Phlebotomy- A gateway to laboratory diagnostics


  • Shehla Ambreen Alizai Islamabad medical & Dental College, Islamabad Pakistan
  • Rabia Sadaf Akhtar Saeed Medical College, Rawalpindi Pakistan
  • Maleeha Atif Akhtar Saeed Medical College, Rawalpindi Pakistan
  • Kanwal Shehzadi Qaid-E-Azam University, Islamabad Pakistan
  • Naima Noor Rawal General and Dental Hospital, Islamabad Pakistan
  • Muhammad Saeed Rawal General and Dental Hospital, Islamabad Pakistan



Objective: To assess the knowledge, practice and attitude about venipuncture amongst Nursing staff of a tertiary care hospital.

Material and Methods: This questionnaire-based survey was done at Rawal General and dental hospital, Islamabad, from January to April 2022. The Questionnaire was developed as per the CLSI H3-A6 and WHO‘s venipuncture guidelines. It was distributed to nursing staff by hand. Most were filled inside the classes in front of the teacher. 

Results: The frequency of correct responses in the knowledge section varied from 4(4.6%) about the number of tube inversions to 79(90.8%) about wearing of gloves before taking a sample while 47(54%) selected the correct option of identifying a patient. Regarding the standard phlebotomy protocols, the response was quite low which was 26(29.9%), 18(20.7%) and 8(9.2%) about the correct angle of needle insertion, what to inspect of the supplies and the location of applying the tourniquet respectively. Recapping with two hands is still done by 13% and 79% still put the sample by holding tube in the other hand. In spite of all this 66% still think that one can learn venipuncture by practicing the techniques without going through a proper course. 

Conclusion: Nursing staff in Rawal General and dental hospital is not fully aware about basic laboratory protocols and their importance. This unawareness can lead to generation of erroneous lab reports. Formal education, training with summative assessments should be a part of the curriculum of nursing courses followed by rigorous implementation monitoring.  

Keywords: Awareness, Nurses, Phlebotomy, Venipuncture, Sample


Crous L, Armstrong SJ. The bloody truth: Investigating nurse phlebotomy competencies at a private laboratory in Johannesburg, South Africa. Health SA Gesondheid. 2016; 21(1): 339-47. DOI:

Burchill CN, Seballos SS, Reineks EZ, Phelan MP. Emergency nurses’ knowledge, attitudes, and practices related to blood sample hemolysis prevention: An exploratory descriptive study. J Emerg Nurs. 2021; 47(4): 590-8.


Batool H, Mumtaz A, Qadeer S, Bakht ZA. Impact of supervised phlebotomy training programme on performance skills of phlebotomy staff. Annals of King Edward Medical University. 2018 20; 24(2): 776-80. DOI:

Ersoy S, Ilanbey B. A single-center prospective study of the effects of different methods of phlebotomy in the emergency department on blood sample hemolysis rates. J Emerg Nurs. 2023; 49(1): 134-9. DOI:

He M, Huang S, Xiong J, Xiao Q. Improving adherence to facility protocol and reducing blood culture contamination in an intensive care unit: A quality improvement project. Aust Crit Care. 2020; 33(6): 546-52. DOI:

Cai Q, Zhou Y, Yang D. Nurses’ knowledge on phlebotomy in tertiary hospitals in China: A cross-sectional multicentric survey. Biochem Med. 2018; 28(1): 42-54. DOI:

Jain S, Chraiti MN, Pittet D, Mclaws ML. Blood collection guidelines for inpatients and outpatients, home-based care and long-term care facilities. J Hosp Infection. 2020; 104(4): 600-2. DOI:

Muzzamil F, Rafiq M, Siddiqui ZK, Hamza M, Arooj A, Lail RA. Awareness of pre-analytical errors amongst healthcare workers of DHQ teaching hospital, Sahiwal, Pakistan. Rawal Med J. 2022; 47(2): 426–30.

Waheed NA, Bajwa MS, Anwar S, Ali H. Pre-analytical phase awarness amongst doctors of a tertiary care hospital-A Cause for concern. Annals King Edward Medical University. 2019; 25: 58–64.

Unnithan A, Das S, Raju K. Evaluation of phlebotomy quality metrics: An effective tool for quality patient care. Adv Human Biol. 2023; 13(Suppl 1): S80-4. DOI: 10.4103/aihb.aihb_201_22

Sonmez C, Yıldız U, Akkaya N, Taneli F. Preanalytical phase errors: Experience of a central laboratory. Cureus. 2020; 12(3): 1–8. DOI:

Unnithan A, Das S, Raju K. Evaluation of phlebotomy quality metrics: An effective tool for quality patient care. Adv Human Biol. 2023; 13(Suppl 1): S80-4. DOI: 10.4103/aihb.aihb_201_22

Banković Radovanović P. Quality improvement project: Reducing non-conformities of the samples for haemostasis testing in a secondary healthcare centre through the nurses’ education in phlebotomy. Biochem Med. 2020; 30(2): 287-95.


Fernando ES, Kuruwitage GS, Rathnayake M, Das CV, Mahalingam N. Knowledge on practice of phlebotomy among nursing and biomedical students in Gampaha District, Sri Lanka. 2021; 2659.

Arslan FD, Karakoyun I, Basok BI, Aksit MZ, Celik E, Dogan K, et al. The effects of education and training given to phlebotomists for reducing preanalytical errors. J Med Biochem. 2018;37(2):172–80. DOI:

Ali M, Bibi A, Khan J, Arshad S, Durdana M, Musafir Y. Student nurses knowledge of needle stick injuries at a private institute, Karachi, Pakistan. J Heal Sci. 2023; 79–83. DOI:

Kulkarni KK, Bhandari AP, Unni AK. Questionnaire-based study to assess knowledge of preanalytical phase of laboratory testing among trainee doctors in a tertiary care hospital medical college. J Lab Physicians. 2020; 12(03): 178-83.





How to Cite

Alizai SA, Sadaf R, Atif M, Shehzadi K, Noor N, Saeed M. Phlebotomy- A gateway to laboratory diagnostics. Pak J Pathol [Internet]. 2024 Mar. 29 [cited 2024 Apr. 23];35(1):26-33. Available from: