PHLEBOTOMY AND THE HEALTH CARE DELIVERY SYSTEM

PHLEBOTOMY

 ‘Phlebotomy’ comes from the Greek word phlebos, meaning veins, and tome, meaning incision.
 It is an invasive procedure that involves the body through cutting or puncture, performed by phlebotomists.
 Two main phlebotomy procedures:
(1) Venipuncture
(2) Capillary Puncture

HISTORICAL PERSPECTIVE:

 Historical evidence suggests the possibility of blood letting for therapeutic reasons may have begun in EGYPT around 1400 B.C.
 Tomb paintings from this time show the application of a leech to a patient.
 HIPPOCRATES (460-377 B.C.), also known as the father of modern science, was responsible for early medical (HUMORAL)
theory, which believed illness was caused by an imbalance in the body.
 The removal of this excess was thought to restore this balance. Health was thought to be restored by plugging, starving, vomiting, or
blood letting.
 GALEN – believed that blood was formed in the liver and was brought from the intestines by the portal vein.

 ANDREAS VESALIUS – presence of valves in the veins.

 REALDUS COLUMBUS – discovered pulmonary circulation.
 WILLIAM HARVEY – discovered blood circulation from observations on living animals and dissections; determined the
function of valves

BLOOD LETTING
 Removal of blood in the body.
 Standard practice for releasing spirits (Egyptians), cleansing blood of impurities (Hippocrates), adjusting excess body fluids
(William Harvey up to present)
 Note: unknown of aseptic techniques

BLOOD LETTING TECHNIQUES

1. Venesection
 Came form Latin words vena (vein) and secto (cutting).
 used scalpel, lancets and fleams
2. Arteriotomy
 was less frequently done because it was a dangerous method, involves the temporal artery vein.
3. Cupping
 involved a procedure that required placing a suction cup over an area of skin.
 Suction was applied to create a blister or swollen area.
4. Leeching
 leeches were applied to the patient’s skin on the affected area and allowed to fill themselves with blood.
 Leeches usually fell off when they became full of blood.
HISTORICAL PERSPECTIVE: (cont.)
 The art of bloodletting was flourishing well before Hippocrates in the fifth century B.C.
 By the Middle Ages, both surgeons and barbers were specializing in this bloody practice.
 The practice reached unbelievable heights in the 18th and early 19th centuries.
 The first U.S. president, GEORGE WASHINGTON, died from a throat infection in 1799 after being drained of nine pints of blood
within 24 hours. The draining of 16-30 ounces (1-4 pints) of blood was typical.
 By the end of the 19th century (1875-1900), BLOOD LETTING was declared quackery.

HISTORICAL PERSPECTIVE: (OTHER ACCOUNTS)

PHLEBOTOMY AT MODERN TIMES:

Many types of laboratory tests are performed on blood specimens. The process of collecting blood is called phlebotomy.
Individuals called phlebotomists have been specifically trained in blood collection techniques and are employed primarily to collect blood
specimens.
 Obtain blood for diagnostic purposes
 Blood Donation
 Treatment for Polycythemia Vera
 Venipuncture and Capillary Puncture
 Point of Care Testing (POCT)
 Evacuated Blood Collection System – manufactured by Hynson, Wescott, and Dunning

TRADITIONAL DUTIES OF THE PHLEBOTOMIST

1. Correct identification and preparation of the patient before sample collection.
2. Collection of the appropriate amount of blood by venipuncture or dermal puncture for the specified tests.
3. Selection of the appropriate sample containers for the specified tests.
4. Correct labeling of all samples with the required information.
5. Appropriate transportation of samples back to the laboratory in a timely manner.
6. Effective interaction with patients and hospital personnel.
7. Processing of samples for delivery to the appropriate laboratory departments.
8. Performance of computer operations and record-keeping pertaining to phlebotomy.
9. Observation of all safety regulations, quality control checks, and preventive maintenance procedures.
10. Attendance at continuing education programs.

ADDITIONAL DUTIES OF THE PHLEBOTOMIST

1. Training other health-care personnel to perform phlebotomy
2. Monitoring the quality of samples collected on the units
3. Evaluation of protocols associated with sample collection Performing and monitoring point-of-care testing (POCT)
4. Performing electrocardiograms
5. Performing measurement of patient’s vital signs
6. Collection of arterial blood samples
7. Collection of samples from central venous access devices (CVADs)

PROFESSIONAL AND PERSONAL CHARACTERISTICS FOR PHLEBOTOMISTS

 Conduct and qualities that characterizes a professional.
 A professional phlebotomist must have the ff. characteristics:
Dependable, Cooperative, Committed
Compassionate, Courteous, Respectful
 Integrity, Honesty, Competence
Organized, Responsible, Flexible
Communication (Verbal, Listening Skills, Non-verbal)
Appearance

GENERAL APPERANCE GUILDELINES

 Clothing and lab coats must be clean and unwrinkled. Lab coats must be completely buttoned and completely cover clothing.
 Shoes must be clean, polished, closed toed, and skid-proof.
 If jewelry is worn, it must be conservative. Dangling jewelry including earrings can be grabbed by a patient or become tangled in
bedside equipment.
 Many institutions do not permit facial piercings and tattoos; if present, they must be completely covered.
 Makeup must also be conservatively applied.
 Perfume and cologne are usually not recommended or must be kept to a minimum.
 Hair including facial hair must be clean, neat, and trimmed.
 Long hair must be neatly pulled back. Like jewelry, long hair can become tangled in equipment or pulled by the patient.
 Long hair hanging near an infectious patient can transport the infection to your next patient.
 Personal hygiene is extremely important.
 Fingernails must be clean and short. Based on the Centers for Disease Control and Prevention (CDC) Handwashing Guidelines,
artifical nail extenders are not allowed.

GENERAL CULTURAL DIVERSITY GUILDELINES FOR PHLEBOTOMISTS

1. Approach all patients with a smile and use a friendly tone of voice.
2. Be alert to patient reactions to your approach and direct your actions to accommodate them. Do not force your style on them.
3. Do not stereotype a particular culture; not all people of same ethnic culture react in the same manner.
4. Remember the amount of personal space varies not only among people but also among cultures.
5. Plan to spend additional time explaining procedures and patient instructions. Be sure instructions are understood by asking the
patient to repeat the instructions to you. In some cultures nodding is considered a sign of politeness and not understanding.
6. Above all, show respect for their diversity.
TELEPHONE SKILLS
1. Answer the phone promptly and politely, stating the name of the department and your name.
2. Always check for an emergency before putting someone on hold, and return to calls that are on hold as soon as possible. This may
require returning the current call after you have collected the required information.
3. Keep writing materials beside the phone to record information such as the location of emergency blood collections, requests for test
results, and numbers for returning calls.
4. Make every attempt to help callers, and if you cannot help them, transfer them to another person or department that can. Give callers
the number to which you are transferring them in case the call is dropped during the transfer.
 5. Provide accurate and consistent information by keeping current with laboratory policies, looking up information published in
department manuals, or asking a supervisor.
6. Speak clearly and make sure you understand what the caller is asking and that he or she understands the information you are
providing.
7. Goal 2 of the National Patient Safety Goals is to improve effectiveness of communication among caregivers. The goal states that for
verbal or telephone orders or telephone reporting of critical test results, the individual giving the order or test result verifies the
complete order or test result by having the person receiving the information record and read back the complete order or test result.

TWO MAIN CATEGORIES OF THE HEALTH CARE DELIVERY SYSTEMS

1. Inpatient – hospitals, nursing homes, rehabilitation centers

2. Outpatient – physician offices, reference laboratories, blood banks (blood donor centers)
A PHLEBOTOMIST MUST ALSO BE AWARE OF HIS/HER:

 Personal Appearance – OSHA

 Ethics – refers to good values and actions
 HIPAA (Health Insurance portability and accountability Act) – an act that protects patient information and maintains confidentiality
of results.
 Hospital Organization
 Hospital Patient-Care Areas
 Hospital Departments/ Services Laboratory Organization
CLINICAL LABORATORY PERSONNEL

1. Pathologist – is a physician who specializes in diagnosing disease.

2. Laboratory administrator\ (Chief Medical Technologist) - is usually a technologist with an advanced degree and several years of
experience. Duties include overseeing all operations involving physician and patient services.
3. Technical Supervisor (Section Head) – responsible for the administration of an area and reports to the lab administrator .
4. Medical Technologist/ Medical Laboratory Scientist - performs all levels of testing in any area of the laboratory.
5. Phlebotomist – trained to collect blood samples in the laboratory. Primary role is to collect blood by venipuncture or capillary
puncture.