[TRANS] [PMLS II] LESSON 1 : Understanding Phlebotomy

INTRODUCTION Today, phlebotomy is performed to:

What is Phlebotomy? ● Obtain blood for diagnostic purposes and to
● It is the act or practice of drawing or removing monitor prescribed treatment;
blood from the circulatory system through a cut ● Remove blood for transfusions at a donor
or puncture center; and
● “The act or practice of bloodletting as a ● Remove blood for therapeutic purposes, such as
therapeutic measure” for polycythemia and hereditary
● It was once thought that the practice would rid hemochromatosis
the body of diseases and provide a cure for
almost all ailments. Phlebotomy is primarily accomplished by one of two
procedures:
HISTORY OF PHLEBOTOMY ● Venipuncture- involves collecting blood by
penetrating a vein with a needle and syringe or
Middle Ages other collection apparatus
● Bloodletting was practiced by barbers, whose ● Capillary puncture- involves collecting blood
red-and- white poles became the symbol of their after puncturing the skin with a lancet
trade
● Aside from bloodletting, barbers also extract Phlebotomist
teeth, setting bones and treating wounds. ● A phlebotomist is a person trained to obtain
Two Basic Methods of Phlebotomy blood samples primarily by venipuncture and
1. Venesection - A sharp lancet-type instrument micro techniques.
pierced the veins and made them bleed ● “The result of the tests depends on the quality of
2. Cupping - Involved the application of a heated the blood they obtained”
suction apparatus (cup) to the skin to draw blood
to the surface. Traditional Duties of a Phlebotomist
Leeching (Hirudo medicinalis) 1. Correct identification and preparation of the
● It involves enticing the medicinal leeches to the patient before sample collection
spot needing blood-letting with a drop of milk or 2. Collection of the appropriate amount of blood by
blood on the patient’s skin. venipuncture or dermal puncture for the
● A.k.a Hirudotherapy specified tests
● The value of leech therapy lies in the 3. Selection of the appropriate sample containers
components of the leech’s saliva, which contains for the specified tests
a local vasodilator, a local anesthetic, and 4. Correct labeling of all samples with the required
hirudin. information
December 1799 5. Appropriate transportation of samples back to
● George Washington had a severe throat the laboratory in a timely manner
infection; 6. Correct identification and preparation of the
● he was bled of more than 9 pints of blood in less patient before sample collection
than 24 hours; 7. Collection of the appropriate amount of blood by
● died on December 14, 1799 venipuncture or dermal puncture for the
19th Century specified tests
● The discovery of microorganisms as the 8. Selection of the appropriate sample containers
causative agent for many diseases started to for the specified tests
change the thinking of how to treat diseases 9. Correct labeling of all samples with the required
● Blood was begun to be examined for diagnostic information
purposes 10. Appropriate transportation of samples back to
the laboratory in a timely manner

APPROACHES TO PHLEBOTOMY
DAVID. DEL ROSARIO. EBERO. FULLO. GELSANO. MIRALLES. NONES. PANTINO. SEÑARIS. SET | LEVEL 1 MT
● Centralized phlebotomy ● Phlebotomists are part of a service-oriented
● Decentralized phlebotomy industry, and specific personal and professional
● Hybrid phlebotomy characteristics are necessary for them to be
successful in this area.
A. Centralized Phlebotomy ● It is important for phlebotomists to understand
- Phlebotomist is dispatched from the that they are the actual face of the laboratory
laboratory to either nursing units or because they are the people who interact with
outpatient areas. the patients.
- After blood collection, the phlebotomist
will bring the samples to the laboratory. A. Dependable, Cooperative, and Committed
- The phlebotomist starts on the second - Failure to appear or arriving late puts additional
round of collection. pressure on the staff members present.
- The remainder of the day is spent in - Be willing to demonstrate your commitment to
returning to the nursing units or your job and your cooperation to assist fellow
outpatient employees.
- areas to collect one or two blood B. Compassionate, Courteous, and Respectful
samples at a time as new tests are - They must be sensitive to their needs,
ordered. understand a patient’s concern about possible
- Difficulties in collecting blood from a diagnosis.
patient also add a delay to the collection - Courteous phlebotomists introduce themselves
B. Decentralized Phlebotomy to the patients before they approach them.
- More people are collecting blood C. Honesty, Integrity, and Competence
samples during the busy time. - The phlebotomist should never hesitate to admit
- The duties of the hospital staff revolve a mistake, because a misidentified patient or
more around the patient and the need to mislabeled sample can be critical to patient
treat the patient quickly rather than safety.
being restricted to a specific job - Phlebotomists must demonstrate competence in
description. the procedures they are trained to perform.
- Since more people are collecting the D. Organized, Responsible, and Flexible
samples, each person does not have as - Always maintain an organized and well-stocked
many to collect collection tray or station. Not only do
- When the phlebotomist’s blood phlebotomists need to organize their collection
collection duties are completed, he/she equipment, they must also organize and
does not return to the laboratory but prioritize their work.
instead continues to work on the nursing
unit. A PHLEBOTOMIST ANATOMY
- During the rest of the day, the ● General Appearance
phlebotomist collects blood samples that - Clothing and lab coats must be clean
are needed, handles patient care, and and unwrinkled.
does point of care laboratory tests. - Clothing worn under the laboratory coat
C. Hybrid Phlebotomy should be conservative and meet
- A blend of centralized and decentralized institutional requirements.
phlebotomy - Shoes must be clean, polished, closed
- It is applied to reduce the errors of toed, and skid-proof.
decentralized phlebotomy - Always maintain an organized and well-
- Typically sends laboratory-based stocked collection tray or station. Not
phlebotomists to the nursing units during only do phlebotomists need to organize
the early morning collections and then their collection equipment, they must
keeps a limited number of phlebotomists also organize and prioritize their work.
available the rest of the day to help - Perfume and cologne are usually not
patient care technicians with difficult recommended or must be kept to a
collections. minimum.
- Hair, including facial hair must be clean,
neat, and trimmed.
- Personal hygiene is extremely important
PROFESSIONAL AND PERSONAL TRAITS OF A because of close patient contact;
PHLEBOTOMIST - Fingernails must be clean and short.
● Communication Skills

DAVID. DEL ROSARIO. EBERO. FULLO. GELSANO. MIRALLES. NONES. PANTINO. SEÑARIS. SET | LEVEL 1 MT
 - Verbal Skills - Verbal skills enable
Public Greater than 12 feet
phlebotomists to introduce themselves,
explain the procedure, reassure the - Telephone Skills
patient, and help assure the patient that ❖ Phlebotomists should have a thorough
the procedure is being competently understanding of the telephone system
performed. regarding transferring calls, placing calls
on hold, and paging personnel.
❖ Answer the phone promptly and politely;
Barrier Methods to Overcome
❖ Always check for an emergency before
putting someone on hold;
Hearing Implants Speak loudly and clearly
❖ Keep writing materials beside the phone
Look directly at patient to
to record information such as location of
facilitate lip-reading
emergency blood collections, requests
Patient emotions Speak calmly and slowly for test results, and numbers for
Do not appear rushed or returning calls;
disinterested ❖ Make every attempt to help callers, and
if you cannot help them, transfer them to
Age and Education Avoid medical jargon, you another person or department that can;
levels are collecting a blood sample ❖ Provide accurate and consistent
rather than performing a information by keeping current with
phlebotomy laboratory policies, looking up
Use age-appropriate phrases information published in department
manuals, or asking a supervisor;
Non-english speaking Locate a hospital-based
interpreter THE CLINICAL LABORATORY
Use hand signals, show Main Laboratory
equipment, etc ● Office section - receives and routes laboratory-
Remain calm, smiling, and related telephone calls, sample collection
reassuring requests, and some patient samples.
● Sample collection area – close proximity to the
- Listening Skills office; more commonly known as phlebotomy
❖ Looking directly and attentively at the area or extraction area
patient Hematology Section
❖ Encouraging the patient to express ● Hematology staff studies blood cells and
feelings, anxieties, and concerns performs qualitative and quantitative analyses
❖ Allowing the patient time to describe along with microscopic examinations.
why he or she is concerned ● Studies the blood in normal and diseased states.
❖ Providing feedback to the patient ● Usually limited to the study of cellular
through appropriate responses components and not the chemistry of blood.
❖ Encouraging patient communication by ● The CBC, is a routine test, providing the
asking questions physician with a large amount of valuable
- Nonverbal Skills information about a patient’s state of health.
❖ Nonverbal skills (body language) include ● CBC, hemoglobin, hematocrit, platelet count,
facial expressions, posture, and eye sedimentation rate, body fluid cell counts
contact.
❖ Allowing patients to maintain their zone
of comfort (space) is important in
phlebotomy even though you must be
close to them to collect the sample. Urinalysis section
● Staff performs qualitative and quantitative
Zone Amount of Distance chemical and microscopic examinations of urine
to detect urinary tract infections, diabetes, and
Intimate 2 feet liver or kidney disease
● Clinical Microscopy section
Personal 2 to 4 feet Chemistry section
● Works with the fluid portion of the blood (serum
Social 4 to 12 feet or plasma) or other body fluids.

DAVID. DEL ROSARIO. EBERO. FULLO. GELSANO. MIRALLES. NONES. PANTINO. SEÑARIS. SET | LEVEL 1 MT
 ● A variety of analyzers measures for chemicals ● Environmental Services – maintains a clean
such as glucose, electrolytes, BUN, BUA, and facility
creatinine. ● Food services – provides diets to patients
● The staff performs biochemical analysis of blood ● Gastrointestinal Laboratory – diagnoses GI
and body fluids by manual or automated disorders
techniques. ● Laboratory – provides testing of patient samples
Microbiology section ● Medical Records – maintains patient records
● Studies organisms that are so small that can ● Nursing – provides direct patient care
only be seen with the aid of a microscope. ● Respiratory therapy – provides therapy to
● The technologist identifies aerobic and evaluate the lungs
anaerobic bacteria, fungi, mycobacteria (such as
tuberculosis), and parasites. NURSING DEPARTMENT
● Samples brought to this area include throat ● Phlebotomists may need to ask nurses for
cultures, urine cultures, wound and skin assistance with patients who are unwilling to
cultures, blood cultures, and other types of hold still or to check with them about the proper
cultures. time to draw a sample.
● Once the organism that is causing the problem ● The phlebotomist who is well liked and
is determined, a test called sensitivity is run to cooperates with others for the patients’ care is
determine what antibiotic would be best to one who will earn cooperation from other
eliminate the problem organism. individuals.
Immunology section ● The ability to work smoothly with other
● Studies antigen-antibody reactions. departments of the hospital is a key trait of the
● Antigens are substances seen as being “foreign” best phlebotomist.
in the body, and antibodies are proteins made
by the body to combat specific antigens. AREAS OF NURSING
● Staff performs tests to detect and evaluate HIV, ● Coronary care unit (CCU) – increased care of
hepatitis, infectious mononucleosis, rheumatoid the patient due to a heart condition
arthritis, and syphilis, and they also perform ● Emergency department – emergency treatment
fluorescent antibody tests. of patients
Immunohematology section ● Geriatric – elderly patients
● Studies antigens and antibodies as they relate to ● Home health care – follow-up care of a patient at
the red blood cells. home
● This section performs ABO Rh blood typing, ● Intensive care unit (ICU) – increased care due to
type and screen testing, the critical needs of the patient
cross-matching/compatibility testing, and ● Neonatal – newborn care
screening for antibodies. ● Nephrology – patients on dialysis
● The primary testing is to determine compatibility ● Obstetrics – patients in labor of childbirth
of blood cells from a donor with the plasma of ● Oncology – patients with cancer
the recipient. ● Orthopedic – patient with broken bones
● This cross-matching of donor recipient ● Pediatrics – infants and children
determines if the blood that the recipient will ● Recovery – recovery treatment of patients
receive is compatible.
● Proper patient identification is critical when the
blood the phlebotomist draws will be used to
determine a product that will be infused into the
patients.
● A misidentification of a patient opens the
possibility that the patient will receive the wrong
type of blood, with serious complications to the
patient, including fatal transfusion reaction.
● Few hospitals draw their own donors, while most
hospitals procure the blood they transfuse from
a central donor facility, such as red cross or
local blood centers

ANCILLARY HOSPITAL AREAS

● Administration – keeps the hospital in
compliance

DAVID. DEL ROSARIO. EBERO. FULLO. GELSANO. MIRALLES. NONES. PANTINO. SEÑARIS. SET | LEVEL 1 MT