The word "phlebotomy" comes from a Greek word meaning "to cut into a vein which results in the removal or discharge of blood." The history of phlebotomy goes back to 1000 B. C. Since then, the profession has developed in a profound way.

The American Society of Phlebotomy Technicians (ASPT), which represents and certifies healthcare professionals throughout the world, discovered many years ago that one of the most difficult jobs in the hospital is that of the phlebotomist.  There were no training programs except for some in-house training, which was basic at best. 

An Educator's Perspective
Many times hospital employees are transferred from one department to phlebotomy without any formal training.  As well, the trainer for these phlebotomists may not be updated with all the new-and-improved safety guidelines or updated standards and recommendations critical to the collection of blood. 

Sometimes it is difficult for more experienced employees to change their ways and habits in the laboratory.  For example, if a phlebotomy supervisor is not directly involved in the collection of blood or has not been trained by a supervisor directly involved with the collection of blood, then safety concerns arise from the lack of continuing education.

Phlebotomy Standards
CLSI (Clinical Laboratory Institute Standards, which is the former NCCLS) is an international, non-profit, educational organization that promotes the development and use of voluntary consensus standards within the healthcare community.  I rely on these standards not only for the practice of phlebotomy, but also for the teaching of new students. Disregarding these standards may cause harm or even death to the healthcare worker or patient. 

What follows is a list of standards often overlooked by phlebotomists today. The information comes from the Sixth Edition Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture. H 3-A6, Vol. 27 No. 26, replaces H 3-A5, Vol. 23 No. 32.   

• CLSI standards 8.9.2, Venipuncture procedure using needle and syringe:  In general, venipuncture using a needle and syringe should be avoided for safety reasons. If you must use a syringe you should follow 8.9.2 in the above directive.
• Follow 8.10 and 8.10.1 for Order of Draw. The order of draw is as follows:
  • blood culture tube;
  • coagulation tube;
  • serum tubes with or without clot activator or with or without gel;
  • heparin tubes with or without gel;
  • EDTA tubes; and
  • (grey tubes) with glycolytic inhibitor.  
• Plastic or glass serum tubes containing a clot activator may cause interference in coagulation testing; however, glass non-additive serum tubes or plastic tubes without a clot activator may be drawn before the coagulation tube.  
• Standard 8.16 goes over special handling with many tests that will sometimes be overlooked.  Examples include a bilirubin test and vitamin levels.  This is only a sample of specimens needing to be protected from light. 
• 8.6.1: Clenching Fist. Veins are more prominent when a patient clenches a fist, but there must not be vigorous pumping because it can cause changes in the concentration of certain analytes in the blood. 
• Standard 8.8.1 states that one should use a gauze pad with 70% isopropyl alcohol solution.  Clean the site in a circular motion from the center to the periphery (concentric) motion.  Allow the area to air dry to prevent hemolysis and the patient experiencing a burning sensation when venipuncture is performed to obtain antiseptic effect of alcohol.  

The Professional
In closing, remember that there should be two identifiers when working with both in- and outpatients. The importance does not merely lie with the steps of a draw being performed correctly; performing the venipuncture on the correct patient is the most important step.  Failure to do so may cause harm or even death to such patient.  As the trained professional, it is essential to consider that "professionals do what is right, even when no one else is looking."

Helen Maxwell is president and executive director of The American Society of Phlebotomy Technicians, Inc.

Return to the main page for Update in Phlebotomy Standards Learning Scope Package, click here.