How to Become a Phlebotomist

Phlebotomy, A Great Career Choice

Phlebotomy is a growing field in medicine for lots of reasons:

  • The United States Bureau of Labor Statistics predicts it as one of the medical professions that have more job openings. There is an expected job growth of 14% for skilled phlebotomists in the coming six years (2012 – 2018).
  • Many people want to enroll for skills that have a short training program, which only lasts for eight weeks or less than two years.
  • Passing the examination certifies you as a licensed practitioner. Further pursuit of a Master’s degree in a related field opens doors of opportunity.
  • With the cost of healthcare group going up, various clinical laboratories are searching for certified and more experienced personnel who can collect blood while communicating with the patient.

There are a lot more juicy information on why phlebotomy is a growing career in every page of this book. This book has seven chapters, containing all the things you need and want to know about Phlebotomy (statistics, qualifications, examination tips, laboratory procedures, salary, and ethics). These are arranged for easy reading and understanding.

Chapter 1: Why Phlebotomy?

As part of the human race, you need a stable job to feed yourself, to buy what you want and, most importantly, to feed your family. Out of survival, you might be in a job that you have learned to love, but is not actually in the field where your interest lie in. In some ways, life becomes more stressful because it seems like you do not have any choice in that matter.

Have you always pictured yourself working in the field of science— medical science to be exact? In situations where pursuing a college degree is out of the question (or finances are tight), I think you picked the right book to open the door to the world of a medical practitioner.

Now, visualize a surgeon.

A big responsibility is put upon a surgeon’s shoulder each time he enters an operating room. Inside an operating room, it is no longer an excuse to forget a step. A step forgotten instantly means that the patient may succumb to coma or, worse, die.

That’s the science in health care.

Armed with 10 years in medical school and more for internship, a surgeon puts a patient’s life in their hands. This may appear stressful to others, but it is rewarding at the same time.This field is an introduction to the science and art of drawing blood.

Why Study Phlebotomy?

For people who love the medical field (but only have the means for a short course), studying Phlebotomy is the answer to earning $ 10.50 to $12.50 per hour. This is an opportunity to earn more in a medical science-related job.

Phlebotomy is also for people who have their medical degrees, but find it less/not challenging enough. A graduate of psychology can decide to take up phlebotomy to gain more skills or satisfaction.

Interest in Phlebotomy has peaked for people of both situations mentioned above. This field is for people who have a heightened attention to detail, an interest in blood processes, and those who are inclined to not get queasy at the sight of blood.

Phlebotomy is a growing field in health care. The United States Bureau of Labor Statistics claims there’s an expected job growth of 14% for skilled phlebotomists over the next few years. That is why investing your money in a short-course training in a medical field means you will not have any trouble finding a stable job with perks and benefits once you are certified.

Big and small hospitals all over  the country are looking for individuals with a deep interest in the specific task of drawing blood— without sacrificing the essential need to interact with people. You will never know… they may be looking for someone like you.

Five Reasons to Consider Studying Phlebotomy

Job Security

Services done by phlebotomist are needed in hospitals. Doctors regularly order blood testing for their patients. They also need someone to draw blood and prepare it for further lab testing right after.

Brief Training Period

Most training programs for phlebotomists only last for two years or less. Some even take two to six months, depending on the type of demands required by the state. The availability of students and teachers also matter, too, for you can consider being a Phlebotomy instructor after gaining experience.

Because of the short training and few students inside a classroom, the sessions become faster.

Training in phlebotomy focuses on hands-on training than classroom discussion. You are given more hours to complete your internship.

Helping Others

The coolest part of being a phlebotomist is the act of helping people by competently doing your job. Your job is not limited to just drawing blood. You are expected to help a child or adult relax and calm down when they seem uncomfortable during the process.

Flexibility

Once you are a phlebotomist, you are given the right to choose a schedule according to your liking. You can choose to work on a part-time basis or in a full-time staff at a hospital or blood bank. The necessity for blood to be drawn is a 24/7 need for doctors.

The various places to work at is another good reason to study phlebotomy. Whether you choose to work in a hospital, a private laboratory, a clinic or a blood center— you can be sure that you will be able to put your skills to good use.

If you passed a phlebotomy program five years ago— but had to stop for some reason— you can still consider this career and take the course again. Doing so will update you about the new innovations on venipuncture. It is also a course which helps you to improve on drawing blood.

Prequel to Any Medical Field

Dreaming about becoming a doctor someday?

Study phlebotomy first. It is one of the most ideal introductory courses to higher medicine such as nursing, surgery or neurology. Studying the various parts of the human body, while mastering how each organ functions, is usually the opening chapter in a phlebotomy course outline.

More Income for Degree Holders

Based on the statistics released by the United States Census Bureau, there is an estimate of higher job earnings based on education level.

A person with a bachelor’s degree can earn $2.1 million a year, while a holder of a professional degree can earn as high as $4.4 million.

This is one of the reasons why committing yourself to a phlebotomy program is important. Phlebotomy helps you enjoy the perks of your professional success.

Estimate Salary

Graduate of Bachelor’s Degree $2.1 Million

Holder of Professional Degree $4.4 Million

The Bureau of Labor Statistics says that the field of phlebotomy is expected to grow until 2018. If you are going to invest your money in the field, you will see more career opportunities and earn more income.

Phlebotomy is not closing its doors for everyone. Phlebotomy does not only accept those with bachelor or master’s degree.— anyone is welcome to complete this course.

Chapter 2: Where to Study Phlebotomy

There are schools near your state where you can drive to, while some phlebotomy schools offer online course completions. Think wisely and decide which you would prefer.

Choosing a Traditional School

Selecting a reputable phlebotomy school is crucial. It is the most difficult part of the process, and it may take time, even days. Your choice of school needs to match your personal needs without sacrificing the quality of education.

Knowing What You Need

Finding the right school in phlebotomy involves answering several questions. Consider these questions to fully understand your needs:

  • Do you have the budget to pay for the training program?
  • If you answered yes, then are you enrolling as a full-time or working student?
  • Is it okay if you are going to spend more time in training?
  • What are your long-term goals when enrolling in the program?

Once you have clear answers to these questions, search for accredited schools using the telephone directory or an online directory. Make sure you know where the school is located. Travelling several miles from home to school will make the classes more difficult to ace.

Narrowing Down Your List

It is important to select five schools among the hundreds you have researched. These schools must also be recommended by higher institutions such as National Phlebotomy Association (NPA) or American Society for Clinical Pathology (ASCP).

Make sure that these five schools also offer payment options. There are phlebotomy schools that ask for full payment before classes start. Others allow you to pay monthly and with federal assistance programs.

Your success in phlebotomy depends on the reputation of your school. Remind yourself that it is better to choose a more expensive school that offers contemporary facilities than to save money by enrolling in a cheaper school with low-quality education.

Visiting the Campus

Conduct a thorough research on these five schools by visiting them. Observe how the lecture rooms and laboratories look like. The lecture room must be conducive for learning. It should provide lockers for each student, the floor should be tiled, and the entire area should be air-conditioned. There should also be a fast internet connection for important research.

An ideal classroom for phlebotomy must be open for discussion. It should not be a place for book smarts. There should be a wide-screen television for instructional films and mini-component system for audio learning.

Lecture hours are not limited for reading books and demonstration, and lecture rooms are for visual and audio learners, as well.

The laboratory is an ideal ground for clinical procedures. It should offer up-to-date materials for phlebotomy.

Once enrolled in the school, you are given easy access to any equipment, as long as they are needed in projects.

Comparing Offers

  • Which school meets your expectations (e.g. scheduling classes and payment options)?
  • Which school embodies real-life clinical setting?
  • Which school includes books as part of their tuition?
  • Which school offers internship programs?
  • Which school offers job placement programs for graduates?

Schools in phlebotomy support your career transitions. You need to choose a school that offers college credits for phlebotomy training. Let us say you are not pursuing further education in medicine; you can still have savings by attending a technical school and become a certified phlebotomist.

Cost, Duration and Courses

Cost

It depends. Whether you are in a community college or trade school, the average cost for a phlebotomy course is $500.

Expenses usually cover registration, textbooks, tuition fees, skills kit, physical examinations, malpractice insurance (additional), and health immunizations against diseases such as Hepatitis B. A number of trade schools accept students without a high school diploma, provided that you pass the G.E.D (General Educational Development).

Duration

A phlebotomy course, depending on the state where you live, normally lasts from two weeks to two semesters. Some schools even offer a program for three days, and this comes with a State Phlebotomy Certification.

Upon obtaining your certification, you need to consider taking the National Certification Examination for Phlebotomy. However, the payment for this exam is not included in your school fees.

Courses

The entire program for phlebotomy is divided into two courses: Phlebotomy Essentials and Phlebotomy Clinical. These two courses contain six credits, and they may serve as electives for your associate degree programs. You can expect a well-paying job once you master and pass these two courses.

Study Online

The power of information is at the tip of your fingers. The Internet answers your deepest curiosity, and it also makes you more productive. With e-mail providers and instant messaging tools, completing your phlebotomy course is possible.

Studying a course online can be advantageous, especially when you are working on weekdays. The truth is, there are no major differences when you are studying phlebotomy online or offline. The range of topics and procedures are the same. You are still required to complete a specific number of hours for internship, though.

Some things to consider

Make sure that the online schools you choose are accredited. You need to take time in exploring their entire website. Though it is not easy to know outright which online schools are legitimate, there are some red flags to keep in mind:

  • P.O.box address
  • Run by a company with no mention of names of certified phlebotomists
  • Telephone number has been disconnected
  • Less than 40 hours of training time
  • Google the name of the school by typing: name of school + rating in the search box. Seeing what people are saying about the school will help you make your decision.
Study the classes they offer and course summary for phlebotomy

The online school should give you an account to their private library. It is only when you are logged in that you are allowed to download the course modules and other publication materials. It is also an advantage when there is an online mentor who evaluates your weekly performance.

See what they offer as against their payment plans

Comparing the online curriculum to a traditional training school will give you a better idea on which phlebotomy school knows what they are doing and if they are worth every penny you pay.

How long will the course be?

Accredited training courses should not go below the required hours that you will need to complete for a licensure exam. Going through the training just to find out that your hours are below the required time when applying for a license would make everything not worth it.

Most importantly, the online school must authorize you to complete an internship to their affiliate hospitals and other work settings.

Some of the most popular schools which offer online courses are Kaplan University, Keiser University, A.T., Still University, and Herzing College. These schools are trusted institutions, and the quality of all their services is first-rate.

These schools offer e-learning modules derived from physical phlebotomy courses. Just to make sure you are getting the best training, never limit yourself with the suggested schools mentioned. Select an online school that is known within your medical community.

The Truth About Free Online Training

One thing that we have to understand with trainings that do not involve cash, most specifically the online kind, is that they will give no guarantees nor be liable for anyone’s performance. Take what you can from these trainings, but invest in paid trainings to get the proper skills in drawing blood. Paid training schools with traditional schools have tie-ins with

clinics, hospitals, care centers that will provide enough experience in drawing blood.

Free trainings have limitations and may not equip you enough to be an effective phlebotomist. The most trusted free training (if it exists) must supplement your training.

Option 1: Free Online Exams

Search for various websites that provide practice exams. These sites will help you pass the actual examination.

Option 2: Join Medical or Related Forums

You need to visit various forums where you can share your experiences with other people who are taking a phlebotomy course, too. It is helpful when you talk with a professional. Ask him or her for more tips about free phlebotomy training.

Option 3: Watch Instructional Videos

Online resources on venipuncture procedures are available in medical websites, even in Youtube. Learn what you can from these videos and apply them to your actual jabbing task.

The Truth About Free Training Offers (Offline)

Option 1: State Employment Office

It is clearly difficult to enroll in a paid phlebotomy course if you are unemployed. That is why you should let the State Unemployment Office help you.

Each state usually offers a training program for early job placement for unemployed people. The employment office provides a list of phlebotomy courses with specific names and locations. Most of these free training programs are almost as good as paid training programs.

Option 2: Volunteer Time in Exchange For Experience

Check some nursing homes for elders. Some homes sponsor selected students for professional training programs. The only requirement they need is for you to work with them for a certain period of time. Once the training course is completed and the certification is obtained, you can officially work for them with regular pay.

Chapter 3: The Excellent Student in Phlebotomy

Aristotle once said “We are what we repeatedly do. Excellence, then, is not an act, but a habit.”

Habits involve steps through a process. Like phlebotomy, no matter how short the period of training is, you still need to acquire the essential habits to become excellent.

These habits involve psychomotor, cognitive and affective requirements, all of which provide you the confidence to fully participate in any clinical training until you complete the entire course.

The Psychomotor Demands include:

  • The ability to move freely
  • The ability to maneuver in small spaces, either by standing or walking for long periods
  • The ability to access areas within the healthcare facility
  • The hearing ability to respond to messages asked by patients and staff

The Cognitive Demands include:

  • The ability to handle phlebotomy equipment to safely collect, process and store a patient’s specimen
  • The visual ability to discern colors for labels and perform phlebotomy procedures
  • The visual ability to read and interpret test results and requests ordered by the physician
  • The ability to operate a computer and specialized software
  • Remembering accurate procedures, either oral or written
  • Maintaining accurate records
  • Organizing paperwork and completing them on time
  • Using critical thinking skills to solve problems

The Affective Demands include:

  • Establishing an effective working relationship with other team members
  • Communicating in a professional and tactful manner with patients, laboratory personnel, superiors and other health care employees
  • Accepting responsibility for actions
  • Valuing patient confidentiality
  • Displaying well-groomed and neat appearance
  • Exercising ethical judgment, integrity, dependability and accountability in laboratory responsibilities
  • Handling taxing workloads effectively

All phlebotomy training programs require possible students to have their high school diploma or pass the General Educational Development (GED).

Since phlebotomy is not only about extracting blood, but also a job that requires a personnel to calm a patient during the process, students are expected to have good communication skills. There will be instructions on what to expect and how to handle patients, but having communication skills is still a plus. Once enrolled in a program, you are expected to effectively communicate with faculty members, physicians, patients and other students.

Training Materials

The following are the training materials that you will have in phlebotomy class. All equipment and procedures follow the standard policies. Even when arranging test tubes on a tray, phlebotomy students are expected follow these policies. Procedures and standards are detailed to avoid malpractice and other accidents inside the laboratory.

Blood Drawing AreaAn ideal blood drawing area consists of a chair with a wide, flat and clean surface for the arm of the patient. The surface area should be wide enough for the patient’s arm to rest comfortably while the elbow lies against it. For patients who would prefer lying down rather than propping their arm on an armrest, the blood drawing area can be the examination table.

Medical GlovesThe pair of gloves can either be latex or non-latex. It should be sanitized, disposable, and fit the hands well. Gloves are important; these are your defense against exposure to blood and risk of cross contamination between patients.

Medical Masks, Lab Gown, Scrub Suit, Visors or GogglesThese are mandatory for your overall protection. These are used while on duty and must not be forgotten at home. Professors are given instructions not to allow anyone to perform any clinical procedure without even one of these four items.

TourniquetTourniquets are either long rubber straps or cuffs with velcro fasteners. These are used to expand the veins for a comfortable venipuncture process. Both tourniquets are available for adults and pediatric sizes.

Practices for tourniquet usage differ according to the patient’s status. Phlebotomists assigned to a pedia ward may be asked to dispose the tourniquets after each use. Children are more susceptible to bacteria, and this is one of the safeguards against it. Disposing tourniquets for adults is also a practice during venepuncture for the same reason.

They use several tourniquets in blood donation centers. These tourniquets are sanitized and changed after several days of use.

AntisepticItems to sterilize equipment and extraction area in clinical procedures include isopropyl alcohol, iodine solution, swabs, swab sticks and plastic wash bottle. The 70% isopropyl alcohol is also available in individual wipes used to clean the venipuncture site. Povidone-iodine solution is used to clean the insertion area before blood donation. The plastic wash bottle with solution should be available to clean up tiny blood spills.

SharpsThe sharps is simply a rectangular or circular container used for needle disposal. It is color regulated by each country and it is always marked with a warning: “BIOHAZARD INFECTIOUS WASTE.” The container ensures that used needles are out of sight and cannot be picked up or used again by mistake. The Sharps container should be within your reach in the blood-letting area.

Blood Collecting TraysThis is a specialized tray which phlebotomists bring during bloodletting rounds or while extracting blood within a bloodletting area that holds several patients. Your tray should be lightweight with a long handle across the width of the tray for easy handling. Conventional trays will have enough space for several specimen bottles, alcohol soaked gauze, cotton swabs, lancets, syringes, bandages, medical tape, adhesive labels, test tubes with stoppers, markers and gloves.

NeedlesThere are different types of needles which a phlebotomist will use. Two of the most used are the Hypodermic needle and the Butterfly needle. All needles come in a wide range of lengths and gauges— all used for specific procedures. A needle gauge is the size of the needle, and the if your patient has a small vein, blood-drawing can be easier with the use of a very small needle size of about 27 – 29 G.

The Butterfly needle is attached to a plastic holder that sticks out like wings. These are used for specific extractions or venipunctures.

The Hypodermic needle, on the other hand, is a needle used for syringes. This type of needle has a plastic needle hub that attaches to the syringe’s end. There is also a double-ended needle used for the vacutainer, which is also used for blood extraction. Phlebotomy trainees should pay attention to these types in order to know which should be used in a blood-drawing process.

SyringesEveryone is familiar with these. Syringes come in several sizes and have various uses and types.

According to the World Health Organization, there are safety syringes for injection safety:

  • Auto-disable (AD) syringes – these are reuse prevention syringes that have an internal mechanism which blocks the plunger once pressed down fully.
  • Breaking Plunger syringes – just like the AD, this type of syringe cracks the barrel when the plunger is fully pressed.
  • Needlestick Prevention syringes – these have a mechanism that prevents reuse. The syringes have a shield that protects the user from being pricked by mistake.
  • Retractable syringes – unlike the previous syringes, this type has a needle that withdraws inside the barrel once the plunger is retracted.

Special-size LancetA lancet is a small surgical instrument with a sharp-pointed two-edge used in a venipuncture procedure. It derived its name from its shape that looks like the lance used by knights in jousting games.

There are three types of lancet:

  • Simple Lancet – it is double-edged blade enclosed in plastic. To use this, you have to break off the plastic enclosing the blade and prick the skin.
  • Automatic Lancet Device – it is a double-edged blade that is in a tube and is drawn out by pressing the end, which activates the spring-action mechanism. It works like a retractable pen, but instead of a ball point, a lancet is in place.
  • Laser Lancet – this type is also called a “lasette,” which is battery-operated device where the lancet works like a laser beam. What is nice about this type is that once the the procedure is done, there is no bruising evident.

Capillary Tubes These tubes are used to get a sample of blood for testing and blood cultures. The small amount of blood siphoned from a finger prick is transferred to a slide or petri dish.

Microscope Slides and Cover Slipsthis is the rectangular glass where blood is smeared on while the cover of the specimen needs protection. Technology provides better equipment that give accurate results, but when the sickness is complex and a check on the discrepancies needs to be manual, a blood smear is needed to confirm results.

Bandages or TapeAdhesive bandages (hypoallergenic) should be within your reach when you are dealing with sensitive skin. Medical adhesive tapes are either clear or not, and should be porous.

Ammonia Inhalant Ammonia inhalant is used to resuscitate patients who faint. Though ammonia inhalants are basically used for fainting, you will be instructed on how to handle patients who have fainting spells, seizures or unconsciousness.

Gauze PadsSmall and gauze pads are used to bring comfort for patients. These are available in rolls or in individual packs.

 

Cold PackCold compress can be be used to resuscitate patients who get dizzy. Cold packs can also be used to soothe the pain receptors in order to make needle pricks painless. These are reliable when the patients are children, or adults who are not comfortable with needles.

Warm Packs/ Heating PadsThese are used to dilate the veins, which makes it easier for phlebotomists to find the right vein to extract from. Heat packs are not used during extraction, but before getting blood.

Adhesive LabelsThese are important strips of stickers, about 1.0 x 2.5 inch in size, which are used for labeling blood specimens. Information like the name, age and date of extraction are written on these labels, which are identified by the bar code.

Warming DevicesThese are used to keep the blood from coagulating. The ideal temperature for any warming devices should not exceed 42º.

Reference Lab ManualIt is mandatory to bring your test manual with you. It will save you from forgetting the correct order of test tubes and the volume requirements for various tests, such as specimen-handling instructions and precautions.

Blood-Sampling TubesLaboratory tubes must be arranged in order, and each should have its colored stopper. Cross contamination and erroneous lab results are immediately declared when this “order of draw” is not strictly followed.

Blood CultureThis refers to a tube or tubes that contain an appropriate media for the purpose of preservation of specific microbes growth.

  • Red stopper (the serum) – This is the tube that has no anticoagulant or clot activator, and is regularly used by chemists.
  • Light Blue stopper (the plasma) – This tube contains 3.2% sodium citrate that acts as an anticoagulant. These tubes are commonly used for coagulation studies. These need to be completely filled to assure that the proper ratio of blood to anticoagulant is achieved.
  • Gold Stopper (the serum) – This tube contains no anticoagulant. It contains clot activator and silicone gel for the separation of cell or serum.
  • Royal Blue stopper (the plasma or serum) – This tube contains sodium heparin or nothing at all. These tubes are known as the cleaners and these are used for specific drugs and heavy metals. These should be placed after the light blue stopper once a heparinized tube is drawn.
  • Green stopper (the plasma) – This tube contains lithium heparin. These tubes are used primarily by chemists.
  • Lavender stopper (the plasma) – This tube contains K2EDTA and its anticoagulant is either in liquid or powder form. The tube is primarily used in Hematology, procedures done by the blood bank and chemistry procedures.
  • Gray stopper (the plasma) – This tube contains sodium fluoride/potassium oxalate as its anticoagulant inhibits glycolysis. These tubes are used for glucose testing.
  • Yellow stopper (the plasma and cells) – This tube contains ACD anticoagulant solution or solution A/B. It is used for molecular genetics for DNA testing.
  • QuantiFERON tubes: QuantiFERON is preferably called QFT. It is a registered trademark of the test used to diagnose tuberculosis infection. This tube contains one gray top tube of 1mL NIL Control, one red top tube of 1mL TB Antigen and one lavender top tube of 1mL Mitogen Control.

Chapter 4: Phlebotomy Training

A Phlebotomy Class

Phlebotomy is an applied science that deals with the process of drawing or receiving samples from a patient. These samples are blood, urine, sperm and fecal samples. When you are inside a lecture class, you need to familiarize yourself with the proper steps in clinical procedures.

Students will also be expected to have a lot of individual, pair or group presentations. Your professor will expect you not to rely on textbooks alone. It is a need to follow the procedures written in books, but it is not enough to simply memorize the information. Understand it and draw a picture inside your mind while reading.

The Course Outline

The first part of the course outline in a phlebotomy class will focus on the theories and practices. You are introduced to the work-flow cycle, standard precautions, ethics, cleaning, disinfection and disposal of used equipment.

Mastering the essentials of anatomy and physiology is also important. You are expected to be knowledgeable in the structures and functions of human body systems. Phlebotomy usually targets two systems: the Integumentary and the Cardiovascular.

The remainder of the course focuses on hands-on training inside the laboratory. You are taught how to use the various equipment for blood procurement, waste management, labeling and procedures for spillage and breakage. You will also practice different types of blood sampling (capillary blood, arterial blood, venous blood) to different ages.

Completing your on-the-job training is an essential step to passing your phlebotomy exam. Working inside a hospital gives you a lot of confidence— as well as experience— to ace the examination by the end of the course.

Phlebotomy Procedures

Laboratory results depend heavily on the specimen given. A faulty lab test will lead to the misdiagnosis of a patient.

As phlebotomists, procedures required for patients have to be followed down to the very minute detail. A mistake in the procedure will most likely result to the destruction of a specimen.

In this course, you are expected to collect samples or specimens from the vein or  an incision on the skin. Procedures are different because of test specimen requirements. In the four procedures below, three of these involve inserting a needle to penetrate the skin and vein, while one involves skin breakage.

PROCEDURE 1 – Routine Venipuncture

Venipuncture is a procedure that requires you to search for a possible vein to draw a specimen from. Since you will be looking closely and feeling for a vein, washing your hands and wearing gloves are required.

You will use a tourniquet to make the veins visible below the skin. Some apply a warm pack to coax the blood into the vein, making it more visible. Once you have chosen the vein, techniques will be taught on how to sanitize, tourniquet and anchor the vein, and extract blood using either the Vacutainer or the Butterfly (with tubes or syringe).

This procedure is done for numerous tests. There may be a time when a phlebotomist would have to extract enough amount of blood with multiple draws if a patient’s blood is ordered for several testing. Paying attention to situations that may arise are always useful.

Materials:

  • Syringe
  • Needle
  • Sharps
  • Protective Gloves
  • Protective Mask
  • Cotton wipes
  • Tourniquet
  • Fresh Bandage

Procedure:

  1. First, assemble all the necessary equipment on a tray.
  2. Observe proper handwashing. Put on gloves when both hands are dry. Wear mask.
  3. Patients who drop by the emergency room for a blood test are called by name to give the information needed on the forms. You need to ask their birth date to confirm if their answer matches what is written on their request forms. Patients who are admitted in the hospital have an identification brand on their arm and a medical record number (MRN). It is practiced that no blood should be drawn if a hospital patient has no MRN.
  4. You need to check the patient’s preparation. There are certain specimens that require your patient to go on a fasting or diet. It is also important to know if the patient is allergic to latex, metal (needles), isopropyl alcohol, iodine (cleansing agents), adhesive tape, cotton, etc.
  1. After monitoring, proceed to selecting the right sizes of tubes and needles to be used for the collection. If you are using tubes that contain additives, stick a label to its surface to identify it.
  2. Open a new package of sterile needles. Make sure to not remove the needle cap. You just need to secure it into the plastic holder and insert the tube into its holder. Piercing the tube must not be done, as this will only lose the vacuum pressure.
  3. To avoid confusion, certain specimen tubes must be arranged in order. The correct order is: (1) Clean and sterile tubes (2) Non-additive tubes with red, SST or gold stopper (3) Citrate tubes with light blue stopper (4) Gel separator with SST tube (5) Heparin tubes with green stopper (6) EDTA tubes with lavender stopper (7) Oxalate/fluoride tubes with gray stopper.
  4. Ask your patient which arm is best for drawing blood. The patient should be positioned in a comfortable manner. The sleeve must be rolled up, arm extended upfront, and back supported by a chair or bed. If the patient is lying down, lowering the side-bed rails is necessary. If the patient is sitting, placing a pillow or towel under the arm can be helpful.
  5. You must apply the tourniquet three to four inches above the puncture site. Most patients may feel uncomfortable with tourniquet, that is why you need to assure them that they are going to be fine and it is not going to be longer than a minute or two. If there is a skin lesion at the tourniquet location, you need consider an alternate draw site.
  6. Instruct your patient to make a fist. Refrain him/her from any hand exercises like pumping, whirling, etc., as these can affect the test results.
  7. Feel the venipuncture site. Choose the part in which you feel the larger and fuller median cubital vein. The venipuncture site must have no cuts, scarring or burns. If an IV is inserted in a venipuncture site, the procedure must only be done after the IV is turned off for ten minutes. When a patient undergoes blood transfusion, only perform venipuncture after fifteen minutes.
  8. Once a good vein is found, tap the inner elbow with your index finger. It is also helpful to massage the arm from the wrist to the elbow, as this procedure forces the blood to flow into the vein and causes it to dilate. There are two other ways to make the vein dilate: by applying a warm and wet towel to the arm for five minutes, and by dangling the arm also for five minutes.
  9. Clean the punctured area with alcohol wipe. Only make a smooth and circular direction moving outward from the zone of penetration. Dry the skin. Make sure that you do not touch the puncture area after cleaning.
  10. Perform venipuncture by holding the needle or tube assembly using your dominant hand. Remove the cap and bevel up the needle tip at thirty degrees or less.
  11. Hold the patient’s arm below the puncture site using your non-dominant hand. Pull the skin tight with your thumb or index finger.
  12. Align the needle or tube assembly fifteen degrees to the skin. Quickly (but lightly) push the first tube to the skin. Simply enter the vein in one direction, if possible.
  13. Hold the plastic tube holder below the puncture site. Push the tube onto the needle and puncture the stopper.
  14. When the tube is filled with additives, keep the tube at upright angle to prevent the additives from entering the patient.
  15. The blood should freely flow once the needle hits the stopper. If not, the needle is either too far or not in the vein. Reposition is needed if the puncture is not in the vein. If the puncture is in the vein but the blood does not flow, consider using another tube. The rule says, “The patient must not be stuck more than two times by the same phlebotomist.”
  16. After the blood flow, release the tourniquet. Inform the patient to open his hand.
  17. The constant forward pressure is necessary. This keeps the rubber foot from closing.
  18. Remove the tube when blood stops to flow. The rubber boot immediately closes to prevent leakage.
  19. The tube that contains additives should be inverted five to eight times after being removed from the patient.
  20. Before removing the needle from the arm, push the last tube forward. This gentle push will cause the activation of the safety device inside the needle.
  21. Quickly remove the needle to minimize the pain. Apply the gauze and inform the patient to apply pressure on it for twelve minutes.
  22. Once bleeding stops, apply a fresh bandage or tape. Instruct the patient to not remove it for fifteen minutes.
  23. Dispose the needle and its holder. Label the tube with patient’s name, birth date, your initials, date and time of collection.
  24. Remove gloves. Wash your hands.
  25. Make sure that the patient is alright before saying goodbye.
  26. Send the collected tubes to the main laboratory for testing.

PROCEDURE 2 – Skin Puncture Collection

Specimen for this procedure is collected from the capillary or the smallest forms of blood vessels on the fingers, ear or the heel of the foot (for children). A paper cut draws enough blood to be able to diagnose a sickness.

For this procedure you will be taught which part of the body are preferred sites. Materials used will be the capillary tubes- the thin glass tubes that is used to suck blood from the cut. There will also be times that you will be taught to get blood smears with the use or rectangular glass slides. Skin puncture is a procedure that is done when you are tasked to collect whole blood, plasma or serum.

Materials:

  • Glucometer
  • Lancet (in different puncture sizes)
  • Gauze
  • Microtainers (with different stoppers)
  • Protective Gloves
  • Protective Mask
  • Large Test Tube
  • Sharps
  • Adhesive Tape
  • Warm washcloth (42° C)
  • Chucks
  • Disinfectants

Procedure:

  1. Take time assembling all necessary equipment for the procedure.
  2. Wash hands thoroughly. Put gloves when both hands are dry. Wear mask.
  3. Identify your patient. Your patient is an inpatient if his bracelet ID matches the requisition label. The bracelet ID also includes the name and medical record number (MRN) of the patient. Confirm the birth date when dealing with an outpatient.
  4. Choose the appropriate microtainers for the procedure. You should tap the microtainers that contain additives to remove additives from the walls and stopper.
  5. Position your patient in his or her comfortable manner. For finger stick procedure, the patient usually sits and his/her dominant arm is resting on the blood drawing chair with arm support. For heel stick procedure, disrobe the baby’s clothes and blanket. The adult who carries the baby must have a protective barrier under the baby for protection. In case there is no one to assist, simply position the baby in the center of an examination table. The heel is the ideal site for puncture for babies who are six months old.
  6. Choose the puncture site. For finger stick procedure, use the middle or ring finger if the patient is a child or an adult. The ideal site is located at the outer and upper region of the fingertip – that is halfway between the center of the fingerpad and the edge of the fingernail. For heel stick procedure, the ideal site is located on plantar surface beyond the lateral and medial limits of the heel bone. The heel bone is a sensitive part. A puncture in this area can be damaged, that is why it is not recommended to puncture on the infant’s central foot.
  1. Explain the procedure to the patient. Your patient can easily digest what you are saying if you use simple terms.
  2. Apply a warm and wet washcloth to the puncture area for three minutes. This warming technique can increase the blood flow.
  3. Cleanse the puncture site by using an alcohol or povidone-iodine prep. Dry the skin by using gauze. You need to keep the skin dry to avoid the blood from spreading all over the area.
  4. Prepare the puncture device packaging. Be extra careful when opening it. Make sure not to contaminate the side.
  5. It is time to perform the skin puncture. For finger stick procedure, you must first exert pressure on the fingertip. Hold it with your index finger and thumb. The direction of the pressure must be upward. Using the lancet, make a quick puncture in the area. Only release the finger and wait for the first drip of blood to form. Then, wipe it away. You do not need to squeeze it excessively as the tissue fluids interfere with the testing. The microtainer with a lavender stopper should be drawn first. Positioning the collection top at 45 degrees angle, the blood will flow by capillary action down the top to the inside of a tube. Just fill it between 250 – 500 ul mark. Most importantly, don’t shake the tube; just mix it gently 5 to 7 times after removal of the collection top. For heel stick procedure, hold the foot firmly. Puncture the selected area and release the foot while the first drips of blood start to form. Then, wipe the first drop of blood without squeezing the punctured area. Hold the foot firmly and start collecting blood. After that, release the foot. Allow the baby to kick, as kicking increases blood flow. Wipe the punctured site. Apply gauze (not tape) and put some pressure to it. Hold the gauze until bleeding stops.
  1. Dispose the puncture device.
  2. Seal the tubes. Put a label on it.
  3. Before sending it to the laboratory for testing, make sure your patient is alright. Make sure the bleeding has stopped.
  4. Once the bleeding does not stop for 5 minutes, bring the patient to a physician.

Considerations on Capillary Blood Sampling

You need to process capillary blood samples after it is drawn.

The first step is to keep the tubes capped. This is the only way to preserve the specimen.

The second step is to avoid stirring the specimen. You will know when specimen is inappropriately stirred when there is a breakdown of red blood cells (hemolysis). Badly hemolyzed specimens are unacceptable. That is why, handle specimen with extra care. Use gentle inversion to mix specimens.

Third, be familiar with the specimen time constraints. You should follow the recommended minimum and maximum hours to which the specimen is left in the tube.

Fourth, consider refrigerating the specimens if it is not tested immediately. To preserve its best quality, it should be stored at two to eight degrees celsius. Specimen exposed to heat causes hemolysis.

PROCEDURE 3 – Blood Culture Collection

Blood culture is a procedure done to detect infections which are spreading through the bloodstream. Here are three types of culture technique:

  • Bact/Alert System – isolating the aerobic, facultative and anaerobic microorganisms and yeast
  • Isolator Lysis-centrifugation system – detecting the dimorphic fungi obtained from microbiology laboratory
  • MB Bact Alert System – detecting the mycobacteria obtained from a microbiology laboratory

Materials:

  • Blood Culture Bottles (with different caps: green, orange, pink)
  • Winged Needle Set/18 Gauge Needle (Butterfly)
  • Vacutainer barrel
  • Luer Adapter
  • Gauze
  • Protective Gloves
  • Protective Masks
  • Alcohol Pads
  • Syringe

Procedure:

  1. Gather all necessary equipment.
  2. Wash hands thoroughly. Put gloves when hands are dry.
  3. Explain the procedure to the patient.
  4. Before starting, wear mask.
  5. Clean the top of the bottles using pads with 70% Alcohol. Allow them to dry thoroughly. Be attentive to maintaining the blood sterility. The bottle tops, needles and syringe openings should be sterile, too.
  6. Clean the area of venipuncture using alcohol, followed by iodine tincture. Allow the iodine to dry. If your patient is allergic to it, apply alcohol twice.
  7. Feel the venipuncture site and insert the butterfly needle with tubing.
  8. Connect the butterfly tubing to the vacutainer barrel using the luer adapter to transfer the blood to the aerobic and anaerobic bottles.
  9. Ideally, the amount of collected blood in adults must be limited to 5ml per bottle. It can be four to ten ml of blood in green bottle (aerobic), or divide the amount evenly by collecting 10ml in both green (aerobic) and orange (anaerobic) bottles. For babies, it is 0.5 ml per bottle.
  10. Never overfill the bottles. Overfilling results to false positives. Remove the syringe.
  11. After labeling the bottles with the right information, send them to laboratory for testing.
  12. Make sure the patient is alright.

PROCEDURE 4 – Mycobacterium Culture Procedure

The blood culture for mycobacterium is similar with blood culture. Materials to be used are the same, although there are some changes in the procedure.

Procedure:

  1. Follow the first few steps in blood culture (1 – 6).
  2. Upon collecting, use a winged set without anticoagulant. Insert it directly into the MB Bact Culture Bottles (3 – 5 ml per bottle).
  3. Monitor the blood volume intake into the bottle to avoid over-insertion.
  4. Make sure that the amount of blood collected is only 5ml on the markings.
  5. Label the bottle.
  6. Transport the bottle to the microbiology laboratory.

Safety Precautions

No matter what procedure, a phlebotomist is always exposed to body fluids from patients, mainly the blood.

Patients are expectedly sick, and some sickness can be spread through the blood. Accidental needle pricks from used syringes are possible, and making sure that you know the safeguards against this or the emergency action if it does happen will save you.

All medical staff (including phlebotomists) are exposed to sickness, which is why every hospital has back-up plans that protect the personnel from harm.

The Availability of Post-Exposure Prophylaxis (PEP)

The biggest risk of taking phlebotomy course is the exposure from various viruses and bacteria. These incidents of exposure are inevitable. It is part of the field. It is one of your biggest responsibilities to record all incidents, accidental or not, in a designated logbook. Phlebotomists should also think about protecting their health all the time. The use of postexposure prophylaxis (PEP) can be helpful in averting HIV and Hepatitis B infections. PEP is effective once the treatment begins within an hour of exposure.

Avoidance of Contaminated Instrument

There are plenty of single-use items inside a phlebotomy laboratory. Needles, sharps and gloves are only three of the many items that have to be disposed right after a procedure. Tourniquets are disposable too. They are a source of methicillin-resistant Staphylococcus aureus (MRSA), a type of distinctive round shape bacteria that does not respond to some antibiotics. Statistics show that 25% of tourniquets are contaminated due to improper use. You must observe proper hand washing before using tourniquets.

Formal training sessions in phlebotomy should cover the essentials (laboratory procedures, introduction to items, prevention), and each training session, however easy or difficult it is, should be supervised by an experienced staff.

Even if you are an excellent student, you can be frustrated with your job if there is no involvement and cooperation from your patient. In an actual setting, you will be dealing with people of all ages. Most children will see you as the villain. They think that by sticking a needle in them, you are hurting them. You also cannot escape from those adults who have a fear of needles. Some of them will even faint just by seeing it.

As the training phlebotomist, you can control these situations. Your words of care and gentle touch can make them feel good. Any phlebotomy procedure begins the moment you look your patient in the eye. Of course, expect any patient to feel anxious. That is why you need to immediately comfort them with a smile.

Chapter 5: Passing the Licensure Exam

Obtaining Certification

Certification in phlebotomy is an added bonus that gives you a higher edge from other job-seekers.

A certification is the official documentation of your competence in a specific field or discipline. Certain states have different rules and regulations in terms of obtaining a phlebotomy certification. For example, the state of California has a three-tier certification system (Phlebotomy Certification Guide, 2009):

  1. Phlebotomy Technician
  2. Phlebotomy Technician I
  3. Phlebotomy Technician II

Qualifying as Phlebotomist in California

Limited Phlebotomy Technician
  1. HS Graduate or GED or Equivalent
  2. Submit documentation and application to a CA-approved Phlebotomy Training Program
  3. Complete the following:

1 – 20 hours of basic classes at a CA-approved training program

2 – 25 successful skin punctures in a clinical setting on real patients through a training program or on-the-job

  1. Obtain a certificate of completion from the phlebotomy training program
  2. Perform 25 successful skin punctures in a clinical setting on real patients.
  3. Obtain a certificate or letter signed by a licensed MD, PA, RN, CLB or CLS stating completion of 25 successful skin punctures while on-the-job (OTJ).
  4. Apply online at https://secure.cps.ca.gov/cltreg/ and pay the application fee. Print and return a signed copy of the original attestation page to LFS.
  5. Direct your high school to send your transcript to CA DHS-LFS, Phlebotomy Program. Make a copy of your certificate from the CA-approved Phlebotomy training program that you attended.
  6. Submit the following to California DHS-LFS by mail:

1 – Completed CPT application

2 – Copy of certificate signed by licensed MD. PA. RN. CLB or CLS if punctures done OTJ

3 – Copy of certificate from training program.

4 – Check or money order for $54

5 – 2 Passport size photos

Certified Phlebotomy Technician 1 (CPT 1) No Experience

  1. HS Graduate or GED or Equivalent
  2. Submit documentation and application to a CA-approved Phlebotomy Training Program
  3. Attend a phlebotomy training program and complete the following:

1) 20 hours of basic classes

2) 20 hours of advanced classes

3) 40 hours of practical training in a clinical setting

4) 50 successful venipunctures AND 10 successful skin punctures on real patients

  1. Obtain a certificate of completion from the phlebotomy training program
  2. Experience is not applicable
  3. Experience documentation is not applicable
  4. Submit documentation and an application to a-CA approved Certification Organization to take a written phlebotomy examination
  5. Pass the written phlebotomy examination and obtain a certificate of completion
  6. Apply online at https://secure.cps.ca.gov/cltreg/ and pay the application fee. Print and return a signed copy of the original attestation page to LFS.
  7. Direct your high school to send your transcript to CA DHS-LFS, Phlebotomy Program
  8. Make a copy of your certificate of completion from:

1 – California state approved phlebotomy training program

2 – California approved certification organization

  1. Submit  the following to CA DHS-LFS (See address at top of guide) by mail:

1 – Completed CPT application

2 – Copy of certificates from training program

3 – Check or money order for $54

4 – 2 Passport size photos

Certified Phlebotomy Technician 1

Less Than 1040 Hours Experience (OTJE)**

  1. HS Graduate or GED or Equivalent
  2. Submit documentation and application to a CA approved Phlebotomy Training Program
  3. Attend a phlebotomy training program and complete the following:

1 – 20 hours of basic classes

2 – 20 hours of advanced classes

  1. Obtain a certificate of completion from the phlebotomy training program
  2. Perform 50 successful venipunctures AND 10 successful skin punctures on actual patients.
  3. Obtain documentation from employer(s) of 50 venipunctures & 10 skin punctures- signed by laboratory director/s
  4. Submit documentation and an application to a CA-approved Certification Organization to take a written phlebotomy examination
  5. Pass the written phlebotomy examination and obtain a certificate of completion
  6. Apply online at https://secure.cps.ca.gov/cltreg/ and pay the application fee. Print and return a signed copy of the original attestation page to LFS.
  7. Direct your high school to send your transcript to CA DHS-LFS, Phlebotomy Program
  8. Make a copy of your certificate of completion from:

1 – California state approved phlebotomy training program

2 – California approved certification organization

  1. Submit the following to California DHS-LFS (See address at top of guide) by mail:

1 – Completed CPT application

2 – Copy of certificates from training program

3 – Documentation of 50 venipunctures & 10 skin punctures

4 – Check or money order for $54

5 – 2 Passport size photos

Certified Phlebotomy Technician (CPT 1)

Equal To or Greater Than 1040 Hours On-The-Job Experience (OTJE)** Within the Past Five Years

  1. HS Graduate or GED or Equivalent
  2. Submit documentation and application to a CA-approved Phlebotomy Training Program
  3. Attend a phlebotomy training program and complete 20 hours of advanced classes.
  4. Obtain a certificate of completion from the phlebotomy training program
  5. Perform 50 successful venipunctures AND 10 successful skin punctures on actual patients.
  6. Obtain documentation from employer(s) of 50 venipunctures & 10 skin punctures- signed by laboratory director/s
  7. Submit documentation and an application to a CA-approved Certification Organization to take a written phlebotomy examination
  8. Pass the written phlebotomy examination and obtain a certificate of completion
  9. Apply online at https://secure.cps.ca.gov/cltreg/ and pay the application fee. Print and return a signed copy of the original attestation page to LFS.
  10. Direct your high school to send your transcript to CA DHS-LFS, Phlebotomy Program
  11. Make a copy of your certificate of completion from:

1 – California state approved phlebotomy training program

2 – California approved certification organization

  1. Submit the following to California DHS-LFS (See address at top of guide)by mail:

1 – Completed CPT application

2 – Copy of certificates from training program

3 – Documentation of 50 venipunctures & 10 skin punctures

4 – Check or money order for $54

5 – 2 Passport size photos

Certified Phlebotomy Technician 2 (CPT 2)

  1. HS Graduate or GED or Equivalent:
  • Qualified to be a CPT1
  • Obtained 1040 hours On-the-Job-Experience (OTJE)** within the last 5 years
  1. Submit documentation and application to a CA-approved Phlebotomy Training Program
  2. Attend a phlebotomy training program and complete the following:

1) 20 hours of basic classes

2) 20 hours of advanced classes

  1. Obtain a certificate of completion from the phlebotomy training program
  2. Perform 50 successful venipunctures AND 10 successful skin punctures AND 20 arterial punctures on actual patients
  3. Obtain documentation from employer(s) of 50 venipunctures & 10 skin punctures – signed by laboratory director(s) AND documentation of 20 arterial punctures – signed by licensed MD, PA, RN, CLB, CLS, or RCP
  4. Submit documentation and an application to a CA-approved Certification Organization to take a written phlebotomy examination
  5. Pass the written phlebotomy examination and obtain a certificate of completion
  6. Apply online at https://secure.cps.ca.gov/cltreg/ and pay the application fe. Print and return a signed copy of the original attestation page to LFS. Applicants with an LPT or CPT1 certificate must re-apply for CPT II category.
  7. Direct your high school to send your transcript to CA DHS-LFS, Phlebotomy Program
  8. Make a copy of your certificate of completion from:

1 – California state approved phlebotomy training program

2 – California approved certification organization

  1. Submit  the following to California DHS-LFS (See address at top of guide) by mail:

1 – Completed CPT application

2 – Copy of certificates from training program and certification organization

3 – Documentation of 50 venipunctures & 10 skin punctures

4 – Documentation on 20 arterial punctures

5 – Check or money order for $54

6 – 2 Passport size photos

A state certification is also a necessity in Louisiana. It is already stated in their law that you need to apply for a certification before employment. In Louisiana, it is possible for you to apply for a certification in two organizations: one is the American Society of Clinical Pathologists and the other organization is National Phlebotomy Association (Phlebotomy Certification Center, 2010).

To apply a certification in these two associations, you need to complete their pre-requisites, which include practical hours of application related to venipuncture.

The certificate, along with your transcript of records, is your proof of record that you have the superior skill and experience for the job. Each level of certification requires a specific type of training. You can apply for their certificate once you have completed the requirements.

Should you obtain a higher level of training, you are expected to have advance skills and experience. Therefore, you are given the opportunity not only to demand for a higher salary, but also the right to search for more employment opportunities.

The first step in obtaining a certification is to determine which organization you should go through to earn your certification. The country has three popular certifying agencies, in which the requirements for certification depends on what state you are in.

The American Certification Agency (ACA) for Healthcare Professionals offers two types of certifications for phlebotomists.

You are eligible for phlebotomy technician once:

  • The 100 clinical hours, 100 successful venipunctures and 10 successful cases of dermal punctures are completed
  • Pass the examination that is published online

You are eligible for phlebotomy instructor once:

  • You are a registered nurse or licensed practical nurse (also known as vocational nurses)
  • No need to take the exam as long as the documents for a three-year phlebotomy experience and a year of teaching are submitted

The American Medical Technologists (AMT) grants you a phlebotomist certification and other forms of review materials such as candidate handbook, reference materials, practice tests and examination outline once you have:

  • Graduated from a program accredited by US Department of Education and Regional Accrediting

Commission

  • Completed the 120 hours of instruction and clinical practicum
  • Completed 1,040 hours of work experiences in three years
  • Completed and successful in 50 venipunctures and 25 skin punctures

The National Center for Competency Testing (NCCT) offers two types of certifications.

The first type is a phlebotomist certification that requires you:

  • To be a graduate of accredited program
  • To have a one-year work experience
  • To obtain a phlebotomy performance form
  • To submit a high school diploma or GED
  • To submit a hard or soft copy of application

The second type is a certification for donor phlebotomist and it requires you:

  • To have 80 successful collection procedures
  • To complete six months of clinical experience
  • To submit a high school diploma or GED
  • To submit a hard or soft copy of application

After completing all the requirements for certification, your next priority is to pass the agency’s licensure examination.

The Passing Rate

By the end of your phlebotomy course, you will be preparing for your licensure examination. The examination is prepared by American Society for Clinical Pathology (ASCAP) to see who are competent and who are not.

The licensure examination usually covers six categories. The first category, which is 5% of the total examination, focuses on the structure and function of the circulatory system (heart, arteries, veins, capillaries, blood, plasma, red blood cells, white blood cells and platelets).

The second part (55% of the total examination) covers the various terminologies, procedures, technique, assessment and equipment in phlebotomy.

The third part is 15% of the total examination and it is about the handling and processing of the collected specimen.

All questions on the fourth part are about point-of-car testing (urinalysis, hemoglobin, coagulation and basic chemistry).

Questions about non-blood specimens such as urine, stool, and sperm usually appear on the fifth part. Twelve percent of the examination is mainly about laboratory operations. In this part, the questions are related to quality control, quality improvement, infection control, hygiene practices and disposal of contaminated equipment.

The passing score for the exam is 400. A detailed report is sent to the examinees right after the scoring of the exams. The report provides a scaled score on the total examination. Failure to pass the examination means you will also get scaled scores for each subtext, which identify the areas of your strengths and weaknesses.

Once you pass, you are required to get a certification (valid for three years) from higher institutions. Once you receive your certification, you will be able to use the initials PBT after your name. The initials will let other people know that you are an expert in your field.

Techniques in Passing the Exam

To feel anxious while taking any examination is inevitable. It is one of the reasons why you feel unsure of yourself. When the level of anxiety is too high and you cannot effectively control it, you are going to fail. That is why here are the tips on how to ace your exam.

Tip #1:

A year before the exam day, investing your money on a reliable reviewer will be a big help. You can purchase it at your school’s bookstore or in online stores.

Your reviewer allows you to familiarize yourself with the possible test items that may appear in the exam. All questions are usually based on three levels:

  • Test items that belong in Level 1 involve the ability to recall the facts and theories from learned knowledge.
  • Test items belonging in Level two involves the ability to interpret verbal,numeric and visual data.
  • The highest test level is problem solving, which requires you to resolve a certain real-life situation by making an appropriate decision.

Tip #2:

Go through the procedures with the equipment you have and run through it in your mind. There is nothing like internalizing the things you are to do. You can also write down the procedures to see if you have it all down to the last detail.

Tip #3:

Prepare all your pens and other documents a day before the examination. Without these things inside your mind, you can surely have a good night sleep.

Tip #4:

On the day of the examination, make sure to eat a light meal before arriving at the test center.

Tip #5:

The exam lasts for an hour, therefore, brace yourself the moment you sit on your chair. While receiving the test paper, go through the pages. By checking the types of items, it will be easier for you to figure out the questions that can provide you with most points.

Tip #6:

Feel confident as you answer each question. Understand the given question like reading a novel that you love without over analyzing it. Your answer can usually be wrong when you are over-analyzing a test question.

Tip #7:

It can also save your time when you start with questions that are easy. This technique gives you more time in answering harder questions. Difficult questions require more time in analysis. Usually, it is a need to read it thrice and underline the important keywords before understanding what it means.

Tip #8:

Ask for clarifications when you cannot understand something. It is better to ask than to guess what you are supposed to do.

Tip #9:

Allow yourself to review your answers five minutes before submitting your paper. Make sure you review it from the beginning. Also, check your name and any information your instructor asks you to include.

Chapter 6: Certified Phlebotomist – The Duties

A man who is hungry for knowledge is always a student. You do not stop reading, learning and aiming for greatness.

For a hungry man, passing the licensure examination in phlebotomy is not enough. It is not yet the end of the line. Your real journey begins when you start looking for a job.

Where to Find a Job

Apart from hospital laboratories, your expertise is needed everywhere. You are needed in blood banks, plasma centers, specialized clinics, reference laboratories, diagnostic laboratories, employment companies, insurance companies, schools and nursing homes. There are even times that you need to travel outside the hospital to personally meet the patients in their homes.

To look for a job, start by browsing the placement programs offered by your school. In case your school does not offer these types of programs, directly ask your professors for some leads.

Try listing all the possible hospitals in your state. Check their website for some job openings or choose to call their Human Resources Department for help.

Look for blood and plasma centers. The centers collect blood and plasma in two different ways. One is by waiting for donors to arrive at their offices. Second, by inviting participants to attend their donation drive or bloodmobile. For these reasons, they are constantly in need of phlebotomists who are willing to deal with various donors every day.

Other Ways

BloodBanker.com/banks is an online directory that has a large database of blood and plasma banks in United States and selected cities in Canada. Every page of a center contains the complete address, Google maps, contact numbers and testimonials.

Joining organizations such as Association of American Medical Technologist (AAMT) and National Phlebotomy Association (NPA) is also a good way to find a job. Once a member of any of these organizations, it allows you to network with people who might help you land a job in your community.

When hired, become a phlebotomist who is a good team player and a keen listener. Learn to work well with your superiors (medical technologists, physicians, nurses and other laboratory technicians with higher degree in biomedical sciences) and pay attention to the needs of your patients.

Handling Emergencies

Emergency situations are inevitable in all types of situations. In the field of phlebotomy, emergency protocols are created in all clinical practices to handle emergency situations with less pressure.

Precautionary Measures

To protect yourself from any form of accidents and contamination, you must wear your lab gown, disposable gloves and face mask all the time. Needles must be capped and they should not fall on the floor.

Peripheral Lines

The preferred veins of a patient in trauma are inaccessible. That is why you should learn how to directly establish a peripheral line to a superficial vein located in an upper limb.

Superficial veins are simple to catheterize due to its intravenous lines. Only the veins in the foot and lower leg of a patient in trauma are accessible in drawing blood.

Emergency Requests

In such cases when more than ten pints of blood are needed by a physician, you or your superior should immediately complete an emergency blood request, and a courier should be dispatched by the hospital to retrieve the units. Any issue of incompatibility between patient and blood must be reported immediately.

Blood Spillage

This is the most common accident inside a laboratory. As a phlebotomist on duty, certain steps must be carefully followed.

The first step involves wearing non-sterile and disposable gloves. As you get closer to the spillage, make sure to use tongs (pan with brush may do) to pick up the broken glass on the floor.

Depending on the size of the broken glass, decide if you are going to wrap it in a thick layer of paper before disposing it in sharps.

Mop the entire area with water and detergent until clean. Disinfect it using sodium hypochlorite 0.5% (10,000 ppm available chlorine) and 1:10 dilution of 5.25% sodium hypochlorite bleach.

Rinse off the tongs under running water until it dries. After rinsing, remove gloves and discard them immediately.

Wash your hands thoroughly and dry it with the use of disposable towels. Record the time of the incident and include all the names involved in the incident.

Fainting

Not all people are comfortable seeing blood or any body fluids coming from their arm, and not all people are fearless when facing a needle either.

Fainting due to a situation like the ones mentioned is normal, unless the patient’s vital signs were not good at the beginning of the phlebotomy process.

For situational fainting, the key is to keep calm and do the following to help revive the patient:

  • Lower your patient’s head and arms if he is sitting (lift the feet if he is lying down).
  • Loosen his clothing and immediately apply cold compress to his forehead and back portion of his neck.
  • Revive your patient’s consciousness with the use of ammonia or smelling salts.
  • It is a good response if your patient coughs, but if he does not, you need to call a nurse or a doctor. Record the incident.

Nausea

Request the patient to sit comfortably and lower his head. Then instruct him or her to breath deeply and slowly. Repeat the process.

Vomiting

Once the patient feels the urge to vomit, immediately roll him or her onto one side (if he is lying down in a prone position) and hand him the basin. Once the vomiting stops, assist your patient with water and disposable towels. Inform the physician right away.

Excessive Bleeding

Apply direct pressure to the site of venipuncture. If the bleeding does not stop for more than five minutes, immediately call the physician.

Seizures

Make sure to safely guard the patient from self-injury. Immediately call the doctor.

The Legal Issues

Once a phlebotomist, love everything about your job. Stay positive with challenges each day. Respect your co-workers and superiors. Most importantly, show genuine care to your patients. Once you fail to love your job, you will be in legal trouble and charged with negligence immediately.

Negligence is the most common and major legal issue faced by phlebotomist, and no one is exempted from it. The negligence issue does not only cover arriving late in the workplace, but it also includes the following mistakes:

  • Incorrect identification of the patient
  • Sticking the patient more than twice to their discomfort
  • Improper positioning of the patient during procedure
  • Choosing the wrong puncture site
  • Utilizing the wrong equipment for the collection of specimen
  • Incorrect tracking of specimens
  • Shouting at your patient
  • Unprofessional display of emotional outburst in the working area
  • Complaining

You are dishonoring your profession once you are charged and found guilty of negligence.

Never wait for the moment to happen to you. Be responsible as soon as you get hired. You are expected to :

  • Report to work on time
  • Work with your co-workers without issue
  • Respect the opinion of others
  • Greet your patient with a warm attitude
  • Follow all guidelines and safety protocols made by the employer
  • Use your initiative in every task
  • Pay attention to details
  • Communicate in a humble tone
  • Protecting yourself with liability insurance

Chapter 7: Salary of Phlebotomist

The salary of a phlebotomist is computed differently in different states. The computation is primarily done by the US Government Bureau of Labor Statistics.

As shown in ASCP Wage and Vacancy Survey, your annual average earning should be around $24,350 once you are certified. It even goes higher (around $35,000) when you are promoted to the supervisory position.

Phlebotomist’s Salary

Hourly Median Rate $20.28

Lowest 10% Hourly Rate $12.19

Upper 10% Hourly Rate $30.00

Annual Median Rate $42,180.00

Lowest 10% Annual Rate $25,000.00

Upper 10% Annual Rate < $60,000.00

Between 2010-2011, the US Department of Labor has listed over 78,600 phlebotomists working in clinical and diagnostic laboratories, which are the best-paying industries in phlebotomy field. Due to competition, other phlebotomists decided to work in blood centers, junior colleges and insurance companies that have a salary range from $13–30 per hour.

Who says phlebotomist cannot earn much? They are generously paid, but in some selected states only. Top-paying phlebotomists are found in the following states and cities.

Top Paying phlebotomist Salary States:

Connecticut $57,450.00

Tennessee $56,760.00

Alaska $52,650.00

Hawaii $52,010.00

Minnesota <$51,770.00

Top Paying phlebotomist Salary Cities:

Grand Junction, Colorado $73,200.00

Norwich-New London, Connecticut $65,090.00

Nashville-Davidson-Franklin, Tennessee $61,580.00

Bremerton, Washington $61,580.00

New Haven, Connecticut $59,610.00

The typical employment benefits package for phlebotomists is worth more than $20,000/year. The benefits include vacation, paid sick days and accessibility to healthcare and pension plans.

Conclusion

According to Forbes, the United States of America was short of 15.2 million jobs in January 2012. This number was supported by the Bureau of Labor Statistics (BLS), which confirmed that 12.7 million Americans were officially unemployed or out of work.

The main reasons for unemployment are:

  • growing population
  • financial instabilities of many firms due to fierce competition from other countries
  • automation of production facilities or employees replaced by machines
  • increased number of lay-off
  • dissatisfaction in minimum wages ($6.55)
  • emphasis on multitasking, which results in too much stress
  • younger generation pursuing a higher study (BizyMoms, 2011)

While the number of unemployment is alarming, there is a good chance that a portion of those unemployed, especially those who belong in the younger generation, can increase their chances of getting hired.

The healthcare industry is opening vacancies for all aspiring phlebotomists. The vacancy for the said position expects a growth of 56,700 job openings by 2018 (US Bureau of Labor Statistics, 2012).

Phlebotomy is an interesting field to pursue, as you ascend to the hierarchy in medicine. Aspiring phlebotomists make use of the opportunity and skill in drawing blood to gain more experience in preparation for higher medicine such as nursing and surgery.

References

Phlebotomy Technician. “5 Great Reasons to Become A Phlebotomist.”

http://www.phlebotomytechnician.com/5-great-reasons-to-become-a-phlebotomist/

Phlebotomist-Training. “Phlebotomy Training & Certification.”

http://www.phlebotomist-training.org/phlebotomy-training-and-certification/

Phlebotomy Training Guide. “How to Get Phlebotomy Certification in Different States.”

http://www.phlebotomytrainingguide.net/how-to-get-phlebotomy-certification-in-different-states

Cert Phlebotomy Training. “Schools.”

http://www.certphlebotomytraining.com/schools/

Phlebotomy Training Guide. “How to Become a Phlebotomist through Online Training.”

http://www.phlebotomytrainingguide.net/how-to-become-a-phlebotomist-through-online-learning

Phlebotomist Training. “Free Phlebotomy Training: Is it Possible?”

http://www.phlebotomist-training.org/free-phlebotomy-training-is-it-possible/

Phlebotomy Training Guide. “Phlebotomy Medical Equipment and Tools.”

http://www.phlebotomytrainingguide.net/phlebotomy-medical-equipment-and-tools

Lab Handbook. “Tube Types & Order of Prefs.”

http://labhandbook.hitchcock.org/tubes.html

Lab Handbook. “Venipuncture Using A Syringe.”

http://labhandbook.hitchcock.org/syringe.html

Lab Handbook. “Routine Venipuncture.”

http://labhandbook.hitchcock.org/routine.html

Lab Handbook. “Skin Puncture.”

http://labhandbook.hitchcock.org/skinPuncture.html

Health Care Salary Online. “Phlebotomist Salary.”

http://www.healthcaresalaryonline.com/phlebotomist-salary.html

Phlebotomy Certification Guide. “The Different Phlebotomy Certification Training Agencies.”

http://www.phlebotomycertificationguide.com/the-different-phlebotomy-certification-training-agencies

Phlebotomist Training. “4 Tips for Passing the Phlebotomy Exam.”

http://www.phlebotomist-training.org/4-tips-for-passing-the-phlebotomy-exam/

Phlebotomy Certification Training. “Legal & Ethical in Phlebotomy.”

http://phlebotomistcertificationtraining.com/legal-and-ethical-issues-in-phlebotomy/

E-How. “How to Find Phlebotomy Jobs.”

http://www.ehow.com/how_4745339_phlebotomy-jobs.html

E-How. “Phlebotomy Clinic Emergency Procedures.”

http://www.ehow.com/list_7211480_phlebotomy-clinic-emergency-procedures.html

 

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