Introduction to Phlebotomy

History of Phlebotomy
- “an incision into a vein”

- Oldest medical procedures by early Egyptians

- “bloodletting” is first used to cure diseases and maintain the body in a state of
well-being

- Hippocrates believed that 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.

- Bloodletting is now called “therapeutic phlebotomy”

- Greek “Phleb” (vein) and “tomia” (to cut) -Oldest medical procedure dating back to
the early Egyptians

Techniques for bloodletting (earlier times) includes:

a. suction cup devices with lancets that pulled blood from the incision
b. the application of blood-sucking worms called “leeches” to an incision
c. barber surgery – blood from an incision produced by the barber’s razor was
collected in a bleeding bowl

Phlebotomy
• Primary role of phlebotomy is the collection of blood samples for laboratory analysis
to diagnose and monitor medical conditions.
• Phlebotomist is cross-trained in venipuncture, capillary collection, patient care,
 receptionist duties, sample processing and computer work.

Duties of a Phlebotomist

Traditional Duties
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 labelling of all samples with the required information.
5. Appropriate transportation of samples back to the laboratory in a timely manner.
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
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
4. Performing and monitoring point-of-care testing (POCT)
5. Performing electrocardiogram
6. Performing measurement of patient’s vital signs
7. Collection of arterial blood samples
8. Collection of samples from central venous access devices(CVADs)

Professional and Personal Characteristics of a

Phlebotomist
1. Dependable, cooperative, committed
2. Compassionate, courteous, respectful
3. Integrity, honesty, competence
4. Organized, responsible, flexible
5. Appearance (Clothing, Hygiene)
6. Communication

- Verbal Skills
- Nonverbal Skills
- Body language

7. Respecting Cultural Diversity.

8. Telephone skills

Ethical and Legal Issues

- Principles of right and wrong, called the code of ethics, provide the personal and
professional rules of performance moral behaviour as set by members of a
profession. Medical ethics or bioethics focus on the patient to ensure that all
members of a health-care team possess and exhibit the skill, knowledge, training,
professionalism, and moral standards necessary to serve the patient.

Patient’s Rights (DOH)

Ethical and Legal Issues
• Tort- A wrongful act committed by one person against another that causes harm to
the person or his or her property.

• Assault-threat to touch another person without his or her consent and with the
intention of causing fear of harm.

• Battery- actual harmful touching of a person without his or her consent.

• Defamation- spoken or written words that can injure a person’s reputation.
e.g. -Releasing or are overheard saying any confidential information

• Libel- false defamatory writing that is published.

• Slander -false and malicious spoken word.
• Invasion of Privacy -is the violation of the patient’s right to be left alone and the
right to be free from unwanted exposure to public view.
e.g. -Unwanted releasing of confidential information is considered an invasion of
privacy.
e.g. -Entering a patient’s room without asking permission

• Medical Malpractice- misconduct or lack of skill by a health-care professional that

results in injury to the patient.

• Negligence- as failure to give reasonable care by the health-care provider, must be

proven in a malpractice suit

• In phlebotomy, be wary of the following that may cause the patient to file a case of
malpractice/negligence against you:
a. Nerve Injury
b. Hemorrhage:
- From accidental arterial puncture.
- From inadequate pressure to the vein

c. Drawing from inappropriate locations(ex. Same side as mastectomy).

d. Injuries occurring when a patient faints
e. Death of a Patient caused by misidentification of a patient or sample

Clinical Laboratory
• The clinical laboratory is divided into two areas, Anatomical and Clinical.
• The Anatomical Area is responsible for the analysis of surgical specimens, frozen
sections, biopsies, cytological specimens, and autopsies.

Administrative Office – responds to telephone calls, handles specimen collection

requests and handles some specimens.

Phlebotomy (Sample Collection) – collects samples from patients and processes

samples for testing or transport.

ANATOMICAL
1. Cytology Section - cytologists (CTs) process and examine tissue and body
fluids for the presence of abnormal cells, such as cancer cells. The Papanicolaou(Pap)
smear is one of the most common tests performed in cytology.

2. Histology Section - histologytechnicians (HTs) and technologists(HTLs)

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

3. Cytogenetics - is the section in which chromosome studies are performed

to detect genetic disorders. Blood, amniotic fluid, tissue, and bone marrow specimens
are analyzed.

CLINICAL
• The clinical area is divided into specialized sections: hematology, coagulation,
chemistry, bloodbank (immunohematology), serology (immunology), microbiology,
urinalysis, phlebotomy, and sample processing. In the clinical sections, blood, bone
marrow, microbiology samples, urine, and other body fluids are analyzed.

Hematology Section
- Hematology is the study of the formed (cellular) elements of the blood. In this
section, the cellular elements, red blood cells(RBCs), white blood cells(WBCs), and
platelets (Plts) are enumerated and classified in all body fluids and in the bone
marrow.

Coagulation Section
- The coagulation laboratory is sometimes a part of the hematology section, but in
larger laboratories it is a separate section. In this area, the overall process of
hemostasis is evaluated; this includes platelets, blood vessels, coagulation factors,
fibrinolysis, inhibitors, and anticoagulant therapy (heparin and Coumadin).

Clinical Chemistry Section

- Most automated area
- May perform electrophoresis, therapeutic drug monitoring and enzyme
immunoassays to measure substances such as proteins, carbohydrates, enzymes
and hormones and toxicology

Blood Bank Section

- Where blood may be collected, stored, and prepared for transfusion.
- Testing procedures involve RBC antigens (Ag) and antibodies (Ab).
- Blood from patients and donors is tested for its blood group (ABO) and Rh type. Also
tests compatibility (crossmatch) between patient and donor
- Detect and identification of abnormal antibodies

Immunology and Serology Section

- Performs tests to evaluate the body’s immune response; that is, the production of
antibodies (immunoglobulins) and cellular activation.

Microbiology Section
- Responsible for the identification of pathogenic microorganisms and for hospital
infection control. In large laboratories, the section may be divided into bacteriology,
mycology, parasitology, and virology.
- Common Tests include Culture and Sensitivity and Gram Staining

Urinalysis Section
- Routine screening procedure to detect disorders and infections of the kidney and to
detect metabolic disorders.
- Consists of physical, chemical, and microscopic examination of the urine