CLINICAL LAB SCIENEC

284
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
Table 11-5 Grading Sheet for Performance of Phlebotomy Procedure
in Class
Phlebotomy Class Evaluation Form
Student ___________________________________________ Date ______________
OBJECTIVE: Upon completion of the introduction for performing a venipuncture, the student will:
• Utilize proper tourniquet application and vein selection.
• Properly and successfully obtain blood samples from a patient.
EVALUATION: Rating system is as follows:
Each area has a maximum of 2 points that may be assigned. A perfect score would
yield a total of 30. A score below 24 is unacceptable and is not a passing grade. For
scores below 23, the procedure must be repeated, correcting mistakes and omissions.
2 All steps satisfactorily performed A = 26 + points
1 Acceptable, improvement necessary B = 24–25 points
0 Incorrect or did not perform C = 22–23 points
1. Positions arm correctly for vein selection.
2. Assembles equipment and supplies properly, within reach.
3. Selects appropriate tourniquet application site.
4. Places tourniquet in fl at position behind arm.
5. Smoothly positions hands when crossing and tucking or using Velcro closure.
6. Fastens tourniquet at appropriate tightness.
7. Tourniquet is not folded into arm or pinching arm.
8. Loop and loose end do not interfere with puncture site.
9. Asks patient to clench fi st.
10. Selects antecubital area if appropriate to palpate for vein.
11. Performs palpation using correct fi ngers.
12. Palpates entire area of both arms if necessary.
13. Checks depth and direction of veins.
14. Performs procedure accurately (insertion of needle, insertion of tubes, removal of
needle), and discards wastes properly.
15. Removes tourniquet smoothly and in a timely manner (no more than 1 minute).
1st Attempt 2nd Attempt 3rd Attempt
Total points earned ____________ ____________ ____________
Letter grade assigned ____________ ____________ ____________
Comments __________________________________________________________________
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__________________________________________________________________________
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Instructor’s Signature _______________________________________ Date _____________
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