GUIDANCE

There are MANY misunderstandings in the world of phlebotomy. Even though 'guidance' is just that and is NOT the law, you would be glad you followed the guidance if you WERE Standing in that court of law justifying your actions and inactions.

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Phlebotomy FAQ's

General Questions

Q: What is phlebotomy?

Phlebotomy is the practice of drawing blood from a vein, usually for diagnostic testing, transfusion, research, or treatment. It is a fundamental skill in many clinical roles.

Q: Who can perform phlebotomy?

In the UK, trained healthcare professionals such as nurses, healthcare assistants, and phlebotomists can perform phlebotomy, provided they have completed appropriate training and demonstrated competency.

Q: Do I need a formal qualification?

There is no statutory qualification required, but most employers expect completion of a training course followed by supervised practice and documented competency assessment.

Technique and Equipment

Q: What is the best site for venepuncture?

The median cubital vein in the antecubital fossa is commonly used due to its size, stability, and accessibility. However, vein choice should be based on individual patient assessment.

Q: Should I use a butterfly or a straight needle?

Straight (vacutainer) needles are cost-effective and suitable for routine blood draws. Butterfly (winged) needles offer more control and are often preferred for small, fragile, or difficult-to-access veins, especially in paediatric or elderly patients. Choice depends on patient needs, vein condition, and practitioner confidence.

Q: Should I wipe off the alcohol before inserting the needle?

No. The cleansing agent (such as alcohol or chlorhexidine) should be allowed to fully dry before proceeding. This reduces the risk of haemolysis, skin contamination, and inaccurate results, especially in blood cultures. It also allows time to disinfect the site.

Q: What is the correct angle for needle insertion?

Generally, an insertion angle of 15 to 30 degrees is appropriate, depending on the depth of the vein. The vein should be anchored securely, and the needle inserted with confidence and care.

Sample Handling

Q: What is the correct order of draw?

Blood cultures (if required), Citrate, Serum, Heparin, EDTA, Fluoride. Following the correct order prevents additive cross-contamination and ensures accurate test results.

Q: Do I need to mix the tubes after collection?

Yes. Tubes containing additives should be gently inverted the correct number of times to ensure proper mixing. Avoid shaking, which can cause haemolysis and affect test accuracy. (There are some exceptions such as Quantiferon, where tubes can be more vigorously shaken).

Q: What happens if I underfill a tube?

Depends on the tube. Underfilling can lead to incorrect additive-to-blood ratios, which may produce inaccurate test results. This is particularly important with citrate and EDTA tubes. But not as important for tests like antibodies.

Patient Care and Safety

Q: What should I do if I cannot find a vein?

Try warming the site, adjusting the arm position, or using a vein finder if available. Seek assistance or follow local escalation procedures. Avoid repeated probing or “digging” with the needle. Come on my course and learn ALL the tips!

Q: How can I support a patient with needle phobia?

Speak calmly and reassuringly. Explain each step, allow the patient to lie down if needed, and offer distraction techniques. Empathy and clear communication are key.

Q: What aftercare advice should I give the patient?

Advise the patient to keep pressure on the site for one to two minutes, keep the dressing in place for at least 30 minutes, and avoid strenuous use of the arm for a few hours. Bruising may occur. They should seek advice if there is swelling, persistent pain, or signs of infection.

Labelling and Documentation

Q: Do I need consent to take blood?

Yes. Verbal, informed consent is required. The procedure should be explained clearly, and any concerns addressed. Consent should then be documented in the patient notes.

Q: When should I label the blood tubes?

Tubes must be labelled immediately after collection and in the presence of the patient, using full identifiers such as name, date of birth, and NHS number. Never pre-label tubes before the draw.

Infection Control, Sharps Safety & HIV Awareness

Q: Do I need to wear gloves for every procedure?

Ideally. Gloves are to protect you. They won't stop a nedle penetrating but they will wipe off a lot of blood on the way into your skin. Additional PPE (e.g. aprons or eye protection) should be used if there is risk of splashing blood or body fluids.

Q: What should I do if I sustain a needlestick injury?

Encourage bleeding from the site and wash thoroughly with soap and water. Report the incident immediately and follow your workplace protocol, which may include occupational health referral for potential post-exposure prophylaxis (PEP). PEP is most effective if started within 24 hours and ideally within 72 hours post-exposure

Q: What is the risk of HIV transmission from a needlestick injury?

The percutaneous transmission risk is approximately 0.3%; risk increases with deep injuries or visible blood on the device. Also remember that undetectable + transmissible. There have been no confirmed HIV transmission cases via needlestick in UK healthcare workers since 1999

Q: Should patients living with blood borne diseases like HIV or hepatitis B be treated differently when handling sharps?

No. Clinical practice should follow universal precautions—treat all blood and sharps diagnosis or no diagnosis as potentially infectious. Current expert guidance states that as long as everyone, including staff, is treated under the same infection-control standards, practices are not discriminatory

Q: Is treating patients with HIV as if they are infectious discriminatory?

Not if this is how you treat everyone. The principle of HIV exceptionalism—singling out people with HIV for special precautions—is outdated and stigmatising. Evidence shows that being on effective antiretroviral therapy reduces viral load to undetectable levels, making HIV transmission negligible. Discrimination in employment or clinical practice persists due to misunderstanding, rather than infection risk.

Q: Can a healthcare worker living with HIV perform phlebotomy?

Yes, if not classified as performing exposure-prone procedures (EPPs). For roles involving EPPs—such as surgery or obstetrics—strict regulations apply: workers must have well-suppressed viral load (< 200 copies/mL), regular monitoring, and occupational health oversight. Phlebotomy alone does not usually require these restrictions

Best practice in phlebotomy. Practice Nurse 2025;55(2):9-13. (First published in Practice Nurse https//:practicenurse.co.uk and given permission to share here)

“The blood is the life!” Bram Stoker