Phlebotomy Blood Draws Done Right

My most recent visit to a local laboratory has made me as a Phlebotomist and a patient write this article. I have been a Licensed Phlebotomist for over 15 years with an Associates Degree in Laboratory Science and have to tell you that it is very discouraging to find out that the so called Phlebotomist that drew my blood last week only went to school for 9 weeks verses my 2 years for my Associates Degree and an additional year to add on the RMA (Registered Medical Assistant). My experience was terrifying, not only did the girl use improper technique and poor sterilization of the area to be used; she missed the vein and then started to probe around in my arm to find it. I ended up with serious Phlebitis which is an inflammation of the Phlebotomy site with blood that has leaked out of the vein and pooled around the area to cause sever bruising, knotting of the area and discomfort for over a week now. As a Phlebotomist myself, if i ever missed my mark I was thought to never Probe the vein because you could do more damage to the surrounding tissue and muscles, if I were to miss i would simply apologize to the patient and then start over.

I tried to explain to the girl whom drew my blood that she was doing it all wrong and she actually got an attitude with me and told me that I did not know what I was talking about. After she pulverized my arm I then revealed to her that I have been a Phlebotomist and Laboratory Technician for 15 years and that I did not appreciate her comments or her lack of knowledge in field.

I can tell you form being at the top of my field that Phlebotomy is more than just drawing the blood. As a Phlebotomist you must be able to make the patient feel comfortable enough to let you stick a 21 gage needle into there arm and collect a blood specimen and fill up 5-6 vials of blood. We need to have GREAT customer service skills, must have a vast knowledge of the tests that we run and know how to send out for reference testing. Every day I deal with patients on a very personal level and have direct contact with the patients, so if you can not gain there trust they most likely will have a bad experience. To ensure that the patient has a good experience I would start off by explaining the procedure to them in detail.

The steps to draw blood are as follows, first use the universal precautions and put gloves on and DO NOT rip off one of the fingers so you can feel better this will only put the Phlebotomist at risk. Explain the procedure then place the tourniquet in place. This next step is where a lot of Phlebotomist makes their first mistake. After the tourniquet is in place you must palpate the phlebotomy site to feel for a vein. Most Phlebotomist will say " Oh I can't see any veins" that would be because we are supposed to palpate for the vein not go by sight. The vein may look good but in reality it could be a thready, rolling or a vein that has been used to often and would collapse. Most likely this could cause the Phlebotomist to miss. Then clean the area with an alcohol pad and insert the needle with the bevel up and attach the vaccutainer and draw the specimen according to the tests ordered. To finish up I would then take the tourniquet off, remove the last vial and apply a pressure cause bandage.

Infants and toddlers, this is very difficult as the infants cannot communicate with us and the toddlers are limited in there communication. So it takes extra time and a special skill to do a Venus blood draw. I specialize in Pediatric Phlebotomy and in most cases the tests ordered by the physician, can be drawn by collecting a capillary specimen, which is a finger stick. On the infants I use the outer edge of the heal. I then use a heal warmer to circulate the blood in the heal for less manipulation of the foot. For the older children I use the fourth finger because it has fewer nerves than lets say the index finger or the thumb. Some tests ordered require more specimen and would need to do a venous blood draw, all I can say about this is that it takes years of practice and a special skill to be able to do a venous draw without hurting the child.

So the next time you find yourself at the laboratory remember to ask your Phlebotomist if they are Certified or Licensed and how much experience they have. Don't afraid to request someone that has had more experience either, we as patients have the right to receive the best care possible.

References for this article include Center for Phlebotomy Education.