phlebo.1

• Phlebotomy


  An incision into a vein
• Phlebotomy was one of the oldest medical procedures

  Early Egyptians
• Bloodletting


  A practice used to cure disease and maintain the body in a state of well-being
• Hippocrates


  Believed disease was caused by an excess of body fluids, including blood, bile, and phlegm, and that removal of the excess would cause the body to return to or maintain a healthy state
• Techniques for bloodletting


  1. Suction cup devices with lancets that pulled blood from the incision

  2. Application of blood-sucking worms, called "leeches", to an incision

  3. Barber surgery, in which blood from an incision produced by the barber's razor was collected in a bleeding bowl
• Barber pole


  Symbolizes the barber surgery technique and represents red blood and white bandages and the pole that the patients held on to during the procedure
• Bloodletting


  Now called "therapeutic phlebotomy" and is used as a treatment for only a small number of blood disorders
• Phlebotomy


  The primary role is the collection of blood samples for laboratory analysis to diagnose and monitor medical conditions
• Phlebotomy has become a specialized area of clinical laboratory practice and has brought about the creation of the job title "phlebotomist"
• Phlebotomists are not available at all times and in all situations, so phlebotomy still remains a part of laboratory training programs for medical laboratory technicians and scientists
• Phlebotomist


  • No longer just someone who "takes blood" but is recognized as a key player on the health-care team
  • Must be familiar with the health-care system, the anatomy and physiology related to laboratory testing and phlebotomy, the collection and transport requirements for tests performed in all sections of the laboratory, documentation and patient records, and the interpersonal skills needed to provide quality patient care
• Phlebotomists often the only personal contact a patient has with the laboratory, so they can leave a lasting impression of the quality of the laboratory and the entire health-care setting
• Traditional duties and responsibilities of the phlebotomist

  • Correct identification and preparation of the patient before sample collection
  • Collection of the appropriate amount of blood by venipuncture or dermal puncture for the specified tests
  • Selection of the appropriate sample containers for the specified tests
  • Correct labeling of all samples with the required information
  • Appropriate transportation of samples back to the laboratory in a timely manner
  • Effective interaction with patients and hospital personnel
  • Processing of samples for delivery to the appropriate laboratory departments
  • Performance of computer operations and record-keeping pertaining to phlebotomy
  • Observation of all safety regulations, quality control checks, and preventive maintenance procedures
  • Attendance at continuing education programs
• Changes to increase the efficiency and cost effectiveness of the health-care delivery system

  • Eliminating the need to move patients to centralized testing areas and the necessity for health-care personnel to travel from a central testing area to the patient's room and then back to the testing area
  • Cross-training of persons already located in nursing units to perform basic interdisciplinary bedside procedures
  • Relocation of specialized radiology and clinical laboratory equipment and personnel to the patient-care units
• Patient-focused care


  Decentralization of phlebotomy by either cross-training personnel working in the patient units to perform phlebotomy or transferring phlebotomists to the patient units and cross-training them to perform basic patient-care tasks
• Additional duties of phlebotomists

  • Training other health-care personnel to perform phlebotomy
  • Monitoring the quality of samples collected on the units
  • Evaluation of protocols associated with sample collection
  • Performing and monitoring point-of-care testing (POCT)
  • Performing electrocardiograms
  • Performing measurement of patient's vital signs
  • Collection of arterial blood samples
  • Collection of samples from central venous access devices (CVADs)
• Characteristics associated with professionalism

  • Dependable, cooperative, committed
  • Compassionate, courteous, respectful
  • Integrity, honesty, competence
  • Organized, responsible, flexible
  • Appearance
  • Communication
• Dependable, cooperative, committed


  • Laboratory testing relies on the phlebotomist to report to work whenever scheduled and on time
  • Willing to demonstrate commitment to the job and cooperation to assist fellow employees
  • Attends staff meetings, reads pertinent memoranda, and observes notices placed on bulletin boards or in newsletters
• Compassionate, courteous, respectful


  • Sensitive to patient needs, understand patient concerns, and take time to reassure each patient
  • Introduce themselves to patients before approaching them
  • Understand and respect the cultural diversity of patients
• Integrity, honesty, competence


  • Never hesitate to admit a mistake, as a misidentified patient or mislabeled sample can be critical to patient safety
  • Protect patient confidentiality and never discuss patient information with anyone who does not have a professional need to know it
• Appearance


  • Neat and clean appearance that portrays a professional attitude to the patient
  • Clothing and lab coats must be clean and unwrinkled
  • Shoes must be clean, polished, closed toed, and skid-proof
  • Jewelry must be conservative, no dangling jewelry or facial piercings
  • Perfume and cologne must be kept to a minimum
  • Hair including facial hair must be clean, neat, and trimmed
• Communication skills


  • Verbal skills, listening skills, and nonverbal skills or body language are needed for effective communication
  • Verbal skills enable phlebotomists to introduce themselves, explain the procedure, reassure the patient, and help assure the patient that the procedure is being competently performed
  • Active listening involves 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, and encouraging patient communication by asking questions
  • Nonverbal skills (body language) include facial expressions, posture, eye contact, and hand gestures
• Verbal and listening skills make up approximately 20 percent of communication and nonverbal skills contribute approximately 80 percent
• 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
• Verbal communication


  Tone of voice and emphasis on certain words is important
• Barriers to verbal communication

  • Physical handicaps such as hearing impairment
  • Patient emotions
  • Level of patient education, age, and language proficiency
• Phlebotomist who recognizes communication barriers


  • Is better equipped to communicate with the patient
• Active listening


  • 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
• Nonverbal skills (body language)


  • Facial expressions, posture, and eye contact
• Positive body language (brisk entry, smile, direct eye contact)


  Makes patients feel important and that you care about them and your work
• Negative body language (shuffling, avoiding eye contact, gazing out window)


  Indicates boredom and disinterest in patients and their tests
• Zones of comfort vary among different cultures
• General cultural diversity guidelines for phlebotomists


  • Approach all patients with a smile and use a friendly tone of voice
  • Be alert to patient reactions and accommodate them, do not force your style
  • Do not stereotype a particular culture
  • Amount of personal space varies among cultures, some are not as welcoming to touching
  • Plan to spend additional time explaining procedures and instructions, ensure understanding
  • Show respect for their diversity
• Telephone skills


  • Essential for phlebotomists, phlebotomy department acts as a switchboard for the laboratory
• Rules of proper telephone etiquette

  • Answer promptly and politely
  • Check for emergencies before putting on hold, return calls on hold quickly
  • Keep writing materials beside phone
  • Make every attempt to help callers, transfer if needed
  • Provide accurate and consistent information
  • Speak clearly and verify understanding
• Goal 2 of the National Patient Safety Goals is to improve effectiveness of communication among caregivers
• Phlebotomy education programs


  • Combination of classroom instruction and clinical practice, follow national guidelines
• Membership in professional organizations enhances professionalism and provides continuing education opportunities
• Health-care settings for phlebotomists

  • Hospitals
  • Physician office laboratories
  • Health maintenance organizations
  • Reference laboratories
  • Urgent care centers
  • Nursing homes
  • Home health-care agencies
  • Clinics
  • Blood donor centers
• Traditional hospital services


  • Nursing services
  • Support services
  • Fiscal services
  • Professional services