Phlebotomy

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Phlebotomy
Phlebotomy-practice-university-of-delaware.jpg
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.

Contents

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]

Etymology

From Ancient Greek : φλεβοτομία (phlebotomiaphleb 'blood vessel, vein' + tomia 'cutting'), via Old French : flebothomie (modern French phlébotomie).[ citation needed ]

Phlebotomies

Blood is collected from a vein by a phlebotomist Drawing blood from a vein through phlebotomy and venipuncture.jpg
Blood is collected from a vein by a phlebotomist

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]

Australia

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]

United Kingdom

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]

United States

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.

South Africa

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.

Sample tube types

Vacutainer/sample tube types for venipuncture/phlebotomy   edit
Tube cap color or type in order of drawAdditiveUsage and comments
Blood culture bottleSodium 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 to the proper line.
Plain redNo additiveSerum: 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.
OrangeClot activator and serum separating gel [17] Rapid serum-separating tube (RST).
Dark greenSodium heparin (anticoagulant)Chromosome testing, HLA typing, ammonia, lactate
Light greenLithium 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
PinkK2 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
TanSodium 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

Draw station

A phlebotomy draw station is a place where blood is drawn from patients for laboratory testing, transfusions, donations, or research purposes. The blood is typically drawn via venipuncture or a finger stick by a healthcare professional such as a phlebotomist, nurse, or medical assistant. [21] The draw station typically includes a padded chair or a bed for patients prone to fainting during blood draws. Draw stations can be found in various settings, such as hospitals, clinics, blood donation centers, and independent laboratories or as part of patient service centers (PSC).

History

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.

See also

Related Research Articles

<span class="mw-page-title-main">Bloodletting</span> Therapy, now rarely used in medicine

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 was 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.

<span class="mw-page-title-main">Clinical chemistry</span> Area of clinical pathology that is generally concerned with analysis of bodily fluids

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.

<span class="mw-page-title-main">Test tube</span> Glass or plastic laboratory glassware

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.

<span class="mw-page-title-main">Venipuncture</span> Process of obtaining intravenous access

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.

<span class="mw-page-title-main">Vacutainer</span> Type of blood collection equipment for medical testing

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.

<span class="mw-page-title-main">Blood test</span> Laboratory analysis performed on a blood sample

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.

<span class="mw-page-title-main">Blood culture</span> Test to detect bloodstream infections

A blood culture is a medical laboratory test used to detect bacteria or fungi in a person's blood. Under normal conditions, the blood does not contain microorganisms: their presence can indicate a bloodstream infection such as bacteremia or fungemia, which in severe cases may result in sepsis. By culturing the blood, microbes can be identified and tested for resistance to antimicrobial drugs, which allows clinicians to provide an effective treatment.

In human anatomy, the median cubital vein is a superficial vein of the arm on the anterior aspect of the elbow. It classically shunts blood from the cephalic to the basilic vein at the roof of the cubital fossa. It is typically the most prominent superficial vein in the human body, and is visible when all other veins are hidden by fat or collapsed during a shock.

<span class="mw-page-title-main">Fresh frozen plasma</span> Liquid portion of whole blood

Fresh frozen plasma (FFP) is a blood product made from the liquid portion of whole blood. It is used to treat conditions in which there are low blood clotting factors or low levels of other blood proteins. It may also be used as the replacement fluid in plasma exchange. Using ABO compatible plasma, while not required, may be recommended. Use as a volume expander is not recommended. It is administered by slow injection into a vein.

<span class="mw-page-title-main">Medical laboratory scientist</span> Medical professional who works in the laboratory

A Medical Laboratory Scientist (MLS) or Clinical Laboratory Scientist (CLS) or Medical Technologist (MT) is a licensed Healthcare professional who performs diagnostic testing of body fluids, blood and other body tissue. The Medical Technologist is tasked with releasing the patient results to aid in further treatment. The scope of a medical laboratory scientist's work begins with the receipt of patient or client specimens and finishes 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.

<span class="mw-page-title-main">Winged infusion set</span> Specialized venipuncture needle

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.

<span class="mw-page-title-main">Medical laboratory</span> Principles of management with special reference to medical science

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.

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<span class="mw-page-title-main">Sampling (medicine)</span> Collection of bodily substances for medical assessment

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.

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<span class="mw-page-title-main">Iatrogenic anemia</span> Anemia caused by medical interventions

Iatrogenic anemia, also known as nosocomial anemia or hospital-acquired anemia, is a condition in which a person develops anemia due to medical interventions, most frequently repeated blood draws. Other factors that contribute to iatrogenic anemia include bleeding from medical procedures and dilution of the blood by intravenous fluids. People may receive blood transfusions to treat iatrogenic anemia, which carries risks for complications like transfusion reactions and circulatory overload.

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.

References

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