A phlebotomist is a valued member of a health care team and plays an important role. They are responsible for collecting, processing, and transporting blood specimens to the laboratory. A phlebotomist is skilled in the art of venipuncture which the puncture of a vein with the intention of drawing blood is carried out. A phlebotomist obtains blood samples, there are 3 ways blood can be taken by a phlebotomist which are venepuncture, drawing blood from a vein, capillary puncture, obtaining blood from the capillary bed, and arterial puncture which is drawing blood from an artery. The most common collections are venipuncture which is from the vein and dermal puncture which is where a lancet is used to puncture the skin and draw blood from the capillary. A phlebotomist will take blood samples at a skill level that requires blood to be collected in appropriate testing tubes and then the tubes are sent to a laboratory for testing. There are three main veins to obtain blood and are the median cubital vein, this vein lies over the cubital fossa and serves as an anastomosis between the cephalic and basilic veins, the cephalic vein, shown in both forearm and arm, can be followed proximally where it empties into the axillary vein and lastly the basilic vein, it divides to join the brachial vein.
A phlebotomist should review the collection order and priority, being prepared will establish confidence. There is a certain order of drawing that must be followed. A phlebotomist will always explain the procedure to the patient and must remember the patients’ rights before any procedure can begin, after explaining the procedure to the patient a phlebotomist must remember that the patient has the right to refuse. Patients have been known to refuse blood to be drawn even if the sample is ordered by a physician. Even after explaining to a patient that the sample is needed for results regarding treatment the patient refuses this must be noted and reported to the appropriate person. A phlebotomist must never ignore the patient’s refusal because this can lead to a lawsuit for battery if a patient is intentionally touching a patient without consent. There are a few ways consent can be given for example nonverbal consent is where a patient might offer you their arm once a procedure has been explained and another is verbal, his is when a patient clearly states their consent by communication. A phlebotomist must be careful not to harm a patient, they must take blood correctly so that it can be used for testing, they must label the samples correctly, store the blood taken properly and deliver samples to the lab.
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A phlebotomist must learn and follow all safety regulations, these are very important especially when dealing with body fluids and potentially infectious samples. Data shows that there are between 900 and 1000 needlestick injuries in Ireland every year with almost half being nurses but most are not reported due to the stigma which means that they could be at risk from fatal infections.
The knowledge, skills, and attitudes will now be discussed in detail in relation to what a phlebotomist is required to have in order to carry out his or her job in a competent professional manner. As a phlebotomist will be working on human patients in real-time, there is no room for error. Knowledge of human anatomy, first aid, and interpersonal skills are required. phlebotomists draw blood from patients for testing, research, transfusions, and blood donations. They also label the blood for processing, enter information into a computer database and assemble and maintain all relevant medical equipment needed. Hand hygiene is very important and is the first step to infection control. A few examples of hand hygiene are, hands should be washed before putting on gloves, and again when the gloves have been removed, hands should be washed properly using the appropriate handwashing technique and again in between patient contacts. Gloves do not replace hand washing.
Labeling and entering information into a database might seem like a simple task at first, but the importance of this job cannot be overstated. If a person taking blood in any way mislabels test tubes or enters incorrect results into a database this could have a detrimental effect on the result and could put the patient’s life in jeopardy. As has been shown recently in Ireland, there were some false positive cervical smear test results. Knowledge in a system of correct labeling and the correct recording of information in a database is as important as the art or skill required to obtain the patients’ blood.
As it is the phlebotomist’s job to assemble and maintain the medical equipment needed to draw blood, knowledge of the maintenance and functionality of these instruments would be an advantage. Sharps bins are provided and need to be used correctly, they are used for used syringes, lancets, and needles. These buns should only be filled to the indicated line and, closed and locked, and then your name and date are written on the label. Phlebotomists will always have to explain the procedure to the patients, get consent, and reassure patients who might be of a nervous disposition. A phlebotomist needs certain skill sets which fall into two categories called hard and soft skills. The hard skills are the skills required to physically carry out the job at hand. This is when the practical aspects of the training course and work experience become essential. The soft skills are compassion and empathy, these are required for an anxious patient so you can put yourself in their position and imagine they would feel.
Overall there are five main skills for a phlebotomist to acquire and they are as follows, attention to detail, communication, data entry, dexterity, and empathy. When dealing with the public especially when carrying out these procedures interpersonal communication is an important soft skill to have. Clients when attending their first procedure may be anxious, a caring and understanding phlebotomist who can empathize with the patient will try to make the patient as comfortable as possible. Communication with the patient and maintaining confidentiality are also very important. In relation to interpersonal skills the importance of listening to a patient can be beneficial. If a patient does not feel listened to this can increase their anxiety and can make them feel like the procedure is being rushed. Personal attributes such as accuracy, attention to detail, collaboration, continual professional development, dexterity are a few skills that can be learned and put to great use when working as a phlebotomist.
Once a person becomes a phlebotomist, this is not the end of the training, upskilling and retraining are important as they keep the phlebotomist up to date on any changes and standards that may occur. When it comes to phlebotomy, dexterity is one of the most important physical attributes to have when taking a blood sample. Any misdirected syringes could damage a vein or hit an artery. A person with bad dexterity could make the patient nervous. A hospital can be very busy at times, a phlebotomist must balance efficiency along with due care and attention to the patient, greeting and identifying the patient and having a friendly conversation is the first step. A phlebotomist's image is very important. Behaviour, personal appearance, and tone of voice all contribute to this image. Acting in a professional and courteous manner keeps the patient at ease and gives the patient in the phlebotomist. In relation to general appearance, good hygiene is recommended.
Always respect a patient’s personal space even when greeting them on arrival and carrying out the procedure. Body posture is equally important and always make eye contact when explaining a procedure. A calming and reassuring voice can put the patient at ease. Blood samples are taken to figure out what’s wrong with a patient, to make sure treatment is working, and to develop the right treatment or choose the right drugs. Working as a phlebotomist has certain risks, blood can transmit dangerous viruses, bacteria, and airborne contaminants. Needle sticks are common injuries among phlebotomists and those who start intravenous infusions. Between 600,000 to 800,000 people stick themselves with needles each year; around half don't report their injury, the director of the National Institute for Occupational Safety and Health reported in 2000.
Knowing what to do when a needle stick injury occurs is vital. Squeeze the wound to encourage it to bleed, hold the wound under running warm water, dry the wound and cover it with a plaster and seek urgent medical advice. Do not suck the wound or scrub it while washing it. phlebotomists can also have a latex allergy which can cause respiratory problems, rashes, wheezing, and shortness of breath. A Phlebotomist can also encounter difficult patients; they can be intoxicated and combative, so they need to be careful when taking blood to protect themselves, the patient, and the people around them.
So, to conclude a phlebotomist has a very important job, they are a valued member of the medical team. Phlebotomy is an invasive procedure; patients can suffer permanent disabling injuries if they do not know what they are doing. You need to focus and know exactly what you are doing. A phlebotomist’s responsibilities include safeguarding the health and wellbeing of the public, taking blood in a safe manner, labeling the vials with patient’s names and dates of birth, and transporting the vials safely to a laboratory for testing. A phlebotomist will need to have a friendly and courteous manner, they will need to sympathize with anxious or nervous patients, present themselves in a professional manner and be confident in their job. Honesty is an important skill to have when working as a phlebotomist, saying that the procedure will not hurt is not being honest with your patient because every patient is different. Good dexterity is needed when working with needles, it is very easy to hurt a patient when taking blood. Blood needs to be drawn quickly and efficiently.
A phlebotomist must know exactly where the vein is and be careful not to hit an artery or cause harm. Infection control is one of the most important skills for a phlebotomist to have in order to stop the spread of infectious diseases. Hand washing must be done before and after patient contact. Work areas must always be kept clean and sharps must be handled with caution and disposed of in a safe manner in the sharp’s container.
The three main points needed to become a successful phlebotomist have been discussed at length. The knowledge and skills needed for this evasive procedure are of paramount importance in conducting a clean and safe venipuncture. When you combine the knowledge and skills that you have, you will in time become a competent and professional Phlebotomist. As already stated, the knowledge and skills obtained must be continuously worked on over the years. It is not good enough to just complete a phlebotomist course and think that this is the end, in fact, this is only the beginning of a long road of training and upskilling that you will indeed yourself be able to pass on to the next generation of young phlebotomists. You will learn many things through books and courses but the knowledge you obtain from seasoned professionals will be very important as you progress through your chosen profession. While the knowledge you obtain from coursework can be obtained by anyone, the actual soft skills to learn can be personal. Not everyone interacts with people in the same way. There are extraverted people and introverted people which have different personalities, and these people interact with the public in different ways. If you are an extrovert, you will probably find it easier to interact with people and therefore make the patient comfortable. This is not to say that an introverted person cannot become a good phlebotomist, in fact, there is a possibility that with the correct training and working with the right people, a person could over time become outgoing and could benefit from it.
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