![]() | The examples and perspective in this article may not represent a worldwide view of the subject.(July 2018) |
Phlebotomy | |
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![]() Students practising phlebotomy | |
ICD-9-CM | 38.99 |
MeSH | D018962 |
Phlebotomy is the process of making a puncture in a vein, usually in the arm, with a cannula for the purpose of drawing blood. [1] The procedure itself is known as a venipuncture, which is also used for intravenous therapy. A person who performs a phlebotomy is called a phlebotomist, although most doctors, nurses, and other technicians can also carry out a phlebotomy. [2] In contrast, phlebectomy is the removal of a vein.
Phlebotomies that are carried out in the treatment of some blood disorders are known as therapeutic phlebotomies . [3] The average volume of whole blood drawn in a therapeutic phlebotomy to an adult is 1 unit (450–500 ml) weekly to once every several months, as needed. [4]
From Ancient Greek : φλεβοτομία (phlebotomia – phleb 'blood vessel, vein' + tomia 'cutting'), via Old French : flebothomie (modern French phlébotomie).[ citation needed ]
Phlebotomies are carried out by phlebotomists – people trained to draw blood mostly from veins for clinical or medical testing, transfusions, donations, or research. Blood is collected primarily by performing venipunctures, or by using capillary blood sampling with [5] fingersticks or a heel stick in infants for the collection of minute quantities of blood. [6] The duties of a phlebotomist may include interpreting the tests requested, drawing blood into the correct tubes with the proper additives, accurately explaining the procedure to the person and preparing them accordingly, practicing the required forms of asepsis, practicing standard and universal precautions, restoring hemostasis of the puncture site, giving instructions on post-puncture care, affixing tubes with electronically printed labels, and delivering specimens to a laboratory. [7] Some countries, states, or districts require that phlebotomists be licensed or registered.[ citation needed ]
A therapeutic phlebotomy may be carried out in the treatment of some blood disorders (example: Hemochromatosis, polycythemia vera, porphyria cutanea tarda), and chronic hives (in research). [8] [9]
In Australia, there are a number of courses in phlebotomy offered by educational institutions, but training is typically provided on the job. The minimum primary qualification for phlebotomists in Australia is a Certificate III in Pathology Collection (HLT37215) from an approved educational institution. [10]
In the UK there is no requirement for holding a formal qualification or certification prior to becoming a phlebotomist as training is usually provided on the job. The NHS offers training with formal certification upon completion. [11]
Special state certification in the United States is required only in four states: California, Washington, Nevada, and Louisiana. A phlebotomist can become nationally certified through many different organizations. However, California currently only accepts national certificates from six agencies. These include the American Certification Agency (ACA), American Medical Technologists (AMT), American Society for Clinical Pathology (ASCP), National Center for Competency Testing/Multi-skilled Medical Certification Institute (NCCT/MMCI), National Credentialing Agency (NCA), and National Healthcareer Association (NHA). [12] These and other agencies such as the American Society of Phlebotomy Technicians also certify phlebotomists outside the state of California. To qualify to sit for an examination, candidates must complete a full phlebotomy course and provide documentation of clinical or laboratory experience.
In South Africa learnerships to qualify as a Phlebotomy Technician are offered by many public and private educational institutions as well as by private academies owned up by pathology laboratories (such as Ampath Laboratories, Lancet, PathCare) and healthcare service providers (such as Netcare, South African National Blood Service). Some of the larger retail pharmacy chains offering in-store clinical services (such as Clicks, Dis-Chem) also provide training for aspirant phlebotomists. Certification can be obtained from a number of examination and testing institutions. To work as a phlebotomist in South Africa, registration with the Health Professions Council of South Africa (HPCSA) is required.
Tube cap color or type in order of draw | Additive | Usage and comments |
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Blood culture bottle | Sodium polyanethol sulfonate (anticoagulant) and growth media for microorganisms | Usually drawn first for minimal risk of contamination. [13] Two bottles are typically collected in one blood draw; one for aerobic organisms and one for anaerobic organisms. [14] |
Blue ("light blue") | Sodium citrate (weak calcium chelator/anticoagulant) | Coagulation tests such as prothrombin time (PT) and partial thromboplastin time (PTT) and thrombin time (TT). Tube must be filled 100%. |
Plain red | No additive | Serum: Total complement activity, cryoglobulins |
Gold (sometimes red and grey "tiger top" [15] ) | Clot activator and serum separating gel [16] | Serum-separating tube (SST): Tube inversions promote clotting. Most chemistry, endocrine and serology tests, including hepatitis and HIV. |
Orange | Clot activator and serum separating gel [17] | Rapid serum-separating tube (RST). |
Dark green | Sodium heparin (anticoagulant) | Chromosome testing, HLA typing, ammonia, lactate |
Light green | Lithium heparin (anticoagulant) Plasma separator gel | Plasma . Tube inversions prevent clotting |
Lavender ("purple") | EDTA (chelator / anticoagulant) | Whole blood : CBC, ESR, Coombs test, platelet antibodies, flow cytometry, blood levels of tacrolimus and cyclosporin |
Pink | K2 EDTA (chelator / anticoagulant) | Blood typing and cross-matching, direct Coombs test, HIV viral load |
Royal blue ("navy") | EDTA (chelator / anticoagulant) | Trace elements, heavy metals, most drug levels, toxicology |
Tan | Sodium EDTA (chelator / anticoagulant) | Lead |
Gray | Fluoride Oxalate
| Glucose , lactate, [19] toxicology [20] |
Yellow | Acid-citrate-dextrose A (anticoagulant) | Tissue typing, DNA studies, HIV cultures |
Pearlescent ("white") | Separating gel and (K2)EDTA | PCR for adenovirus, toxoplasma and HHV-6 |
Black | Sodium Citrate | Paediatric ESR |
QuantiFERON Grey, Green, Yellow, Purple | QuantiFERON 1. Grey (nil) tube 2. Green (TB1 antigen) tube 3. Yellow (TB2 antigen) tube 4. Purple (mitogen) tube | Tuberculosis |
Early phlebotomists used techniques such as leeches and incision to extract blood from the body. Bloodletting was used as a therapeutic as well as a prophylactic process, thought to remove toxins from the body and to balance the humors. While physicians did perform bloodletting, it was a specialty of barber surgeons, the primary provider of health care to most people in the medieval and early modern eras.
Pathology is the study of disease and injury. The word pathology also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatment, the term is often used in a narrower fashion to refer to processes and tests that fall within the contemporary medical field of "general pathology", an area that includes a number of distinct but inter-related medical specialties that diagnose disease, mostly through analysis of tissue and human cell samples. Idiomatically, "a pathology" may also refer to the predicted or actual progression of particular diseases, and the affix pathy is sometimes used to indicate a state of disease in cases of both physical ailment and psychological conditions. A physician practicing pathology is called a pathologist.
A capillary is a small blood vessel, from 5 to 10 micrometres in diameter, and is part of the microcirculation system. Capillaries are microvessels and the smallest blood vessels in the body. They are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the site of the exchange of many substances from the surrounding interstitial fluid, and they convey blood from the smallest branches of the arteries (arterioles) to those of the veins (venules). Other substances which cross capillaries include water, oxygen, carbon dioxide, urea, glucose, uric acid, lactic acid and creatinine. Lymph capillaries connect with larger lymph vessels to drain lymphatic fluid collected in microcirculation.
Bloodletting is the withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by leeches, was based on an ancient system of medicine in which blood and other bodily fluids were regarded as "humours" that had to remain in proper balance to maintain health. It is claimed to have been the most common medical practice performed by surgeons from antiquity until the late 19th century, a span of over 2,000 years. In Europe, the practice continued to be relatively common until the end of the 19th century. The practice has now been abandoned by modern-style medicine for all except a few very specific medical conditions. In the beginning of the 19th century, studies had begun to show the harmful effects of bloodletting.
Clinical chemistry is a division in medical laboratory sciences focusing on qualitative tests of important compounds, referred to as analytes or markers, in bodily fluids and tissues using analytical techniques and specialized instruments. This interdisciplinary field includes knowledge from medicine, biology, chemistry, biomedical engineering, informatics, and an applied form of biochemistry.
A test tube, also known as a culture tube or sample tube, is a common piece of laboratory glassware consisting of a finger-like length of glass or clear plastic tubing, open at the top and closed at the bottom.
Transfusion medicine is the branch of medicine that encompasses all aspects of the transfusion of blood and blood components including aspects related to hemovigilance. It includes issues of blood donation, immunohematology and other laboratory testing for transfusion-transmitted diseases, management and monitoring of clinical transfusion practices, patient blood management, therapeutic apheresis, stem cell collections, cellular therapy, and coagulation. Laboratory management and understanding of state and federal regulations related to blood products are also a large part of the field.
In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous blood sampling or intravenous therapy. In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics, phlebotomists, dialysis technicians, and other nursing staff. In veterinary medicine, the procedure is performed by veterinarians and veterinary technicians.
A vacutainer blood collection tube is a sterile glass or plastic test tube with a colored rubber stopper creating a vacuum seal inside of the tube, facilitating the drawing of a predetermined volume of liquid. Vacutainer tubes may contain additives designed to stabilize and preserve the specimen prior to analytical testing. Tubes are available with a safety-engineered stopper, with a variety of labeling options and draw volumes. The color of the top indicates the additives in the vial.
A blood gas test or blood gas analysis tests blood to measure blood gas tension values, it also measures blood pH, and the level and base excess of bicarbonate. The source of the blood is reflected in the name of each test; arterial blood gases come from arteries, venous blood gases come from veins and capillary blood gases come from capillaries. The blood gas tension levels of partial pressures can be used as indicators of ventilation, respiration and oxygenation. Analysis of paired arterial and venous specimens can give insights into the aetiology of acidosis in the newborn.
A blood test is a laboratory analysis performed on a blood sample that is usually extracted from a vein in the arm using a hypodermic needle, or via fingerprick. Multiple tests for specific blood components, such as a glucose test or a cholesterol test, are often grouped together into one test panel called a blood panel or blood work. Blood tests are often used in health care to determine physiological and biochemical states, such as disease, mineral content, pharmaceutical drug effectiveness, and organ function. Typical clinical blood panels include a basic metabolic panel or a complete blood count. Blood tests are also used in drug tests to detect drug abuse.
A Medical Laboratory Scientist (MLS) or Clinical Laboratory Scientist (CLS) or Medical Technologist (MT) performs diagnostic testing of blood and body fluids in clinical laboratories. The scope of a medical laboratory scientist's work begins with the receipt of patient or client specimens and terminates with the delivery of test results to physicians and other healthcare providers. The utility of clinical diagnostic testing relies squarely on the validity of test methodology. To this end, much of the work done by medical laboratory scientists involves ensuring specimen quality, interpreting test results, data-logging, testing control products, performing calibration, maintenance, validation, and troubleshooting of instrumentation as well as performing statistical analyses to verify the accuracy and repeatability of testing. Medical laboratory scientists may also assist healthcare providers with test selection and specimen collection and are responsible for prompt verbal delivery of critical lab results. Medical Laboratory Scientists in healthcare settings also play an important role in clinical diagnosis. An estimated 70% of medical decisions are based on laboratory test results and MLS contributions affect 95% of a health system's costs.
Radiographers, also known as radiologic technologists, diagnostic radiographers and medical radiation technologists are healthcare professionals who specialise in the imaging of human anatomy for the diagnosis and treatment of pathology. Radiographers are infrequently, and almost always erroneously, known as x-ray technicians. In countries that use the title radiologic technologist they are often informally referred to as techs in the clinical environment; this phrase has emerged in popular culture such as television programmes. The term radiographer can also refer to a therapeutic radiographer, also known as a radiation therapist.
A winged infusion set—also known as "butterfly" or "scalp vein" set—is a device specialized for venipuncture: i.e. for accessing a superficial vein or artery for either intravenous injection or phlebotomy. It consists, from front to rear, of a hypodermic needle, two bilateral flexible "wings", flexible small-bore transparent tubing, and lastly a connector. This connector attaches to another device: e.g. syringe, vacuum tube holder/hub, or extension tubing from an infusion pump or gravity-fed infusion/transfusion bag/bottle.
The American Society for Clinical Pathology (ASCP), formerly known as the American Society of Clinical Pathologists is a professional association based in Chicago, Illinois encompassing 130,000 pathologists and laboratory professionals.
A medical laboratory or clinical laboratory is a laboratory where tests are conducted out on clinical specimens to obtain information about the health of a patient to aid in diagnosis, treatment, and prevention of disease. Clinical medical laboratories are an example of applied science, as opposed to research laboratories that focus on basic science, such as found in some academic institutions.
The National Healthcareer Association (NHA) is a national professional certification agency for healthcare workers in the United States. Granting credentials in more than 8 allied health specialties, it is an organizational member of the National Organization for Competency Assurance (NOCA). The National Healthcareer Association partners with educational institutions nationwide with over 350,000 certified individuals. It is one of the largest certification and continuing education providers. The National Healthcareer Association works with health training institutions, hospitals, unions, and the US Defense Department through DANTES; it has approved over 2400 training/testing locations throughout the US and in several countries. These institutions offer allied health programs and use the national certification as their "End Of Program Credential." Healthcare professional certification is different from a license such as a Registered Nurse, or a licensed practical nurse. Although certification is not state mandated and/or regulated in all 50 states, most employers and industry organizations prefer their employees to be certified.
In medicine, sampling is gathering of matter from the body to aid in the process of a medical diagnosis and/or evaluation of an indication for treatment, further medical tests or other procedures. In this sense, the sample is the gathered matter, and the sampling tool or sampler is the person or material to collect the sample.
A healthcare technician is a health professional that provides care to patients. Healthcare technician's primary position is to assist medical staff complete tasks around their assigned unit or clinic's and accommodate patient needs. Healthcare technicians are typically found in specialty clinics, intensive care, emergency departments, or laboratory collection facilities. Technicians will perform basic cardiology reports such as, electrocardiograms and will have basic understanding of bodily function. The technician is an integral member of the unit-based healthcare team, they contribute to the continuity of care by decreasing fragmentation through decentralization of selected diagnostic and therapeutic treatment modalities.
Phlebotomy licensure is the process by which various regulatory bodies regulate the practice of phlebotomy within its jurisdiction through licensure. In many countries a license is not required, or is obtained through other broader qualifications, while in others, professional phlebotomists are separately licensed.
Phlebotomy licensure in the United States is the process by which various regulatory bodies regulate the practice of phlebotomy through licensure. There are no federal phlebotomy training or certification requirements, though several states have imposed their own requirements. In 2024, four states require licensure for phlebotomy: California, Louisiana, Nevada, and Washington.
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