Overview of Phlebotomy
Phlebotomy, also known as drawing blood, is a procedure that has been around for a long time and can be traced back to ancient Greece. It was used in the past as a way to treat and prevent diseases. People used to believe that illnesses were caused by an imbalance of bodily fluids, and they used bloodletting to restore the balance. However, these practices were not regulated or well-understood, and therefore often led to poor health results. For instance, George Washington, the first president of the United States, died after undergoing bloodletting as a treatment for a serious throat infection.
With time and advances in medical understanding, phlebotomy has become an essential tool in diagnosing and treating conditions. Now, it is regularly used in healthcare settings to help doctors understand a patient’s illness and improve their health outcome. This writing will give an overview of the up-to-date understanding of phlebotomy, including the best locations on the body for drawing blood, the equipment required, and the right way to do it. We will also discuss the reasons and situations when phlebotomy is recommended, situations where it should not be done, as well as any potential risks involved.
Anatomy and Physiology of Phlebotomy
When taking blood, it’s important to make the process efficient and comfortable for the patient. That’s why we usually take blood from veins instead of arteries. Veins are just beneath the skin’s surface, making them easier to reach. Arteries, on the other hand, have thick walls and are closer to nerve endings, so sticking a needle in them can be more painful. We normally only sample arterial blood when we need specific information on gases in the bloodstream.
The usual spot for a blood draw is in the bend of the elbow. In this area, the vein we use (the median cubital vein) is close to the surface and located over a strong tendon in your elbow crease. This vein is often chosen because it has robust walls that can handle the suction created when withdrawing blood.
This isn’t the same as the back of the hand, which is usually the preferred spot for placing an IV drip. Here it’s important to note that the vein in the middle of your arm (the median cubital vein) is different from the basilic vein, which runs down the side. Extra care is needed when drawing blood from this vein due to its close proximity to an artery and nerve, with a puncture in this area possibly causing a lot of pain and discomfort. In worse cases puncturing the nerve near the basilic vein would lead to a loss of feeling in the skin of that part of the forearm.
Other common areas for blood draws are the side of the heel in babies and the cephalic and basilic veins in the elbow crease.
Why do People Need Phlebotomy
Phlebotomy, which is the process of drawing blood from a patient, can be used for various reasons. These reasons typically fit into two categories: diagnosis and treatment.
Diagnosis
Many medical conditions can be diagnosed based on the results from a blood test. Here are a few examples:
Laboratory values: Bilirubin, which is a breakdown product of red blood cells, can be assessed to determine a proper treatment plan. Doctors can also test the blood to find out if a patient is anemic (low blood count) and what might be causing it by looking at various values such as mean corpuscular volume, lactate dehydrogenase, reticulocyte count, and haptoglobin levels. Moreover, certain heart conditions such as myocardial infarction (heart attack) can be identified by detecting specific enzymes released into the bloodstream when the heart is damaged.
Peripheral blood smear (PBS): This is a test that looks at blood under a microscope to determine the cause of anemia by examining characteristics of red blood cells (RBC). It can be instrumental in diagnosing conditions such as sickle cell disease. It can also help identify problems with platelets (blood cells responsible for clotting) and white blood cells, too many of which could indicate a condition such as leukemia (a type of cancer).
Treatment
Phlebotomy can also be used as a therapeutic treatment for certain conditions when removing red blood cells or serum iron improves the patient’s health.
Polycythemia Ver: This is a disorder where too many red blood cells are produced, causing the patient’s blood to be too thick and potentially leading to blood clots. The standard treatment is therapeutic phlebotomy, which helps reduce the number of blood cells, thereby improving symptoms and outcomes.
Hemochromatosis: This is a condition where the body absorbs too much iron, leading to an overload. Excessive iron can cause multiple organ failures, including the heart, pancreas, and liver. Phlebotomy is an efficient treatment for this condition because removing blood is the most effective way of reducing iron levels in the body.
Porphyria: These are a group of disorders caused by an interruption in heme synthesis, a crucial process in the production of hemoglobin. Phlebotomy can help reduce iron levels and thus manage symptoms.
Research is being conducted to see if phlebotomy could also be a potential treatment for other conditions, such as Hemoglobin SC disease and sickle cell disease.
When a Person Should Avoid Phlebotomy
In some cases, drawing blood may not be recommended due to certain factors related to the patient’s health or the site where blood is to be taken. In particular, drawing blood may not be suitable for patients who have high levels of iron in their blood, but this increase isn’t caused by a genetic mutation. Drawing blood from these patients can lead to issues like iron deficiency anemia, a condition where the body doesn’t have enough red blood cells, and tiredness.
With regards to where on the body the blood is drawn from, previous sites with leftover scar tissue should be avoided. Certain skin conditions like cellulitis (skin infection) or an abscess (collection of pus) can make it easier for bacteria to enter the bloodstream. Other reasons to avoid drawing blood include: having a vascular graft (a new piece of blood vessel used to divert blood flow), a hematoma (a collection of blood outside of a blood vessel), venous fibrosis (thickening or hardening of the vein walls), a history of a type of surgery on the same side of the body called radical mastectomy, and any device used to access veins such as ports, central or intravenous catheters. To avoid any issues from drawing blood, the patient’s medical history should be thoroughly reviewed.
Equipment used for Phlebotomy
Drawing blood is a straightforward and safe procedure when the right tools are used. These tools include a tourniquet, an appropriate needle, gloves, alcohol wipes, and a container to hold the collected blood.
A tourniquet is a band that wraps around your arm and is gently tightened. This increases pressure in your veins and slows down the flow of blood, causing your veins to expand and become more visible. This makes it easier for the medical professional to find a vein and successfully draw blood.
The needle, gloves, and alcohol wipes are all necessary to maintain cleanliness and avoid infection. Gloves protect both you and the medical professional, while the alcohol wipes are used to clean the area where the needle will be inserted.
There should be enough supplies on hand for the process and they should all be appropriate for their intended use in collecting blood from a vein. Typically, these supplies are organized in a tray, which includes:
1. A utility cart
2. Gloves
3. Equipment for collecting blood safely, including needles and
holders, or needles that come with their own holders
4. Containers for blood collection in all sizes, all of which haven’t
expired
5. Tourniquet
6. Anti-bacterial solution
7. Bandages and small pieces of gauze
8. Trash can
9. A small instrument to mix the collected blood in the tubes
10. Bags that are waterproof for safely transporting the collected blood samples
Who is needed to perform Phlebotomy?
Drawing blood, also known as phlebotomy, can be done by different types of healthcare workers. These can include a doctor, a nurse, a medical laboratory technician, or a specialized professional known as a certified phlebotomist whose main job is to draw blood.
Preparing for Phlebotomy
Before a healthcare professional draws your blood, either for testing or as a treatment (also known as therapeutic phlebotomy), they will need to take certain steps. Clear communication with you is vital for a successful procedure. They will explain to you in detail what will happen during the procedure, why it is being done and how you might feel. Your comfort is important, so this conversation will help create a professional and supportive atmosphere.
The healthcare professional will introduce themselves by their first name and briefly explain their role in your care. They will verify your identity and the purpose of the procedure (such as the specific tests to be run with the blood sample), and how much blood will be drawn. It’s important to discuss any concerns or questions you may have, so everything is clear before the procedure begins.
After you understand what’s going on and why, you will be asked for your agreement to proceed with the procedure, which is called ‘informed consent’. The healthcare professional will answer any further questions you may have and make sure you know how and when you will get the results. They will also ask about the best location on your body to draw the blood.
If you feel nervous or have had reactions like fainting during prior similar procedures, be sure to let the healthcare professional know. Counting down, for instance, can help ease anxiety and make the blood-drawing process smoother. If you have a severe history of anxiety during such procedures, laying down might be more comfortable for you.
Your body position during the procedure is important too. It can affect certain blood test results. So, whether sitting or lying down, you should maintain the same position for at least 10 to 15 minutes before and during the procedure. If you are in an office-like setting, make sure to sit for at least 15 minutes before the procedure starts. Any change in position should be well documented to interpret the test results accurately.
You will be asked to provide your personal identification data (like your name, address, social security number etc.) which will be double-checked along with the labels on the blood sample tubes. This is to avoid any misunderstanding . None of your blood will be drawn until everything matches perfectly. All information should be noted in front of you to minimize any chance of mistakes
If needed, the healthcare professional will verify whether you’ve fasted properly for the test. Certain diets, medications, and supplements can influence the blood test results. Generally, morning blood samples are taken after a 12-hour fast. However, fasting rules can change depending on the specific test being done. Typically, plain water is okay to drink during your fasting period, but coffee, energy drinks, and alcohol should be avoided. Starting the fast at least 24 hours before the test is the norm. Also, try to avoid excessive physical activity within 24 hours of blood collection.
For your comfort, the testing area will be clean, private, and well-organized, with a comfortable chair and proper lighting. The healthcare professional will ensure their hands are clean and they have all the tools they need neatly arranged.
They will use fresh needles and blood collection tubes from a reliable manufacturer. They will also pay close attention to the room temperature and humidity, and control any exposure to light to ensure the best possible blood sample. All instruments have an expiration date and using expired ones could affect the test results, it will always be ensured that all used tools are within their valid use period.
How is Phlebotomy performed
When drawing blood, one hand is used to hold the area above the vein tight. This is done by using the thumb to pull the skin down and slightly away from the site where the needle will be inserted. The needle is then inserted slowly into the vein with the other hand, at an angle between 15 and 30 degrees from the surface of the arm.
After the needle is in the vein, a tube is attached to the needle to collect the blood. The needle shouldn’t go too deep into the vein, beyond the inner part of the vein, as it can cause a pool of blood to form under the skin, known as a hematoma. After the final tube is filled with blood, remove the elastic band that was used to swell the vein (tourniquet).
The elastic band should not be left on the arm for more than 1 minute. Keeping it for too long can lead to hemoconcentration, a condition causing false lab results due to concentration of blood components. After the blood is collected, put a clean piece of gauze over the area and apply pressure as the needle is quickly removed. Keep applying pressure to the gauze and tape it to the site of the draw to prevent a hematoma from forming. A bandaid may also be used to cover the gauze.
Possible Complications of Phlebotomy
Medical procedures have improved greatly since the old practice of bloodletting centuries ago, which has made complications much less likely. However, certain problems like increased pain or possible damage to nerves might happen if the procedure is not done correctly. Other studies have found that mistakes in patient identification and incorrect labeling of the tubes used for the procedure are the likeliest mistakes.
There’s also a chance of developing a hematoma – which is a bruise or swelling filled with blood. This happens if there isn’t enough pressure applied during and after drawing blood with a needle. However, these complications can be almost entirely avoided if everything is done with the proper technique and using the right equipment.
What Else Should I Know About Phlebotomy?
Phlebotomy, the process of drawing blood, is crucial in medical care. It’s used to diagnose various illnesses, monitor levels of electrolytes (essential minerals in the body) in order to adjust treatment plans, and even treat certain conditions. Phlebotomy plays a key role in improving patient health, acting as a connector between the lab where blood tests are processed and the patient. It’s an essential part of healthcare service.
