PMLS II

• Phlebotomy


  The drawing of blood through surgical puncture of a vein
• Purposes of phlebotomy

  • Transfusion
  • Diagnostic testing
  • Medication
  • Experimental procedures
• Phlebotomy in the Middle Ages


  • Bloodletting was practiced by barbers whose red and white poles became the symbol of their trade
  • Aside from bloodletting, barbers also extract teeth, setting bones and treating wounds
• Bloodletting


  The act or practice of bloodletting as a therapeutic measure
• It was once thought that the practice of bloodletting would rid the body of diseases and provide a cure for almost all ailments
• Historical methods of phlebotomy

  • Venesection - A sharp lancet-type instrument pierced the veins and made them bleed
  • Cupping - Involved the application of a heated suction apparatus (cup) to the skin to draw blood to the surface
  • Leeching (Hirudo medicinalis) - Involves enticing the medicinal leeches to the spot needing blood-letting with a drop of milk or blood on the patient's skin
• Leech therapy


  The value of leech therapy lies in the components of the leech's saliva, which contains a local vasodilator, a local anesthetic, and hirudin
• George Washington had a severe throat infection and was bled of more than 9 pints of blood in less than 24 hours, and died on December 14, 1799


  December 1799
• The discovery of microorganisms as the causative agent for many diseases started to change the thinking of how to treat diseases
• Blood began to be examined for diagnostic purposes in the 19th century
• Purposes of phlebotomy today

  • Obtain blood for diagnostic purposes and to monitor prescribed treatment
  • Remove blood for transfusions at a donor center
  • Remove blood for therapeutic purposes, such as for polycythemia and hereditary hemochromatosis
• Phlebotomy procedures of Modern Day

  • Venipuncture
  • Capillary puncture
• Roles of a phlebotomist today

  • Drawing blood from blood donors and patients
  • Evaluate a patient's ability to withstand procedures
  • Explain various blood-drawing procedures to patients and answer any questions they may have
  • Perform basic care testing, such as blood glucose levels
  • Prepare urine, blood, and other specimens for testing
  • Maintain medical equipment such as test tubes, needles, and blood vials
• Approaches to phlebotomy


  • Centralized phlebotomy
  • Decentralized phlebotomy
  • Hybrid phlebotomy
• Centralized phlebotomy


  • Phlebotomist is dispatched from the laboratory to either nursing units or outpatient areas
  • After blood collection, the phlebotomist will bring the samples to the laboratory
  • The phlebotomist starts on the second round of collection
  • The remainder of the day is spent in returning to the nursing units or outpatient areas to collect one or two blood samples at a time as new tests are ordered
  • Difficulties in collecting blood from a patient also add a delay to the collection
• Decentralized phlebotomy


  • More people are collecting blood samples during the busy time
  • The duties of the hospital staff revolve more around the patient and the need to treat the patient quickly rather than being restricted to a specific job description
  • When the phlebotomist's blood collection duties are completed, he/she does not return to the laboratory but instead continues to work on the nursing unit
  • During the rest of the day, the phlebotomist collects blood samples that are needed, handles patient care, and does point of care laboratory tests
• Hybrid phlebotomy


  • A blend of centralized and decentralized phlebotomy
  • Typically sends laboratory-based phlebotomists to the nursing units during the early morning collections and then keeps a limited number of phlebotomists available the rest of the day to help patient care technicians with difficult collections
  • Mostly done in the hospitals today
• Professional and personal traits of a phlebotomist

  • Dependable, Cooperative, and Committed
  • Compassionate, Courteous, and Respectful
  • Honesty, Integrity, and Competence
  • Organized, Responsible, and Flexible
• Dependable, Cooperative, and Committed


  • Failure to appear or arriving late puts additional pressure on the staff members present
  • Be willing to demonstrate your commitment to your job and your cooperation to assist fellow employees
• Compassionate, Courteous, and Respectful


  • Phlebotomist must be sensitive to the patient's needs, understand a patient's concern about a possible diagnosis
  • Courteous phlebotomists introduce themselves to the patients before they approach them
• Honesty, Integrity, and Competence


  • The phlebotomist should never hesitate to admit a mistake, because a misidentified patient or mislabeled sample can be critical to patient safety
  • Phlebotomists must demonstrate competence in the procedures they are trained to perform
• Organized, Responsible, and Flexible


  • Always maintain an organized and well-stocked collection tray or station
  • Not only do phlebotomists need to organize their collection equipment but they must also organize and prioritize their work
• First impression


  • The appearance of the phlebotomist is the first thing noticed by a patient
  • First impressions are lasting impressions often made within 30 seconds and the phlebotomist represents the entire laboratory staff
  • A sloppy appearance indicates a tendency toward sloppy performance
• General appearance guidelines for phlebotomists

  • Clothing and lab coats must be clean and unwrinkled
  • Clothing worn under the laboratory coat should be conservative and meet institutional requirements
  • Shoes must be clean, polished, closed toed, and skid-proof
  • Perfume and cologne are usually not recommended or must be kept to a minimum
  • Hair, including facial hair must be clean, neat, and trimmed
  • Fingernails must be clean and short
• Verbal skills


  Enable phlebotomists to introduce themselves, explain the procedure and reassure the patient
• Verbal communication barriers


  • Hearing Impairment
  • Patient emotions
  • Age and education levels
  • Not speaking the local language
• Hearing Impairment


  • Speak loudly and clearly with hand gestures
  • Look directly at the patient to facilitate lip-reading
• Patient emotions


  • Speak calmly and slowly
  • Do not appear rushed or disinterested
• Age and education levels


  • Avoid medical jargon, "you are collecting a blood sample" rather than "performing a phlebotomy"
  • Use age-appropriate phrases
• Not speaking the local language

  • Locate a hospital-based interpreter
  • Use hand signals, show equipment, etc
  • Remain calm, smiling, and reassuring
• Listening skills


  • Looking directly and attentively at the patient
  • Encouraging the patient to express feelings, anxieties, and concerns by asking questions and giving the patient enough time to explain
  • Providing feedback to the patient through appropriate responses
• Nonverbal skills


  • Facial expressions, posture, and eye 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
• Telephone skills


  • Answer the phone promptly and politely
  • Always check for an emergency before putting someone on hold
  • Keep writing materials beside the phone to record information
  • Make every attempt to help callers, and if you cannot help them, transfer them to another person or department that can
  • Speak clearly and make sure you understand what the caller is asking and that he or she understands the information you are providing
  • Ask the caller to repeat the information you have given
  • Provide accurate and consistent information by keeping current with laboratory policies, looking up information published in department manuals, or asking a supervisor
• Clinical laboratory areas


  • Anatomical - responsible for the analysis of surgical specimens, frozen sections, biopsies, cytological specimens, and autopsies
  • Clinical - responsible for the analysis of blood, bone marrow, microbiology samples, urine, and other body fluids
• Clinical laboratory sections


  • Hematology
  • Coagulation
  • Blood Bank
  • Serology
  • Chemistry
  • Microbiology
  • Urinalysis
  • Phlebotomy
• Anatomical laboratory sections


  • Cytology
  • Histology
  • Cytogenetics
• Cytology


  Cytologists process and examine tissue and body fluids for the presence of abnormal cells, such as cancer cells. Papanicolau smear is one of the most common tests performed in cytology
• Histology


  Histotechnicians process and stain tissues obtained from biopsies, surgery, autopsies, and frozen sections. A pathologist then examines the tissue.
• Cytogenetics


  The section in which chromosome studies are performed to detect genetic disorders
• Main laboratory areas


  • Office section - receives and routes laboratory-related telephone calls, sample collection requests, and some patient samples
  • Sample collection area - close proximity to the office; more commonly known as phlebotomy area or extraction area