Introduction To Phlebotomy

The drawing of blood in a clinical

setting for clinical testing.

A balancing act between the comfort of the patient and the quality of the sample(s).

What is Phlebotomy?

It is the job of the phlebotomist to maintain comfort

for the patient while obtaining the appropriate sample(s) to complete the tests ordered.

What is Phlebotomy?

1. Diagnostic testing – what’s wrong with the patient?

2. Therapeutic assessment – is the drug at the right therapeutic level?

3. Monitoring patient’s condition – is the patient getting better?

3 purposes for collection and analysis of laboratory samples:

Good phlebotomy begins with

finding an appropriate draw site.

Knowledge of the anatomy of the draw site is vital.

A good phlebotomist is familiar with many different potential sites on the arm and hand.

Overview

Veins grow in response to

pressure and follow NO exact pattern.

The basic idea is to look for a draw site TWICE as long as you actually perform the venipuncture.

Overview

A phlebotomist is a medical

technician trained specifically to take blood samples from patients

He/she performs basic laboratory tasks including setting up samples for analysis and might also enter lab results into a computer system

What is a Phlebotomist?

While many medical professionals practice in addition to other skills, especially in small offices, many major medical centers and blood donation organizations maintain a staff of phlebotomists to handle blood samples and collection

What is a Phlebotomist?

What is a Phlebotomist’s

role in a healthcare facility?

They collect blood primarily by performing venipuncture and, for collection of minute quantities of blood, finger sticks.

Blood may be collected from infants by means of a heel stick.

Specially trained phlebotomists collect arterial blood samples from the radial artery of the wrist or brachial artery in the antecubital area (bend in the arm).

Must possess manual dexterity and apply proper

body mechanics to perform proper blood sampling techniques and handle related equipment and instruments, have a thorough understanding of the venous anatomy of the limbs, and know proper procedures when it comes to handling and processing specimen containers and kits.

Traits and Abilities

Since phlebotomists work primarily with patients, it

is essential that they have good people skills.

They should be friendly, have good oral and written communication skills, and they should be able to work in a stressful environment.

Traits and Abilities

Adequate training in blood

and urine specimen collection is essential!

An improperly collected sample will lead to false lab results and errors that can harm the patient, or even cause their death.

Only through skillful and careful blood drawing procedure can a quality blood sample be obtained and reliable results be recorded.

Duties and responsibilities center around the

obtaining and proper handling of human blood.

Basic services include taking blood samples from patients and correctly cataloging them for lab analysis

The importance of the phlebotomist is far more critical than this simple description implies.

Phlebotomists’ Duties

Draws blood specimens from

patients by using finger stick, heel stick and/or venipuncture. 

Collects throat culture specimens. 

Greets patients and instructs them in proper specimen collection methods. 

Examples of Duties:

Labels specimens for

identification purposes and enters specimen data into computer. 

Prepares specimens for reference laboratory by using centrifuge to spin blood. 

Examples of Duties:

Answers telephone

calls and routes calls to appropriate member of the medical or laboratory staff. 

More Duties:

Writes test results sent from

reference laboratory into patient report; distributes report to clinicians. 

(Many labs now send patient reports via computer - with EMR/HER software - electronic medical/health records).

More Duties:

Inventories and

requisitions medical laboratory supplies; stocks work area as needed. 

Keeps work areas clean and orderly.

More Duties:

Phlebotomists have an

extremely high potential to be exposed to blood borne diseases and contaminants, the level of caution and expertise they use in the execution of their duties is critical to their own safety as well as all others that may be exposed to the fluid samples they draw.

Critical Responsibilities:

Prior to collection, it is the phlebotomist’s

responsibility to assure that all collection instruments and environments are sterile and of first use.

Any error in the job of a phlebotomist can have consequences that range from misdiagnosis to fatal contamination.

Critical Responsibilities:

Some duties, for example those that conduct home

care visits, will also include being responsible for transportation of fluid samples between the sample site and the laboratory.

In some cases duties will also include being responsible for performing certain functions to process blood samples for further analysis by attending medical professionals.

Additional Duties:

Phlebotomists that work in a

laboratory environment have the added task of ensuring that samples are correctly analyzed by enforcing quality control and safety measures to prevent the contamination of samples during analysis.

Additional Duties:

A phlebotomist must understand that each

person is different, each situation is unique, know all possible problem areas

and complications, and prevent procedural errors

from occurring.

Must be able to perform the proper technique to prevent unnecessary errors, especially false laboratory results or findings.

Proper technique will also prevent injuries to patients.

Injuries such as hematomas, anticoagulant reflux and nerve injury have to be prevented at all costs.

Using proper phlebotomy techniques will prevent samples from being compromised.

Along with the basic skills in venipuncture, finger stick and capillary puncture, must be keenly aware of the client’s general health, gender, culture, allergies and medications taken.

Prior to getting a blood sample, the client must be prepared and be instructed properly.

If the primary site for venipuncture does not become viable, you must know another site where to puncture best.

Good phlebotomists know the safety regulations and infection control procedures and techniques to avoid injuring others and themselves.

Phlebotomy is one of a variety of allied health or lab technician fields vital to the work of a hospital or medical practice. 

Doctors rely on blood samples to diagnose a wide variety of diseases and in order to assess the general health of their patients. 

Phlebotomists are also essential to every blood bank in order to collect each community’s supply of plasma and whole blood for transfusions and other medical procedures and surgeries.

Phlebotomists can find work in a wide variety of medical settings including (but not limited to):

hospitals, commercial laboratories, medical practices and clinics, blood banks, home health care agencies, prison hospitals, military base hospitals, hospices, visiting nurse organizations, pharmaceutical and research labs, home health agencies, and public health clinics.

WHERE DO PHLEBOTOMISTS WORK?

Phlebotomy until the mid-nineteenth century was

the ancient practice of bloodletting. Ancient physicians believed that the blood was one

of the “humors” that caused illness.  They employed barbers and sometimes an insect

called a leech to bleed individuals thought to suffer from a blood-related disease. 

HISTORY OF PHLEBOTOMY

Often bloodletting weakened the patient and

caused death. Occasionally, the bloodletting procedure

actually brought relief, as in the case for those with high blood pressure.

The barber’s red and white barber pole is an ancient symbol of the combination of red for drawing of blood and white for the tourniquet that kept the blood from flowing out of control.

HISTORY OF PHLEBOTOMY

Performed by a cut into a

vein with a sharp instrument to drain blood

The lancet was the most popularly used instrument

Aseptic practices were not known, so the lancet was reused for several patients

Bloodletting

Removing blood from veins dates back to about 1400 B.C. when leeches were applied to the skin of sick people.

In the early 1800’s, medicinal leeches were used for the procedure known as bloodletting.

Bloodletting was typically performed by barbers or anyone claiming medical training.

Phlebotomy means to cut into a vein. This procedure of cutting or puncturing a vein is

performed by a phlebotomist. Primary role is to obtain blood specimens for

testing. Other roles include packaging urine specimens,

accepting incoming specimens, and routing specimens to other departments.

Phlebotomy at a Glance

Profession emerged as a result

of technology and expansions in laboratory function

Performed by trained professionals

Standards of practice set by the Clinical and Laboratory Standards Institute (CLSI)

Modern - Day Phlebotomy

Check armband or ID label

in acute care settings Check driver’s license or

picture ID in outpatient settings

PATIENT IDENTIFICATION

PATIENT IDENTIFICATION IS A 3-STEP PROCESS:

ASK COMPARE VERIFY/VALIDATE

DERMAL PUNCTURE

Use of a puncture device to obtain

capillary blood by pricking the skin

VENIPUNCTURE

Insertion of a needle into a vein to remove blood

MOST COMMONLY USED COLLECTION METHODS

Physician orders indicate type of specimen and time of collection

Specimen Collection METHODS

Personal Hygiene Dress Neat, well-groomed

appearance Jewelry

Professionalism

Many institutions require that phlebotomists wear a lab jacket and specified shoes to meet OSHA guidelines.

Verbal and nonverbal Avoid the use of slang Speak in a calm, clear voice Avoid inappropriate terms Maintain eye contact Respect personal space

Communication

Clinical Laboratory Improvement Amendment

(CLIA)

Established in 1988 to ensure that all laboratories receiving federal funds, regardless of size, would meet the same standards

As of 1992, this legislation became the main regulatory body for all laboratories

Establishes qualifications for phlebotomists

CLIA1988

Congress passed the Clinical Laboratory Improvement Amendments (CLIA) in 1988

establishing quality standards for all laboratory testing to ensure the accuracy, reliability and timeliness of patient test results regardless of where the test was

performed. 

Clinical Laboratory Improvement Amendments (CLIA) of 1988 are United States federal regulatory standards that apply to all clinical laboratory testing performed on humans in the United States, except clinical trials and basic research.

In accord with the CLIA, the CLIA Program sets standards and issues certificates for clinical laboratory testing.

CLIA defines a clinical laboratory as any facility which performs laboratory testing on specimens derived from humans for the purpose of providing information (1) for the diagnosis, prevention, or treatment of disease or impairment, and (2) for the assessment of health.

Regulatory Agencies

Centers for Disease Control (CDC) Occupational Safety and Health Administration

(OSHA) Clinical and Laboratory Standards Institute

(CLSI)

Regulatory Agencies

Healthcare Finance Administration (HCFA) Department of Health and Human Services (DHHS) The Joint Commission on Accreditation of

Healthcare Organizations (JCAHO) and the College of American Pathologists (CAP) help ensure a high standard of care for patients.

JCAHO is the main accrediting agency for hospitals. Now called THE JOINT COMMISSION

Laboratory classifications are based on

the complexity of testing

Waived

Moderately Complex

Highly Complex

There are over 25,000 possible laboratory tests, with around 500 performed in most institutions.

http://www.ascls.org/labtesting/index.asp POCT – testing at bedside, may be performed

by phlebotomist

The art of phlebotomy has evolved from the use of

leeches to modern-day certified phlebotomists. Phlebotomists are responsible for collecting, processing,

and transporting blood specimens. Professionalism involves a positive attitude and

appearance, proper communication to the patient, and providing quality customer service.

Phlebotomists are employed at hospitals, rehabilitation centers, nursing homes, clinics, physician’s offices, ambulatory care centers, blood banks, and reference labs.

IN SUMMARY:

There are many regulating agencies for phlebotomy

including CLSI, JCAHO, HCFA, CDC and OSHA.

Errors that can occur during the collection and handling of blood specimens are potentially numerous.

Standards for venipuncture can reduce or alleviate many of these errors in much the same way that quality control standards have reduced errors within the laboratory. 

IN SUMMARY: