PMLS 2 L. #1

• Phlebotomy


  To cut into a vein
• Phlebotomy


  • Involves invasive procedures usually by cutting or puncture
  • Performed to obtain blood specimen for diagnostic testing either by venipuncture, arterial puncture or capillary/dermal puncture

  
• Crude tools are used to cut blood vessels and drain excess blood from the body

  Late Stone Age
• Mesoamerican practice bloodletting for rituals and religious purpose


  3500 B.C.
• Egypt: Papyrus records and tomb paintings depicts bloodletting procedures using leeches


  1400 B.C.

  
• Hippocrates of Cos and his contemporaries

  Believed that an imbalance of blood, phlegm, yellow and black bile would cause a disease. Treatment includes bloodletting, purging, catharsis, diuresis
• Aelius Galenus/Galen of Pergamum


  Believed that blood was the dominant humour and the one in most need of control. Advocated the bleeding of patients with leeches
• Leech therapy


  1. Place a drop of milk or blood on patient's skin

  2. Introduce hirudo medicinalis to the site

  3. Allow the leech to engorge and fall off
• • Monks & clergy men performed bloodletting to treat various conditions, until it was banned in 1163
  • Barbers began offering a range of services that included bloodletting, cupping, tooth extractions, lancing and even amputations


  Early Middle Ages: Europe
• Phlebotomy procedures were performed at its peak. A loss of approximately 10 mL (2 teaspoon) was standard


  1800's
• Venesection


  A process by which the median cubital vein is pierced with a sharp object (fleams or lancet) to drain blood
• Fleams


  Devices with multiple, variably sized blades that folded into a case like a pocketknife
• Thumb Lancet/Lancet


  Small sharp-pointed, two-edged instruments often with an ivory or tortoise shell case
• Scarification


  Scraping the skin with a cube-shaped brass box containing multiple small knives that delivers a uniform set of parallel cuts
• Cupping


  Heated air inside the cups created a vacuum causing blood to flow into the cup
• Leeching or Hirudo Therapy


  • Use of medicinal leech, Hirudo medicinalis, which can ingest about 5 to 10 ml of blood
  • Leech injects local vasodilator, local anesthetic and Hirudin, an anticoagulant
• • Leech therapy resurfaced and is used for microsurgery
  • Phlebotomy profession emerged as an expansion to Medical Technology


  19th Century - Present
• Who are allowed to practice phlebotomy in the Philippines

  • Registered Medical Technologist
  • Registered Medical Laboratory Technician
  • Graduate of Medical Technology or Medical Laboratory Science
  • Graduate of other health profession and has undergone intensive training for phlebotomy (including blood bank phlebotomy)

  
• Requirements to practice phlebotomy in other countries like US and Europe


  • Certification: voluntary process by which agency grants recognition to an individual who has met certain prerequisites in a particular technical area
  • Licensure: act of getting an official document or permit granted by a state agency that gives legal permission for a person to work in a particular health profession
  • Continuing Education: update of knowledge or skills of healthcare professionals
• Traditional duties and responsibilities of a phlebotomist


  • Demonstrate professionalism by their conduct, appearance, composure and communication skills
  • Know facility's policies and procedure
  • Properly identify patients
  • Collect both venous and capillary blood specimens
  • Select the appropriate and accurate specimen container for specified tests
  • Properly label, handle and transport specimens following its policies
  • Sort specimens received and process specimen for delivery to each laboratory sections
  • Perform computer operations and/or update log sheets where require
  • Perform basic laboratory procedures including preparation of reagents, care and maintenance of glassware and preparation of laboratory specimen for testing
  • Observe all safety regulations and always practice confidentiality
  • Attendance in a Continuing Professional Education
• Professional traits of a phlebotomist


  • Dependable, Cooperative & Committed
  • Compassionate, Courteous & Respectful
  • Good Communication Skills
  • Self-Motivated
  • Organized, Responsible and Flexible
  • Integrity, Honesty & Competence
  • Professional Appearance
  • Accurate & Precise
• Communication in healthcare setting


  • The process by which information is exchanged or transmitted
  • Components: verbal, active listening and non-verbal
• Verbal skills


  • Introduction to patients, explaining the procedure, reassure the patient and assure the patient that procedure is accurately done
  • Barriers: Hearing impairment, patient emotions, Age and education levels, Non-English Speaking, PWDs
• Listening skills


  • Looking at the patient directly
  • Encouraging the patient to express feelings anxieties and concerns
  • Allowing the patient to describe his/her concerns
  • Providing prompt feedback to the patient
  • Encouraging patient communication by asking
• Non-verbal communication


  • Kinesics: characteristics of body motion and language such as facial expression, gestures, and eye contact
  • Proxemics: the study of an individual's concept of space which plays major role in patient relations
  • Appearance: Appearance should communicate cleanliness, confidence and a trustworthy professional
  • Touch: Because medicine is a contact profession, touching privileges are granted to and expected of healthcare workers under certain circumstances
• Positive gestures


  • Body language
  • Good body posture
  • Eye contact
  • Neat, well-groomed appearance
  • Respecting personal space
  • Cultural Diversity
• Negative gestures


  • Dropping shoulder with head held low
  • Looking down or away from the patient
  • Dingy, wrinkled lab coat; too much jewelry
  • Immediately approaching patient's space before greeting and explaining procedure
• Different kinds of patient


  • The excessively quiet
  • The hostile
  • The confused or disoriented
  • The full of question
  • The demanding
  • The over-friendly or seductive
• Privileges are granted to and expected of healthcare workers under certain circumstances.
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• Positive gestures


  • Body language
  • Good body posture
  • Eye contact
  • Neat, well-groomed appearance
  • Respecting personal space
  • Cultural Diversity
• Negative gestures


  • Dropping shoulder with head held low
  • Looking down or away from the patient
  • Dingy, wrinkled lab coat; too much jewelry
  • Immediately approaching patient's space before greeting and explaining procedure
• Different kinds of patients


  • The excessively quiet
  • The hostile
  • The confused or disoriented
  • The full of question
  • The demanding
  • The over-friendly or seductive
  • The opinionated
  • The confident
  • The scared and in pain
  • The grieving
  • The frustrated
• Goal of communication in healthcare


  Ensure that the patient was able to fully comprehend the process of the procedure to be performed this also includes assurance of patient comfort and other important instructions.
• Elements of communication in healthcare


  • Empathy: identifying with the feelings or thoughts of another person
  • Control: in control of individual's self well-being; recognizing the fear of patients
  • Respect & Confirmation: demonstration of positive feeling; honoring the uniqueness of a person
  • Trust: unquestioning belief by the patient that health professionals are performing responsibilities
• How to achieve communication elements in phlebotomy

  • Give recognition: always greet your patients; give complements
  • Share information: explain the procedure
  • Listen do not just hear them: listen to their requests
  • Demonstrate empathy, understanding and patience: give considerations
  • Perform with comfort: do the procedure with ease
  • Express gratitude: always thank the patient after the procedure
• Telephone communication


  Fundamental part of communication in the hospital setting
• Proper telephone etiquette


  • Answer promptly
  • Introduce yourself
  • Be helpful
  • Prioritize calls
  • Transfer and put on-hold properly
  • Be prepared to record information
  • Know the laboratory policies
  • Defuse hostile situation
  • Try to assist everyone
• Administrative Order No 147 s 2004


  Revised Rules and Regulation Governing The Registration, Licensure and Operation of Hospitals and Other Health Facilities in the Philippines