If you’ve been scrolling through phlebotomy social media lately, you’ve probably encountered the viral videos that have the community buzzing: healthcare workers performing venipuncture at seemingly impossible speeds, with techniques ranging from impressively swift to downright theatrical. As someone who’s dedicated my career to phlebotomy education, I find this conversation fascinating—not just for what these videos show, but for what they reveal about our profession’s ongoing evolution and the fundamental principles that make for excellent venipuncture.

The Story Behind the Technique

The technique generating all this attention, officially known as the Xiao Li-style pain-free vein puncture, was developed by Li Fusheng, a phlebotomist at Shanghai Chest Hospital in China. What I find most compelling about this story is the why behind the innovation. Li created this method specifically to help patients with extremely difficult venous access—particularly cancer patients whose veins have been compromised by long-term chemotherapy and elderly patients with collapsed or fragile vessels. Shanghai Chest Hospital serves over 600 patients daily, many with veins measuring less than 1 millimeter in diameter. That’s remarkably challenging work, and it speaks to a genuine commitment to improving the patient experience.

What the Technique Actually Looks Like

Here’s where things get interesting, and why I wanted to dig deeper into this topic. The term “flying needle” has been applied to a range of techniques circulating on social media, and they’re not all the same thing. Some videos show what appears to be a literal flicking or throwing motion, where you can see the needle shoot in so rapidly, it almost looks like it’s flying through the air before entering the skin. It looks dramatic, almost theatrical.

Click here to see the Li Fusheng article and video demonstrating this technique.

However, when you watch Li Fusheng himself performing his technique, you see something quite different. His approach is an extremely rapid insertion—research shows approximately 0.02 seconds compared to 0.8 seconds for conventional insertion—but his hand maintains contact with and control over the needle throughout the procedure. He holds the butterfly needle wings between his thumb and index finger and moves with exceptional speed, but there’s a crucial difference: he’s guiding the needle, not releasing it.

This distinction matters enormously, and it’s at the heart of what makes good phlebotomy.

The Case for Speed

Let’s talk about something I think we can all agree on: quick insertion matters. A fast, confident stick is less painful than a slow, hesitant one. The science backs this up—when a needle penetrates quickly, there’s less time for pain signals to register and be processed. The rapid insertion minimizes the duration of tissue disruption and reduces the activation of pain receptors. Think of it like removing a bandage: a quick pull causes less discomfort than a slow peel.

In my experience, and in the experience of skilled phlebotomists across the profession, speed is part of excellent technique. When a vein allows it (when it’s round and decently sized), a quick insertion is absolutely the right approach. Slow insertions cause more pain, give rolling veins more opportunity to move, and can lead to more complications.

The research from Xiamen Humanity Hospital supports this principle. Their study of 600 patients comparing rapid insertion to conventional technique showed impressive results:

• Pain scores: The rapid insertion group reported significantly lower pain (1.96 ± 1.42 vs 2.87 ± 1.42)
• Adverse events: Fewer complications occurred with rapid insertion (0.25 ± 0.59 vs 0.52 ± 0.87)
• Patient fear: Fear scores after the procedure were lower with rapid insertion
• Satisfaction: 97.33% satisfaction rate compared to 87.33% with conventional technique

These numbers validate what many of us have learned through years of practice: when done properly, quick insertions work.

The Critical Balance: Speed and Control

Here’s where nuance becomes essential. Speed is important, but it cannot come at the expense of accuracy, precision, and depth control. These elements must work together, not in opposition to each other.

When I watch Li Fusheng’s controlled rapid insertion, I see someone who has achieved that balance through extensive training and practice. His hand maintains contact with the needle, allowing for the tactile feedback that’s essential for proper venipuncture. He can feel the resistance of the skin, sense when he’s entered the vein, and control the depth of insertion—all at remarkable speed.

In contrast, techniques where the needle is actually flicked or thrown too quickly, sacrifice that control. Once the needle leaves your hand, you’ve lost your ability to adjust angle or depth, to respond to what you’re feeling, or to make real-time corrections. You’re entirely dependent on your initial trajectory being perfect. For any vein, but especially small, damaged veins measuring less than a millimeter, this seems like an enormous risk.

In conventional phlebotomy, we rely on tactile feedback throughout the insertion. We feel the initial resistance of the skin, the subtle “pop” as we enter the vein, and we adjust our angle and depth based on what we’re sensing. This feedback loop is what allows us to successfully navigate difficult veins, to avoid going through the back wall, and to make the micro-adjustments that result in a successful first stick.

The Role of Practice and Experience

The key to achieving both speed and control lies in practice and experience. Li Fusheng practices regularly on rubber tubing that mimics the feel and elasticity of real blood vessels. Shanghai Chest Hospital has trained nearly 100 nurses and technicians to perform rapid insertions with maintained control. This level of dedication to skill development is admirable.

Experienced phlebotomists naturally develop the ability to stick quickly while maintaining excellent control. It’s not about forcing speed—it’s about building the muscle memory, proprioceptive awareness, and confidence that allow speed and control to coexist. The hand moves quickly because it knows exactly where it’s going and what it will encounter along the way. The insertion is fast, but it’s not reckless. It’s precise.

This is the kind of skill development we should all aspire to: continuous refinement that allows us to work quickly without sacrificing the fundamentals that ensure patient safety and comfort.

When Speed Should Be Moderated

It’s also important to acknowledge that not every vein allows for maximum speed. Some vessels are too fragile, too flat, too deep, or too compromised to handle an ultra-rapid insertion, even from the most skilled practitioner. Part of being an excellent phlebotomist is recognizing when to modify your approach based on the patient’s specific venous anatomy.

A flat vein in an elderly patient with thin skin might require a steadier, more careful approach. A scarred vein from repeated chemotherapy might need extra precision at a slightly slower speed. This is clinical judgment, and it’s as important as technical skill.

The goal should always be: as quick as the vein safely allows while maintaining full control over accuracy, precision, and depth.

My Perspective on the Viral Techniques

Having watched various videos circulating on social media, here’s my assessment:

Li Fusheng’s original technique: This represents an impressive mastery of rapid insertion while maintaining control. For practitioners working with extremely difficult venous access in a specialized setting, and with extensive training and practice, this approach shows clear clinical benefits. The research supports its effectiveness.

Techniques involving actual flicking or throwing or reckless speed: These concern me significantly. When the needle leaves the phlebotomist’s fingers, or “flicking” at such high speeds, control is lost. The room for error becomes substantial, especially with the small, damaged veins that are claimed to be ideal for this approach. While they may look impressive on video, I would not recommend these methods. The risk of missed veins, blown veins, or through-and-through punctures seems too high, and the sacrifice of tactile feedback is too significant.

Below are some examples I found that demonstrate excessive speed, misinformation, or overall dangerous technique with this “flying needle” insertion:

• Example 1
• Example 2
• Example 3

The principle of quick insertion: This is sound technique that we should all be practicing within the bounds of controlled, guided insertion. Whether your insertion takes 0.02 seconds or 0.5 seconds, the goal is the same—quick enough to minimize pain and prevent complications, but controlled enough to ensure accuracy and proper depth (something I think that the majority of the examples in the three above links are lacking).

What Phlebotomists Should Take Away

Rather than attempting to imitate dramatic techniques seen on social media, here’s what I believe we should focus on:

Embrace quick insertions: When a vein allows it, a fast, confident stick is better than a slow, hesitant one. Practice developing your speed while maintaining control.

Never sacrifice control: Your hand should guide the needle throughout the entire insertion. Maintain contact, feel what’s happening, and be ready to make micro-adjustments.

Practice deliberately: Regular skills practice, even for experienced phlebotomists, keeps your technique sharp. Consider using practice arms to work on your speed while maintaining precision.

Assess each vein individually: Some veins can handle rapid insertion; others require a more moderated approach. Good clinical judgment means knowing the difference.

Learn from innovation: Different healthcare systems develop different solutions. We can appreciate international techniques while maintaining our own evidence-based practices.

Follow established standards: In the United States, we have CLSI guidelines and protocols that include tourniquet use, needle safety devices, needle stabilization, and standardized angles of insertion. These standards exist for good reason and should be followed.

• Tourniquets should be applied and removed within one minute of application to prevent hemoconcentration.
• Needle safety devices are required by OSHA. You will see in the videos that the types of butterflies being used have one wing, and no safety. That’s pretty different from what most of us are familiar with. They are not legally allowed to be used in healthcare facilities in the US (unless you want to pay millions in fines).
• CLSI requires that needles are secured during the entire draw by either being held onto with fingers, or taped down. They cannot be let go of and just sit freely in the skin like most of those videos that are linked show. An unsecured needle increases risks for both the patient and the phlebotomist. The needle may move when the tubing is pulled on or bumped, losing the draw and causing a hematoma or other injuries. The needle may also come out of the vein entirely, and then there is increased risk of an accidental stick, which would lead to exposure if it happened to the phlebotomist.
• CLSI requires that all venipunctures must be performed at 30 degrees or less. Some of the angles you see with this technique show significantly higher angles, especially once the butterfly has been let go of, increasing risks to nerve and artery damage if the needle is not in the perfect position (or if the patient moves their arm).

The Broader Conversation

What I find most valuable about the flying needle conversation is that it’s got us all thinking more carefully about insertion speed and technique. That’s a good thing. Too often, phlebotomists are trained to be overly cautious, inserting slowly out of fear of hurting the patient, when in fact a quick insertion would be less painful.

Li Fusheng saw patients struggling with difficult venous access and dedicated himself to developing a solution. That commitment to patient care and continuous improvement is something we should all admire and emulate. His success in reducing pain and improving satisfaction rates validates the importance of technique refinement.

At the same time, we need to be thoughtful about what we adopt and how we practice. Speed for the sake of looking impressive on social media is not the goal. Speed in service of better patient outcomes, combined with unwavering commitment to control and safety, is what we should be striving for.

The Bottom Line

A quick stick is an excellent stick—when it’s done with proper control, accuracy, and precision. The flying needle conversation has highlighted an important principle that sometimes gets lost in phlebotomy training: hesitant, slow insertions cause more pain and more problems than confident, quick ones.

But confidence and speed must be built on a foundation of solid technique, extensive practice, and never-ending refinement of skills. They cannot come at the expense of the tactile feedback and controlled guidance that allow us to navigate difficult veins successfully.

The next time you see a flying needle video on social media, use it as an opportunity to reflect on your own technique. Are you inserting as quickly as the vein safely allows? Are you maintaining full control throughout? Are you practicing regularly to improve both your speed and your precision?

Innovation in phlebotomy is exciting, and cross-cultural learning broadens our perspective. But the foundation of excellent phlebotomy remains constant across all techniques and all cultures: a commitment to patient comfort, continuous skill development, and the wisdom to know that speed and control are not opposites—they’re partners in providing the best possible care.

Quick sticks save patients pain. Controlled sticks ensure safety and success. Master both, and you’ll be providing truly excellent phlebotomy care.

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