The Ultimate Guide to Phlebotomy Training

Introduction

Your role may involve ‘taking bloods’ from patients, residents or service users. The technical term for taking bloods is ‘phlebotomy.’

This guide explains why phlebotomy is so important. It will explain who can take blood samples, the importance of good training and what this training may involve.

It’s aimed at anyone working in health and social care. Even if you’re unlikely to take blood samples, you may need to support colleagues or patients, request blood tests or help patients respond to results. So, it’s good practice for all staff to understand how and why phlebotomy is performed.

Contents

• What is ‘phlebotomy’?
• How do I become a Phlebotomist?
• The need for specialised training
• What does phlebotomy training involve?
• Workplace competency
• Choosing a training provider
• Keeping up to date
• Sources of further reading

What is ‘phlebotomy’?

Definition

Phlebotomy is the practice of obtaining venous blood (i.e. from a vein) samples from patients. You may also hear it referred to as ‘venepuncture’. Venepuncture is a broader term, meaning puncturing a vein to draw blood but also for other procedures, such as to administer an intravenous injection.

Phlebotomy is a routine task in hospitals, GP surgeries, out-patient clinics and other healthcare settings. When obtained, blood samples are sent to a laboratory for testing and analysis.

What sort of things can blood samples help with?

The doctor or nurse who requests the blood sample will specify what tests they want you to take. These can include: full blood count, urea and electrolytes (known as ‘U&E’s), thyroid function tests etc.  Each result is then analysed against the normal range. So, for example, if someone’s white blood count is high this can indicate the presence of an infection or something else.

A wide range of medical conditions and illnesses can be diagnosed by investigating the chemical structure of blood samples. It’s also a way of measuring and monitoring the progress of some health issues and managing certain medical conditions such as heart, liver or kidney disease or diabetes.

Clinical and care staff using this skill

• Until relatively recently it was only doctors and senior nurses who performed phlebotomy. However, over the past couple of decades, changes to everyone’s roles mean that phlebotomy is now routinely carried out by all grades of nurses and health care assistants.
• Other clinical staff able to take bloods may include student nurses, associate nurses, trainee phlebotomists, and medical students. There will also be times when phlebotomy is carried out by paramedics, and trainee paramedics.
• However, there are also specialists who focus specifically on this procedure. They are known as ‘phlebotomists’.
• Phlebotomists carry out venepuncture procedures for a variety of purposes, including taking blood samples from children (paediatrics), Glucose Tolerance Tests (known as ‘GTTs’) and inserting cannulas. They are usually skilled at finding a vein in a challenging situation!
• Phlebotomists are usually trained on the job. So, if this is something you want to specialise in, you should apply for a position as a trainee phlebotomist, e.g. in a hospital or GP surgery.
• The minimum age to start training is usually 17.

How do I become a Phlebotomist?

Qualifications and skills needed

There are usually no entry requirements, though some employers may ask for at least two GCSEs (or equivalent). Some employers and trainers require a BTEC or equivalent vocational qualification in health and social care, or previous healthcare experience, e.g. as a healthcare assistant.

As you will be working closely with patients, relatives and other healthcare staff you will need to be:

• Kind and caring
• Good with people
• Patient
• Organised
• A good communicator
• Able to work as part of a team
• Follow instructions
• Explain procedures in simple terms to others

As part of your workplace training you will attend a specialist training course where you have the chance to learn the knowledge and skills you will need for your role. Let’s look at the training in more detail, and why it’s so necessary.

The need for specialised training

Even though phlebotomy is often considered a routine procedure, it is still important that you are trained properly.

• As with all clinical procedures, there are risks and complications if phlebotomy is not carried out carefully. This is largely because you are puncturing not just the patient’s skin but also the vein. This is known as an ‘invasive’ procedure.
• Important aspects of the role include knowing how to minimise discomfort, pain or distress for your patient as well as reducing the risk of infection – for you as well as your patient.

Training helps you learn the skills needed to draw blood smoothly, minimise the risks and manage the patient’s response.

According to guidelines issued by WHO (World Health Organisation), before undertaking phlebotomy, health workers ‘should be trained in, and demonstrate proficiency for, the blood collection procedures on the patient population that will be within their scope of practice.’

If you are a registered nurse, paramedic, doctor etc you will have a professional accountability when undertaking – or delegating- this skill. This requires you to have the knowledge skills and competency to perform the role.

You may also have to take refresher trainer if:

• You haven’t performed phlebotomy for a while, e.g. after a career break or change in role.
• You lack confidence or demonstrate a lack of competence.

What does phlebotomy training involve?

Though you will be expected to develop competence in phlebotomy in a real clinical environment, it all starts with understanding the theory behind it. And practicing skills in a training environment.

Theory

Phlebotomy theory training looks at:

• The anatomy and physiology of veins in the human arm and leg, and how to decide which one to use.
• Infection control.
• Which equipment and technique to use for which category of patient or purpose.
• How blood clotting works.
• Communication and patient preparation.
• Preparing the room and your workspace.
• Safe handling of ‘sharps’ (items that may cut or puncture your skin, such as needles).
• How to prevent needle stick injuries (when you accidentally scratch or puncture the skin on yourself of a patient).
• What to do if there is a needle stick injury.
• Contra-indications for venepuncture – which means when it would be unsafe to proceed, or when special measures are required to minimise risk.
• Any potential complications and what to do.
• Correct labelling and reporting requirements.

Practical training

Once you’re familiar with the theory, you will be given supervised opportunities to gain practical skills in phlebotomy.

• To start with, you may practise on a special dummy patient (mannequin). You will need to talk through what you’re doing to demonstrate your knowledge to your mentor.
• Following this, you would be given opportunities to draw blood from live patients, under close supervision.

Specialist training

Depending on where you work, you may be trained specifically in phlebotomy related to your field. So, this could be drawing blood for paediatric, neonatal and intensive care, or for blood transfusion purposes, for example. This would also dictate how long your supervisory period extends before you can take bloods independently.

If you’re training to be a phlebotomist, your course would be far more comprehensive. You would need to demonstrate competency across various venepuncture techniques.

Workplace competency

Having completed the theory and practical elements of your training, the next stage would put your new skills to use on a ward or in other clinical setting. You will work under the supervision or a skilled and qualified mentor (e.g. senior nurse). This is referred to as a ‘workplace competency assessment’.

During this time your performance is measured against agreed competency frameworks. That means the standards that have been agreed for phlebotomy in your health field.

Your mentor will use this time to help perfect your skills. For you, the workplace competency assessment is a chance to ask questions and benefit from constructive feedback.

The sort of thing your mentor would be looking at, includes:

• Whether you understand relevant legislation, national guidelines, organisational policies and protocols that relate to taking blood samples.
• Your grasp of accountability, and your duty to report any problems.
• The correct way to take blood samples to ensure all risks – particularly infection – are managed and controlled.
• The type and function of different blood collection systems.
• Your ability to recognise and respond to common adverse reactions and things that could go wrong during blood sampling.
• How you prepare your patient, manage their experience and provide information on caring for the puncture site.

Choosing a training provider

If you want to enrol on a phlebotomy training course, this section will help you to decide which one best meets your needs.

If you’re applying for training through an employer, they are required to carry out due diligence, meaning they must ensure the training provision is appropriate.

If you’re considering using an external training provider, you should base your choice on such things as:

• Cost: what do you get for your money?
• Syllabus content – does the course cover the essential information laid out in the WHO guidelines on drawing blood: best practices in phlebotomy?
• Will it prepare you to meet the Skills for Health: Standard for obtaining venous blood samples?
• Certification – has a relevant professional body endorsed the course completion certificate?
• Quality – does the training provider have proper accreditation and evidence of their quality assurance plan?
• Qualifications of trainers – are they accredited in this field from an appropriate health related organisation?
• CPD – will the course help you acquire CPD hours and meet your revalidation requirements?
• Reviews – does the training provider have testimonials from previous trainees?

Keeping up to date

As with any clinical skill it is important that you keep up to date with any changes to local and national guidance. You may want to consider subscribing to relevant professional newsletters as well as networking with other colleagues who routinely perform venepuncture.

Reflecting on your own practice is an important aspect of your CPD. Not only is this mandatory for some professionals (e.g. nurses) but it can help you learn and develop.

If you are a phlebotomist, you can become a member of the National Association of Phlebotomists (NAP) or associate members of the Institute of Biomedical Science (IBMS). These provide information on good practice and news of developments in this field.

You could also network with colleagues who routinely perform venepuncture to stay updated.

Sources of further reading

National Association of Phlebotomists FAQ

Step into the NHS: phlebotomist

Health careers: phlebotomist