02 Understanding Phlebotomy

• PHLEBOTOMY

  • THE PROCESS OF COLLECTING BLOOD THROUGH THE VEIN BY USING INCISION OR A PUNCTURE METHODS TO DRAW BLOOD FOR ANALYSIS OR AS PART OF THERAPEUTIC OR DIAGNOSTIC MEASURES UNDER THE PHYSICIAN’S REQUEST.
• PHLEBOTOMY

  • THE WORD IS DERIVED FROM TWO GREEK WORDS: PHLEBOS, WHICH MEANS VEIN, AND TEMNEIN, WHICH MEANS TO CUT. IT IS ALSO CALLED AS VENESECTION.
• EVOLUTION OF PHLEBOTOMY

  • THE ANCIENT EGYPTIANS PRACTICED PHLEBOTOMY AS A FORM OF “BLOODLETTING” AS EARLY AS 1400 BC
• EVOLUTION OF PHLEBOTOMY

  • HIPPOCRATES (460-377 BC), A GREEK PHYSICIAN, BELIEVED THAT A PERSON’S HEALTH WAS DEPENDENT ON THE BALANCE OF THE FOUR HUMORS:

  1. EARTH – BLOOD AND BRAIN
  2. AIR – PHLEGM AND LUNGS
  3. FIRE – BLACK BILE AND SPLEEN
  4. WATER – YELLOW BILE AND GALL BLADDER
• EVOLUTION OF PHLEBOTOMY

  • THE REMOVAL OF EXCESS HUMOR THROUGH BLOODLETTING MUST BE PERFORMED TO KEEP THE BALANCE.
• EVOLUTION OF PHLEBOTOMY

  • MIDDLE AGES – BARBER-SURGEONS PERFORMED BLOODLETTING AS PART OF THE TREATMENT FOR SOME ILLNESSES.
• EVOLUTION OF PHLEBOTOMY

  • 17TH AND 18TH CENTURY – PHLEBOTOMY WAS TREATED AS A MAJOR THERAPY
• EVOLUTION OF PHLEBOTOMY

  • CUPPING – IS AN ALTERNATIVE MEDICINE THAT HELPS EASE PAIN, INFLAMMATION, OR OTHER HEALTH-RELATED CONCERNS. IT INVOLVES THE USE OF SPECIAL HEATED SUCTION CUPS AND A FLEAM (LANCET).
• EVOLUTION OF PHLEBOTOMY

  LEECHING

  • ALSO KNOWN AS HIRUDOTHERAPY
  • A METHOD THAT USES LEECHES FOR BLOODLETTING AND IS CURRENTLY USED FOR MICROSURGICAL REPLANTATION.
  • IT INVOLVES PLACING A DROP OF MILK OR BLOOD ON THE PATIENT’S SKIN AND INTRODUCING HIRUDO MEDICINALIS (MEDICINAL LEECH) TO THE SITE, ALLOWING IT TO ENGORGE AND FALL OFF.
• EVOLUTION OF PHLEBOTOMY

  BLOODLETTING

  • IS NOW CALLED “THERAPEUTIC PHLEBOTOMY”
  • USED AS A TREATMENT FOR ONLY A SMALL NUMBER OF BLOOD DISORDERS SUCH AS HEMOCHROMATOSIS.
• BLOODLETTING TOOLS:

  1. Scarificator
  2. Suction Cup Device
• MAIN GOALS OF THE PHLEBOTOMY PRACTICE

  1. FOR DIAGNOSIS AND TREATMENT USING BLOOD SAMPLES.
  2. FOR TRANSFUSION, TO REMOVE BLOOD FROM THE DONOR.
  3. FOR REMOVAL OF BLOOD FOR POLYCYTHEMIA OR THERAPEUTIC PURPOSES.
• MAIN METHODS USED IN PHLEBOTOMY

  1. VENIPUNCTURE – THE METHOD OF BLOOD COLLECTION USING A NEEDLE INSERTED IN A VEIN.
  2. CAPILLARY PUNCTURE – DONE BY PUNCTURING THE SKIN.
• ROLE OF THE PHLEBOTOMISTS

  • TO COLLECT BLOOD SAMPLES FOR LABORATORY TESTING OR FOR TRANSFUSION
  • PROPERLY LABEL COLLECTED BLOOD SAMPLES WITH NECESSARY DATA TO IDENTIFY THE PATIENT
  • RESPONSIBLE IN DELIVERING OR TRANSPORTING COLLECTED SAMPLES WITHIN APPROPRIATE PRESCRIBED TIME LIMITS.
  • IN OTHER INSTITUTIONS, PHLEBOTOMISTS ALSO PROCESS COLLECTED SAMPLES SUCH AS CENTRIFUGING AND ALIQUOTING SAMPLES READY FOR LABORATORY TESTING.
  • ASKED TO ASSIST IN COLLECTING OTHER SPECIMENS SUCH AS URINE AND OTHER NON-BLOOD SAMPLES FROM PATIENTS.
• TRAITS THAT FORM THE PROFESSIONAL

  IMAGE OF THE PHLEBOTOMISTS

  • GOOD MANUAL DEXTERITY
  • SPECIAL COMMUNICATION SKILLS
  • GOOD ORGANIZATIONAL SKILLS
  • THOROUGH KNOWLEDGE OF LABORATORY SPECIMEN REQUIREMENTS
  • TRAINING IN PHLEBOTOMY SKILLS COUPLED WITH STANDARD PRACTICE
• TRAITS THAT FORM THE PROFESSIONAL IMAGE OF THE PHLEBOTOMISTS:

  --- CREDENTIALS

  PHLEBOTOMISTS SHOULD HAVE THE FOLLOWING:

  • CERTIFICATION OR LICENSE

  • CONTINUING EDUCATION
• TRAITS THAT FORM THE PROFESSIONAL IMAGE OF THE PHLEBOTOMISTS:

  --- PATIENT-CLIENT INTERACTION

  • SHOULD BE REASSURING AND PLEASANT WHEN DEALING WITH PATIENTS
  • SHOULD BE ABLE TO COMMUNICATE WELL DESPITE CULTURAL AND SOCIAL DIFFERENCES
  • SHOULD MAINTAIN POSITIVE CUSTOMER RELATIONS
  • MUST UNDERSTAND THE DIVERSITY OF PATIENTS AND BE ABLE TO ADJUST ACCORDINGLY
• TRAITS THAT FORM THE PROFESSIONAL IMAGE OF THE PHLEBOTOMISTS:

  --- QUALITIES OF PROFESSIONALISM

  • PROFESSIONAL APPEARANCE SHOULD BE MAINTAINED
  • MUST HAVE SELF-CONFIDENCE
  • MUST BE PERSONS OF INTEGRITY, EXHIBITING HONESTY AND CONSISTENCY IN THEIR ACTIONS, VALUES AND BELIEFS
  • MUST SHOW COMPASSION, SENSITIVITY TO THE NEEDS OF OTHERS AND THE ABILITY TO STAY CALM AND MAINTAIN A HELPFUL DEMEANOR TOWARDS THOSE IN NEED
• TRAITS THAT FORM THE PROFESSIONAL IMAGE OF THE PHLEBOTOMISTS:

  --- QUALITIES OF PROFESSIONALISM

  • SELF-MOTIVATED, HAVING POSITIVE ATTITUDE AND THE INITIATIVE TO FOLLOW THROUGH TASKS AND CONTINUOUSLY LOOK FOR AREAS OF IMPROVEMENT
  • DEPENDABLE, OBSERVE PROPER WORK ETIC AND TAKE PERSONAL RESPONSIBILITY FOR THEIR ACTIONS
  • DISPLAY GOOD ETHICAL BEHAVIOR, CONFORMING WITH STANDARDS SO AS TO AVOID EXPOSING PATIENTS TO HARM
• PHLEBOTOMISTS NEED TO HAVE GOOD COMMUNICATION SKILLS WHICH ARE ESSENTIAL TO ENSURE THAT THE PATIENT FEELS AT EASE DURING THE VENIPUNCTURE PROCEDURE.
• COMMUNICATION IS IMPORTANT IN THE HEALTHCARE SETTING BECAUSE OF VALUABLE INFORMATION THAT NEEDS TO BE TRANSMITTED PROPERLY FROM ONE PATIENT TO ANOTHER.
• THE COMPONENTS OF GOOD COMMUNICATION ARE AS FOLLOWS:

  • VERBAL COMMUNICATION
  • NON-VERBAL COMMUNICATION
  • ACTIVE LISTENING
• TRAITS THAT FORM THE PROFESSIONAL IMAGE OF THE PHLEBOTOMISTS:

  • CREDENTIALS
  • PATIENT-CLIENT INTERACTION
  • QUALITIES OF PROFESSIONALISM
• VERBAL COMMUNICATION

  • VERBAL SKILLS
  • TO INTRODUCE THEMSELVES, EXPLAIN THE PROCEDURE, REASSURE THE PATIENT, AND HELP ASSURE THE PATIENT THAT THE PROCEDURE IS BEING COMPETENTLY PERFORMED.
  • BARRIERS TO VERBAL COMMUNICATION THAT MUST BE CONSIDERED INCLUDE PHYSICAL HANDICAPS SUCH AS HEARING IMPAIRMENT; PATIENT EMOTIONS; AND THE LEVEL OF PATIENT EDUCATION, AGE, AND LANGUAGE PROFICIENCY.
• NON-VERBAL COMMUNICATION

  • NONVERBAL SKILLS
  • INCLUDE FACIAL EXPRESSIONS, POSTURE, AND EYE CONTACT. IF YOU WALK BRISKLY INTO THE ROOM, SMILE, AND LOOK DIRECTLY AT THE PATIENT WHILE TALKING, YOU DEMONSTRATE POSITIVE BODY LANGUAGE. THIS MAKES PATIENTS FEEL THAT THEY ARE IMPORTANT AND THAT YOU CARE ABOUT THEM AND YOUR WORK
  • 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.
• COMMUNICATION SKILLS

  • LISTENING 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