Phlebotomists
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Phlebotomy is the process of making a puncture in a
vein Veins () are blood vessels in the circulatory system of 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 those of the pulmonary and feta ...
, usually in the arm, with a
cannula A cannula (; Latin meaning 'little reed'; : cannulae or cannulas) 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 out ...
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 Sampling (medicine)#blood, blood sampling (also called ''phlebotomy'') or intravenous therapy. In healthcare, this procedure is p ...
, which is also used for
intravenous therapy Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...
. 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 A phlebectomy, or vein stripping, is a surgical procedure done under general or local anaesthetic to aid in the treatment of varicose veins and other manifestations of chronic venous disease. The vein "stripped" (pulled out from under the skin us ...
is the removal of a vein. Phlebotomies that are carried out in the treatment of some
blood disorders Hematologic diseases are disorders which primarily affect the blood and Blood formation, blood-forming organs. Hematologic diseases include rare genetic disorders, anemia, HIV, sickle cell disease and complications from chemotherapy or transfusio ...
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 ( – 'blood vessel, vein' + 'cutting'), via (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
venipuncture In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous Sampling (medicine)#blood, blood sampling (also called ''phlebotomy'') or intravenous therapy. In healthcare, this procedure is p ...
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 ...
s or a heel stick 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 e ...
, 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. Hemostasis involves three ...
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 Iron overload is the abnormal and increased accumulation of total iron in the body, leading to organ damage. The primary mechanism of organ damage is oxidative stress, as elevated intracellular iron levels increase free radical formation via the ...
,
polycythemia vera In oncology, polycythemia vera (PV) is an uncommon myeloproliferative neoplasm in which the bone marrow makes too many red blood cells. Approximately 98% of PV patients have a JAK2 gene mutation in their blood-forming cells (compared with 0.1-0 ...
,
porphyria cutanea tarda Porphyria cutanea tarda (PCT) is a type of longterm porphyria characterised by fragile skin and sore blisters in areas of skin that receive higher levels of exposure to sunlight, such as the face and backs of the hands. These blisters burst easily ...
), and chronic hives (in research).


Australia

In
Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...
, 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 term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
offers training with formal certification upon completion.


United States

Special state certification in the
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
is required only in four states:
California California () is a U.S. state, state in the Western United States that lies on the West Coast of the United States, Pacific Coast. It borders Oregon to the north, Nevada and Arizona to the east, and shares Mexico–United States border, an ...
,
Washington Washington most commonly refers to: * George Washington (1732–1799), the first president of the United States * Washington (state), a state in the Pacific Northwest of the United States * Washington, D.C., the capital of the United States ** A ...
,
Nevada Nevada ( ; ) is a landlocked state in the Western United States. It borders Oregon to the northwest, Idaho to the northeast, California to the west, Arizona to the southeast, and Utah to the east. Nevada is the seventh-most extensive, th ...
, and
Louisiana Louisiana ( ; ; ) is a state in the Deep South and South Central regions of the United States. It borders Texas to the west, Arkansas to the north, and Mississippi to the east. Of the 50 U.S. states, it ranks 31st in area and 25 ...
. 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 The Institute for Credentialing Excellence (I.C.E.) is one of the two main U.S. organizations that accredit personnel certifications or certificates. In November 2009 the ICE formally changed its name from the National Organization for Competency ...
(ACA),
American Medical Technologists The American Medical Technologists (AMT) is a professional association that encompasses 80,000 allied health professionals. It was founded in 1939. The organization published a bi-monthly journal entitled ''The Journal of American Medical Technol ...
(AMT),
American Society for Clinical Pathology The American Society for Clinical Pathology (ASCP), formerly known as the American Society of Clinical Pathologists, is a professional association based in Chicago, Illinois, encompassing 130,000 pathologists and laboratory professionals. Founded ...
(ASCP),
National Center for Competency Testing National may refer to: Common uses * Nation or country ** Nationality – a ''national'' is a person who is subject to a nation, regardless of whether the person has full rights as a citizen Places in the United States * National, Maryland, ce ...
/ Multi-skilled Medical Certification Institute (NCCT/MMCI), National Credentialing Agency (NCA), and
National Healthcareer Association The National Healthcareer Association (NHA) is a national professional certification agency for healthcare workers in the United States. Granting credentials in more than 8 allied health specialties, it is an organizational member of the National ...
(NHA). These and other agencies such as the American Society of Phlebotomy Technicians 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. Laboratories are found in a variety of settings such as schools ...
experience.


South Africa

In
South Africa South Africa, officially the Republic of South Africa (RSA), is the Southern Africa, southernmost country in Africa. Its Provinces of South Africa, nine provinces are bounded to the south by of coastline that stretches along the Atlantic O ...
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 Netcare (officially Netcare Group Limited) is a South African private healthcare company. The group provides a range of medical services across the healthcare spectrum, and operates South Africa’s largest network of private hospitals. The ...
, 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 The Health Professions Council of South Africa (HPCSA) is the statutory body regulating specific healthcare professions within South Africa. The council oversees healthcare practice, establishes standards for education and training, and upholds ...
(HPCSA) is required.


Sample tube types


Draw station

A phlebotomy draw station is a place where blood is drawn from patients for laboratory testing, transfusions, donations, or research purposes. The blood is typically drawn via
venipuncture In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous Sampling (medicine)#blood, blood sampling (also called ''phlebotomy'') or intravenous therapy. In healthcare, this procedure is p ...
or a finger stick by a healthcare professional such as a
phlebotomist Phlebotomy is the process of making a puncture in a vein, usually in the arm, with a cannula for the purpose of drawing blood. The procedure itself is known as a venipuncture, which is also used for intravenous therapy. A person who performs a ...
,
nurse Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...
, or medical assistant. The draw station typically includes a padded chair or a bed for patients prone to fainting during blood draws. Draw stations can be found in various settings, such as hospitals, clinics, blood donation centers, and independent laboratories or as part of patient service centers (PSC).


History

Early phlebotomists used techniques such as
leeches Leeches are segmented parasitic or predatory worms that comprise the subclass Hirudinea within the phylum Annelida. They are closely related to the oligochaetes, which include the earthworm, and like them have soft, muscular segmented bod ...
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 surgeon The barber surgeon was one of the most common European medical practitioners of the Middle Ages, generally charged with caring for soldiers during and after battle. In this era, surgery was seldom conducted by physicians. Instead, barbers, who ...
s, the primary provider of health care to most people in the medieval and early modern eras.


See also

* Cytotechnologist *
Injection (medicine) An injection (often and usually referred to as a "shot" in US English, a "jab" in UK English, or a "jag" in Scottish English and Scots) is the act of administering a liquid, especially a drug, into a person's body using a needle (usually a h ...
* Medical technologist *
List of surgeries by type Many Surgery, surgical procedure names can be broken into parts to indicate the meaning. For example, in gastrectomy, "ectomy" is a suffix (linguistics), suffix meaning the removal of a part of the body. "Gastro-" means stomach. Thus, ''gastrectom ...
*
Phlebotominae The Phlebotominae are a subfamily of the family Psychodidae. In several countries, their common name is sandfly, but that name is also applied to other flies. The Phlebotominae include many genera of blood-feeding ( hematophagous) flies, includi ...
* Phlebotomy licensure


References

{{Vascular procedures Vascular surgery Blood tests Phlebotomy Laboratory healthcare occupations