WPCn #HfZ}XL7P$\r[̖.ˠpDX0٨%Tv DDӭC&׼5\xFM€Dhp!$=\{J8S^Oi`BHoV}D;_M*r$sZ>EPױ!:)A?^!^V|(4 L!ZUOTtgV|=@2LnNZame!%WJR'#u ݅ +I&.М(uPFF+C0vffG!hǛxFv#%)bMh!KǮ9F аi{qT$I 4cq^&)6%J~O)5X?Z!u l Ϛ\ V=ɨlez,Cc%BU. %z D+Ju 0s; 0C AM oG> @ RUJ"RElR"nRU2RU4R CRfSaS B&SCSnSS 0XVNYV[Vw\W4`W 0ttWWUNW^ 8X#DX m [ 1u$[ 72[ 0[ 0ac\ 0U] 0r] 0O^ 0_ 0_ 0z` 0'a 0a 0ob 0 c 0c 0d 0Ae 0e 0f 0$g 0g 0Hh 0h 0i 0Sj 0j 0k 0?l 0l 0im 0mU >ynU@n<6X9`(CourierX' Venipuncture CheckoffForm  0 .   'dxd Level 1 Level 2 Level 3 Level 4 Level 5(K2$ !         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(@ Z 6Times New Roman Regularn5 Journal Note Writer 0U3#37=CIQYag1.a.i.(1)(a)(i)1)a)!i)({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#(;3$2#  0  .3  0  *+ (_2623  ..*D+D (_25   ," <DL,23  ..," <DL,   *5+5 (_24  ) <DL)23  ..) <DL)  *2+2 (_23 ` &<<DL&23  ..&<<DL& ` */+/ (_22  #DL#23  ..#DL#  *,+, (_21   DL 23  .. DL  *)+) (_20 h DDL23  ..DDL h *&+& (_19  L23  ..L  *#+# (_18   L23  .. L  *>> (_17  2( 4 <DL223  Ԁ2( 4 <DL2  *DD (_16   ," <DL,23  Ԁ," <DL,   *55 (_15  ) <DL)23  Ԁ) <DL)  *22 (_14 ` &<<DL&23  Ԁ&<<DL& ` *// (_13  #DL#23  Ԁ#DL#  *,, (_12   DL 23  Ԁ DL  *)) (_11 h DDL23  ԀDDL h *&& (_10  L23  ԀL  (## &_9   L23  Ԁ L  (>> &_8  2( 4 <DL223  2( 4 <DL2  (DD &_7   ," <DL,23  ," <DL,   (55 &_6  ) <DL)23  ) <DL)  (22 &_5 ` &<<DL&23  &<<DL& ` (// &_4  #DL#23  #DL#  (,, &_3   DL 23   DL  ()) &_2 h DDL23  DDL h (&& &_1  L23  L  &## $_   L23   L  \  `&Times New Roman(O Z(Times New Roman !         _Xh QA=z (` D@ H@EXMMXM $$$$2XX ;W2RR$PhlebotomyTechnicianProgram   $$$$? ' X dEX ?     ;W @ u VenipunctureCheckoff  C X%sXAXxXXX%sPhlebotomystudentswillbeobservedbyanauthorizedexperiencedclinicalinstructor.Eachitem - onthechecklistmustbeperformedforeachvenipuncture.Afterobservation,theclinicalinstruction q  willsignnameanddate.Put NAforitemsnotperformedatyoursite.Aphlebotomystudentis ]   consideredcapableofvenipunctureaftercompletingfive(5)successful,observedvenipuncturesand I   submittingcopiesofthecompletedchecklisttothephlebotomyinstructor. 5  NameofPhlebotomyStudent:#X%sXXAXx(##XX%s #(#(#(#    9Y * ddd Xdd Xdd X(#(#_,@0,00 ,@0 ,@0 ,@0 ,@0 ,@@ +  :+_ _  p: TASK Draw#: '  Room#: 5& 5#1 ;,!' " ;#2 ;,!' " ;#3 ;,!' " ;#4 ?,!' " ?#5 SD,' " p   pS !(#33!"$3"  $3' 2#  1  ڈ.3  0 @   $3' T ݌  9,!!U 9Ifthepatientishospitalized,knockgentlyonpatientdoor.Checkforany ! isolationnoticesandfollowinstructionsaccordinglyifpresent. 2# 2 2#! 2 2#! 2 2#! 2 6#! 6 J;#! p   8pJ"$3"  $3 2#  2  ڈ.3  0 @   $3 " ݌  9,!U 9Identifyselfandpurposeofvisit. )  ) )! ) )" ) )# ) -$ - J;#% p 8  pJ"$3"  $32#  3  ڈ.3  0 @   $3D݌  9,!M&U 9Askpatienthis/hername.VerifynameandpatientnumberbycheckingID M' bandorotherform(s)ofID.(Thisisthemostimportantstepinthe ( collectionprocedure.) )}) ) )M* ) )M+ ) )M, ) -M- - E6#M. p   pE"$3"  $32#  4  ڈ.3  0 @   $3݌  0#! /U 0Ifoutpatientcallnameandverifyidentityaccordingtoclinicprotocol. ) 0 ) ) 1 ) ) 2 ) ) 3 ) - 4 - E6 5 p  pE"$3"  $32#  5  ڈ.3  0 @   $3L݌  9,!=6U 9Reviewrequestform(s).Gatherappropriatesuppliesfortest(s)ordered. )=7 ) )=8 ) )=9 ) )=: ) -=; - J;#=< p   pJ"$3"  $3g2#  6  ڈ.3  0 @   $3g݌  9,!q=U 9Checkfordietrestrictions.(Ifthetestrequiresafastingspecimen,besure q> patientisfasting.) )5? ) )q@ ) )qA ) )qB ) -qC - J;#qD p   8pJ"$3"  $32#  7  ڈ.3  0 @   $3 ݌  9,!iEU 9Washhands. 2#iF 2 2#iG 2 2#iH 2 2#iI 2 6#iJ 6 J;#iK p 8  8pJ"$3"  $32#  8  ڈ.3  0 @   $3B݌  9,!ELU 9Putongloves. 2#EM 2 2#EN 2 2#EO 2 2#EP 2 6#EQ 6 J;#ER p 8  8pJ"$3"  $3O2#  9  ڈ.3  0 @   $3O|݌  9,!ySU 9Positionthepatient. 2#yT 2 2#yU 2 2#yV 2 2#yW 2 6#yX 6 J;#yY p 8  pJ"$3 "  $32#  10  ڈ.3  0 @   $3݌  9,! ZU 9Positionequipmentinappropriateplaceclosetopatient.Verifythat  [ necessarytubesarepresent.Applyneedletovacutainerholderorsyringe. 2# q\ 2 2# ] 2 2# ^ 2 2# _ 2 6# ` 6 J;# a p   pJ"$3 "  $3c"2#  11  ڈ.3  0 @   $3c""݌  9,!!bU 9Selectsiteforvenipuncture(NOTABOVEIVINFUSION)andapply !c tourniquet. 2#"i d 2 2#!e 2 2#!f 2 2#!g 2 6#!h 6 J;#!i p   pJ"$3 "  $3$2#  12  ڈ.3  0 @   $3$%݌  9,!#!jU 9Palpateforvein.(NEVERLEAVETHETOURNIQUETONFOR #!k LONGERTHAN 1MINUTE .) 2#$a"l 2 2##!m 2 2##!n 2 2##!o 2 6##!p 6 E6##!q p   pE"$3 "  $3|'2#  13  ڈ.3  0 @   $3|''݌  0#!%#rU 0Releasetourniquet. )%#s ) )%#t ) )%#u ) )%#v ) -%#w - E6%#x p  8pE"$3 "  $3)2#  14  ڈ.3  0 @   $3))݌  9,!#'$yU 9Cleanvenipuncturesitewithanalcoholpadandallowtoairdry. 2##'$z 2 2##'${ 2 2##'$| 2 2##'$} 2 6##'$~ 6 E6##'$ p 8  pE"$3"  $3+2#  15  ڈ.3  0 @   $3+,݌  0#!W(%U 0Assembleequipment. )W(% ) )W(% ) )W(% ) )W(% ) -W(% - @1W(% p  p@"$3"  $3-2#  16  ڈ.3  0 @   $3-.݌  0#!)3'U 0Reapplytourniquetandhavepatientclenchfist.DONOTHAVEPATIENT )3' PUMPHAND. )O*' ) ))3' ) ))3' ) ))3' ) -)3' - E6)3' p  pE"$3"  $3@02#  17  ڈ.3  0 @   $3@0m0݌  9,!++)U 9Grasppatient'sarmapproximately12inchesbelowthevenipuncturesite ++) andanchorveinbetweenthumbandindexfinger.Itisokaytojustusethe G,) thumb. 2# -* 2 2#++) 2 2#++) 2 2#++) 2 6#++) 6 J;#++) p   pJ"$3"  $3032#  18  ڈ.3  0 @   $303]3݌  9,!?.+U 9Puncturethevein(needlebevelup)atapproximately15$angletothe ?.+ patient'sarmandinadirectlinewiththevein. 2#/, 2 2#?.+ 2 2#?.+ 2 2#?.+ 2 6#?.+ 6 J;#?.+ p   8pJ   XXh    "$3"  $3H62#  19  ڈ.3  0 @   $3H6u6݌  9,! pU 9 Donotswitchhandsmorethanonce.   u    % 2# p 2 2# p 2 2# p 2 2# p 2 6# p 6 J;# p p 8  8pJ"$3"  $382#  20  ڈ.3  0 @   $388݌  9,!TU 9Ifusing_vacutainer_Ԁholder,filltubesincorrectorderofdraw. 2#T  2 2#T  2 2#T  2 2#T  2 6#T  6 J;#T p 8  8pJ"$3"  $3_;2#  21  ڈ.3  0 @   $3_;;݌  9,!U 9Mixtubesimmediatelybutgently. 2# 2 2# 2 2# 2 2# 2 6# 6 J;# p 8  8pJ"$3"  $3=2#  22  ڈ.3  0 @   $3==݌  9,! U 9Havepatientopenhand. )  ) )  ) )  ) )  ) -  - J;#  p 8  8pJ"$3"  $3?2#  23  ڈ.3  0 @   $3??݌  9,! @U 9Releasetourniquet. 2# @ 2 2# @ 2 2# @  2 2# @! 2 6# @" 6 J;# @# p 8  pJ"$3"  $3B2#  24  ڈ.3  0 @   $3B1B݌  9,!$ t$U 9Placeasquareofgauzeorcottonoverthepuncturesite,quicklyremovethe $ t% needleandIMMEDIATELYactivateneedlesafetydevice. 2# 8& 2 2#$ t' 2 2#$ t( 2 2#$ t) 2 6#$ t* 6 J;#$ t+ p   8pJ"$3"  $3D2#  25  ڈ.3  0 @   $3DD݌  9,! l,U 9Appypressureimmediatelyuntilthebleedinghasstopped. 2# l- 2 2# l. 2 2# l/ 2 2# l0 2 6# l1 6 J;# l2 p 8  pJ"$3"  $3-G2#  26  ڈ.3  0 @   $3-GZG݌  9,!P 3U 9Ifasyringewasused,removeneedleandattachbloodtransferdevice,fill P 4 tube(s)inproperorderallowingthevacuumtofillthetubes.Mixgently. d 5 NOTE:<( 4 <DLX<@:  9Y@<]  @:NEVERinsert#@:  @<]5I#@<]  @:needleintotubesheldinyourhand.Ifsafetytransfer ( 6 deviceNOTavailable#@:  @<]I#@<]  @:placetubesinrack.NEVERapplypressuretosyringe,  7 bloodwill#@:  @<]'J#@<]  @:automatically_Ԁbepulledintotubebythe_vacuum.#@:  @<]J##9Y  @:I#_ 2#L 8 2 2#P 9 2 2#P : 2 2#P ; 2 6#P < 6 J;#P = p   pJ"$3"  $3L2#  27  ڈ.3  0 @   $3LL݌  9,!l >U 9Applyabandagewhenbleedingstops.DONOTBANDAGEA l ? PUNCTURESITETHATISSTILLBLEEDING. 2#0@ 2 2#l A 2 2#l B 2 2#l C 2 6#l D 6 J;#l E p   pJ"$3"  $3hO2#  28  ڈ.3  0 @   $3hOO݌  9,!dFU 9Correctlylabeltubeswithappropriateinformationatthebedside. 2#dG 2 2#dH 2 2#dI 2 2#dJ 2 6#dK 6 J;#dL p   8pJ"$3"  $3Q2#  29  ڈ.3  0 @   $3QR݌  9,!MU 9Discardusedequipmentproperly. 2#N 2 2#O 2 2#P 2 2#Q 2 6#R 6 E6#S p 8  pE"$3"  $3T2#  30  ڈ.3  0 @   $3TLT݌  0#!TU 0Forinpatientreplacebedrailtoaraisedposition. )U ) )V ) )W ) )X ) -Y - E6Z p  8pE"$3"  $3EV2#  31  ڈ.3  0 @   $3EVrV݌  9,!P[U 9Thankpatient. 2#P\ 2 2#P] 2 2#P^ 2 2#P_ 2 6#P` 6 L;#Pa p 8  HpL"$3"  $3X2#  32  ڈ.3  0 @   $3XX݌  =,!4bU =Removeglovesandwashhandsifgloveswerecontaminated. 4#4c 4 4#4d 4 4#4e 4 4#4f 4 6#4g 63)'4h p H  3   `    Signature (#Date j 1stdrawsupervisedby:(#(#(# ,m 2nddrawsupervisedby:(#(#(# ( xp 3rddrawsupervisedby:(#(#(# t"s 4thdrawsupervisedby:(#(#(# $ v 5thdrawsupervisedby:(#(#(#  '\"y