PMLS 2 MT TERM
UNDERSTANDING PHLEBOTOMY
OUTLINE
I. A Historical Perspective
II. Phlebotomy today
III. The Healthcare Setting
OBJECTIVES
• Describe the evolution of phlebotomy and the role of the
phlebotomist in today’s healthcare setting.
• Describe the traits that form the professional image and
identify national organizations that support professional
recognition of phlebotomists.
• Describe the basic concepts of communication as they
relate to healthcare and how appearance and nonverbal
messages affect the communication process. • To distinguish their profession from that of the Long Robe
• Describe proper telephone protocol in a laboratory or surgeon, barber –surgeons placed a striped pole, from
other healthcare setting. which a bleeding bowl was suspended, outside their
• Demonstrate an awareness of the different types of doors.
healthcare settings. • The pole represented the rod squeezed by the patient to
• Describe traditional hospital organization and identify the promote bleeding and the white stripe on the pole
healthcare providers in the inpatient facility. corresponded to the bandages, which were also used as
• Describe the different levels of personnel found in the tourniquets. Soon, handsomely decorated ceramic
clinical laboratory and how Clinical Laboratory bleeding bowls came into fashion and were passed down
Improvement Amendment regulations affect their job from one generation to the next. These bowls, which often
descriptions. doubled as shaving bowls, usually had a semi-circular
• List the clinical analysis areas of the laboratory and the area cut out on one side to facilitate placement of the bowl
types of laboratory procedures performed in the different under the chin
areas.
TIMELINE
PHLEBOTOMY: A HISTORICAL PERSPECTIVE • During the 17th and early 18th centuries,
phlebotomy was considered a major therapeutic
• An early medical theory developed by Hippocrates (460- (treatment) process, and anyone willing to claim
377 a.c.) medical training could perform phlebotomy.
• blood, phlegm, black bile, and yellow bile • The lancet, a tool used for cutting the vein during
• Venesection - which comes from the Latin words vena, venesection, was perhaps the most prevalent medical
“vein,” and section, “cutting” – was the most common instrument of the times. The usual amount of blood
method of general bloodletting. withdrawn was approximately 10 mL, but excessive
• Venesection is another word for Phlebotomy, which phlebotomy was common.
comes from the Greek words phlebos, “vein” and tome,
“incision.”
TIMELINE ART OF CUPPING
• Some authorities believe phlebotomy dates back to the • The art of cupping required a great deal of practice to
last period of the Stone Age, when crude tools were maintain the high degree of degree of dexterity necessary
used to puncture vessels and allow excess blood to to avoid appearing clumsy and thus frighten the patient
drain out of the body. away.
• A painting in a tomb showing the application of a leech • Cupping involved the application of a heated suction
to a patient evidences bloodletting in Egypt in about apparatus, called the “cup,” to the skin to draw the blood
1400 b.c. to the surface.
• Early in the Middle Ages, barber-surgeons flourished. • Then the capillaries in that area were severed by making
• By 1210, the Guild of Barber-Surgeons has been a series of parallel incisions with a lancet or fleam.
formed: it divided the surgeons into Surgeons of the
Long Robe and Surgeons of the Short Robe.
• Soon, the Short Robe surgeons were forbidden by law
to do any surgery except bloodletting, wound surgery,
cupping, leeching, shaving, tooth extraction, and
enema administration.
, TRANS: UNDERSTANDING PHLEBOTOMY
FLEAM • Today, phlebotomy is performed to:
• The typical fleam was a wide double-edge blade at right
angles to the handle. o Obtain blood for diagnostic purposes and to monitor
• Eventually, multiple fleams were attached and folded into prescribed treatment
a brass case for easy carrying. o Venipuncture, which involves collecting blood by
• The blades were wiped clean with only a rag: therefore penetrating a vein with a needle and syringe or other
collection apparatus.
they readily transmitted a host of blood-borne infection
o Remove blood for transfusions at a donor center.
from patient to patient.
o Capillary puncture, which involves collecting blood
after puncturing the skin with a lancet.
o Remove blood for therapeutic purposes, such as
treatment for polycythemia, a disorder involving the
overproduction of red blood cells
o Obtain blood for diagnostic purposes and to monitor
prescribed treatment
o Venipuncture, which involves collecting blood by
penetrating a vein with a needle and syringe or other
collection apparatus.
o Remove blood for transfusions at a donor center.
o Capillary puncture, which involves collecting blood
Typical fleams. (Courtesy Robert Kravetz, MD, Chairman, after puncturing the skin with a lancet.
Archives Committee, American College of Gastroenterology.) o Remove blood for therapeutic purposes, such as
treatment for polycythemia, a disorder involving the
• Fleams were used for general phlebotomy to open an overproduction of red blood cells
artery or, more commonly, a vein to remove a large o The changing role of the phlebotomist in the
amounts of blood. emerging healthcare environment
• This procedure involved enticing the Hirudo medicinalis,
a European medicinal leech, to the spot needing COMMON DUTIES AND RESPONSIBILITIES
bloodletting with a drop of milk or blood on the patient’s ASSOCIATED WITH THE ROLE OF PHLEBOTOMIST
skin. • Prepare patients for collection procedures associated
• After the leech engorged itself with blood, which took with laboratory samples.
about an hour, it was allowed to drop off. • Comply with all procedures instituted in the procedure
manual.
• Promote good relations with patients and hospital
personnel.
• Collect routine skin puncture and venous specimens for
testing as required.
• Perform quality-control checks while carrying out clerical,
clinical, and technical duties.
• Prepare specimens for transport to ensure stability of
sample.
• Maintain patient confidentiality.
• Transport specimens to the laboratory.
Hirudo medicinalis • Assist in collecting and documenting monthly workload
and recording data.
• Perform skin tests.
• By the mid-18th century, leeching was widely practiced • Maintain safe working conditions.
in Europe,especially in France, Leeches were kept in
• Perform appropriate laboratory computer operations.
special vessels that were filled with water and had
• Prepare and process specimens.
perforated tops, so that the leeches could breathe.
• Collect urine drug screen specimens.
• Early leech jars were glass and later ones ceramic. A
leech jar. • Perform electrocardiography.
• The value of leech therapy lies in the components of the • Participate in continuing education programs.
worm’s saliva, which contains a local vasodilator • Collect and perform point-of-care testing (POCT).
(substance that increase the diameter of blood vessels), • Perform front-office duties, current procedural
a local anesthetic, and hirudin, an anticoagulant (a terminology coding, and paperwork.
substance that prevents clotting. • Perform quality-control checks on POCT instruments.
PHLEBOTOMY TODAY
• The practice of phlebotomy continues to this day;
however, principles and method have improved
dramatically.
BSMT-1D | CATANPATAN 2
, TRANS: UNDERSTANDING PHLEBOTOMY
OFFICIAL RECOGNITION • The phlebotomist is often the only real contact the patient
has with the laboratory. In many cases, patients equate
CERTIFICATION this encounter with the caliber of care they receive while
in the hospital.
• Certification is a voluntary process by which an agency • Positive “customer relations” involves promoting goodwill
grants recognition to an individual who has met certain and a harmonious relationship with fellow employees,
prerequisites in a particular technical area. visitors, and especially patients.
• Certification indicates the completion of defined academic • A competent phlebotomist with a professional manner
and training requirements and the attainment of a and a neat appearance helps to put the patient at ease
satisfactory score on an examination. and establish a positive relationship.
• This is confirmed by the awarding of a title or designation.
• Phlebotomist certification is signified by initials that the RECOGNIZING DIVERSITY
individual is allowed to display after his or her name.
Examples of national agencies that certify phlebotomists,
along with the title and corresponding initials awarded, • Despite similarities, fundamental differences among
are listed in Table 1-1 (reference book). people arise from nationality, ethnicity, and culture as well
as from family background, life experiences, and
LICENSURE individual challenges.
• These differences affect the health beliefs and behaviors
• Licensure is the act of granting a license. of both patients and providers.
• A license in healthcare is an official document or permit • Culturally aware healthcare providers enhance the
granted by a state agency that gives legal permission for potential for more rewarding interpersonal experiences.
a person to work in a particular health profession. This can lead to increased job satisfaction for them and
• Without a license, it would be against the law for a person increased patient satisfaction with the healthcare services
to practice that profession in that state. they provide.
• Typically, the individual must meet specific education and • Critical factors in providing healthcare services that meet
experience requirements and pass an examination before the needs of diverse populations include understanding
the license is granted. the:
• The license indicates competency only at the time of o Beliefs and values that shape a person’s approach
examination. to health and illness
• As a demonstration of continued competency, states o Health-related needs of patients and their families
normally require periodic license renewal, by either according to the environments in which they live
reexamination or proof of continuing education. o Knowledge of customs and traditions related to
health and healing
CONTINUING EDUCATION o Attitudes toward seeking help from healthcare
providers
• Continuing education is designed to update the
knowledge or skills of participants and is generally geared
to a learning activity or course of study for a specific group
PROFESSIONALISM
of health professionals, such as phlebotomists.
• Many organizations, such as the American Society for
Clinical Pathology (ASCP), the American Society for • Professionalism is defined as the conduct and qualities
Clinical Laboratory Sciences (ASCLS), and the American that characterize a professional person. As part of a
Medical Technologists (AMT), sponsor workshops, service-oriented industry, persons performing
seminars, and self-study programs that award continuing phlebotomy must practice professionalism.
education units (CEUs) to those who participate. • The public’s perception of the phlebotomy profession is
• The most widely accepted CEU standard, developed by based on the image created by the phlebotomist’s
the International Association for Continuing Education conduct and appearance.
and Training (IACET), is that 10 contact hours equal one • In fact, general appearance and grooming directly
CEU. (International Association for Continuing Education influence whether the phlebotomist is perceived as a
and Training. Retrieved April 14, 2010, from http://www. professional.
iacet.org/content/continuing-education-units.html.) • It has been said that people form opinions of a person
• Most certifying and licensing agencies require CEUs or within the first 3 seconds of meeting, and this judgment
other proof of continuing education for renewal of on the superficial aspect of a person sets an image in the
credentials. observer’s mind that can affect the interaction.
• These requirements are intended to encourage • Conservative clothing, proper personal hygiene, and
professionals to expand their knowledge base and stay physical well-being contribute to a professional
up to date. It is important for phlebotomists to participate appearance.
in continuing education to be aware of new developments • It should be noted that healthcare institutional policies for
in specimen collection and personal safety. attire are influenced by a federal standard that requires
employers to provide protective clothing for laboratory
workers, including phlebotomists.
PATIENT CLIENT INTERACTION • Besides displaying a professional appearance, a person
performing phlebotomy is required to display attitudes,
• As a member of the clinical laboratory team, the personal characteristics, and behaviors consistent with
phlebotomist plays an important role in how the laboratory accepted standards of professional conduct.
is portrayed to the public.
BSMT-1D | CATANPATAN 3
UNDERSTANDING PHLEBOTOMY
OUTLINE
I. A Historical Perspective
II. Phlebotomy today
III. The Healthcare Setting
OBJECTIVES
• Describe the evolution of phlebotomy and the role of the
phlebotomist in today’s healthcare setting.
• Describe the traits that form the professional image and
identify national organizations that support professional
recognition of phlebotomists.
• Describe the basic concepts of communication as they
relate to healthcare and how appearance and nonverbal
messages affect the communication process. • To distinguish their profession from that of the Long Robe
• Describe proper telephone protocol in a laboratory or surgeon, barber –surgeons placed a striped pole, from
other healthcare setting. which a bleeding bowl was suspended, outside their
• Demonstrate an awareness of the different types of doors.
healthcare settings. • The pole represented the rod squeezed by the patient to
• Describe traditional hospital organization and identify the promote bleeding and the white stripe on the pole
healthcare providers in the inpatient facility. corresponded to the bandages, which were also used as
• Describe the different levels of personnel found in the tourniquets. Soon, handsomely decorated ceramic
clinical laboratory and how Clinical Laboratory bleeding bowls came into fashion and were passed down
Improvement Amendment regulations affect their job from one generation to the next. These bowls, which often
descriptions. doubled as shaving bowls, usually had a semi-circular
• List the clinical analysis areas of the laboratory and the area cut out on one side to facilitate placement of the bowl
types of laboratory procedures performed in the different under the chin
areas.
TIMELINE
PHLEBOTOMY: A HISTORICAL PERSPECTIVE • During the 17th and early 18th centuries,
phlebotomy was considered a major therapeutic
• An early medical theory developed by Hippocrates (460- (treatment) process, and anyone willing to claim
377 a.c.) medical training could perform phlebotomy.
• blood, phlegm, black bile, and yellow bile • The lancet, a tool used for cutting the vein during
• Venesection - which comes from the Latin words vena, venesection, was perhaps the most prevalent medical
“vein,” and section, “cutting” – was the most common instrument of the times. The usual amount of blood
method of general bloodletting. withdrawn was approximately 10 mL, but excessive
• Venesection is another word for Phlebotomy, which phlebotomy was common.
comes from the Greek words phlebos, “vein” and tome,
“incision.”
TIMELINE ART OF CUPPING
• Some authorities believe phlebotomy dates back to the • The art of cupping required a great deal of practice to
last period of the Stone Age, when crude tools were maintain the high degree of degree of dexterity necessary
used to puncture vessels and allow excess blood to to avoid appearing clumsy and thus frighten the patient
drain out of the body. away.
• A painting in a tomb showing the application of a leech • Cupping involved the application of a heated suction
to a patient evidences bloodletting in Egypt in about apparatus, called the “cup,” to the skin to draw the blood
1400 b.c. to the surface.
• Early in the Middle Ages, barber-surgeons flourished. • Then the capillaries in that area were severed by making
• By 1210, the Guild of Barber-Surgeons has been a series of parallel incisions with a lancet or fleam.
formed: it divided the surgeons into Surgeons of the
Long Robe and Surgeons of the Short Robe.
• Soon, the Short Robe surgeons were forbidden by law
to do any surgery except bloodletting, wound surgery,
cupping, leeching, shaving, tooth extraction, and
enema administration.
, TRANS: UNDERSTANDING PHLEBOTOMY
FLEAM • Today, phlebotomy is performed to:
• The typical fleam was a wide double-edge blade at right
angles to the handle. o Obtain blood for diagnostic purposes and to monitor
• Eventually, multiple fleams were attached and folded into prescribed treatment
a brass case for easy carrying. o Venipuncture, which involves collecting blood by
• The blades were wiped clean with only a rag: therefore penetrating a vein with a needle and syringe or other
collection apparatus.
they readily transmitted a host of blood-borne infection
o Remove blood for transfusions at a donor center.
from patient to patient.
o Capillary puncture, which involves collecting blood
after puncturing the skin with a lancet.
o Remove blood for therapeutic purposes, such as
treatment for polycythemia, a disorder involving the
overproduction of red blood cells
o Obtain blood for diagnostic purposes and to monitor
prescribed treatment
o Venipuncture, which involves collecting blood by
penetrating a vein with a needle and syringe or other
collection apparatus.
o Remove blood for transfusions at a donor center.
o Capillary puncture, which involves collecting blood
Typical fleams. (Courtesy Robert Kravetz, MD, Chairman, after puncturing the skin with a lancet.
Archives Committee, American College of Gastroenterology.) o Remove blood for therapeutic purposes, such as
treatment for polycythemia, a disorder involving the
• Fleams were used for general phlebotomy to open an overproduction of red blood cells
artery or, more commonly, a vein to remove a large o The changing role of the phlebotomist in the
amounts of blood. emerging healthcare environment
• This procedure involved enticing the Hirudo medicinalis,
a European medicinal leech, to the spot needing COMMON DUTIES AND RESPONSIBILITIES
bloodletting with a drop of milk or blood on the patient’s ASSOCIATED WITH THE ROLE OF PHLEBOTOMIST
skin. • Prepare patients for collection procedures associated
• After the leech engorged itself with blood, which took with laboratory samples.
about an hour, it was allowed to drop off. • Comply with all procedures instituted in the procedure
manual.
• Promote good relations with patients and hospital
personnel.
• Collect routine skin puncture and venous specimens for
testing as required.
• Perform quality-control checks while carrying out clerical,
clinical, and technical duties.
• Prepare specimens for transport to ensure stability of
sample.
• Maintain patient confidentiality.
• Transport specimens to the laboratory.
Hirudo medicinalis • Assist in collecting and documenting monthly workload
and recording data.
• Perform skin tests.
• By the mid-18th century, leeching was widely practiced • Maintain safe working conditions.
in Europe,especially in France, Leeches were kept in
• Perform appropriate laboratory computer operations.
special vessels that were filled with water and had
• Prepare and process specimens.
perforated tops, so that the leeches could breathe.
• Collect urine drug screen specimens.
• Early leech jars were glass and later ones ceramic. A
leech jar. • Perform electrocardiography.
• The value of leech therapy lies in the components of the • Participate in continuing education programs.
worm’s saliva, which contains a local vasodilator • Collect and perform point-of-care testing (POCT).
(substance that increase the diameter of blood vessels), • Perform front-office duties, current procedural
a local anesthetic, and hirudin, an anticoagulant (a terminology coding, and paperwork.
substance that prevents clotting. • Perform quality-control checks on POCT instruments.
PHLEBOTOMY TODAY
• The practice of phlebotomy continues to this day;
however, principles and method have improved
dramatically.
BSMT-1D | CATANPATAN 2
, TRANS: UNDERSTANDING PHLEBOTOMY
OFFICIAL RECOGNITION • The phlebotomist is often the only real contact the patient
has with the laboratory. In many cases, patients equate
CERTIFICATION this encounter with the caliber of care they receive while
in the hospital.
• Certification is a voluntary process by which an agency • Positive “customer relations” involves promoting goodwill
grants recognition to an individual who has met certain and a harmonious relationship with fellow employees,
prerequisites in a particular technical area. visitors, and especially patients.
• Certification indicates the completion of defined academic • A competent phlebotomist with a professional manner
and training requirements and the attainment of a and a neat appearance helps to put the patient at ease
satisfactory score on an examination. and establish a positive relationship.
• This is confirmed by the awarding of a title or designation.
• Phlebotomist certification is signified by initials that the RECOGNIZING DIVERSITY
individual is allowed to display after his or her name.
Examples of national agencies that certify phlebotomists,
along with the title and corresponding initials awarded, • Despite similarities, fundamental differences among
are listed in Table 1-1 (reference book). people arise from nationality, ethnicity, and culture as well
as from family background, life experiences, and
LICENSURE individual challenges.
• These differences affect the health beliefs and behaviors
• Licensure is the act of granting a license. of both patients and providers.
• A license in healthcare is an official document or permit • Culturally aware healthcare providers enhance the
granted by a state agency that gives legal permission for potential for more rewarding interpersonal experiences.
a person to work in a particular health profession. This can lead to increased job satisfaction for them and
• Without a license, it would be against the law for a person increased patient satisfaction with the healthcare services
to practice that profession in that state. they provide.
• Typically, the individual must meet specific education and • Critical factors in providing healthcare services that meet
experience requirements and pass an examination before the needs of diverse populations include understanding
the license is granted. the:
• The license indicates competency only at the time of o Beliefs and values that shape a person’s approach
examination. to health and illness
• As a demonstration of continued competency, states o Health-related needs of patients and their families
normally require periodic license renewal, by either according to the environments in which they live
reexamination or proof of continuing education. o Knowledge of customs and traditions related to
health and healing
CONTINUING EDUCATION o Attitudes toward seeking help from healthcare
providers
• Continuing education is designed to update the
knowledge or skills of participants and is generally geared
to a learning activity or course of study for a specific group
PROFESSIONALISM
of health professionals, such as phlebotomists.
• Many organizations, such as the American Society for
Clinical Pathology (ASCP), the American Society for • Professionalism is defined as the conduct and qualities
Clinical Laboratory Sciences (ASCLS), and the American that characterize a professional person. As part of a
Medical Technologists (AMT), sponsor workshops, service-oriented industry, persons performing
seminars, and self-study programs that award continuing phlebotomy must practice professionalism.
education units (CEUs) to those who participate. • The public’s perception of the phlebotomy profession is
• The most widely accepted CEU standard, developed by based on the image created by the phlebotomist’s
the International Association for Continuing Education conduct and appearance.
and Training (IACET), is that 10 contact hours equal one • In fact, general appearance and grooming directly
CEU. (International Association for Continuing Education influence whether the phlebotomist is perceived as a
and Training. Retrieved April 14, 2010, from http://www. professional.
iacet.org/content/continuing-education-units.html.) • It has been said that people form opinions of a person
• Most certifying and licensing agencies require CEUs or within the first 3 seconds of meeting, and this judgment
other proof of continuing education for renewal of on the superficial aspect of a person sets an image in the
credentials. observer’s mind that can affect the interaction.
• These requirements are intended to encourage • Conservative clothing, proper personal hygiene, and
professionals to expand their knowledge base and stay physical well-being contribute to a professional
up to date. It is important for phlebotomists to participate appearance.
in continuing education to be aware of new developments • It should be noted that healthcare institutional policies for
in specimen collection and personal safety. attire are influenced by a federal standard that requires
employers to provide protective clothing for laboratory
workers, including phlebotomists.
PATIENT CLIENT INTERACTION • Besides displaying a professional appearance, a person
performing phlebotomy is required to display attitudes,
• As a member of the clinical laboratory team, the personal characteristics, and behaviors consistent with
phlebotomist plays an important role in how the laboratory accepted standards of professional conduct.
is portrayed to the public.
BSMT-1D | CATANPATAN 3
