DEFINITION OF PHLEBOTOMY In 1799

▪ Process of collecting blood ▪ 1st US president, George Washington,

▪ Act or practice of bloodletting as a had a severe throat infection.
therapeutic measure (Webster ▪ Cure was heavy bleeding for more than 9
dictionary) pints of blood in less than 24 hours
▪ Result? Death
▪ Beginning to change philosophy of
HISTORY OF PHLEBOTOMY bleeding as cure to disease

▪ Was a cure for disease In the middle of 19th century

o Bleeding removed “bad” blood
▪ Discovery of microorganisms as
o Methods of bleeding:
causative agent of disease started to
• Venesection
change thinking of how to treat diseases
• Cupping
➢ Leeches
• Leeches
o Limited uses today
➢ Venesection
o Problem: leech has to be
o Sharp lancet-like instrument
changed from time to time
pierced the veins to bleed
because it easily gets full
o Often used to reduce fever or to
o Are used for amputations to
produce a faint so an expectant
remove excess blood and
mother would deliver her baby
prevent clotting when an
by the time she recovered
appendage is reattached
➢ Cupping
▪ Therapeutic phlebotomy usually
o A heated glass cup was placed
removes 500 mL of blood from the
on a person’s back
patient.
o As the cup is cooled, it created a
▪ Bleeding in from of therapeutic
suction that pulled blood to the
phlebotomy done today for diseases like
capillaries under the cup
polycythemia vera and hereditary
o Then a spring-loaded box
hemochromatosis
containing multiple blades cut
the area to produce massive
bleeding
 PHLEBOTOMY IN HEALTH CARE AREAS OF NURSING

➢ Phlebotomist ▪ Neonatal
o Multiskilled ▪ Obstetrics
o Known as laboratory ▪ Oncology
representative ▪ Orthopedics
▪ The phlebotomist today handles patient- ▪ Pediatrics
focused care and more duties than just ▪ Intensive Care
phlebotomy. ▪ Coronary Care
▪ Phlebotomist must work with all areas of ▪ Emergency
any organization ▪ Nephrology
➢ Centralized ▪ Geriatrics
o Phlebotomist is part of
laboratory team and dispatched
to hospital units to collect blood PATIENT-FOCUSED CARE CONCEPT

samples
▪ Takes laboratory out of physical location
➢ Decentralized
o Brings laboratory to patient
o All members of the health care
team share responsibility to
collect blood samples. AREAS OF THE LABORATORY

▪ Phlebotomy

AREAS OF THE HOSPITAL ▪ Chemistry

▪ Hematology
▪ Electroencephalography (EEG)
▪ Coagulation
▪ Electrocardiology (EKG)
▪ Histology
▪ Radiology
▪ Urinalysis
▪ Pharmacy
▪ Microbiology
▪ Physical Therapy
▪ Immunology
▪ Occupational Therapy
▪ Immunohematology (blood bank)
▪ Nursing
▪ Cytology
▪ Laboratory
▪ Molecular Diagnostics
▪ Environmental Services
▪ Administration
▪ Food Service
▪ Medical Record
 PHASES OF SAMPLE TESTING LABORATORY STAFF

▪ Preexamination ▪ Pathologist
▪ Examination ▪ Medical laboratory scientist
▪ Postexamination ▪ Medical laboratory technician
▪ Phlebotomy technician
➢ Preexamination ▪ Cytotechnologist
o Previously known as ▪ Histotechnologist
preanalytical phase
o Includes all processes from
collecting the sample to having ETHICAL CONSIDERATIONS

it ready for testing

▪ Ethics is hard to define as it consists of
➢ Examination
more than a written set of rules or
o Previously known as analytical
guidelines varying by individual, religion,
phase
social status, or heritage
o Includes all processes done to
▪ For phlebotomist-ethics requires
sample to achieve result
responsibility to provide high-quality
➢ Postexamination
patient care
o Previously known as
postanalytical phase
o Process in which the results of
the testing are communicated to
the health care provider

MANAGED CARE

▪ Coordinates providing health services

and health benefits
▪ Health maintenance organization (HMO)
▪ Preferred provider organization (PPO)

AFFORDABLE HEALTH CARE ACT

▪ Enacted to help those who could not

afford insurance
▪ Requires all people to have health
insurance
 5 STAGES OF EMOTIONS
➢ Denial
o family or patient deny reality
o (“I will be okay, just let me go
home”)
➢ Anger
o (“I don’t want you to draw my
blood, I am going to die
anyway”)
➢ Bargaining
o willing to do anything to change
what has happened
o (“Let me live, I’ll change my
ways”)
➢ Depression
o the process is recognized; there
is deep sorrow
o (“I will do whatever you want
me to do, I don’t care”)
➢ Acceptance
o realistic acknowledgement of
the fact that one is going to die
o (“God’s will be done, I am
ready”)
PATIENT RIGHTS
▪ Patient has right to considerate and
respectful care.
▪ Patient has right to receive
understandable information.
▪ Patient has right to make decisions
about plan of care and refuse treatment.
▪ Patient has right to have an advanced
directive.
▪ Patient has the right to privacy.
▪ Patient has the right to confidentiality of
his or her medical records.
▪ Patient has the right to review records.
▪ Patient has right to expect that within its
capacity and policies, a hospital will
make reasonable response to the
request of a patient for appropriate and
medically indicated care and services.
▪ Patient has the right to information
regarding hospital business relationships
that might impact his or her care.
▪ Patient has the right to consent or
decline to participate in proposed
research studies.
▪ Patient has the right to expect continuity
of care.
▪ Patient has the right to be informed of
hospital policies and practices that relate
to patient care, treatment, and
responsibilities.
 PROFESSIONAL ATTITUDE PROFESSIONAL GROOMING

▪ Everyone must follow professional code ▪ No visible tattoos.

of conduct in treatment of patients.
o Includes professional approach
to all aspects of job and
professional grooming and dress
ATTITUDE BY CHARLES SWINDOLL
▪ No body piercing other than a maximum
of two in the ears.
▪ No fingernails longer than one-quarter
inch.
▪ No blue jeans or casual attire.
▪ No T-shirts or sweatshirts.

▪ The longer I live, the more I realize the

impact of attitude on life.
▪ Attitude, to me, is more important than
the past, than education, than money,
than circumstances, than failures, than
successes, than what other people think
or say or do.
▪ It is more important than appearance,
giftedness, or skill.
ADVANCED DIRECTIBES
▪ Documents written before incapacitating
illness that give instructions about a
persons’ health care, if in the future,
they cannot speak for themselves.
REGULATORY AGENCIES

▪ It will make or break a company... a

▪ The Joint Commission
church... a home.
▪ CAP (College of American Pathologists)
▪ The remarkable thing is we have a choice
▪ State Board of Health
everyday regarding the attitude we
▪ CLSI (Clinical Laboratory Standards
embrace for that day.
Institute)
▪ We cannot change our past.
▪ CLIA (Clinical Laboratory Improvement
▪ We cannot change the inevitable.
Act of 1988)
▪ The only thing we can do is play on the
▪ OSHA (Occupational Safety and Health
one string we have, and that is our
Administration)
attitude.
▪ NAACLS (National Accrediting Agency for
▪ I am convinced that life is 10% what
Clinical Laboratory Sciences)
happens to me and 90% how I react to it.
▪ And so, it is with you.
▪ We are in charge of our attitudes.
 QUALITY ASSURANCE

▪ Quality is phlebotomist’s responsibility

▪ Result of test sent to physician depends
on quality of sample obtained
▪ Laboratories must have certain levels of
patient satisfaction to continue receiving
payments from insurance companies
o All programs work to ensure the
quality of the samples and result
as a method of improving
patient satisfaction.
▪ Must have quality assurance program,
total quality management program, and
continuous quality improvement
program.

EXAMPLES OF QUALITY IMPROVEMENT ITEMS

▪ Phlebotomist response time (for

inpatients)
▪ Patient waiting (for outpatients)
▪ Time it takes to perform phlebotomy
procedure
▪ Number of redraws due to inappropriate
amount of specimen
▪ Number of incorrect tubes drawn
▪ Number of patients requiring a second
attempt
▪ Number and size of hematomas

By: Rowen Palalulu