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The Evolution of Phlebotomy:
From Bloodletting to Modern
Diagnostic Practices
History of Phlebotomy
Phlebotomy
The process of collecting blood From the Greek word: Phlebos- venipuncture; Tome- incision (to cut) The act or practice of bloodletting as a therapeutic measure (Webster's)
Venipuncture
Syringe method Evacuated tube system Butterfly syringe
Two Basic Methods
Venesection Most common A sharp lancet-type instrument pierced the veins and made them bleed Lacing- thought to eliminate the "bad blood", remove the disease Used to reduce fever Cupping A heated glass cup was placed on a person's back Cooled- create suction that pulled blood to the capillaries Multiple blades cut the area- massive bleeding
George Washington
The first President of the USA Suffered from severe throat infection At the time, the cure was HEAVY BLEEDING Bled more than 9 pints of blood (4,000 mL) in less than 24 hours Died: December 14, 1799
Mid 19th Century
Discovery of microorganisms as the causative agent for many diseases Blood began to be examined for DIAGNOSTIC PURPOSES Bloodletting was NO LONGER considered the cure for all illnesses Urine & Feces: Examined since Medieval times
Bleeding of individuals to reduce the patient's amount of blood- used to treat POLYCYTHEMIA VERA (too much RBC) and HEREDITARY HEMOCHROMATOSIS- UNDERGOE therapeutic phlebotomy
Contemporary Phlebotomy
Blood is removed to find cure Therapeutic to DIAGNOSTIC
Phlebotomist
PRIMARY ROLE: collect blood for accurate and reliable test results Represent the laboratory Indirect contact with the patients TRADITIONAL: ONLY ONE JOB- to collect blood
Decentralized vs Centralized Phlebotomy
Centralized Phlebotomy (85%)
Phlebotomist is dispatched from the laboratory to either Nursing Units (wards) or OPD (outpatient department) Start as early as 4:30AM due to FASTING patients Blood collection is done purely by the phlebotomist, by batch if needed depending on the bulk of patients in line for extraction
Decentralized Phlebotomy (15%)
More people are collecting blood samples during the BUSY TIMES Everyone who has contact with the patient needs to become multiskilled The nurse needs to learn how to collect blood samples, and the Phlebotomist needs to learn some of the nursing duties
Professional Attitude of a Phlebotomist
Patients are usually apprehensive about the procedure It is important to obtain a good sample with as minimal trauma to the patient possible Patients must be treated like anyone would like to be treated
Professional Grooming
No visible tattoos No body piercing other than a minimum of two in the ears (one for each ear) No fingernails longer than ¼ inch No blue jeans or casual attire No open-toed shoes No t-shirts or sweatshirts
Universal Precautions
Developed in 1985 by Center for Disease Control and Prevention (CDC) as a response to increase in blood-borne diseases such as AIDS and Hepatitis B States that any patient has the potential to be infected with these blood-borne pathogens Assumed that all blood and most body fluids were potentially infectious Evolved into a system called BODY SUBSTANCE ISOLATION
Standard Precautions
Combine many of the basic principles of universal precautions with techniques from BSI Maintain that PPE and barrier control must be worn for contact with all body fluids, whether or not blood is visible Goal: reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection
Five Main Points in Standard Precautions
Wash hands when changing gloves and between patients Wear gloves when likely to touch body substances, mucous membranes, or nonintact skin, and during all blood drawing Wear protective cover when clothing is likely to be soiled Wear a mask and eye protection in addition to a protective body cover when likely to be splashed with body substances Place intact needle/syringe and sharps in designated sharp containers; do not bend, break or cut needles
Reducing Exposure Risk
Six major tactics: 1. Engineering controls 2. Work practices 3. Housekeeping
- HBV vaccination 5. Private rooms 6. Personal Protective Equipment
Engineering Controls
Puncture-resistant containers Safety needles/ self-sheathing needles Autoclaves Biohazards color-coding Splash guards Volatile liquid containers Centrifuge safety buckets Biological safety cabinets Fume hoods Mechanical pipetting devices Computer wrist/ arm pads Sensor-controlled sinks Foot/knee/elbow-controlled faucets Chemical storage cabinet
Eyewash stations Safety showers
Work Practice Controls
Housekeeping Private rooms Handwashing
Personal Protective Equipment (PPE)
Used to protect the phlebotomist from infectious material contacting street clothes, skin, mucous membranes Employers must provide this equipment free of charge and must maintain and clean the equipment at no charge to the phlebotomist
Preventing Infection Transmission in
Healthcare Settings
Glove Usage and Removal
Gloves should be changed between patients or before/after eating, applying makeup, or when visibly soiled/contaminated. To remove gloves properly, follow a specific sequence to avoid contamination.
Masks
Masks are used to prevent the transmission of infectious agents through the air. Paper masks are the most economical and efficient option. Fluid-proof masks are available for work conditions where the spattering of body fluids is likely and should be worn once. Masks should never be worn around the neck and then moved up to cover the nose and mouth when entering another room. Masks are no longer effective once they become moist from breathing. The proper way to use a mask is to have the white portion inside and the blue colored portion outside, covering the nose, mouth, and chin. The metallic side should be placed on the nose.
Gowns
Gowns are necessary when there is a possibility of soiling clothes while caring for patients. Gowns should be fluid-resistant and used only once. Appropriate foot wear, such as closed shoes, should be worn.
Needleless Systems : Devices that do not use needles for the collection of body fluids or the administration of medications.
Surface Decontamination
A 1:10 bleach solution (10 parts bleach, 1 part water) or other EPA- approved disinfectant should be used. Bleach solutions should be prepared daily. Cleaning must be done at the end of each shift or whenever a surface is visibly contaminated. Gloves should be worn when cleaning.
Hazard Identification
Biohazard (Biological Hazards) : All blood samples and other body fluids should be collected, transported, and processed using strict precautions. Proper use of personal protective equipment (PPE) and handwashing are essential.
Contaminated needles and other sharps must be placed in puncture- resistant, leak-proof, and labeled containers.
Fire Hazard :
The four factors causing fire are fuel, heat, oxygen, and an uninhibited reaction.
Fire extinguishers should be available for small fires, and personnel should know how to use them safely.
Electrical Hazards :
Phlebotomists are exposed to electrical hazards when using equipment like centrifuges, computers, fans, and space heaters.
Frayed cords, removed grounding prongs, and any type of shock when using equipment should be addressed immediately.
Chemical Standards :
Employees must be notified of the potential health hazards of handled chemicals. Toxic or irritant vapors must be used only in an approved chemical hood. Appropriate personal protective equipment, such as a chemical- resistant apron and face shield, should be worn when there is a danger of splashing.
Safety showers and eye wash stations must be available in case of chemical spills or splashes.
Radiation Exposure :
The principles of radiation exposure are distance, shielding, and time.
Monitoring devices should be worn if the phlebotomist is collecting samples from patients treated with radioactive implants or returning from nuclear medicine scans.
Latex Allergy :
Phlebotomists are at high risk for latex allergies, which can range from itchy irritations to more severe reactions. Exposure to latex must be eliminated, as there is no cure, only prevention.
Disposal of Used Materials
Two requirements: Alter the product to prevent reuse and render it non-infectious. Three methods: Incineration, chemical treatment, and autoclaving.
Importance of Following Safety Guidelines
Safety guidelines are essential for both the patient's and the phlebotomist's safety. Failure to follow guidelines can result in OSHA fines of up to $7,000. The most prevalent hazard for phlebotomists is accidental needlestick exposure.
Responses to Accidental Biohazard Exposure
Immediately wash the exposed area with soap and water, or flush the mouth or eyes with water. Report the incident. The exposed associate and source patient must be tested for HIV or HBV, with the associate's consent. If the source patient refuses testing and is in a high-risk category or known to be HIV or HBV positive, the associate may elect to receive prophylaxis treatment. The exposed associate should be counseled to be alert for viral symptoms for 12 weeks after the exposure.
