The Royal Derbyshire Hospital in Derby has employed a new robotic blood testing system that processes routine blood tests and releases the results in just a few hours.
Every day the hospital receives more than 2, 500 blood samples from GP surgeries. Prior to the introduction of the new robotic technology they had to be manually put through a number of different machines. It was a labour intensive process and meant that the results took at least two days to come through. But those days are gone.
In an interview with the BBC Steve Kyte, the pathology service manager at the hospital commented on how well the system had bedded in with staff.
“I’m very impressed with this system – the staff have implemented it very well with very few hiccups.”
It is not a case of the machines taking over; the autonomous assistant is simply much quicker than all other methods and helps staff to carry out their roles more effectively.
Not only is the robotic system a boon to the working lives of staff, making their jobs easier, but it is particularly useful when test results are needed fast. This is something that could make a huge different to patient care.
Erythrocytes – these are the mature red blood cells. Unlike the body’s other cells they do not possess a nucleus. They contain haemoglobin and distribute oxygen.
Leukocytes – these are the white blood cells that are central to the immune systems response against incoming pathogens.
Thrombocytes – also known as platelets which are responsible for blood clotting. They contain an enzyme that converts fibrinogen into fibrin.
Blood is slightly alkaline; it has a pH that is regulated to keep within a narrow range of 7.35-7.45.
Proteins – there are three proteins found in blood plasma. 1) Fibrinogen which is essential for clotting 2) albumin, which is produced by the liver and maintains blood osmotic pressure and volume 3) globulin proteins which help with the production of antibodies.
Gases –these include carbon dioxide, nitrogen and oxygen.
Other important components include amino acids, fatty acids, and electrolytes such as sodium and chloride.
If you are injured and cut yourself fibrin forms part of your body’s emergency response unit. It is a tough protein substance that forms long thread-like chains.
A cut in the skin must be closed quickly so that virsuses, bacteria and fungi cannot enter and cause infection. When a blood vessel is cut or broken platelets travel toward it and plug the gap. They are stuck together by a fibrous material called fibrin. This mesh of blood and fibrin forms a scab which keeps pathogens out and allows the wound to heal.
Fibrin is made from fibrinogen, a soluble protein that is produced by the liver and found in the blood plasma. When an injury results in bleeding the fibrinogen is converted into fibrin at the site of the wound by a clotting enzyme called thrombin.
However after the blood draw fibrin can be the phlebotomist’s and blood test technician’s foe. Once collected blood undergoes irreversible changes; and one of these is coagulation. If the blood clots in a tube it can lead to inaccurate results and instrumentation problems. Fibrin can form in all tubes during the blood testing procedure and the common causes are overfilling, premature centrifugation, improper mixing and incomplete clotting (delayed or prolonged coagulations that results in fibrin formation). All of these issues can be resolved by following standard procedures.
Blood – the poet’s and artist’s muse. This is part two of our look at some of the funny and thoughtful quotes tainted with blood.
“Music is not written in red, white and blue. It is written in the heart’s blood of the composer.” – Nellie Melba, superstar soprano
“The word ‘politics’ is derived from the word ‘poly’, meaning ‘many’, and the word ‘ticks’, meaning ‘blood sucking parasites’”. -Larry Hardiman, comedian
“All the soarings of my mind begin in my blood.” – Rainer Maria Rilke, Bohemian-Austrian poet
“Your belt is stopping the blood flow to your head!” – Singer Darius Danesh to Simon Cowell
“Writing is easy. All you do is stare at a blank sheet of paper until drops of blood form on your forehead.” – Gene Fowler, journalist, author and dramatist.
“When liberty comes with hands dabbled in blood it is hard to shake hands with her.” – Oscar Wilde, playwright, poet and author
“The true colour of life is the colour of the body, the colour of the covered red, the implicit and not explicit red of the living heart and the pulses. It is the modest colour of the unpublished blood.” - Alice Meynell, writer
Blood is the vital life force that flows through us, and it’s also the source of some funny and thought provoking quotes.
“Playwriting gets into your blood and you can’t stop it. At least not until the producers or the public tell you to.” – T. S. Eliot, poet and playwright
“Blood is that fragile scarlet tree we carry within us.” – Osbert Sitwell, writer
“Blood is thicker than water… but it makes lousy lemonade!” Alfred E Newman, fictional mascot that appeared on the cover of MAD magazine
“Blood will tell, but often it tells too much.” – Don Marquis, humorist
“You know you’re old if they have discontinued your blood type.” – Phyllis Diller, actress
“I have nothing to offer but blood, toil, tears and sweat.” – Winston Churchill, statesman, former Prime Minister
“Like getting into a bleeding competition with a blood bank.” - Richard Branson, entrepreneur
“Of all that is written, I love only what a person has written with his own blood.” – Friedrich Nietzsche, philosopher
“I was always shocked when I went to the doctor’s office and they did my X-ray and didn’t find that I had eight more ribs than I should have or that my blood was the colour green.” – Nicolas Cage, actor
From the very first day of training phlebotomists have to know the importance of correctly labelling blood samples. It cannot be emphasised enough that patient care depends on it.
The possible outcome of failing to follow your facility’s labelling protocol could be disastrous for a patient. It could lead to over-treatment, under-treatment or misdiagnosis.
The GP or consultant who has requested the patient’s blood test relies on it to diagnose a disease or to monitor the course of a condition or treatment.
This means that a phlebotomist must have an absolute commitment to the job. If phlebotomists are aware of the consequences of mislabelling they are more likely to follow the rules.
Follow your local guidelines to the letter. You may well experience times when you are rushed off your feet and be tempted to use a temporary identifier. Even if you think you’ll be able to get by with your own system, don’t do it. Complete identification as soon as the blood is drawn is essential. The potential risks to your patient are too great to contemplate otherwise.
If mistakes are made and a patient is harmed it could also damage the reputation of the hospital or facility and lead to disciplinary action.
Phlebotomists have a much more important job and greater responsibilities than can be seen on the surface. Employers must understand the pressures they face, value them and offer rewards accordingly.
There are so many rules, procedures and manuals covering the drawing of blood specimens that we thought we’d boil down the essentials into 7 golden rules. They’ll not only help you the phlebotomist but will also ensure that patients will become your new best friends – well almost!
1) Guard against injury – always use gloves, needle disposal units and proper procedures to minimize your risk of an accidental needle stick. The potential risks include contracting some form of hepatitis or even HIV.
2) Label specimens immediately – this does not mean using temporary markers to be replaced later when you find the time. Complete identification is a must. Find the time. Patients have died because of mislabelled specimens.
3) Befriend the medial vein – it’s the vein of choice for a number of reasons – it doesn’t hurt as much as other veins; it isn’t hidden amongst an undergrowth of nerves or arteries; it is generally closer to the surface of the skin; and it is more stationary.
4) Puncture the skin at a fifteen degree angle – most textbooks agree on a fifteen-to-thirty degree angle of insertion – anymore and you are liable to cause hematoma–blood leaking into surrounding tissues which can be painful for the patient.
5) Stretch the skin at the puncture site – this anchors the vein and minimizes the pain of the puncture.
6) Know when to quit – if your patient’s arm is looking like a sieve you’ve gone way too far. Blood draws are not easy and everyone can experience difficulty at some time, even the most experienced practitioner. After two failed attempts you should consider calling for someone else. Do not be afraid to ask for help.
7) Treat patients like family – for many people hospitals are nerve-wracking places at the best of times. A calm manner, gentle technique and kind words will ease their fears.
Newborn blood screening is a vital part of the national child public health programme and it is offered to every baby in the United Kingdom. The aim is to identify those infants who are at high risk of having some medical conditions before the symptoms develop.
Conditions that are tested for in the UK are Congenital Hypothyroidism (CHT), Phenylketonuria (PKU), Sickle cell disorders, Cystic Fibrosis (CF) and Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCADD).
Screening is not diagnosis; it identifies babes who will need to have further diagnostic tests to determine whether or not they have a condition. Early detection means that treatment can start sooner so as to minimise the severity of the condition. The heel prick can cause the baby some distress, and it is inevitably painful.
According to a Canadian study premature babies who undergo a heel prick test can benefit from skin to skin contact with their parents. Although such contact is not always encouraged in UK neonatal units the researchers from McGill University found that it could aid their recovery.
The scientists carried out the test on babies who were being cuddled. They measured their facial expressions, heart rate and blood oxygen levels to gauge the amount of pain suffered.
Pain scores after 90 seconds for the cuddled babies were markedly lower than for those who were not cuddled by their parents.
Blood groups were discovered in 1901 by the Austrian biologist and physician Karl Landsteiner (1868-1943).
In 1875 he pointed out that when people are given blood transfusions from other animals the foreign blood corpuscles are clumped and broken up in blood vessels. This clumping can cause toxic reactions, with fatal consequences.
Landsteiner later suggested that a similar reaction might occur when the blood of one person is transfused to another individual, and that this might be the reason why shock and jaundice followed earlier attempts at blood transfusion. He discovered that the clumping was an immunological reaction caused by the raising of antibodies against donor blood cells.
The physician classified blood into the now familiar blood groups, A, B, AB, and O and showed that new blood cells are destroyed when blood is transfused between individuals of group A or B. The problems occur when the donor blood comes from a person belonging to a different group. For this research he was awarded the Nobel Prize in Physiology or Medicine in 1930.
William Harvey was the man who discovered the circulation of blood. Born in Folkestone, Kent on 1 April 1578, he was educated at King’s College, Canterbury and then studied at Cambridge University. After a study trip to Italy he returned to England in 1602 to practice as a physician. His career was helped by the fact that he was married to Elizabeth Browne, the daughter of Elizabeth I’s physician.
Harvey became a fellow of the Royal College of Physicians in 1609 and in 1618 became the physician to King James I and his son Charles when he became king. Both royals took a close interest in his research and encouraged his intellectual pursuits.
Harvey was enthralled by the way blood flowed through the human body and the role that valves played in circulation. In 1628 he published his landmark theories in a book called ‘Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus’ (’An Anatomical Study of the Motion of the Heart and of the Blood in Animals’). He explained how the heart propelled blood through the body in a circular course.
His research met with some controversy as most people at the time believed that food was converted into blood by the liver, and then consumed as fuel by the body.
Despite the furore his ideas were accepted and he was widely recognized as a leader in his field. Harvey also made another landmark contribution to medicine. He was the first person to suggest that the reproduction of humans and other mammals was via fertilization of an egg by a sperm.
A phlebotomist has a vital job in healthcare. The main responsibility is to collect blood from patients and then send it away for analysis. But there are a whole range of other tasks that have to be performed as part of your daily routine. These include: –
• Explaining the procedure to patients, their relatives and carers
• Comforting and reassuring distressed and anxious patients who may be afraid of blood and/or needles
• Expertly finding a vein and drawing the blood in a way that does not cause undue stress or pain to the patient
• Applying a clean dressing to the puncture wound
• Labelling each tube with the patient’s correct details as any errors could result in misdiagnosis
• Sending the blood samples away to a laboratory within the time limit that will have been specified to you
• Checking requests for blood samples made by doctors, consultants or other medical staff
• Filling in forms, maintaining computer records and re-ordering stock when necessary
• Being responsible for your safety and that of the patients
Depending on where you work you may have additional duties and responsibilities such as handling phone calls from patients and doctors about appointments and/or visiting patients in care homes.
In pathology labs duties can include drawing a patient’s blood, correctly labelling the samples, and preparing them to be analysed.
Phlebotomists work in a variety of settings including hospitals, pathology laboratories and nursing homes. You must be able to skillfully draw blood whilst minimizing the pain for patients.
You do not need to have a stash of qualifications to embark on a phlebotomy career, but most employers favour those who have at least two GCSEs with good passes. Although not essential they demonstrate that you have reached a certain level of educational attainment.
Other qualifications that can help you include BTEC Awards and the Diploma in Society, Health and Development.
Although you won’t possess a piece of paper that says patients are your number one priority you must have and be able to demonstrate a strong interest in healthcare and a desire to help patients.
There is though one qualification that you must have and that is the Certificate of Competency. It involves up to six months training that consists of theory classes, practise draws on mannequins and then live draws with real people.
The certificate is recognised by all healthcare employers. In fact many will not even offer you an interview if you don’t have it.
Not only will it help you to get a job but it will also help you to get ahead in the profession.
Phlebotomy is a medical skill and for non-medical practitioners training is the only way forward to learn how to draw blood correctly. It is also the best way of gaining your Certificate of Competency.
Training to become a phlebotomist usually takes up to six months and is almost entirely on the job. It involves learning to take blood from different patient groups such as the very young and the old.
Trainee phlebotomists first practise on mannequins before drawing blood from live patients in medical settings. And there are theory classes too.
Your training will give you a valuable insight into the medical profession and you will be taught the following: –
• The different methods of blood collection
• The correct handling of equipment
• The health and safety aspects of phlebotomy
• All aspects of blood taking, the need for different sample tubes and labelling protocols
• How to choose the correct sites for venipuncture and the anatomical and physiological conditions that you must take into consideration
• The importance of professional standards and codes of practice
Once your training has been completed successfully you will be awarded with the Certificate of Competency and be in a very strong position to start your medical career.
Although plastic collection containers are now in widespread use, blood spills can and do still occur and sometimes this may also involve broken glass as well.
Your institution should have clearly visible guidelines about what to do in such a situation, but in general the following steps should be followed.
At the first sign of spillage make sure the area is contained and that no one can walk through and potentially spread the blood to other areas.
For small spills and splashes that do not involved broken glass the area should be saturated with a solution containing bleach and mopped up with absorbent towels.
Never attempt to clean any spillage without wearing appropriate protective clothing. You should never touch blood with your hand, even when wearing protective disposable gloves.
Never spray a blood spill as this may cause aerosols. Instead, gently pour bleach or disinfectant onto the affected area.
For bigger spills and splashes involving glass the area should also be flooded with a solution containing bleach, and sprinkled with an absorbent compound.
At a minimum the bleach or disinfectant must be in contact with the spill area for two minutes.
Your hospital or facility may provide you with commercial spill kits that contain gloves, scoops, disinfectants and biohazard waste disposal bags.
To remove the hazard sweep the shattered glass and blood-soaked absorbent compound into a dustpan, and then put the debris into a sharps container.
Bleach the floor again and wipe with absorbent towels. Place towels in a biohazard receptacle. And at the end of the process remember to wash your hands.
If you want to be a great phlebotomist who is much in demand and stands apart from the rest of the field then a Certificate of Competency will help you to achieve your goals.
Although there are no pre-requisite qualifications needed to become a phlebotomist in the UK a Certificate of Competency is a must. It will drastically improve your chances when applying for phlebotomy-related positions.
Not only will you be able to demonstrate expert knowledge, but you will also have a body of valuable practical experience to call on.
A Certificate of Competency is an investment in your future that lets a prospective employer know that you know how to draw blood properly and are serious about your chosen career
This will allow you to work without close supervision, and the certificate is recognised by all hospitals and medical institutions.
There are many practising phlebotomists who don’t have a Certificate of Competency, they learnt on the job. But this is no longer considered as the best way of training. A structured program with plenty of theory and practical training is now viewed as the most valuable way of picking up the required skills and knowledge.
Maxis Healthcare provides first class training where you will practise on real life patients in a medical setting. We follow the 18 core competencies recommended by the NHS and our lecturers are amongst the most senior people in their fields.
A phlebotomist is at the frontline of patient care and as such is a great risk of being exposed to pathogens.
Infection by a pathogen occurs when a microbe such as a virus, bacterium, fungi, or protozoa invades the body, multiplies and causes a disease in the process.
Although most microbes are non pathogenic all patients must be considered as if they are carrying disease-causing organisms.
Therefore infection control is vital to prevent the spread of disease.
Infection control methods include; –
Hand washing – this is one of the most important means of stopping the spread of infectious organisms. Hands should be washed before and after a phlebotomy procedure. Make sure you are familiar with the hand hygiene procedures of your hospital or institution.
It is impossible to overestimate the importance of scrupulous hygiene procedures. The spread of antibiotic resistant microbes has been due in large part to lax hygiene protocols in hospitals.
Protective equipment – used properly, clothing acts as an effective barrier against the spread of infection. These items should also be disposed of properly after use to prevent the risk of infection to others.
Protective items of clothing include clean gloves, which should be pulled over cuffs of gowns or lab coats. Hands must be washed every time gloves are removed.
Fluid-resistant gowns are also worn to protect the skin and to prevent clothing from being soiled.
Face shield – face shields or protective glasses are worn by some staff to protect against splashes of body fluids.
It can be sometimes difficult to understand just how much danger is posed by a pathogen. After all they are tiny and can’t even be seen with the naked eye. But consider this. The HBV virus which causes hepatitis B can survive on contaminated surfaces for up to a week.
Therefore a phlebotomist puts patients, staff and the wider population at risk by not wearing appropriate hospital attire, or by not maintaining a clean draw station.
Many phlebotomists feel that the most satisfying part of their job comes from being in the front line of patient care. They feel great reward from playing a vital role in improving the health and wellbeing of the patients they meet. And they are made to feel a core part of the team by senior colleagues who understand the demands and pressures of the job.
Many phlebotomists also enjoy and thrive on the interaction with patients.
There is immense satisfaction to be had from making the blood draw experience a pleasant one for the countless number of patients who dread having their blood taken. This is achieved by your calm and caring manner, the knowledge you have acquired about which needles to use for which veins as well as your ability to draw blood with minimal pain.
Your skills will be in most demand for those extreme cases where an individual’s fear of needles and the sight of blood might prevent them from seeking out medical help when they need it.
And last, but not least there is the tremendous sense of achievement and satisfaction to be had when you get the draw right first time!
You’ve made the big decision that you want to become a phlebotomist and play an integral part in patient healthcare, but how do you go about getting the job?
The first thing to note is that you do not need any specific qualifications to be able to draw blood. However, it’s helpful if you have a few good GCSE passes and a definite and demonstrable interest in the human body and patient care.
What you will need is professional training so that you qualify for your Certificate of Competency. This is essential for non-medical practitioners and many hospitals and health care trusts won’t even consider an application from you unless you have it.
Then you need to find an accredited organisation that will give you the right training and experience.
At Maxis Healthcare we have a range of courses for medical and non-medical students which are taught by senior figures in phlebotomy with vast teaching experience.
Your Certificate of Competency will ensure that you stand head and shoulders above the competition and it shows that you are able to draw blood in the correct way.
Once you have the certificate in your hands you will be able to apply for jobs immediately and take your first step toward an exciting and dynamic medical career.
You will find jobs advertised in regional newspapers, on job search websites, and with some recruitment agencies.
During a phlebotomy procedure blood is generally taken from veins in the arm of a patient, though hand veins can sometimes be used.
The three most commonly used veins in phlebotomy are the cephalic, median cubital and basilic veins. They are found in the antecubital region which is the area of the arm near the elbow.
The cephalic vein is found on the outside of the arm. The basilic vein is located on the inner part of the antecubital area, whilst the median cubital vein is situated close to the centre.
The median cubital vein is by far the much preferred vein for phlebotomy. This is because it is larger than the other veins, lies close to the surface and remains stationary. Veins have a tendency to roll which can make life difficult for the phlebotomist.
The cephalic and basilic veins are used if the phlebotomist cannot for whatever reason use the median cubital. For example, it may be damaged in some way. If this is the case the cephalic vein is the second choice as it is reasonably well anchored.
The basilic vein is third choice because it is less stationary and it is also situated close to a nerve and artery, making it a potentially more dangerous area to use.
Hand veins are sometimes used when veins in the antecubital area cannot provide a suitable site. However, they are not ideal as they tend to roll, and with many nerves running through the hand this kind of venipuncture can be more painful for a patient.
Although veins of the legs, feet an ankle can be used it is usually left for a doctor to carry out these procedures as there is a potential for clots to form.
There has never been a better time to get a job as a phlebotomist, as opportunities are increasing at a rapid rate. With staff turnover and the rise of more health screening initiatives there is an urgent need for highly skilled and well trained professionals.
This growth is also driven by the medical needs of an ageing population and the requirement for more diagnostic testing. There is also an increase in health care services in the home.
In some areas, particularly London and other major cites there is even a shortage of phlebotomists.
Although most phlebotomists are employed by the National Health Service there are other employers crying out for skilled medical professionals who are trained to draw blood. Plenty of jobs can be found in the private healthcare sector and in pathology laboratories.
Vacancies are advertised in local newspapers, on job search websites such as www.jobs.nhs.uk and through recruitment agencies. Some agencies are solely for medical personnel.
Or you could get your name known by getting in touch with the human resources department or phlebotomy manager at your local hospital or primary care trust. They may know when the next lot of opportunities will appear for trainees.
Haemochromatosis is a condition where the body absorbs too much iron from the diet. Although it is an essential nutrient it can cause major league problems if the body cannot get rid of excess amounts. Iron can accumulate in organs and damage them.
Therapeutic phlebotomy (TP) is an ideal solution for patients with haemochromatosis and works by removing blood cells that are rich in iron. Although there have been attempts to develop more elegant solutions, TP is still seen as the most economical and safe treatment.
Phlebotomy removes red blood cells from the body which stimulates the bone marrow to create replacements. Iron is therefore removed from body to stores to make haemoglobin, the oxygen carrying component of every red blood cell. In this way a patient’s iron level is reduced to a safe and healthier amount.
The consequences of too much iron in the body are serious and can sometimes be fatal. These include elevated risk of liver cancer, cardiomyopathy, arthritis, diabetes and abdominal pain.
Venipuncture is usually performed once a week and every pint of blood removed contains about a quarter of a gram of iron.
Depending on the amount of iron overload treatment may continue like this for about two years, with serum levels being continually monitored.
This however, will not be the end of the story as the patient will still be producing excess amounts of iron. Therefore TP will then take place every three or four months for the rest of the patient’s life.
If haemochromatosis is diagnosed early enough the treatment can be very effective. It will not be able to cure cirrhosis of the liver or diabetes if these conditions are already present at time of diagnosis. But fatigue and abdominal pain should decrease, cardiomyopathy may improve and cirrhosis tends not to get any worse.
The good news is that you have already made a positive impression on your prospective future employers. They have seen something in your CV or application form that tells them that you have potential.
You have stood out from the many hundreds of applicants. Sure, others are going to be interviewed, but you are now a contender and have the opportunity to prove that you really are the right person for the job.
There is only one person who knows what questions you will be asked in your interview, and that’s the interviewer. But thinking ahead and preparing for the types of questions you think will be asked will stand you in good stead, and help you to deal with the nerves.
Your interviewer will want to know if you posses the requisite skills, dedication and enthusiasm for the job, so the best preparation here is to research the role thoroughly.
There will be questions based on your CV – they could be about your employment history, interests and qualifications. So draw up a list of the types of questions you think you will be asked.
For example, interview favourites are – What three things would your last boss say about you? Why do you want the job? What is the most challenging situation you’ve had to face and how did you deal with it?
Question areas to expect are: –
• Questions about your previous work
• Questions on how you work with others and relate to the public
• Questions about how you cope in difficult situations
• Questions about life outside of the working environment
• Questions about your strengths and weaknesses
No two interviews are the same – the tone, seating arrangements, and questions can differ as the interviewer assesses your skills, competency, motivation and commitment. This is your chance to sell yourself and the qualities you will bring to the job. Be confident, but don’t be brash.
Your interviewer will also want to know how interested you are in the job, so prepare a couple of questions about the role and the place you want to work in. Good luck!
One of the great challenges of phlebotomy is calming down a patient who is needle phobic. It makes the job of a phlebotomist much tougher and is a serious concern.
It has been estimated that more than 10% of the population has an extreme and intense fear of needles.
For some people the fear is so great that they will not seek out medical advice for anything that ails them. This is potentially life-threatening, and it is unknown how many people have died because they have been too scared to seek out medical care because of their phobia.
If a patient professes to be needle phobic this should not be taken lightly. Some phobics can experience a shock type effect before, during or after venipuncture. In the most severe cases patients have been known to suffer cardiac arrest.
Patients who are scared of needles and who have built up the courage to have their blood taken should be treated with empathy. And there are several steps that a phlebotomist can take to make the procedure easier for them.
• The first thing to say is that only the most experienced phlebotomist should see a needle phobic patient
• Be aware that some of the equipment in your draw station may send a patient into panic mode. Consider if it all needs to be on show
• Shallow and quick breathing is symptomatic of a needle phobic person and it cannot be emphasised enough how encouraging them to take deep and slow breaths will help them to calm down
• Have the patient lie down with legs elevated. This can help prevent loss of consciousness
• Try to establish a rapport with the patient and always speak in calm and measured tones
• Apply an ice pack to the venicpunture site for about 10 minutes prior to needle insertion. This will numb the area
• Some needle phobics will know their preferred sites for needle insertion.
Needle phobics will differ in their responses and the individual must be considered when seeking a solution. There is no catch-all answer that will help all needle phobics.
If a needle phobic patient is so anxious that they refuse to take part then follow your facility’s guidelines on what to do next, such as aborting the procedure or whether a skin puncture/incision will do, if only small amount of blood is required.
Phlebotomy is a rapidly expanding field and it can offer you a dynamic medical career. There are a number of opportunities for advancement and promotion for those who want to climb higher.
Just like any other industry career progression is something that has to be worked at and opportunities exist for those individuals who shine at their work.
The NHS Agenda for Change was designed in part to provide opportunities to develop for all NHS staff. Your training needs have to be taken seriously by your health trust and line managers as there is plenty of room to advance in your career.
Through additional education and experience a phlebotomist can rise through the NHS ranks to become senior phlebotomists, phlebotomy supervisors, phlebotomy trainers, team leaders, and phlebotomy managers or service managers.
You can keep your career challenging and interesting by constantly learning new things. Not only via on-the-job training, but also through seminars and courses on specific skills.
Opportunities also abound outside the hospital campus in pathology labs, research institutes and nursing homes.
With a passion for learning and a desire to help people you will be able to meet every challenge head on, and as you gain more skills and experience more doors will open for you.
Bloodletting as a means of healing illness dates back to 1,000 years BC to the Egyptians on the River Nile. Today, it is valued as a diagnostic tool, although it can be a life-saver for people with heamochromatosis.
From the Nile the practice spread to the Greeks and the Romans and there are records of its use in nearly all civilisations including the Aztecs, the Mesopotamians and the Mayans. It achieved peak popularity in the Middle Ages, but bloodletting for therapy began to wane toward the end of the 19th century.
In ancient Greece the popularity of bloodletting was reinforced by Galen of Rome, a student of Hippocrates. There were two key concepts at this time that governed the system of bloodletting. The first was that it was thought that blood did not circulate around the body, it stagnated.
And the second was that many illnesses were due to an imbalance of the four humours. These were blood, black bile, phlegm and yellow bile. Galen believed that blood was the dominant humour and therefore the one needed to be kept under control. This could be achieved by draining the body of some its blood content. The more severe the disease, the more blood that would be let.
Even when the humeral theory of disease fell out of favour bloodletting was still continued by surgeons and barber-surgeons. In medieval times some surgical procedures were usually conducted not by physicians but by barbers.
The barber’s pole hails from this time and the spiral ribbons painted around the pole represent two long bandages; one was twisted around the patient’s arm before bleeding, and the other was used to bind it afterward.
At one time bloodletting was used to treat almost every disease, but by the middle of the 18th century it was falling out of favour. Even so, it was considered to be useful in some situations to release infected blood. Old practices die hard and as late as 1923 the practice was recommended in renowned physician Sir William Osler’s textbook The Principles and Practice of Medicine.
A career in phlebotomy is highly rewarding and satisfying, but it’s not a walk in the park. You will be required to cope with the many physical demands of the job that come from constant patient contact , being on your feet most of the day, and working in a confined space.
To perform your duties you will be walking and sitting intermittently, and continuosly reaching, lifting, bending and carrying objects. You do not need to be an Olympic rower, but a good level of general health and fitness will enable you to meet the demands of the job.
Excellent finger dexterity and good hand-eye coordination are needed to handle equipment such as tests tubes, slides, needles, and hospital computers where information has to be recorded accurately.
Talking to and listing to patients all day can be tiring, but a phlebotomist must be alert at all times even if you feel your eyes glazing over at the end of a shift on a warm summer day.
Good communication skills are as important as your ability to expertly draw blood from a patient.
Other physical demands include the exposure to bodily fluids that could potentially harbour infectious particles, and you may also sometimes come into contact with odorous specimens and chemicals.
Little is known about the origin of bloodletting for diagnostic purposes but the practice has been employed for therapeutic purposes since ancient times.
Nearly every civilisation records examples of bleeding patients for the purpose of healing, using a wide variety of instruments. Some of these seem positively barbaric to us today.
The syringe – the precise record of the birth of the piston and cylinder syringe is lost in the sands of time, but its first use was as a “pus-puller” to get the pus out of wounds. The concept of the piston and cylinder dates back to about 280 BC and the inventor is thought to be Ktesibios, the son of a barber in Alexandra, Egypt.
The lancet – it is widely assumed that early blood letters would have used some kind of lancet to puncture a vein. And these would have initially been sharpened pieces of wood or stone. They are thought to have been used before the 5th century BC.
Spring loaded lancets – these were first employed in the early 18th century. The case was brass and the blade was made of steel. It was cocked by a hook at one end, and the depression of the button at the side would send the blade into the patient.
The scarificator – this was a spring loaded mechanism that could house multiple blades that would make many shallow cuts in a patient. Scarificators became popular in the late 18th and 19th centuries.
Cupping – once a scarificator had slashed away at a patient a cup was placed over the wound to collect the blood. Suction devices were added to the cup to allow for the removal of blood. Sometimes the air inside the cup was heated to create a vacuum which caused the blood to flow into the cup.
Bleeding bowls – since ancient times a large variety of vessels have been used to collect blood. Initially these were probably made from stone or pottery. In the 18th and 19th centuries tin and pewter were more commonplace. Bleeding bowls made from silver are also known.
Leeches – were initially used in ancient Greece, Rome, and Syria. They remain on the body by mucous and suction and inject an anticoagulant to stop the blood from clotting. And then they load up with the red stuff.
Leeches remain a fixture until they are full and then fall off to digest their blood meal. Boxes used to carry leeches are something of a collector’s item.
Phlebotomists can make a good living. Most jobs in the NHS are covered by a pay system known as the Agenda for Change pay scales. There a nine pay bands and typically employees will progress to the next point in their band until they reach the end of it.
Phlebotomists are in Band 2 and the current NHS payment rates in this band are: –
Band 2
Point 1 13,233
Point 2 13,588
Point 3 13,944
Point 4 14,359
Point 5 14,774
Point 6 15,190
Point 7 15,725
Point 8 16,333
These figures are correct as of April 1st, 2009. In addition to basic pay staff who work in areas such as London receive extra money to help toward the higher cost of living.
Phlebotomists who work through agencies can earn approximately £10-£15 per hour.
There is always the potential for phlebotomists with experience to increase their salary if they advance to supervisory positions or jobs in medical administrative management.
The hours that a phlebotomist works usually depends on where they work, but by and large full-time phlebotomists tend to work 37.5 hours per week during normal daytime hours, from Monday to Friday.
Many phlebotomists work part-time and combine their job with other roles such as a nurse or healthcare assistant.
A phlebotomist can work in a number of professional settings; wards, outpatient departments, hospital laboratories, GP practices, health centres and private pathology laboratories. Some phlebotomists will visit patients in their home or in residential care places.
Phlebotomists wear a uniform which tend to be white with a red or maroon piping, but they are not identical around the UK.
All healthcare workers have to comply with strict health and safety measures and guidelines which are designed to protect patients and members of staff. This will involve the need to wear disposable gloves, when taking, handling and transporting blood samples. Aprons and other forms of protective clothing are worn as required.
You do not require any specific qualifications to become a phlebotomist, but the Certificate of Competency will help you to stand out from the competition. It will set you up with the core competency skills, and it tells prospective employers that you are qualified to draw blood.
You may find it helpful to have a few good GCSE passes in subjects such as Maths and English. A grade A-C pass in a science subject could be beneficial if you want to progress further in your healthcare care.
Other qualifications that could you help you to win a position include the Diploma in Society, Health and Development, and BTEC Awards, Certificates and Diplomas in health and social care. A-levels may also improve your chances of achieving a position as a trainee phlebotomist.
Phlebotomists must at the very least have an interest in healthcare and a desire to work with patients. And it may also help your application if you are fascinated by, and have an interest in the way the human body works.
You do not need to know the intricate ins and outs of what goes where, or how it all fits together, but a genuine curiosity will always be looked on favourably by employers.
One of the most difficult parts of the job is dealing with children, especially if their parents haven’t prepared them for their visit. If they already know that they are going to have their blood taken then they don’t get nearly as upset as they would otherwise.
If you and your needle are a big surprise to them then you have your work cut out in trying to pacify their fears and explaining that there is absolutely nothing to be worried about.
But it’s not only children who are anxious and distressed, and how you communicate and support worried patients plays a big part in the overall outcome of the procedure.
Then there are the difficult draws, where you really have to go hunting to find a suitable vein. Sometimes they are too small, or have been damaged by intravenous drug use.
The other noteworthy challenges that you will face are the ability to manage all the competing demands on your time and ensuring that patient safety is paramount.
This means keeping errors at an absolute minimum and ensuring that any blood spills are dealt with swiftly and effectively to avoid the spread of blood borne pathogens.
The best way of avoiding human errors is to undergo comprehensive training and continuing education programmes.
The child is crying, his mother is nervous, you can’t find a vein, and there’s a waiting hall full of patients. Can you keep a cool head and remain calm under pressure?
In other words do you have what it takes to be a phlebotomist? It is a challenging, rewarding and worthwhile career and every successful phlebotomist needs to possess the following skills and personal qualities: –
• Have a caring and considerate manner, especially towards people who may be nervous and anxious. Interacting with patients is a key component of the job and it is important that you are compassionate with every kind of patient – from the injured to the healthiest
• Be able to work well with people of all ages and from different backgrounds
• Have very good manual dexterity
• Be able to respect confidentiality
• Be able to work well under pressure and with competing demands on your time
• Be able to work well on your own, but also as a vital part of a team
• You must not be squeamish at the sight of blood or around needles
• Be able to follow safety and local guidelines
• Keep up-to-date with the latest research related to phlebotomy and be willing to incorporate it into your work
Blood borne pathogens are those microorganisms which can cause disease and are present in the blood and other bodily fluids.
The disease-causing organisms can be present in a patient’s body even if the individual shows no sign of illness. They present a significant biohazard to the phlebotomist. Examples of blood borne pathogens are; –
HIV – the human immunodeficiency virus attacks the body’s immune system leaving it wide open to opportunistic infections. These are caused by microbes that don’t usually do us any harm.
HBV – the HBV virus infects the liver and causes hepatitis B. “Hepatitis” means inflammation of the liver. The virus has been known to survive for up to a week in dried blood and on surfaces such as desks and telephones.
The primary route of transmission in the work place is through needle stick injury. Outside of medical settings the virus is spread through sexual contact and the sharing of dirty needles. Symptoms include flu, muscle and joint ache, nausea and vomiting.
HCV – the HCV virus causes hepatitis C, a disease that affects the liver. It is spread by blood to blood contact and can lead to severe scarring of the liver (cirrhosis) and liver cancer. HCV symptoms are similar to those of HBV infection.
Other blood borne pathogens include the organisms that cause malaria, West Nile virus, relapsing fever, viral haemorrhagic fever, syphilis and Creutzfeldt-Jakob disease. HIV, and hepatitis B and C provide the greatest risks to healthcare workers.
Safety of healthcare personnel is paramount and your hospital or facility should have a list of safety guidelines that must be followed. This will include an assumption that all patients’ bodily fluids are carriers of disease-causing organisms and that regular hand-washing before and after each procedure should be maintained.
Disposable gloves are worn where appropriate and a needle should be discarded in a sharps container after use, and never re-sheathed.
Haemolysis occurs when red blood cells rupture or break open, releasing haemoglobin and other sub cellular contents into the surrounding plasma.
This leaves a pinkish to reddish hue in the serum sample (from the haemoglobin) and interferes with the accuracy of the blood test. It is a common cause of specimen rejection by laboratories.
This is because the concentration of potassium is much higher inside a red blood cell than without. And so haemolysed blood will therefore have a higher potassium concentration. The level of test inaccuracy will depend on the degree of haemolysis. Other analytes can also produce inaccurate results.
Haemolysis can be due to incorrect specimen collection, specimen processing and specimen transport.
Haemolysis can be prevented by taking note of the following: -
• Avoid drawing blood from a hematoma
• Avoid pulling the syringe plunger back too forcefully
• Avoid prolonged tourniquet time as this can bring about the release of interstitial fluid into tissue which can cause haemolysis
• Avoid frothing by ensuring that the needle is fitted properly
• Avoid pushing the syringe plunger too forcibly when transferring the blood into a tube
• Avoid vigorous shaking of the serum samples
• Do not expose blood samples to excessive hot or cold temperatures
• Make sure that the needle isn’t too small. Otherwise it can lead to the creation of a large vacuum which will tear at red cell membranes causing them to rupture.
• Ensure that the venipuncture site is dry
The good news is that haemolysis can almost always be avoided when the reasons for its occurrence are understood.
Adhering to the rules of site selection is vital to avoid causing harm to patients.
The superficial veins of the upper limbs are usually selected as they are the most easily accessible, most numerous and minimise patient discomfort. These veins include the median cubital vein, the cephalic vein and the basilic vein.
Venipuncture site selection will depend on a number of factors including the accessibility of the vein. It should be easy to feel and stabilized, if not it’s time to look for another one. The vein must also be in a good condition so that it can easily accommodate the venipuncture. If it is in a bad shape it may collapse when punctured with the needle.
Patients who have had venipunctures before can sometimes help you select a site as they may have a favoured one.
Veins that should be avoided are those that appear fragile, fibrosed or bruised from injury. Sites close to infection or limbs where there is evidence of intravenous infusion should also not be chosen.
To choose the most suitable venipuncture site a phlebotomist should primarily make use of touch over sight. A suitable and healthy vein will feel “bouncy” when palpated. Contrast this with a thrombosed vein which will not provide an adequate amount blood and will feel stringy and cordlike.
Apply a tourniquet and ask the patient to gently close their hand to make the vein stand out. If the patient clenches their fist too tightly it could confuse the results as it’s known to raise serum potassium levels.
The phlebotomist should feel for the vein with the index finger by rolling it back and forth, which will also help to determine its size. Follow its path and then palpate. Do not leave the tourniquet on for more than a minute as this can cause flawed results.
If a suitable vein is elusive apply hot, moist towels around the site which will cause the vein to dilate and become more apparent.
Haemochromatosis is a medical condition where the body absorbs too much iron from the diet. The body needs iron to function normally but when there excess it will accumulate in organs and damage them.
Phlebotomy is an acceptable first-line treatment where blood draws reduce the levels of iron in the body.
If the haemochromatosis is not detected early and treated iron will accumulate in the body and this can lead to a variety of problems including; arthritis, liver disease, early menopause, cirrhosis of the liver, damage to the adrenal glands and heart abnormalities
There are several different types of haemochromatosis including – 1) primary haemochromatosis, which is also known as hereditary haemochromatosis 2) secondary haemochromatosis, which is caused by a number of disorders including alcoholism and anaemia 3) juvenile haemochromatosis and 4) neonatal haemochromatosis.
The main causes of hereditary haemochromatosis are mutations in a gene known as HFE. The gene has many roles, but its principal one is to help regulate the amount of iron absorbed from food. The two principal mutations that researchers are aware of are C282Y and H63D.
An individual inherits two copies of the HFE gene, one from their mother and one from their father. If a person only inherits one mutated version of the gene they will not develop the symptoms of the disease, but they will be carriers and could pass the mutation onto their children.
To acquire the disease a person must inherit an abnormal gene from both parents. This is known as an autosomal recessive mode of inheritance and when both parents are carriers of haemochromatosis there is a one in four chance of their offspring developing the condition.
However, there is one form of the disease that follows an autosomal dominant pattern form inheritance and that is haemochromatosis type 4. Here, only one mutated gene is sufficient to cause the disease. In this situation most people will have one parent with the condition.
Raised potassium levels in the blood can be indicative of kidney or heart disease. But potassium levels can also be drastically raised if a patient clenches their fist tightly during a phlebotomy procedure.
Phlebotomists have therefore been advised not to let their patients clench their fists tightly, as the potential to confuse the results is too great.
The proof of this phenomenon came from a report that appeared in 2008 in the Annals of Clinical Biochemistry.
Study co-author and biochemist Vanessa Thurlow first became aware of the problem when her department was bombarded with an increasing number of queries about unexpectedly high serum potassium results.
One of her thoughts was that perhaps this intracellular potassium leakage had been brought on by low temperature and long transit time of samples? This has been well documented before.
However, five samples showed persistent high levels of potassium despite prompt analysis. So the patients were re-bled and asked not to clench their fists. The result was that normal potassium levels were recorded.
And this is what prompted Thurlow and her co-author Ian Bailey to carry out their wider study. They looked at 200,000 blood test results taken between 2002 and 2005.
During this period there was a change in practice when patients of the health care trust involved were no longer asked to clench their fists.
The results showed that the percentage of blood tests with worryingly high levels of potassium fell off significantly after the change in practice.
The impact of clenched fists on phlebotomy results has been known for more than 40 years, but generations of phlebotomists have still been taught to ask their patients to clench.
Of course clenching and then relaxing a fist improves blood flow and makes a vein stand out more, but it is not considered best practice.
Other factors such as cooler temperature during transport of serum does affect blood potassium levels. But the study authors considered these changes to be too modest.
The average adult body contains approximately 8-10 pints of blood and is composed of blood plasma and cellular components. The plasma is a straw-coloured liquid and constitutes about 55 per cent of the total blood volume and it is 92 per cent water. The remaining 8 per cent consists of gases, hormones, vitamins, proteins and waste products.
