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| Phlebotomy | |
|---|---|
 Students practising phlebotomy | |
| ICD-9-CM | 38.99 |
| MeSH | D018962 |
Phlebotomy is the process of making a puncture in avein, usually in the arm, with acannula for the purpose ofdrawing blood.[1] The procedure itself is known as avenipuncture, which is also used forintravenous therapy. A person who performs a phlebotomy is called aphlebotomist, although most doctors, nurses, and other technicians can also carry out a phlebotomy.[2] In contrast,phlebectomy is the removal of a vein.
Phlebotomies that are carried out in the treatment of someblood disorders are known astherapeutic phlebotomies.[3] The average volume of whole blood drawn in a therapeutic phlebotomy to an adult is 1 unit (450–500 ml) weekly to once every several months, as needed.[4]
FromAncient Greek:φλεβοτομία (phlebotomia –phleb 'blood vessel, vein' +tomia 'cutting'), viaOld French:flebothomie (modern Frenchphlébotomie).[citation needed]
Phlebotomies are carried out by phlebotomists – people trained to draw blood mostly from veins for clinical or medical testing, transfusions, donations, or research. Blood is collected primarily by performingvenipunctures, or by usingcapillary blood sampling with[5]fingersticks or aheel stick in infants for the collection of minute quantities of blood.[6] The duties of a phlebotomist may include interpreting the tests requested, drawing blood into the correct tubes with the proper additives, accurately explaining the procedure to the person and preparing them accordingly, practicing the required forms ofasepsis, practicing standard anduniversal precautions, restoringhemostasis of the puncture site, giving instructions on post-puncture care, affixing tubes with electronically printed labels, and delivering specimens to a laboratory.[7] Some countries, states, or districts require that phlebotomists be licensed or registered.[citation needed]
Atherapeutic phlebotomy may be carried out in the treatment of some blood disorders (example:Hemochromatosis,polycythemia vera,porphyria cutanea tarda), andchronic hives (in research).[8][9]
InAustralia, there are a number of courses in phlebotomy offered by educational institutions, but training is typically provided on the job. The minimum primary qualification for phlebotomists in Australia is a Certificate III in Pathology Collection (HLT37215) from an approved educational institution.[10]
In theUK there is no requirement for holding a formal qualification or certification prior to becoming a phlebotomist as training is usually provided on the job. TheNHS offers training with formal certification upon completion.[11]
Special state certification in theUnited States is required only in four states:California,Washington,Nevada, andLouisiana. A phlebotomist can become nationally certified through many different organizations. However, California currently only accepts national certificates from six agencies. These include theAmerican Certification Agency (ACA),American Medical Technologists (AMT),American Society for Clinical Pathology (ASCP),National Center for Competency Testing/Multi-skilled Medical Certification Institute (NCCT/MMCI),National Credentialing Agency (NCA), andNational Healthcareer Association (NHA).[12] These and other agencies such as the American Society of Phlebotomy Technicians also certify phlebotomists outside the state of California. To qualify to sit for an examination, candidates must complete a full phlebotomy course and provide documentation of clinical orlaboratory experience.
InSouth Africa learnerships to qualify as a Phlebotomy Technician are offered by many public and private educational institutions as well as by private academies owned up by pathology laboratories (such as Ampath Laboratories, Lancet, PathCare) and healthcare service providers (such asNetcare,South African National Blood Service). Some of the larger retail pharmacy chains offering in-store clinical services (such as Clicks,Dis-Chem) also provide training for aspirant phlebotomists. Certification can be obtained from a number of examination and testing institutions. To work as a phlebotomist in South Africa, registration with theHealth Professions Council of South Africa (HPCSA) is required.
| Tube cap color or type in order of draw | Additive | Usage and comments |
|---|---|---|
| Blood culture bottle | Sodium polyanethol sulfonate (anticoagulant) andgrowth media formicroorganisms | Usually drawn first for minimal risk of contamination.[13] Two bottles are typically collected in one blood draw; one foraerobic organisms and one foranaerobic organisms.[14] |
| Blue ("light blue") | Sodiumcitrate (weak calcium chelator/anticoagulant) | Coagulation tests such asprothrombin time (PT) andpartial thromboplastin time (PTT) andthrombin time (TT). Tube must be filled to the proper line. |
| Plain red | No additive | Serum:Total complement activity,cryoglobulins |
| Gold (sometimes red and grey "tiger top"[15]) | Clot activator andserum separating gel[16] | Serum-separating tube (SST): Tube inversions promote clotting. Most chemistry, endocrine and serology tests, includinghepatitis andHIV. |
| Orange | Clot activator andserum separating gel[17] | Rapidserum-separating tube (RST). |
| Dark green | Sodiumheparin (anticoagulant) | Chromosome testing,HLA typing,ammonia,lactate |
| Light green | Lithiumheparin (anticoagulant) Plasma separator gel | Plasma. Tube inversions prevent clotting |
| Lavender ("purple") | EDTA (chelator /anticoagulant) | Whole blood:CBC,ESR,Coombs test, platelet antibodies,flow cytometry, blood levels oftacrolimus andcyclosporin |
| Pink | K2 EDTA (chelator /anticoagulant) | Blood typing andcross-matching, directCoombs test,HIV viral load |
| Royal blue ("navy") | EDTA (chelator /anticoagulant) | Trace elements, heavy metals, most drug levels,toxicology |
| Tan | Sodium EDTA (chelator /anticoagulant) | Lead |
| Gray | Fluoride Oxalate
| Glucose, lactate,[19]toxicology[20] |
| Yellow | Acid-citrate-dextrose A (anticoagulant) | Tissue typing, DNA studies,HIV cultures |
| Pearlescent ("white") | Separating gel and (K2)EDTA | PCR foradenovirus,toxoplasma andHHV-6 |
| Black | Sodium Citrate | PaediatricESR |
| QuantiFERON Grey, Green, Yellow, Purple | QuantiFERON 1. Grey (nil) tube 2. Green (TB1 antigen) tube 3. Yellow (TB2 antigen) tube 4. Purple (mitogen) tube | Tuberculosis |
A phlebotomy draw station is a place where blood is drawn from patients for laboratory testing, transfusions, donations, or research purposes. The blood is typically drawn viavenipuncture or afinger stick by a healthcare professional such as aphlebotomist,nurse, ormedical assistant.[21]The draw station typically includes a padded chair or a bed for patients prone to fainting during blood draws.Draw stations can be found in various settings, such as hospitals, clinics, blood donation centers, and independent laboratories or as part ofpatient service centers (PSC).
Early phlebotomists used techniques such asleeches and incision to extract blood from the body. Bloodletting was used as a therapeutic as well as a prophylactic process, thought to remove toxins from the body and to balance thehumors. While physicians did perform bloodletting, it was a specialty ofbarber surgeons, the primary provider of health care to most people in the medieval and early modern eras.
This article incorporatestext available under theCC BY 4.0 license.Betts, J Gordon; Desaix, Peter; Johnson, Eddie; Johnson, Jody E; Korol, Oksana; Kruse, Dean; Poe, Brandon; Wise, James; Womble, Mark D; Young, Kelly A (July 28, 2023).Anatomy & Physiology. Houston: OpenStax CNX. 18.1 An overview of blood.ISBN 978-1-947172-04-3.{{cite web}}: CS1 maint: archived copy as title (link)