Phlebotomy and the

Health-Care Delivery
System
RICHARD DAVID SILVESTRE, RMT, MSMT (c )
 OUTLINE

 HISTORY OF PHLEBOTOMY
 HISTORY OF BLOODLETTING
 WHAT IS PHLEBOTOMY
 MODERN PHLEBOTOMY
 PROFESSIONAL ORGANIZATIONS AND STANDARDS
 LEGAL ISSUES IN PHLEBOTOMY
 REVIEW FOR CERTIFICATION
Learning Objectives
1. State the traditional and expanding duties of
the phlebotomist.
2. Describe the professional characteristics that
are important for a phlebotomist.
3. Discuss the importance of communication and
interpersonal skills for the phlebotomist within
the laboratory, with patients, and with
personnel in other departments of the hospital.
4. State and describe the three components of
communication.
5. List the barriers to communication and
methods to overcome them.
Learning Objectives (cont.)

6. Describe a phlebotomist using correct listening

and body language skills.
7. State six rules of proper telephone etiquette.
8. Define cultural diversity and discuss the actions
needed by a phlebotomist when encountering
cultural diversity.
9. State the competencies expected of a
certified phlebotomist.
10. Describe the functions of the nursing, support,
fiscal, and professional hospital service areas
and the functions of the departments
contained in these services.
11. Describe the different types of health-care
settings in which a phlebotomist may be
employed.
HISTORY

 LOUIS PASTEUR
Because of his study
in germs, he
encouraged doctors
to sanitize their hands
and equipment
before surgery
HISTORY

 JOSEPH LISTER
Revolutionized
surgery by sterilizing
instruments and
washing physicians
hands with
antiseptic spray
HISTORY

 Robert koch
Change the way
health departments
for persons with
infectious disease
with his work in
isolating bacteria.
HISTORY

 HIPPOCRATES
 GREEK PHYSICIAN, REFERRED TO AS “
FATHER OF MEDICINE”.

 stated that disease was the result of

excess substance—such as blood,
phlegm, black bile, and yellow bile—
within the body. It was thought that
removal of the excess would restore
balance.
 HISTORY

 1400 B.C- A PAINTING IN A TOMB SHOWING THE APPLICATION OF LEECH TO A

PATIENT EVIDENCES BLOOD LETTING IN EGYPT.
 20TH CENTURY
 MANY INFECTIOUS DISEASES AND EPIDEMICS BECAME CURABLE
 LIFE EXPECTANCY INCREASED
 ANTIBIOTICS DISCOVERED
 SALK AND SABI VACCINES

 EARLY 20TH CENTURY

 BANTING AND BEST DISCOVERY OF INSULIN THAT COULD BE USED WITH DIABETES
 PENICILLIN AND CANER DISCOVERED IN 1928.
 PENICILLIN NOT BROUGHT INTO PRODUCTION UNTIL 1945.
 HISTORY OF PHLEBOTOMY

 Phlebotomy is a term that came to be in the 20th

century, as the process of drawing blood for medical
testing.
 BLOODLETTING- is the withdrawal of often
considerable quantities of blood from a patient to
cure or prevent illness and disease.
 The usual amount of blood withdrawn was
approximately 10 mL, but excessive phlebotomy was
common.
 Phlebotomy
 The primary duty of the phlebotomist is to collect blood specimens for
laboratory analysis.
 The most common method is by venipuncture, opening a vein to
obtain a blood sample without destroying the integrity of the vein.
 This is an invasive procedure which must be performed with skill to
prevent harming the patient.
 Three purposes for collection and analysis of laboratory samples:
a. Diagnostic testing
b. Therapeutic assessment
c. Monitoring patient’s condition
History of Phlebotomy

 “Phleb”-vein “-otomy”-incision
 Phlebotomy, defined
Incision into a vein
 One of the oldest medical
procedures
Blood-letting
Devices
Leeches
 Significance of “barber pole”
 Therapeutic phlebotomy
Role of the Phlebotomist
 Collection of blood specimens for laboratory analysis
 Has become a specialized area of clinical laboratory practice
 Key player, no longer someone who just “takes blood”
Traditional Duties and Responsibilities
 Correct identification of the patient prior to sample
collection
 Collection of the appropriate amount of blood by
venipuncture or dermal puncture for the specified
tests
 Selection of the appropriate specimen 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
Other Important Duties

 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 in Phlebotomist
Duties
 Additional Duties
 Training other health-care personnel to
perform phlebotomy
 Monitoring the quality of samples
collected on the units
 Evaluating protocols associated with
sample collection
 Performing basic bedside laboratory tests
 Performing electrocardiograms
 Performing measurement of patient’s vital
signs
 Professional and Personal
Characteristics for Phlebotomists

 Service-oriented industry
 Phlebotomists are the “face of
the laboratory”
 Professional and Personal
Characteristics for Phlebotomists
 Dependable Honest
 Cooperative Integrity
 Committed Competence
 Compassionate
Organized
 Courteous
Responsible
 Respectful
Flexible
 Appearance Guidelines
Clean and unwrinkled clothing
Clean, appropriate footwear
Conservative jewelry and makeup
Perfume/cologne not recommended
Hair/facial hair clean, neat, and trimmed
Long hair pulled back
Proper personal hygiene
Proper fingernail length and maintenance
No artificial nails (Center for Disease Control
guidelines)
Appearance
 Posture
 Grooming
 Personal Hygiene
(Brush teeth, wash yourself,
Hair pulled back, nails clean,
Clothes clean, shoes clean,
DON’T SMOKE before work!)
Communication Skills for the
Phlebotomist

Verbal skills
Listening skills
Nonverbal skills
Body language
 Verbal Skills
Verbal barriers
Hearing impairment
Emotional level
Patient education level
Age
Language barriers
Medications
Health status
Verbal Communication Barriers
Listening Skills

Active listening
Looking directly at the patient
Allowing patient time to express
feelings
Allowing the patient time to describe
why they are concerned
Providing feedback to the patient
through appropriate responses
Encouraging patient communication
by asking questions
Nonverbal Communication

 Positive body language

 Smiling
 Eye contact
 Display confidence
 Negative body language
 Shuffling
 No eye contact
 Acting distracted
Cultural Diversity Guidelines

Smile and use a friendly tone of voice.

Be alert to patients reactions.
Do not stereotype.
Be mindful of personal space.
Take time to explain procedures.
 Make sure instructions are understood.

Show respect for their diversity.

Telephone Skills
 Telephone manners
 Promptness
 Politeness
 Transferring calls
 Attempt to help first, give patient transfer number
 Provide accurate information
 Placing calls on hold
 Check for emergency
 Speak clearly
Importance of Phlebotomy Education

 Structured programs—Combining classroom

(didactic) with clinical practice
Hospitals
Community college
Technical institutions
 Use national training guidelines
National Accrediting Agency for Clinical
Laboratory Sciences (NAACLS)
 PROFESSIONAL ORGANIZATIONS
AND STANDARDS
 ACCREDITATION
 CERTIFICATION
 CONTINUING MEDICAL EDUTCAITON
NAACLS Phlebotomy Competencies

 Knowledge of the health-care system and

medical terminology
 Knowledge of infection control
 Knowledge of basic anatomy and physiology
and anatomic terminology related to the
laboratory and the pathology of body systems
 Understanding of the importance of sample
collection and integrity for patient care
NAACLS Phlebotomy Competencies

 Knowledge of collection equipment, tube

additives, special precautions, and interfering
substances associated with laboratory tests
 Performance of standard operating procedures in
collecting samples
 Understanding of requisitions, sample transport,
and sample processing
 Understanding of quality assurance and quality
control in phlebotomy
 Use of effective and appropriate communication
skills
Phlebotomy Education and
Certification
 Certification requirements
 Certification examinations
 Computer adaptive testing

 Professional organization membership

 Continuing education
 Required for licensure
 Maintain certification
 Phlebotomy Certifying
Organizations

 American Society for Clinical Pathology (ASCP)

 National Center for Competency Testing (NCPT)
 American Medical Technologists (AMT)
 American Society of Phlebotomy Technicians
(ASPT)
 National Phlebotomy Association (NPA)
 National Healthcareer Association (NHA)
Phlebotomist Certification
Health-Care Delivery System
 Employment settings

Hospital
Physician office laboratories (POL)
Health maintenance organizations (HMO)
Reference laboratories
Urgent care centers
Nursing homes
Home health-care agencies
Blood donor centers
Hospital Patient Care Areas
Hospital Organization
Hospital Services

 Nursing Services--Direct patient care

 Support Services--Maintain the physical hospital
building and services
 Fiscal Services--Business management of hospital
services
 Professional Services--Assist in diagnosis and treatment
of disease
Nursing Services
Cardiac Care Unit (CCU), Emergency
Department (ED), Intensive Care Unit
(ICU), Nursery, and Operating Room (OR)
Health-care Members
Registered Nurse (RN)
Licensed Practical Nurse (LPN)
Certified Nursing Assistant (CNA)
Unit clerk
Surgical technologist
Support Services

 Food service  Laundry

 Grounds care  Maintenance
 Housekeeping  Purchasing
 Human Resources  Security
Fiscal Services

 Accounting
 Admitting
 Business office
 Credit and collection
 Data processing
 Medical records
Professional Services

 Radiology  Occupational therapy (OT)

 X-ray  Daily living functions
 CT scans  Pharmacy
 MRI  Medications
 Radiation therapy
 Cancer treatment
 Nuclear medicine
 Organ scans
 Laboratory tests
Professional Services

 Physical therapy (PT)  Cardiovascular testing

 Treatments  ECGs
 Respiratory therapy  Stress Tests
 Breathing disorders  Imaging
 Clinical laboratory
 Diagnostic testing
Other Health-Care Settings
Physician office laboratories (POLs) and
group practices
Health maintenance organizations (HMOs)
Reference laboratories
Government- and hospital-sponsored clinics
Specialty clinics
Wellness clinics
Alternative medicine clinics
Home health care
THANK YOU 