History of Phlebotomy

1. History of Phlebotomy Louis Pasteur Because of his study in germs, Pasteur encouraged doctors to sanitize their hands and equipment before surgery. The father of preventive medicine >>

2. Phlebotomy • Joseph Lister • Revolutionized surgery by sterilizing instruments and washing physician’s hands with an antiseptic spray • Robert Koch • Changed the way health departments cared for persons with infectious disease with his work in isolating bacteria

3. Contributions to Medicine • Hippocrates • Greek physician Hippocrates, who is referred to as "The Father of Medicine" first mentioned bloodletting in his works, proclaiming that a woman's menses is a means of bleeding out certain toxins that they have more of than men. Hippocratic Oath established guidelines for a physician’s practice of medicine Ancient

4. Phlebotomy • Early 20th century • Many infectious diseases and epidemics became curable • Life expectancy increased • Antibiotics discovered • Salk and Sabin vaccines found for poliomyelitis • Early 20th century • Banting and Best discovered insulin could be used with diabetics • Both penicillin and cancer cells were discovered in 1928 • Penicillin not brought into production until 1945

5. HISTORY of Phlebotomy • Phlebotomy is a term that came to be in the 20th century, as the process of drawing blood for medical testing. Prior to this, it was a widely used therapeutic method known plainly as "bloodletting". • Bloodletting is the withdrawal of often considerable quantities of blood from a patient to cure or prevent illness and disease • The Mesopotamians practiced bloodletting for sacrificial and ritualistic purposes along with medical reasons, as did the Egyptians . • In medieval times, bloodletting was used to “bleed-out” evil spirits

6. History of “bloodletting” • Bloodletting was thought to rid the body of impurities and evil spirits or, as in the time of Hippocrates, simply to return the body to a balanced state. During the 1800’s anyone claiming medical training could perform bloodletting, and barbers most typically performed this procedure. A loss of approximately 10 milliliters(about 2 teaspoons) was standard. However, it was not uncommon for an excessive amount of blood to be withdrawn during these procedures. In fact, the untimely death of the first president of the United States George Washington, was thought to be the result of excessive bleeding in an attempt to treat a throat infection.

7. History of “bloodletting” • A big turning point occurred when Galen discovered that veins and arteries carried actual blood and not air, as was thought previously. • Galen created a complex system of how much blood should be removed based on the patient's age, constitution, the season, the weather and the place. He linked different blood vessels with different organs, according to their supposed drainage. For example, the vein in the right hand would be let for liver problems and the vein in the left hand for problems with the spleen..

8. Bloodletting Devices & Methods • THE LANCET • The earliest bloodletters probably used sharpened pieces of wood and stone to "breath a vein." • Lancets were often used on more then one patient. As there was no concept of antisepsis, infections passed from patient to patient.

9. The process of removing blood from the vein is believed to date back as far as 1400 B.C., where an Egyptian tomb painting shows a leech being applied to the skin of a sick person. I n the early 1800’s leeches were in demand for the procedure known as bloodletting. Leech farms were unable to keep up with the demands for medicinal leeches because bloodletting procedures were so popular.

10. Bloodletting Devices & Methods • LEECHES • They attach to the skin via 3 sharp teeth, inject an anticoagulant so the blood won’t clot, and then "fill up.“ • Back then, leeches were used to remove the “bad blood” from patients that were suffering from things as basic as a headache • Today leeches can be useful after the transplantation and reattachment of tissues.

11. LEECHES Leeches can bite through a hippo's hide! The leech will gorge itself up to five times its body weight. The bite of a leech is painless, due to its own anesthetic.

12. History of the Barber Pole • The modern barber pole originated in the days when bloodletting was one of the principal duties of the barber.  The two spiral ribbons painted around the pole represent the two long bandages, one twisted around the arm before bleeding, and the other used to bind is afterward. • In the Middle Ages, hair was not the only thing that barbers cut. They also performed surgery, toothextractions, and bloodletting.

13. Phlebotomy • The primary duty of the phlebotomist is to collect blood specimens for laboratory analysis. • The most common method is by venipuncture, opening a vein to obtain a blood sample without destroying the integrity of the vein. • This is an invasive procedure which must be performed with skill to prevent harming the patient. • Three purposes for collection and analysis of laboratory samples: • a. Diagnostic testing • b. Therapeutic assessment • c. Monitoring patient’s condition

14. Professional Ethics • Principles of right and wrong conduct for the profession. • Doctors have the Hippocratic Oath (400 BC) 1) Do no harm intentionally 2) Perform according to sound ability and judgement. 3) Do what you’re trained to do, no more. 4) Deal with patients assigned, not those you’re curious about. 5) Keep all patient information confidential. •  Implied code of ethics for all health care professions, most common are: 1) Do no harm to anyone intentionally. 2) Perform according to sound technical ability and good judgement. 3) Respect the patient’s rights

15.  Roles and Responsibilities of the Phlebotomist • Collection of specimens • Processing of specimens • Transporting of specimens • Performing vital signs • Professional Communications and Appropriate Client/Patient Interaction • Performing POCT • Laboratory Computer Skills • Medical Terminology • Anatomy and Physiology • Accurate Tube Identification • Knowledge of Frequently Ordered Lab Test • Time Management • Quality Assurance • Preparation of Blood Smears • Clerical Skills • Highly Motivated • Pleasant Personality • Work Well Under Pressure • Detail Oriented • Empathetic

16. Professional Behavior • Health care professionals have personal responsibility to provide best care possible. • Character attributes for phlebotomists include: 1) Sincere interest in health care. 2) Accountability for doing things right. 3) Dedication to high standards of performance. 4) Propensity for cleanliness. 5) Pride, satisfaction, and self-fulfillment in the job. • Professional behavior involves doing the right thing when no one is watching

17. Communication Skills • Phlebotomist are a critical link in healthcare • Bedside Manner • Patient Interview • Teaching Patients • Communication Strategies • Hearing Disabilities/Impairments • English as second Language • Cultural Diversity • Age • Tone of Voice • Verbal and Non-Verbal Communication • Body Language • Listening Skills

18. Appearance • Posture • Grooming • Personal Hygiene (Brush teeth, wash yourself, Hair pulled back, nails clean, Clothes clean, shoes clean, DON’T SMOKE before work!)

19. Dealing with Stress • Prevalent in workplace • 1) Non-physician lab personnel ranked third in terms of workplace stress. • 2) Rapid changes in technology forced individuals to adjust to faster paced, pressured life.

20. Rules for Low Stress Living • 1)Make time your ally, not your master. • 2) Associate as much as possible with gentle people. • 3) Learn and practice the skill of deep relaxation • 4) Use aerobic exercise • 5) Engage in satisfying, meaningful work. • 6) Don’t let work dominate you entire life. • 7) Find some time in every day for complete privacy. • 8) Open yourself up to new experiences and self renewing opportunities • 9) Read interesting books and articles • 10) Don’t bite off more than you can chew. • 11) Seek rewarding experiences in all dimensions of your life. • 12) Surround yourself with cues that affirm positive thoughts and positive approaches to life and that remind you to relax and unwind occasionally.

21. Patient Rights • It is the responsibility of all members of the health care team to recognize that your first responsibility is to the patient’s health, safety and personal dignity. • Many hospitals and health care facilities have adopted/incorporated “A Patient’s Bill of Rights”, developed by the American Hospital Association into their policy manual. • Patient’s Bill of Rights should include/address the following: • a. Respectful and considerate care • b. accurate information • c. Informed consent. • d. Patient refusal of blood test • e. Privacy • f. Strict confidentiality • g. Advance directives • h. Information about the identity and role of personnel involved in his or her care. • g. Information about research procedures involved in his or her care • h. Billing

22. Family, Visitor’s and Significant Others • Family and visitors may be more difficult to deal with than the patient. • Make requests or demands that are not part of your job duties. • Refuse requests to get food or water, as patient may be NPO, have them contact the nurse. • Ask there cooperation in reassuring the patient. • You can ask family/visitors to step outside during blood collection if necessary. • Physicians, priests, chaplains have right to privacy with patient. • Leave and come back later. • If timed or STAT request ask permission to collect specimen.

23. Department of Clinical Laboratory Medicine-Personnel • Composed of two major areas: • Clinical pathology analyzes blood, body fluids, and biopsy materials • Anatomic pathology involved in autopsies, cytology and surgical pathology • Clinical Laboratory Improvement Act of 1988 (CLIA 1988) established regulations concerning qualifications of personnel, periodic inspections, proficiency testing, and investigation of complaints. Laboratory tests classified as: • a. Waived • b. moderate complexity tests • c. high complexity tests

24. Laboratory DirectorMedical Director • A pathologist with extensive education in pathology. • Aid the patient's physician in the correlation of laboratory results with disease states. • Aid the doctor in setting up lab protocols such as when order what type of laboratory test and determining the "menu" of laboratory testing to offer. • Involved with interpretation of tissues such as those obtained during biopsy, surgery, autopsy and bone marrow. • All problems or abnormal results obtained by the techs are referred to the pathologist.

25. Phlebotomist • H.S. graduate or equivalent. • Training varies - OJT or structured program. • Collects blood specimens from adults, children and babies using appropriate technique and equipment. • Identification of the patient is the most critical step. • Must understand and follow to the letter all precautions related to the collection of blood specimens, whether others follow or not. • May also be responsible for starting and collecting specimens for glucose tolerance tests (GTT), bleeding times, blood cultures, instructing patients on these procedures as well as the proper collection of urine and semen samples, as well as delivering and processing specimens in the lab. • Must be able to deliver specimens in a timely fashion, maintain accurate records/logs, and exhibit professional conduct and attitude at all times.

26. Where Do Phlebotomists Work (Inpatient) • Phlebotomists employed at inpatient facilities work directly with several members of the health care team. Inpatient Facilities Hospitals Nursing Homes Rehabilitation Centers

27. Where Do Phlebotomists Work (Outpatient) • Outpatient Facilities • Physician’s Offices • Home Health Care Agencies • Ambulatory Care Centers • Reference Laboratories • Blood Banks • Ambulatory care centers are the fastest-growing outpatient facilities.

28. Roles and Responsibilities of the Phlebotomist • PATIENT IDENTIFICATION • Check armband or ID label in acute care settings • Check driver’s license or picture ID in outpatient settings Proper Identification Is a Three-Step Process

29. Roles and Responsibilities (cont’d) • Professionalism • Be professional • Apply good interpersonal • skills Dress professionally Many institutions require that phlebotomists wear a lab jacket and specified shoes to meet OSHA guidelines.

30. Roles and Responsibilities (cont’d) Verbal and nonverbal communication should be appropriate, such as: • Avoiding the use of slang • Speaking in a calm, clear voice • Avoiding inappropriate terms • Maintaining eye contact • Neat, well-groomed appearance • Respecting personal space The phlebotomist must be able to communicate using nonmedical terms.

31. Roles and Responsibilities (cont’d) When providing customer service: • Be empathetic • Observe the patient’s behavior • Listen to the patient’s concerns • Address any situation promptly • Be flexible