University of Nebraska Medical Center

Clinical Laboratory Science Program

CLS 424 - Phlebotomy

Student Laboratory
Phlebotomy Competency Checklist Procedure

Goal: After the clinical laboratory science student has completed each of the following
activities, he/she will be able to complete the Student Laboratory Phlebotomy
Competency Checklist Procedure:

1. Review the phlebotomy lecture material.

2. View the venipuncture video

3. Be oriented to the proper venipuncture technique by an instructor

4. Be oriented to the proper capillary technique by an instructor

5. Access reference material

6. Complete several successful venipunctures using a syringe

7. Complete several successful venipunctures using a vacutainer system

8. Complete several successful capillary collections

Assignments:

1. The student will select at random a ‘patient requisition’ (fellow student, instructor or
volunteer) to be drawn.

2. The requisition (order form) will state the patient’s name, identification number, and what
tests need to be drawn.

3. The instructor will observe the student performing the phlebotomy, rating their performance
on the appropriate competency checklist as satisfactory, needs improvement or incorrect/did
not perform.

4. Upon completion of the phlebotomy, the instructor will review the competency checklist
with the student, assess the student’s phlebotomy technique, and give suggestions for
improvement if a rating other than satisfactory is indicated.

5. If a rating of unsatisfactory is obtained on any skill listed on the competency checklist, the
student may be required to practice and demonstrate the skill at another time until a
satisfactory rating is achieved, establishing minimum competency.

CLS 424 Phlebotomy Page 1

Student Laboratory Phlebotomy Competency Checklist
STUDENT LABORATORY PHLEBOTOMY Rating System:
COMPETENCY CHECKLIST -VENIPUNCTURE OK = Satisfactory performance
NOT OK = Incorrect or needs improvement
NA = Not assessed
Skill/Competency:
Rating
1. Washes hands prior to beginning venipuncture procedure ……………………………………… _____

2. Introduces him/herself to the ‘patient’…………………………………………………………….. _____

3. Explains to the ‘patient’ what procedure he/she is going to do ………………………………….… _____

4. Properly identifies the ‘patient’ ……………………………………………………………………. _____

5. Inquires about latex allergies and acts accordingly ……………………………………………… _____

6. Organizes the proper equipment without prompting (stick to eleven) …………………………… _____

7. Anticipates the need for additional equipment in case of ‘problems’ ……………………………... _____

8. Correctly positions arm, then applies tourniquet ……………………………………………………_____

9. Locates appropriate vein to be drawn, then releases tourniquet (1 minute rule) ………………… _____

10. Cleanses venipuncture area, in a circular/outward motion, allowing to air dry ~ 30 seconds……… _____

11. Reapplies tourniquet taking care not to contaminate venipuncture site …………………………… _____

12. Performs the procedural steps, in proper sequence, for a venipuncture: Vacutainer / Syringe
a. Isolates and anchors the selected vein using thumb and pulling taut …………………… _____
b. Inspects needle and inserts needle, bevel up ………………………………………………. _____
c. Anchors vacutainer or syringe blood drawing system ……………………………….. _____
d. For vacutainer draw, changes tubes smoothly without losing vein ……………………….. _____
e. For syringe draw, pulls back on plunger smoothly without losing vein ………………… _____
f. Uses correct ‘order of draw’ when filling collection tubes ……………………………….. _____
g. Adequately fills tubes …………………………………………………………………….. _____
h. Mixes tubes when appropriate ……………………………………………………………. _____
i. Releases tourniquet, applies gauze, then removes needle smoothly and quickly ………… _____
j. Uses appropriate safety technique to blunt or sheath the needle…………………….…….. _____
k. Appropriately applies pressure to wound site (or asks patient to do so) …………………. _____
l. Immediately discards needle into sharps container ………………………………………. _____

13. Labels collection tubes with black indelible marker (legal document) ……………………………. _____

14. Documents venipuncture by signing the requisition/order slip, noting any problems …………….. _____

15. Reexamines wound site ensuring bleeding has stopped ………………………………………… _____

16. Applies band-aid/gauze when appropriate ………………………………………………………… _____

17. Properly disposes of biohazards, sharps and non-biohazard supplies ……………………………. _____

18. Removes gloves and properly washes hands ……………………………………………………… _____

19. Displays a professional, courteous manner/attitude at all times ………………………………… _____

Student being evaluated: _________________________________ Evaluator: __________________

Student being drawn: _____________________________________ Date of evaluation: ____________
CLS 424 Phlebotomy: Student Lab Rotation
Competency Assessment Venipuncture
STUDENT LABORATORY PHLEBOTOMY Rating System:
COMPETENCY CHECKLIST – CAPILLARY COLLECTION OK = Satisfactory performance
NOT OK = Incorrect or needs improvement
NA = Not assessed

Skill/Competency:
Rating
1. Washes hands prior to beginning capillary collection procedure ………………………………… _____

2. Introduces him/herself to the ‘patient’………………………………………………………………_____

3. Explains to the ‘patient’ what procedure he/she is going to do ………………………………….… _____

4. Properly identifies the ‘patient’ ……………………………………………………………………_____

5. Inquires about latex allergies and acts accordingly ……………………………………………… _____

6. Organizes the proper equipment without prompting ………………………………………………_____

7. Anticipates the need for additional equipment in case of ‘problems’ ……………………………... _____

8. Chooses appropriate skin puncture site (finger) ……………………………………………………_____

9. Warms skin puncture site if indicated ………………………………………………………………_____

10. Gently massages finger ……………………………………………………………………………_____

11. Cleanses puncture site area, allowing to air dry ~ 30 seconds ………………………………………_____

12. Performs the procedural steps, in proper sequence, for a capillary collection:
a. Does not contaminate puncture device ……………………………………………………_____
b. Properly grasps finger …………………………………………………………………… _____
c. Smoothly performs puncture across fingerprint using appropriate puncture device ……… _____
d. Wipes away first drop of blood ……………………………………………………………_____
e. Adequately fills collection container, avoiding bubbles when appropriate ………………_____
f. Mixes container when appropriate …………………………………………………………_____
g. Appropriately applies pressure to wound site (or asks patient to do so) …………………. _____
h. Immediately discards puncture device into sharps container……………………………. _____

13. Labels collection containers with black indelible marker (legal document) ………………………. _____

14. Documents capillary collection by signing the requisition/order slip, noting any problems ……… _____

15. Reexamines wound site ensuring bleeding has stopped ………………………………………… _____

16. Cleanses area and applies band-aid/gauze when appropriate …………………………………… _____

17. Properly disposes of biohazards, sharps and non-biohazard supplies ……………………………. _____

18. Removes gloves and properly washes hands ……………………………………………………… _____

19. Displays a professional, courteous manner/attitude at all times ………………………………… _____

Indicate amount of capillary blood collected: < 0.250 mls / 0.250 mls / 0.5 mls
Was capillary blood clotted: yes / no

Student being evaluated: _________________________________ Evaluator: __________________

Student being drawn: _____________________________________ Date of evaluation: ____________
CLS 424 Phlebotomy: Student Lab Rotation
Competency Assessment Capillary