What is Phlebotomy - Essay Example

Phlebotomy Contents Contents 2 Introduction 3 Anatomy and Physiology: An Overview of the Circulatory System and the Skin3 Homeostasis 4 Site Selection 4 Venipuncture 5 Complications Associated with Phlebotomy 5 Factors to Consider Prior to Performing the Procedure 6 Quality Assurance and Specimen Handling 6 Analytical Errors 6 Routine Venipuncture 7 Failure to obtain Blood 7 Special Venipuncture 8 Special Specimen Handling 8 Dermal Punctures/Micro Capillary Collection 9 Order of Draw 9 Test Tubes, Additives and Tests 10 Clinical Laboratory Sections 11 Safety 11 Infection Control/Chain of Infection 12 Legal Considerations in Phlebotomy 12 References 14 Introduction Phlebotomy is the collection of blood for laboratory analysis or bloodletting for therapeutic reasons (Lindh, Poole, Tamparo, & Dahl, 2010). It is used to determine the disease process in the body so as to determine the method of treatment. Medical assistants, also known as phlebotomists, obtain blood specimens from individuals by use of venipuncture and capillary puncture techniques. Given that medical assistants normally have direct contact with patients, they ought to have excellent skills of performing venipuncture so as to leave positive impressions because it is their responsibility to offer high quality care to patients. Professionalism is required while medical assistants work with patients. Therefore, efficiency, competence and a show of concern to patient needs and feelings are crucial (Lindh, Poole, Tamparo, & Dahl, 2010). Anatomy and Physiology: An Overview of the Circulatory System and the Skin A phlebotomist should understand the blood circulatory system and the composition of blood so as to be able to collect blood from an individual or patient. For instance, blood forms in the body organs, and bone marrow is responsible for the formation of blood cells. Blood is produced in sites such as the spleen, thymus and the lymph nodes (Lindh, Poole, Tamparo, & Dahl, 2010). Blood performs crucial functions in the body such as transporting oxygen to body tissues and organs and removing carbon dioxide from such organs and tissues, the waste product of functions of the organs and tissues. In addition, blood carries nutrients to all parts of the body and removes wastes products, which it moves to organs such as the kidney, lungs, liver and the skin for excretion (Lindh, Poole, Tamparo, & Dahl, 2010). Components of the blood circulatory system include the heart, veins, arteries and capillaries. The heart is responsible for the pumping of blood through the body in arteries, veins and capillaries (Lindh, Poole, Tamparo, & Dahl, 2010). Arteries enable blood to flow away from the heart while blood flows into the heart through veins. Capillaries connect veins and arteries. Arteries are thick walled to enable them withstand pressure, and they normally branch to form arterioles which also branch to form capillaries (Lindh, Poole, Tamparo, & Dahl, 2010). Capillaries join to form venules which supply blood back to the veins. Blood is composed of the liquid part which is plasma, red blood cells, platelets and white blood cells (Hoeltke, 2013). The circulatory is divided into two systems and these are the pulmonary system and the systemic system. Blood is circulated to the lungs for enrichment with oxygen and removal of carbon dioxide through the pulmonary system while the systemic system supplies cells with oxygen, fats carbohydrates and other energy sources, as well as, removes waste products (Hoeltke, 2013). The skin is made of three layers. These are the epidermis, the dermis and the hypodermis from the outermost the innermost respectively. Homeostasis Homeostasis is one of the main body functions. It involves the body’s maintenance of its internal environmental through various processes to bring about equilibrium. Therefore, through homeostasis, the body is able to maintain control in a narrow range and this allows the body to adjust to the outside world (Hoeltke, 2013). Site Selection The appropriate venipuncture site varies, depending on the patient. The bend of the upper arm should be checked first, normally called the antecubital area. Here, the median cubital vein is the primary and prominent vein that should be looked for, and is normally found in the middle bend of the arm. Alternatively, a phlebotomist can use basilic, cephalic or median veins as a second choice (Hoeltke, 2013). A phlebotomist should choose a site that will give the best blood return such as the ankle or foot, wrist, in line with the thumb, back of the hand, upper arm, and antecubital area. A phlebotomist should avoid sites such as Edematous arms, arms in casts, cannulas, fistulas, arm with intravenous fusion, areas of scarring and side of a mastectomy. A tourniquet will help fill the veins with blood by constricting the flow of blood and it should be placed three to four inches above the proposed site. Then the medical assistant looks for a vein by feeling with the tip of an index finger or middle finger because these fingers are more sensitive than the thumb which has a pulse (Hoeltke, 2013). The medical assistant should palpate and trace the path of the vein several times. The roundness and direction of the vein should be identified because not all veins go straight up or down the arm. In case the vein that has been identified pulsates, then that is not a vein but an artery and it should not be punctured. Medical assistants should avoid deep probing venipunctures to avoid tampering with nerves. Venipuncture Venipuncture involves a procedure of puncturing into a vein to obtain blood samples. Medical assistants normally use three methods to perform venipuncture and this are the vacuum tube method, the butterfly method and the syringe method (Lindh, Poole, Tamparo, & Dahl, 2010). Medical assistants should have options when they are required to draw blood from a variety of patients in different situations. In all the methods used to perform venipuncture, the blood is transferred to a vacuum tube, be properly selected and used while there should be proper labeling procedures and which contains the chemicals and substances that are necessary for blood tests to be carried out (Lindh, Poole, Tamparo, & Dahl, 2010). Complications Associated with Phlebotomy Medical assistants may experience problems in obtaining a specimen. This occurs when a blood sample cannot be obtained. Probing should be attempted because it is painful to the patient. Another venipuncture may be performed, but a venipuncture should not be attempted more than twice. Other complications may arise due to patient complication such as hematoma, which form under the skin adjacent to the puncture site (Medtexx Medical Corporation, 2007). Petechiae form little, red spots, consisting of extravasated blood as a result of a coagulation abnormality such as platelet defect. Phlebotomy is also associated with fainting (syncopy) of patients when they think of blood or when they see it (Medtexx Medical Corporation, 2007). Factors to Consider Prior to Performing the Procedure Prior to performing phlebotomy, it should be ensured that the patient is properly identified using correct procedures. Equipment should completion of laboratory requisitions (Medtexx Medical Corporation, 2007). Phlebotomists should consider the order of draw in cases of multiple tube phlebotomy. In addition, phlebotomists should identify the venipuncture sites and ensure safety of the patient (Medtexx Medical Corporation, 2007). Quality Assurance and Specimen Handling There should be proper handling of specimen beginning the time blood is drawn into the evacuated tube or syringe and during the collection process, as well transportation and processing of the specimen in the laboratory. Specimens should be handled with utmost concern for blood-borne pathogen safety to protect phlebotomists and others from potentially infectious substances (Kalanick, 2004). Needles and sharps should be monitored to ensure that they are sterile before use. Tubes and other equipment must be used and disposed appropriately (Ridley, 2011). Also, specimens should be properly labeled and protected from lighting. Analytical Errors Analytical errors occur during the process of analysis or testing of the specimens in phlebotomy. Venipuncture sites should be chosen properly because they may be a potential source of analytical errors and risk to the patient (Prince, 2011). These errors are caused by issues such as poor faulty instrumentation and lack of highly skilled testing personnel. Also, the way the specimen is handled and stored may alter the results obtained through testing. Routine Venipuncture Blood should be collected from the antecubital, the median cubital and the cephalic veins, which should be punctured using the evacuated collection system or the syringe or butterfly collection system, in an aseptic manner (Davis B. K., 2010). A phlebotomist should not insert a needle above an intravenous infusion. However, the phlebotomist may draw blood at least two inches below the intravenous site after getting permission from the patient’s physician in cases where there is no other alternative site. Phlebotomists should allow outpatients to sit for fifteen minutes to let the body to recover from stress before attempting a venipuncture. Phlebotomists should release the tourniquet and remove the needle, immediately they discover the venipuncture has began swelling during the venipuncture process (Kalanick, 2004). Failure to obtain Blood Failure to obtain blood is termed as failed venipuncture. When this occurs, a phlebotomist needs to change the position of the needle by rotating it half a turn. A failed venipuncture may result when the bevel of the needle is against the wall of the vein, indicating that the needle has not penetrated the vein far enough (Hoeltke, 2013). In this case, the phlebotomist is required to advance the needle a little bit further, but to be careful not to go too deep. This is because only a small change makes the difference between a failed and a successful venipuncture. Alternatively, when the needle has been penetrated too far into the vein, a phlebotomist may fail to obtain blood and he or she needs to pull the needle back a little. The needle should be pulled back slowly when there is an unsuccessful venipuncture, and the blood will start coming almost immediately as it seems the needle is ready to come out of the skin (Hoeltke, 2013). There are other reasons for failed venipuncture. For instance, the tube may have pulled back out of the holder. Sometimes, the tubes do not stay pushed all the way into the holder while the blood is being collected, and may slide back out leading to a stoppage in filling with blood. The ideal remedy in this situation is to exert slight pressure on the tube into the holder (Hoeltke, 2013). Also, the tube that is in use for drawing blood may not have sufficient vacuum. This requires a phlebotomist to try another tube before withdrawing. Another reason for failing to obtain blood is when the tourniquet is too tight, stopping blood flow. To remedy the problem, the tourniquet should be reapplied loosely. The arm can be massaged and the venipuncture location can be warmed. Finally, a phlebotomist may use a blood pressure cuff, inflated to between the patient’s systolic and diastolic pressure. This provides a larger service area to apply pressure, which can be regulated to bring veins to the surface when other methods have failed (Hoeltke, 2013). Special Venipuncture Special venipuncture results when it is difficult to draw blood from a patient using routine venipuncture. This is normally associated with Edema of the extremities, scarring or burn patients, post mastectomy patients and dialysis patients. Therefore venipuncture should not be performed in Edematous areas, scarring or burnt areas, and fistula or on the same side of the mastectomy (Turgeon, 2005). Special Specimen Handling During phlebotomy, there are specimens which require special handling after collection. These are specimens that have special requirements. Such specimens include those that should be protected from light, those that need to be chilled and those that need to be kept warm (McCall & Tankersley, 2003). Therefore, phlebotomists should ensure that they handle special specimens appropriately for accuracy of the test results for patients. Dermal Punctures/Micro Capillary Collection Phlebotomists perform the venipuncture procedure most frequently. However, this procedure is not appropriate in all circumstances. Laboratory test can be performed on micro samples of blood that are obtained by dermal puncture on adult and pediatric patients as a result of advances in laboratory instrumentation and the need for point of care testing (Strasinger & Lorenzo, 2011). Dermal puncture is performed on the skin or capillaries, and is normally used to collect blood from infants and children who are below two years of age. This is because it is difficult to locate superficial veins that are large enough to be penetrated by even a small gauge needle in infants and children below two years, and available veins need to be reserved for intravenous therapy. Use of deep veins may be dangerous and cause complications such as cardiac arrest among such patients. In addition, if excessive amounts of blood are drawn from infants can lead to anemia (Strasinger & Lorenzo, 2011). Finally, capillary blood is required in certain tests such as newborn screening tests and capillary blood gases. In adults, dermal puncture is performed on burnt or scared patients, patients receiving chemotherapy and patients with thrombotic tendencies. Also patients with fragile veins, inaccessible veins, as well as, obese and apprehensive patients are ideal for dermal puncture (Strasinger & Lorenzo, 2011). Order of Draw Normally, most of the blood collection tubes contain an additive which either facilitates or prevents the specimen from clotting. At times, additive carry-over from one tube to the next can occur, altering results drastically. Additive carry-over occurs when blood or anticoagulant mixture is transferred by the needle used to fill one tube into the next tube filled (Ernst, 2005). This can lead to wrong diagnosis, which is dangerous because it prevents physician intervention. Order of draw may lead to cross-contamination of anticoagulants and contaminate blood culture collections. Since the tops of blood collection tubes are not sterile, the needles that puncture them are likely to pick up and transport bacteria from one tube to the next (Ernst, 2005). If the next tube is a blood culture bottle the culture could be contaminated and lead the laboratory to report a positive blood culture on a patient who does not have bacterial blood infection. This may lead to wastage of funds and prolonged stay in hospital for unnecessary medication and tests. Therefore, it is recommended that blood cultures should be collected before other tubes are filled. The order of draw has significant impacts on patient results and physicians’ responses to the results. Therefore, the following order should be followed. The tubes for blood cultures should come first, followed by tubes containing sodium citrate. These are followed by serum tubes with or without clot activators or gel separators and then tubes containing heparin. Tubes containing EDTA follow and finally, tubes containing sodium fluoride (Davis, 2002). Test Tubes, Additives and Tests A phlebotomist should be properly trained in all blood collection phases and should have the recommended certification. There should be proper preparation before the process is performed. Also, the correct tube or specimen container should be used. This means that phlebotomists must follow the manufacturer’s instructions, pertaining to mixing all tubes with additives to ensure accurate test results and that no microclots form in the tubes. There should be proper checking on all tubes for cracks and expiry dates. Additives should be observed whether they have discoloration, which could indicate contamination while new lot numbers of tubes must be checked to verify draw and fill accuracy (Rodak, 2007). Test tubes are used to collect blood specimen and normally packed with rubber stoppers (DeLaune & Ladner, 2010). They also contain specific substances or chemicals for tests to be run. It is important to read the label to determine the additive that is in the tube when a phlebotomist is in doubt (Gibson, Shah, & Umberger, 2013). Clinical Laboratory Sections There various clinical laboratories have various sections and these subdivisions are made depending on the size and specialties within such laboratories. Various laboratory sections perform special tests as categorized within their expertise. For instance, the Hematology department is responsible for tests of the formed or cellular elements of blood such as red blood cells, platelets and white blood cells. Both quantitative and qualitative tests are carried out in the department such as number and size or shape or maturity (Lindh, Poole, Tamparo, & Dahl, 2010). The blood components’ ability to perform their individual tasks correctly is also tested in the hematology department. The parasitology section is where ova and parasite tests are performed on specimens while microscopic examination of cells are performed to detect early signs of cancer and other diseases is carried in the cytology section. Frozen samples of biopsies are sliced, stained and then examined microscopically for cancer and other diseases in the histology section. (Lindh, Poole, Tamparo, & Dahl, 2010) Safety There should be safety provisions which should be followed for the safety of the patient and that of the medical assistant. Safety must be followed so as to prevent the patient from contracting an infection. Similarly, a medical assistant should not be vulnerable to acquiring a disease from patients while working. New needles and clean gloves should be used always. Medical assistants should try to avoid the use of needles as far as possible, if other effective alternatives are available. Devices with safety features should be used always (Hoeltke, 2013). Priorities and strategies for prevention should be authorized by examination of local and national risk factors information. Proper training of health workers should be instituted to enhance safe use and disposal of needles and sharps (Hoeltke, 2013). Infection Control/Chain of Infection Infections can be contracted through inhaling or through contact. Therefore, there should be proper washing of hands and phlebotomists should adhere to universal precautions strictly. There should be isolation of body substance and identification of patients who are at risk for susceptibility, treating their underlying conditions where possible and isolating them. Medical asepsis should be observed (Lindh, Poole, Tamparo, & Dahl, 2010). Medical asepsis aims at destroying pathologic organisms so as to decrease the risk for transmission to others. Therefore, medical assistants should ensure that objects are medically aseptic when such objects are to be used in procedures that are on the external body or if they will enter a usually contaminated part (Lindh, Poole, Tamparo, & Dahl, 2010). Legal Considerations in Phlebotomy Phlebotomists should not violate the legal rights of patients because this may lead to legal action. Therefore, phlebotomists should consider the rights of patients to be professionally binding. Confidentiality is among the principal legal issues in phlebotomy. This encourages intimate level communication between phlebotomists and a patient. Confidentiality prohibits phlebotomists from disclosing some information that they gain to third parties without the consent of the original source of such information (Davis B. K., 2010). In turn, this will exclude unauthorized people from getting access to client information. Phlebotomists should practice confidentiality because clients may fail to disclose personal information which may be vital for their care and treatment. Phlebotomists’ self discipline when dealing with patient information is crucial. Another legal issue is legal refusal of treatment by patients. For instance, it is common for phlebotomists to face situations in which a patient refuses to have blood drawn. Phlebotomists are expected to respect such a decision (Davis B. K., 2010). This means that phlebotomists should not attempt to proceed and perform phlebotomy to avoid legal suits for patient battery, which is intentionally touching another person without authorization to do so. Instead, proper explanations should be provided to the refusing patients that it is the doctor who has ordered the tests and that the doctor needs the test results for making treatment decisions. Where patients insist and continue refusing, phlebotomists should notify appropriate people such as physicians and nurses and document the client’s refusal (Davis, 2002). References Davis, B. K. (2002). Phlebotomy: A Customer Service Approach : a Textbook for Developing Phlebotomy and Customer Service Skills. Albany: Delmar Thomson Learning Press. Davis, B. K. (2010). Phlebotomy: From Student to Professional. Andover: Cengage Learning Press. DeLaune, S., & Ladner, P. (2010). Fundamentals of Nursing. New York: Cengage Learning. Ernst, D. J. (2005). Applied Phlebotomy. Baltimore: Lippincott Williams & Wilkins Press. Gibson, J. L., Shah, B. M., & Umberger, R. (2013). Clinical Medical Assisting: An Introduction to the Fundamentals of Practice. Burlington: Jones & Bartlett Learning. Hoeltke, L. B. (2013). The Complete Textbook of Phlebotomy. Sidney: Delmar Cengage Learning Press. Kalanick, K. A. (2004). Phlebotomy Technician Specialist: A Practical Guide to Phlebotomy. New York: Delmar/Thomson Learning Press. Lindh, W., Poole, M., Tamparo, C., & Dahl, B. (2010). Delmars Clinical Medical Assisting. New York : Delmar Cengage Learning Press. McCall, R. E., & Tankersley, C. M. (2003). Phlebotomy Exam Review. Philadelphia: Lippincott Williams & Wilkins Press. Medtexx Medical Corporation. (2007). Fundamentals of Phlebotomy . Retrieved from http://www.depts.ttu.edu/hess/_documents/mccomb/lab_safety/phlebotomy.pdf Prince, L. G. (2011). The Art of Phlebotomy. Bloomington: AuthorHouse Press. Ridley, J. (2011). Essentials of Clinical Laboratory Science. New York : Cengage Learning Press. Rodak, B. F. (2007). Hematology: Clinical Principles and Applications. Philadelphia: Saunders Press. Strasinger, S. K., & Lorenzo, M. S. (2011). The Phlebotomy Textbook. Philadelphia: Davis Co Press. Turgeon, M. L. (2005). Clinical Hematology: Theory and Procedures. Philadelphia: Lippincott Williams & Wilkins Press. Read More