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Phlebotomy is the process of drawing blood by puncturing the vein. It is also known as a venipuncture. Phlebotomy is carried out to take blood samples for mainly labortory testing. This procedure could also be used to remove extra red blood cells or extra iron from the blood and treat several blood-related disorders.

Benefits of Phlebotomy:

Phlebotomy can be used to treat people with diseases like:

  • Hemochromatosis
  • Polycythemia vera
  • Porphyria cutanea tarda
  • Sickle cell disease
  • Nonalcoholic fatty liver disease
  • The risk of cancer can also be reduced as extra iron can be removed from the blood.
  • Blood disorders

Side Effects of Phlebotomy:

Several side effects can also be caused by phlebotomy. These are:

  • Hematoma
  • Allergy
  • Hyperventilation
  • Air embolism
  • Anemia
  • Thrombosis

Unsafe phlebotomy can result in bloodborne pathogens which are:

  • Viruses such as HBV, HCV, HIV
  • Bacteria such as syphilis
  • Parasites such as Malaria

Blood Sampling Systems in Phlebotomy:

There are two types of blood sampling systems

  1. Closed or evacuated blood collection systems
  2. An open Blood Collection system

Closed or Evacuated Blood Collection Systems:



  • Needles are double-ended and are available in several recommended gauge sizes.
  • The non-patient end of the needle is covered by rubber sleeves and it is screwed into the barrel also known as the tube holder.
  • A thread separates the two ends of the needle; it is where the holder is screwed into place.



The holder holds the sample collection tube in place.

Laboratory Sample Tubes

They contain appropriate additives and have specific color-coded caps.


Apart from these, training and skills are required for the correct use of equipment.


  1. As the sample tube is under vacuum, once the needle is in the vein, the tube is pressed onto the non-patient end of the needle in the holder, and blood is drawn automatically into the sample tube by vacuum until the required amount is collected.
  2. The next tube is then placed in the correct sequence without removing the needle from the patient.
  3. The needle and the holder are to be discarded as a single entity. However, there is also an option of using a reusable needle holder which has a system to eject the needle after use.

Advantages of Closed or Evacuated Blood Collection System:

The use of a closed or evacuated blood collection system has many advantages. Some of these are:

  • It reduces the risk of direct exposure to blood as the blood directly comes into the tubes.  In this way, there is reduce risk of infections.
  • Makes it easier to take multiple samples from a single venipuncture.

Open Blood Collection Systems:

Materials included:

  • Hypodermic needle
  • Syringes
  • Sample container (vacuum or non-vacuum tubes)

Assembling of hypodermic needle and syringe:

  1. It involves opening the packaging of the hypodermic needle i.e., the back of the needle, and keeping it capped.
  2. Open the sterile packaging of the syringe from the plunger end i.e., back of the syringe, keeping the nozzle protected in the packaging.
  3. Carefully remove the syringe from the package and insert the nozzle of the syringe firmly into the exposed hub of the capped hypodermic needle.
  4. Leave the needle and syringe ready in place until ready to use.

Selecting the Gauge of the Needle:

It is important to select the right gauge of the needle based on the following factors:

  • Age of the patient
  • Amount of blood
  • Type of sample (ticker gauge needles are used for coagulation studies)

Which blood collection system is preferable?

A closed or evacuated blood collection system is preferable to an open blood collection system as it is proven to be safer and provide better specimen quality. One of the key advantages of this system is that the blood comes directly in contact with the anticoagulant avoiding many pre-analytical issues such as micro-clot formation.

The Procedure of Phlebotomy:

Phlebotomy Procedure

Assembling of the required materials:

  • Closed or open collection systems with disposable sterile plastic syringes of various volumes.
  • Tourniquet
  • Disposable well-fitting gloves
  • Mask
  • 70% isopropyl alcohol swabs
  • Dry cotton
  • Band-Aid
  • Hand Sanitizer
  • Blood Culture bottles
  • Citrate tubes for coagulation tests with a light blue cap
  • Plain tube with clot activator with red cap
  • Gel tube with a yellow cap with clot activators and gel separator
  • Green tubes containing sodium/lithium heparin for cytogenetics and plasma-based chemistry assays
  • EDTA tube containing K2 EDTA with lavender cap
  • Grey tubes containing fluoride for glucose
  • ESR Tube with black top
  • Specimen storage racks
  • Needle destroyer

Pre-collection Verification and Use of Personal Protective Equipment:

  • Approach the patient in a calm, appropriate, confident, and professional manner.
  • The phlebotomist must gain the patient’s confidence.
  • Assure the patient that although the venipuncture can be slightly painful, it will be short in duration and necessary for the diagnosis and treatment of their health care problem.
  • Answer any patient’s query related to laboratory procedure.
  • Confirm the identity of the patient with the laboratory requisition form.
  • Wearing gloves is mandatory before sample collection. Also, wear lab coat and mask.
  • Cover all injured and exposed wounds with a bandage before proceeding with sample collection.
  • Then you need to determine the best site for venipuncture.

Common Sites for Venipuncture:

Ante Cubital Area:

Median Cubital Vein

It is the most preferred site as it is large and well-anchored, and it is the least painful).


Cephalic Vein

It is the next preferred site. It is large but not well-anchored. More painful than the median cubital vein.

Basilic Vein

It is the third choice. It is generally large, easy to palpate but not well anchored.

Dorsum of the hand:

The veins on the dorsum of the hand have a higher tendency to bleed. It is easier to access in fat persons.


  • The venipuncture procedure includes labeling of the tubes which can be done prior to or immediately after collection.
  • The label should be clearly written with at least the name of the person. Age and ID Number could also be mentioned.
  • After the patient is made comfortable and seated on a chair ensure proper positioning of the patient’s arm.
  • Apply the tourniquet with three inches of clearance above the puncture site. Ideally, the tourniquet should not be applied for longer than one minute at a time, otherwise, it will cause hemoconcentration. (For coagulation studies avoid using a tourniquet or apply it for less than 1 minute as platelet activation may lead to coagulation testing errors.
  • Clean the venipuncture site with a 70% isopropyl alcohol swab using a circular motion from the center to the periphery.
  • Allow the area to dry before venipuncture. The puncture will be painful if the alcohol has not dried.
  • Alert the patient before venipuncture.
  • Ask the patient to close their fist but do not allow the patient to pump or clench their fist tell them to relax.
  • Make sure that patient’s arm is in a downward position to prevent backflow.
  • Anchor the vein and smoothly insert the needle at a 15 to 30° angle.

Needle Removal:

  • The tourniquet must be fully released, and the patient’s hand should be relaxed and opened before the needle is removed.
  • Hold dry cotton over the site.
  • Gently and quickly remove the needle from the arm and as soon as the needle is removed pressure must be applied to the site to avoid leakage of blood and hematoma formation.
  • Ask the patient to keep slight pressure on the cotton.  The arm is to be kept straight and not bent at the elbow.
  • Instruct the patient to discard the blood-stained swab in the yellow bag before leaving.

Delivering the Blood:

Deliver carefully into the respective tubes as per requirement for the test ordered.

Vacuum Extraction Systems:

  • When using an evacuated system where blood directly flows into the tubes, ensure that the tubes are kept in place till the blood flow completely stops.
  • Place the next tube as per the order of draw till all the required sample tubes are completed.

    This would ensure the collection of the appropriate volume of blood without the need to open the cap.

Refer to this chart for the proper order of draw when using a closed blood collection system:

Order of Use

Type of Tube



Blood culture Bottle



Coagulation Tube (light blue top)



Clot Activator (red top)



Serum separator tube (red-grey tiger top or gold)



Sodium heparin (dark green top)



EDTA (purple-top)



Oxalate/fluoride (light grey top)


8 ESR Tube (Black Top)


The Job of a Phlebotomist:

Phlebotomists are trained to draw blood from a person or animal for tests, transfusions, donations, or research. Before drawing blood, the phlebotomist needs to identify the patient through their medical records. He needs to identify the correct venipuncture method based on the patient age and health. Then, he needs to relax the patient and find the vein that is suitable for puncture. After drawing the blood, they need to label the sample of a particular patient with his/her name, age, and unique ID number. In the end, the phlebotomist will send the sample to the lab for testing.

Benefits of the Phlebotomy Course:

The workers will meet the following objectives after completing the Phlebotomy Certification in Canada:

  • Their knowledge and awareness of risks associated with phlebotomy will increase.
  • They will learn to reduce blood-borne exposure and develop safe practices.
  • The pre-analytical errors will be reduced, and they will provide improved quality of lab tests.
  • You become a phlebotomy-certified professional in Canada.


Phlebotomist course in Ontario:

We offer you a short-duration phlebotomy course which is basically a workshop which you can attend on Saturday or Sunday. This workshop will give you Phlebotomist training. You will have classroom lectures as well as hands-on training during this workshop. The stipulated fee for this workshop is $250 and you will get free parking in the building. You will get a phlebotomist certificate from Canadian Ultrasound Institute after completing the phlebotomist course successfully.


One Day Workshop


Saturday or Sunday


Classroom lectures and Hands-on-training on Phlebotomy



Canadian Ultrasound institute will offer good phlebotomy practices to its health care workers in Canada. In this recognized institute, you will be taught by qualified and experienced faculty, which will help you to clear the Sonography Canada exam in a span of 5-6 months. Afterward, you would be able to practice your license at any of the diagnostic centers.

This one-day (4 hour) workshop helps you learn:

  • Basic Anatomy and Physiology for phlebotomy
  • Common medical Terminology used for phlebotomy
  • Patient interaction and related legal, ethical and safety issues
  • Patient identification and lab requisition form
  • Venipuncture equipment and Vacuumed blood collection system
  • Safety and Universal Precautions in handling the samples
  • Administrative Steps of Phlebotomy
  • Hands- on Practical training on blood and specimen collection
  • Preparing blood collection site and proper managing of the collected sample

Who should take this workshop:

This program is ideal for undergraduate students, international medical graduates (IMGs), nurses (RN, RPN), lab technicians, medical lab assistants, and emergency Medical Technicians or any person with some knowledge in the healthcare field interested in broadening their knowledge and scope or practice. Contact us via Email: or contact the Program Coordinator at 905-507-4756 or 647-909-7865.

Certificate given on successful completion of the workshop.

Phlebotomist Career in Canada:

Phlebotomists plays important role in the health care field and there is a huge demand for a specially trained and qualified person to perform his role as a phlebotomist. Hospitals these days require phlebotomists, there has been an increased demand after the Covid-19 pandemic. Phlebotomist has a very bright future in Ontario Canada. So, you may have questions like how much does a phlebotomist make in Canada? the answer is a tempting salary on average $4091 to $5000 a month.

Phlebotomy Course online in Canada:

This short course is done on campus and is not available for online certification. One has to attend a workshop on Saturday or Sunday to become a certified phlebotomist in Canada.


Canadian Ultrasound Institute and Research Centre in Ontario ensures phlebotomist training in Ontario. You have a promising future ahead just by attending a short workshop on Phlebotomy. So, get enrolled in Canada’s best Institute for becoming a trained and Certified Phlebotomist. You won’t regret it. If you have any queries feel free to contact us via call or email. Have a great day.

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