you will be winning more than loosing.
Many of these mistakes can be avoided with good practice to build your confidence in the skill of phlebotomy. Try using our training kits or get one at a discount (or even free!) alongside our phlebotomy training courses.
Another great tool you can use is our Phlebotomy Competency Workbook on our Free Resources Page! It can be used as set of checklists on your pathway to competency with taking blood!
Good luck! Now go forth and phlebotomise!
For further information on the ins and outs (no pun intended) or performing phlebotomy please refer to the WHO guidelines
For a fantastic range of options and high quality phlebotomy training please visit our phlebotomy page.
