Phlebotomy is the process of making a puncture in a

vein Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenat ...

, usually in the arm, with a

cannula A cannula (; Latin meaning 'little reed'; plural or ) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces ...

for the purpose of drawing blood. The procedure itself is known as a

venipuncture In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous blood sampling (also called ''phlebotomy'') or intravenous therapy. In healthcare, this procedure is performed by medical labor ...

, 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. In contrast, phlebectomy is the removal of a vein. Phlebotomies that are carried out in the treatment of some blood disorders are known as '' therapeutic phlebotomies''. 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.

Etymology

From grc, φλεβοτομία ( – 'blood vessel, vein' + 'cutting'), via fro, flebothomie (modern French ).

Phlebotomies

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

s, or by using capillary blood sampling with

fingerstick In medicine, some blood tests are conducted on capillary blood obtained by fingerstick (or fingerprick) (or, for neonates, by an analogous heelprick). The site, free of surface arterial flow, where the blood is to be collected is sterilized with a ...

s or a

heel stick The neonatal heel prick is a blood collection procedure done on newborns. It consists of making a pinprick puncture in one heel of the newborn to collect their blood. This technique is used frequently as the main way to collect blood from neonat ...

in infants for the collection of minute quantities of blood. 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 Asepsis is the state of being free from disease-causing micro-organisms (such as pathogenic bacteria, viruses, pathogenic fungi, and parasites). There are two categories of asepsis: medical and surgical. The modern day notion of asepsis is deri ...

, practicing standard and

universal precautions Universal precautions refers to the practice, in medicine, of avoiding contact with patients' bodily fluids, by means of the wearing of nonporous articles such as medical gloves, goggles, and face shields. The infection control techniques were ...

, restoring

hemostasis In biology, hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel (the opposite of hemostasis is hemorrhage). It is the first stage of wound healing. This involves coagulation, ...

of the puncture site, giving instructions on post-puncture care, affixing tubes with electronically printed labels, and delivering specimens to a laboratory. Some countries, states, or districts require that phlebotomists be licensed or registered. A therapeutic phlebotomy may be carried out in the treatment of some blood disorders (example: Hemochromatosis,

polycythemia vera Polycythemia vera is an uncommon myeloproliferative neoplasm (a type of chronic leukemia) in which the bone marrow makes too many red blood cells. It may also result in the overproduction of white blood cells and platelets. Most of the healt ...

porphyria cutanea tarda Porphyria cutanea tarda is the most common subtype of porphyria. The disease is named because it is a porphyria that often presents with skin manifestations later in life. The disorder results from low levels of the enzyme responsible for the fift ...

), and chronic hives (in research).

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.

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 The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...

offers training with formal certification upon completion.

United States

Special state certification in the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...

is required only in four states:

California California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...

, Washington,

Nevada Nevada ( ; ) is a state in the Western region of the United States. It is bordered by Oregon to the northwest, Idaho to the northeast, California to the west, Arizona to the southeast, and Utah to the east. Nevada is the 7th-most extensive, ...

, and

Louisiana Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is borde ...

. 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), National Healthcareer Association (NHA), and the National Phlebotomy Certification Examination (NPCE). These and other agencies 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 A laboratory (; ; colloquially lab) is a facility that provides controlled conditions in which scientific or technological research, experiments, and measurement may be performed. Laboratory services are provided in a variety of settings: physic ...

experience.

South-Africa

South Africa South Africa, officially the Republic of South Africa (RSA), is the Southern Africa, southernmost country in Africa. It is bounded to the south by of coastline that stretch along the Atlantic Ocean, South Atlantic and Indian Oceans; to the ...

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

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.

References

{{Vascular procedures Vascular surgery Blood tests