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Abstract
Background: Phlebotomy is one of the most frequently performed invasive clinical procedures in healthcare delivery. Proper blood sampling technique is vital for pre-analytical diagnostic accuracy, patient safety, and the prevention of occupational hazards such as needle-stick injuries. Despite its routine nature, inadequate phlebotomy knowledge and substandard clinical practices among nurses can cause pre-analytical sample rejections, diagnostic errors, and hospital-acquired bloodborne infections.
Objective: To assess the level of knowledge, attitude, and self-reported practice (KAP) regarding phlebotomy among registered nurses at Choudhry Muhammad Akram (CMA) Teaching and Research Hospital, Lahore.
Methodology: A descriptive cross-sectional quantitative research design was employed among 110 registered bedside nurses at CMA Teaching and Research Hospital, Lahore. Participants were recruited through convenience sampling from medical, surgical, obstetrics/gynecology, emergency, and intensive care departments. Data were collected using a validated, structured self-administered questionnaire aligned with Clinical and Laboratory Standards Institute (CLSI) and World Health Organization (WHO) phlebotomy guidelines. The instrument captured demographics, 10 knowledge items, 10 attitude items, and 10 practice items. Data were analyzed using SPSS Version 26.0, employing descriptive statistics, chi-square tests, and domain comparisons, with statistical significance established at p < 0.05.
Results: The majority of participants were female (78.2%, n = 86), aged 26–35 years (36.4%, n = 40), held a B.Sc. Nursing degree (42.7%, n = 47), and worked as staff nurses (52.7%, n = 58). The overall mean knowledge score was 4.68 ± 2.42 out of 10 (46.8%), with only 22.7% showing Good knowledge, 57.3% Moderate knowledge, and 20.0% Poor knowledge. Serious theoretical deficits were observed regarding needle insertion angles (30.9% correct), tube additives for glucose (31.8% correct), and re-palpation of disinfected venepuncture sites (34.5% correct). The mean attitude score was 22.98 ± 8.51 out of 40 (57.5%), with 50.0% displaying Moderate and 35.5% Good attitude. The mean practice score was 19.82 ± 7.14 out of 30 (66.1%), with 48.2% reporting good practice. However, alarmingly high frequencies of undesirable practices were reported, including pushing blood through needles into vacutainers (76.3% at least sometimes), drawing blood from existing IV cannula lines (75.5% at least sometimes), and decanting blood between tubes (78.2% at least sometimes).
Conclusion: Bedside nurses demonstrated moderate overall attitudes and self-reported practices, but significant theoretical knowledge gaps and critical procedural deviations persist. The widespread occurrence of unsafe blood transfer practices poses severe risks of in-vitro hemolysis, spurious laboratory results, and needle-stick injuries. Urgent hospital-wide phlebotomy education, standardized CLSI-aligned procedural checklists, and regular clinical competency audits are essential.