Phlebotomist
Encyclopedia
Phlebotomists are individuals trained to draw blood from a live person or animal.
Phlebotomists collect blood primarily by performing venipuncture
and, for collection of minute quantities of blood, fingersticks. Blood may be collected from infants by means of a heel stick. Specially trained phlebotomists collect blood samples from any artery of the wrist or brachial artery in the antecubital area (bend in the arm) for arterial blood gas
test.
, requirements vary by state. However, most states do require a high school diploma or equivalent, followed by at least a six-day phlebotomy certification class. Many states do not have any requirements for phlebotomy personnel.
train approximately forty hours in a certified career center or trade school.Training covers a basic study of anatomy, how to interact with patients, legal aspects of blood collection, Standard Precautions, aseptic techniques and various blood collection techniques. At the end of the course the person needs to present a Phlebotomy Certification Exam, varying from state to state and pass it successfully. Total of three chances are given to become certified. After failing a third time, must retake the entire course again. A prospective phlebotomist should have a high school diploma or equivalent (GED) in the U.S. Australian phlebotomists require no specific educational prerequisites in order to undergo training, other than culturally relevant language skills. Training ranges from one-day to six-week courses.
The United Kingdom has no prerequisite qualifications to becoming a phlebotomist: many healthcare employers still use on-the-job training to obtain employees with this skill. However, the latest trend now in the UK is to obtain more structured learning and practice through attendance and participation in proper theory classes, dry-lab classes (practising on simulated arms).
The phlebotomist is required to ascertain the needs of the patient by communicating the doctor's order for the collection, and selecting the appropriate vacuum tubes for collection, as well as evaluating the vein size to use proper gauge needle. The tubes are collected in a specific order of priority, "order of draw", to prevent the "carry over" of chemicals contained in each tube from contaminating other more critical tubes/exams (e.g., coagulation tests).A laboratory specific methodology is applied to the color cap of the vacuum tube/addtive/test/laboratory that the tube will be sent to.
The NHA phlebotomy certification includes the EKG technician certification (CET) and phlebotomy technician certification in one general certification.
Other agencies certify phlebotomists without a proctored examination if they can document one or more years of phlebotomy experience. Others allow their employers to issue the examination. Not all certification routes are considered equally valid by all healthcare employers, though, so applicants should choose their certification agency after researching their acceptability among local employers. In California, all phlebotomists must be certified by law, and only after completing a state-approved training program and successful examination issued by NHA, AMT, ASCP-BOC, ACA and NCCT.
The phlebotomist may also encounter tiny veins, damaged veins, or veins hidden by dark skin. These factors make venipuncture difficult or even impossible. In some cases a specialist physician, such as a pediatric anesthesiologist
, may be better able to cope with these difficulties. A hospital will often have a person known as a "dead-eye" on staff or on call.
Phlebotomists collect blood primarily by performing venipuncture
Venipuncture
In medicine, venepuncture, venopuncture or venipuncture is the process of obtaining intravenous access for the purpose of intravenous therapy or for blood sampling of venous blood. This procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics,...
and, for collection of minute quantities of blood, fingersticks. Blood may be collected from infants by means of a heel stick. Specially trained phlebotomists collect blood samples from any artery of the wrist or brachial artery in the antecubital area (bend in the arm) for arterial blood gas
Arterial blood gas
An arterial blood gas is a blood test that is performed using blood from an artery. It involves puncturing an artery with a thin needle and syringe and drawing a small volume of blood. The most common puncture site is the radial artery at the wrist, but sometimes the femoral artery in the groin or...
test.
Training and certification
In the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, requirements vary by state. However, most states do require a high school diploma or equivalent, followed by at least a six-day phlebotomy certification class. Many states do not have any requirements for phlebotomy personnel.
Education
Phlebotomy used to be a skill picked up in one day, but today most phlebotomists in the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
train approximately forty hours in a certified career center or trade school.Training covers a basic study of anatomy, how to interact with patients, legal aspects of blood collection, Standard Precautions, aseptic techniques and various blood collection techniques. At the end of the course the person needs to present a Phlebotomy Certification Exam, varying from state to state and pass it successfully. Total of three chances are given to become certified. After failing a third time, must retake the entire course again. A prospective phlebotomist should have a high school diploma or equivalent (GED) in the U.S. Australian phlebotomists require no specific educational prerequisites in order to undergo training, other than culturally relevant language skills. Training ranges from one-day to six-week courses.
The United Kingdom has no prerequisite qualifications to becoming a phlebotomist: many healthcare employers still use on-the-job training to obtain employees with this skill. However, the latest trend now in the UK is to obtain more structured learning and practice through attendance and participation in proper theory classes, dry-lab classes (practising on simulated arms).
The Practice of Phlebotomy
The practice generally involves aseptically finding a vein suitable for blood extraction from the patient. Once a vein is located and punctured observing aseptic techniques with a needle or single use lancet, the phlebotomist collects blood in sample tubes which are vacuum sealed with a rubber stopper, or micro-collection tubes and may or may not include clot activators, a gel for serum separation, a gel for plasma separation, or additives for reactions such as sodium polyanethol solfonate, buffered sodium citrate, or the like. The tube may also include no reactive agent or separator/coagulant and simply be used for purposes of collection and storage of the sample, or as a "waste" which will collect initial blood which may be contaminated with an antibacterial used at the collection site such as alcohol. (The alcohol would otherwise affect the serum/reactive agent in a prepared tube).The phlebotomist is required to ascertain the needs of the patient by communicating the doctor's order for the collection, and selecting the appropriate vacuum tubes for collection, as well as evaluating the vein size to use proper gauge needle. The tubes are collected in a specific order of priority, "order of draw", to prevent the "carry over" of chemicals contained in each tube from contaminating other more critical tubes/exams (e.g., coagulation tests).A laboratory specific methodology is applied to the color cap of the vacuum tube/addtive/test/laboratory that the tube will be sent to.
Certification and licensing
Agencies that certify all phlebotomy candidates by examination include the American Society for Clinical Pathology's Board of Certification (ASCP-BOC), American Medical Technologists (AMT), the American Credentialing Agency (ACA), the National Center for Competency Testing (NCCT), and the National Healthcareer Association (NHA). The American Association of Medical Assistants (AAMA) also covers phlebotomy on their nationally recognized exam. Certified Medical Assistants (CMA) are commonly hired to be phlebotomists.The NHA phlebotomy certification includes the EKG technician certification (CET) and phlebotomy technician certification in one general certification.
Other agencies certify phlebotomists without a proctored examination if they can document one or more years of phlebotomy experience. Others allow their employers to issue the examination. Not all certification routes are considered equally valid by all healthcare employers, though, so applicants should choose their certification agency after researching their acceptability among local employers. In California, all phlebotomists must be certified by law, and only after completing a state-approved training program and successful examination issued by NHA, AMT, ASCP-BOC, ACA and NCCT.
Professional Concerns
The phlebotomist comes into contact with all walks of life and experience (and, moreover, people in occasionally altered states) and must manage to draw blood from patients under stress either from a prior injury, "white coat" nervousness, fear of needles, or other causes of agitation. The phlebotomist must perform phlebotomy without reaction to the patient's medical condition or state of being, while protecting themselves from incidental, accidental, or deliberate exposure to the patient's body fluids, or the needles used to collect them. The phlebotomist must avoid aggravating the patient's anxiety by repeated tapping on shrinking veins or by giving false reassurances.The phlebotomist may also encounter tiny veins, damaged veins, or veins hidden by dark skin. These factors make venipuncture difficult or even impossible. In some cases a specialist physician, such as a pediatric anesthesiologist
Anesthesiologist
An anesthesiologist or anaesthetist is a physician trained in anesthesia and peri-operative medicine....
, may be better able to cope with these difficulties. A hospital will often have a person known as a "dead-eye" on staff or on call.