Phlebotomy and the Health

Care Delivery System

What is

PHLeBo TOMY?
PHLEBOTOMY
▪ ‘Phlebotomy’ comes from the Greek word phlebos, meaning
veins, and tome, meaning incision.
▪ It is a 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.
Historical Perspective:
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.
Historical Perspective:
GALEN –
believed that
blood was
formed in the
liver and was
brought from
the intestines
by the portal
vein.
Historical Perspective:
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
Historical Perspective:
Historical Perspective:
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

Historical Perspective:
BLOOD LETTING TECHNIQUES
[Link] – Came form Latin words vena (vein) and
secto (cutting).
– used scalpel, lancets and fleams,
Historical Perspective:
BLOOD LETTING TECHNIQUES
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.
Historical Perspective:
BLOOD LETTING TECHNIQUES
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:
The art of blood letting 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.
Historical Perspective:
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),

phlebotomy was declared quackery.
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.
Phlebotomy at Modern Times:
• 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.
TRADITIONAL DUTIES OF THE PHLEBOTOMIST
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
Verbal Skills Listening Skills Non-verbal Skills
▪ Looking directly and
attentively at the patient.
▪ Encouraging the patient to
express feelings, anxieties,
and concerns.
▪ Allowing the patient time to
describe why he or she is
concerned.
▪ Providing feedback to the
patient through appropriate
responses.
▪ Encouraging patient
communication by asking
questions.
General Appearance Guidelines
▪ 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.
General Appearance Guidelines
▪ 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 Guidelines for Phlebotomists

[Link] all patients with a smile and use a friendly tone of

voice.
[Link] alert to patient reactions to your approach and direct your
actions to accommodate them. Do not force your style on them.
[Link] not stereotype a particular culture; not all people of same
ethnic culture react in the same manner.
General Cultural Diversity Guidelines for Phlebotomists
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.
Telephone skills
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. This is done by repeating what the caller has asked
and asking the caller to repeat the information you have given.
Telephone skills
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.
Note:

What are the health care facilities that utilizes phlebotomists?

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)
Note:

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.
Note:

A phlebotomist must also be aware of:

Hospital Organization
Hospital Patient-Care Areas
Hospital Departments/ Services
Laboratory Organization
Hospital Patient-Care Areas
Emergency Immediate Care
Department (ED)
Intensive Care Unit Critically ill patient
(ICU)
Cardiac Care Unit Patient with acute cardiac disorder
Pediatrics Children
Nursery Infants
Short-stay Unit Outpatient surgery
Hospital Patient-Care Areas
Neonatal Intensive Care Newborn experiencing difficulty
Unit (NICU)
Labor and Delivery Room Childbirth
Operating Room Surgical Procedures
Psychiatric Unit Mentally Disturbed Patients
Dialysis Unit Patient with severe renal disorder
Medical/Surgical Unit General patient care
Oncology Center Cancer Treatment
Hospital Departments/ Services
Radiology and Uses various forms of radiant energy to diagnose and treat
Diagnostic Imaging disease. Some of the techniques include x-rays

Radiation Therapy Uses high-energy x-rays or ionizing radiation to stop the

growth of Cancer cells. Radiation therapy technologists
perform these procedures.
Nuclear Medicine In vitro tests analyze blood and urine samples using
radioactive materials to detect levels of hormones, drugs,
and other substances. In vivo tests involve administering
radioactive material to the patient by intravenous (IV)
injection and measuring the emitted rays to examine
organs and evaluate their function.
Hospital Departments/ Services
Occupational Teaches techniques that enable patients with physical,
Therapy mental, or emotional disabilities to function within their
limitations in daily living.
Pharmacy Dispenses the medications prescribed by physicians. The
phlebotomist is often responsible for the collection of
specifically timed samples.
Physical Therapy Provides treatment to patients who have been disabled as a
result of illness or injury by using procedures involving
water, heat, massage, ultrasound, and exercise.
Respiratory Therapy provide treatment in breathing disorders and perform
testing to evaluate lung function.
Cardiovascular evaluate cardiac function using electrocardiograms, stress
Testing tests, and imaging techniques.
Other Health care settings
Physicians Office
Laboratories (POLs)
and Group Practices
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.