The Definitive Guide to Phlebotomy: A Medical Assistant’s Guide

Phlebotomy

Interested in becoming a medical assistant? One of the most important skills a medical assistant can learn is phlebotomy. Phlebotomy, or venipuncture, is the art of drawing blood from a vein with a needle. It’s a highly technical, multi-step skill that requires clinical know-how, good judgment and the ability to make clients feel at ease. Among the wide range of a medical assistant’s responsibilities, venipuncture is among the most essential.

Why is Phlebotomy Important?

Changes in the blood tell a doctor a lot about what’s going on in the body. Samples are used to diagnose and treat diseases such as:

  • Diabetes
  • Anemia
  • Cancer
  • Thyroid disease
  • Rheumatoid arthritis
  • Nutritional deficiencies
  • High cholesterol and triglycerides
  • Lyme disease
  • Liver and kidney disorders
  • Infections

Venipuncture is also used to conduct blood type tests that classify blood into groups based on the presence of surface antibodies is critical for transfusions and self-donation. Blood tests are also used to monitor therapeutic levels of medications, so doctors know if patients are getting enough or too much.

The Medical Assistant’s Role

Venipuncture may be just one part of a medical assistant’s day, but in larger practices or hospitals, phlebotomy can be a full-time job. Either way, the process consists of the same four steps. These steps include reviewing the order, educating the patient, obtaining consent and the actual act of venipuncture.

Reviewing the Order
Venipuncture is only performed with a doctor’s order. Medical assistants don’t decide which tests to do, but they must review orders carefully because each test requires different equipment and procedures.

Venipuncture is only one part of the testing process. Samples must be properly handled and correctly processed. Some tests require additional preparation on the part of the patient, such as fasting or taking a timed dose of medication.

Medical assistants are also responsible for coding requisitions and ensuring that diagnosis codes and tests match. Insurance companies won’t pay for a blood test to check for a broken bone. By evaluating orders, perceptive medical assistants can catch errors before they happen.

Educating the Patient
Clients have a right to know why venipuncture was ordered, how it will be performed, and what the risks are. With a working knowledge of both disease and laboratory procedures, medical assistants can help the doctor by ensuring patients are well informed. For example, because venipuncture breaks the skin, there is always a small risk of infection. Concerned patients will also want to know when to expect results and how they will be delivered.

Obtaining Consent
No medical procedure can be performed without a patient’s consent. Once the order has been checked and the patient understands the risk versus the benefits of testing, medical assistants are responsible for obtaining consent. A responsible parent or legal guardian must approve venipuncture for minors.

Venipuncture
Venipuncture is a standardized technical process. Strict protocols are in place to ensure that blood is drawn correctly every time. The laboratory equipment used to test blood is painstakingly calibrated, so mishandling samples may render them unusable. Technique matters.

Drawing blood is also a stressful event for some patients with trypanophobia or hemophobia, fear of needles or blood. Sound clinical judgment is essential. When patients are at high risk for complications, it’s critical to take every measure possible to minimize the impact.

Tools of the Trade

What type of equipment is used to perform venipuncture? The equipment includes gloves, alcohol pads, needles, tourniquets, vacuum tubes, gauze and bandages.

Gloves
To protect themselves and the patient from blood-borne disease, medical assistants perform venipuncture with gloves on, there are no exceptions.

Alcohol pads
Pre-moistened alcohol or chlorhexidine pads are used to cleanse the skin before inserting a needle. It doesn’t sterilize the area, but it reduces the number of bacteria and helps prevent infection.

Needles
Needles come in all sizes. Diameter is measured in gauge from 14 to 28, the larger the number, the smaller the needle. Based on the size of the patient and the condition of the vein, medical assistants choose the most appropriate size. For children, a 25 G needle is recommended, while a 20 or 22 G is more appropriate for adults.

Length is also important. The medial cubital vein at the crease of the elbow is typically the first choice for venipuncture, but the depth of the vein and the angle of approach may make longer or shorter needles better for the job. Choosing a needle with the optimal diameter and length increases the chances of success on the first attempt.

Tourniquets
A tourniquet helps confine blood to the arm, keeping the vein full and easier to see. It also makes blood vessels less likely to collapse under the pull of a vacuum tube.

Vacuum Tubes
Blood was once drawn with a syringe, but sealed vacuum tubes are now the norm. The strength of the vacuum alone pulls in blood at a pace that won’t damage blood cells. Color-coded tubes come preloaded with the additives necessary for specific tests, so it speeds up the process and reduces errors.

Gauze and Bandages
Since venipuncture pierces a vein, bleeding is to be expected. When the draw is complete, the site is compressed with gauze as pressure stops the bleeding. A small bandage will keep seepage from staining the patient’s clothing.

Skills for Success
There are a few skills that are needed for a successful venipuncture. These skills include empathy, critical thinking, and attention to detail.

Empathy
Venipuncture causes no more pain than a pinch, but for clients who are afraid of needles or blood, it’s scary. Medical assistants need to see the procedure from the patient’s point of view and do whatever it takes to keep patients safe and put them at ease.

Critical Thinking
Critical thinking is the ability to assess facts and come to logical conclusions. Critical thinking is what helps a medical assistant choose the right equipment and venipuncture techniques for individual patients. Better decisions equal better outcomes.

Attention to Detail
Medical errors impact patient health. A misspelled name on a label can lead to mistaken identity and using a tube with the wrong additive may mean a sample is rejected. Mistakes not only require redraws, but they also delay care. Attention to detail for a medical assistant is a must.

Final Thoughts

Because medical assistants are cross trained in both clinical and administrative procedures, they’re the ideal team members to handle phlebotomy in a busy doctor’s office. It’s a demanding responsibility, but one that contributes significantly to quality patient care.

Did learning about phlebotomy interest you? Interested in working with colleagues that want to help their patients stay healthy? Ready for an exciting new career in the medical assisting field? PCI Health Training Center’s Medical Assistant program prepares a graduate to work as an entry-level Medical Assistant. Within this general career category there are several specialty areas, including Medical Administrative Office Assistant, Clinic Assistant, Clinic Tech, Medical Office Manager, Phlebotomist and Physical Therapy Aide in a doctor’s office, clinic or hospital out-patient clinic. Contact PCI Health Training Center for more information on how to become a medical assistant and start a rewarding career today.


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