I've received an email with the following question. I want to refer this person to this forum, rather than emailing directly back. The question is...

I am currently working in a small family practice as "girl Friday". I serve as the front office's receptionist, bookkeeper, sectretary, and back office assistant to the doctor. It's a very small practice, and the doctor is used to drawing his own blood samples, but now wants to show me to learn how to do it. He thinks it's a great opportinity to broaden my skills, however, I am worried. With only a little understanding of the arm's anatomy, I feel nervous. The doctor says, it's not that hard, and since I am working under his supervision, nothing can go wrong. I wonder, if venipuncture is really such an easy skill that anybody can learn in just 1-2 weeks?

Our patients age ranges from the very young, to the very old, and everything inbetween. Please advice.

Your Professional Title/Credentials: Website Owner/Site Admin

Phlebotomy is more of an art, than a skill. Perhaps best put as a "skillful art."

It starts with proper training which includes the anatomy of the blood vessels, and the arm, hand, wrist, etc.. Also other locations to obtain a blood sample must be learned.

Then there is the equipment, and all sorts of techniques, and specimen collection methods. Not to forget the order of draw, labeling, charting, preservation, and transport.

Universal precautions, and proper disposal of sharps. Needle stick injuries, and how to handle them...

Last but not least the unexpected situations, and emergencies.

I believe that good training and then, lots of practice every day is necessary to become a good phlebotomist. It's nothing to be just "thrown into". Recently I hear a lot of talk about "anybody can be taught to be a phlebotomist" and suprisingly, many programs, and doctors seem to do just that. Do I see a big controversy on the horizon....

Your Professional Title/Credentials: Website Owner/Site Admin

I have seen courses only 20 hours long. I think you need to have 10 successful venipunctures to pass. Mind you this is just the skill, not the color tubes for various tests, what the tests mean etc..

Your Professional Title/Credentials: RMA/LPN

Are You Still In School? yes

Are You Working? yes

the community college where I live offers two options:

for credit/as part of the lab tech/lab assistant program: 60 hours theory plus 90 hours lab/clinical experience over a 15 week term

through continuing education: 24 hours theory (8a-5p three Saturdays in a row) plus 24 hours lab/clinical experience.

I would hope that if one was learning on the job that the employer would make sure there was a textbook to go along with the practical learning. If not, I would take it upon myself to get a text on venipuncture. I temped once a long time ago in an office simply filing medical records and the manager gave me a book on record systems and the legal aspects of medical records to read during the down times (it was a big yawner but better than staring out the window!).

I cannot begin to describe how distressing this thread is for me to read. As a trained phlebotomist (which,in reality,is a person with specialized training and certification in phlebotomy only. All others are blood drawers/collectors) who has run into stumbling blocks in obtaining a position,I have come to the conclusion that the collection of blood specimens for a doctor is one of the most important jobs a health care worker can do,yet it is not only a low paying,disrespected position,but is also a job that obviously can be given to just anyone,which may explain why so many competent people can't find jobs in this field-others got there first. To really know what you are doing you have to have intensive clinical lab science education,which is not something that can be taught and learned in a few weeks,as well as training in other subjects,like the A&P with a special emphasis on blood. Only 2 states have gone as far as to make it the law that you HAVE to be FULLY trained and certified in order to get a job as a phlebotomist. No longer will they be allowing just anyone to go through a weekend training session and by Monday morning they are trying out what they just learned on ICU patients. I have heard of one hospital trying to save money by training their janitorial staff to do the blood drawing.
There is an article from The Washington Post that I think I may have found on "Phlebotomy Pages"(?) that explains this more. I am unsure of the link so here it is (I apologize for the length but I think it is important that every MA who draws blood reads this)-

Drawing Without a License
Phlebotomists Get Little Training, Regulation
By Ranit Mishori
Special to The Washington Post
Tuesday, June 1, 2004; Page HE01


When you get your blood drawn, the person who tells you to roll up your sleeve and make a fist may have a professional manner and be dressed in medical scrubs. That doesn't mean he's been to medical school or nursing school . . . or any school at all. In most parts of the country, including the Washington area, phlebotomists -- workers who take blood in a medical setting -- are governed by few rules or none at all.
Unlike your hairdresser, your cosmetologist and even the aromatherapist down the street -- most of whom are licensed by some authority -- the person probing for a vein may have only a few days of on-the-job training.
"Most patients don't realize that the person sticking the needle in their arm today could have been flipping burgers last week," said Dennis Ernst, a veteran phlebotomist who runs a phlebotomy resource center in Ramey, Ind. The consequences -- in mistakes made and injuries to patients -- can be dire: contaminated samples that have to be redrawn, false positive results, incorrect medication doses, fractures, nerve damage and worse. And while the great majority of us will never face a blood-draw injury worse than a sore arm, the potential for harm has proven real.
The virtual absence of regulation for this field often comes as news even to people knowledgeable about the medical field. "I was a little surprised to hear [from a reporter] that phlebotomists have not been required to be licensed by states," said Carnegie Mellon University health care economist Martin Gaynor. "My impression was that most folks practicing in the health area have been required to be licensed a long time ago."

Blood Matters

Phlebotomy -- the word is derived from the Greek for "vein cutting" -- matters because blood matters, in some ways more than it used to. The list of problems that can be identified by analyzing blood is amazingly long: cancer, diabetes, cholesterol, high lead levels, infections, anemia, kidney failure and heart attacks, for starters.
According to the American Society for Clinical Pathology, "an estimated 80 percent of physicians' decisions are based on laboratory test results," most of these involving blood tests. By one estimate, Americans underwent more than 1 billion blood draws last year.
That is why 58-year-old Ken Peloquin of Reston went back to school to learn to draw blood after being downsized out of middle management at a Virginia medical supply firm. And why he expects no trouble finding work, and why so many job-seekers are likely to follow him.Said Frankie Harris-Lyne, who runs the medical lab technician and phlebotomy programs at Northern Virginia Community College Medical Education Center, where Peloquin is a student: "We can only accommodate 15 students per class, or 30 per year," she said. "Currently we have approximately 50 students placed in the major, and that number continues to grow."
Peloquin and his classmates will have an edge over the competition in that they have actually gone to school to learn their profession. Most phlebotomists don't. Only California and Louisiana have training and monitoring standards for phlebotomists.
Ernst knows the harm an unskilled phlebotomist can do, having served as an expert witness at dozens of lawsuits involving phlebotomy injuries. "There's a repeating pattern of errors that inflict permanent injuries," he said.
The biggest problem is nerve injuries: The needle sticks a nerve, not a vein, which can lead to chronic pain, sometimes severe, that can lead to disability or paralysis. But Ernst said he also sees punctured arteries, lacerations and serious bleeding and bruising. Poorly trained phlebotomists can also make simpler, but still devastating mistakes, such as turning their backs on a patient at the wrong time.
"I see a fair amount of injuries, including paralysis from patients who pass out during or immediately following the procedure and fall and fracture bones," he said. "One of them, in fact, was a lady who fell out of a chair in her home. She was being drawn for an insurance examination. The medical assistant turned his back on the woman and she fell out of her kitchen chair, fractured her vertebrae, and she is now paralyzed. [Passing out] is something that happens quite commonly. . . . They're not taught that passing out is a risk of the procedure, and they turn their back on the patient."

Bad Blood

Then there is the case that brought sweeping changes in California, after a phlebotomist's felony conviction for assault with a deadly weapon: a phlebotomy needle.
It was 1999 when the phlebotomist, working at a Palo Alto lab, was found to be using the same needle on multiple patients in thousands of cases over a period of four years. When the investigation ended, more than 3,000 patients had to be tested for HIV and hepatitis.
Soon after, California passed a law that set new standards for phlebotomy. One requirement is that phlebotomists train for a minimum of 80 hours and be tested and certified before they approaching their first patient.
But except for California and Louisiana, which took similar steps in 1993, phlebotomy training varies widely, ranging from 10-hour crash courses -- in some places, said Ernst, even that is considered a lot -- to a 200-hour program. As a rule, phlebotomists are trained on the job, not in programs like Peloquin's. So standards are set by the clinic, hospital or doctor's office that has hired the individual. Almost by definition, said Ernst, a phlebotomist trained this way is going to get the basics and not much more: Where does the needle go in, how deep, and at what angle? How much blood is too much, too little? How do you label and sort the vials?
In the three-month program at Northern Virginia Community College (NVCC), phlebotomy students learn basic anatomy. They are also exposed to physiology, medical terminology, medico-legal issues and patient communications.
Peloquin was surprised at how much psychology was involved. "Every patient is different," he explained, "so you never know what you're going to get with your next stick. . . ." Some patients, he said, are afraid of needles; others, anxious about the purpose of the test. "Depending on each individual patient, you have to adapt to the patient's moods and dislikes."
For April Wharton, one of Peloquin's classmates, the surprise was the complexity of the paraphernalia. "There are so many different kinds of anticoagulant stuff, so many different tubes," she said. "You have to know what every test does and is."
When NVCC students finally begin sticking needles in arms, they aren't the arms of patients.
"We practiced on each other," explained Wharton -- something she called critical to building confidence . . . and technique. "The first time I stuck one of my classmates I was terrified. I was shaking. It was very hard. If a patient were to see me doing that, they probably would have gone crazy."

The Sample

Getting the needle in is only half of the job. Handling the blood sample to avoid contamination or mix-ups is the next challenge. The goal, said Harris-Lyne, is to get a quality blood sample: the right amount of blood, drawn the right way; properly labeled, sealed and preserved; and delivered to the appropriate address for the appropriate test.
The National Committee for Clinical Laboratory Standards (NCCLS) lists 32 steps that, if followed, almost guarantee a successful blood draw. But skip a step or two, even accidentally, and bad things can happen, said Ernst.
An imperfect draw, for example, can result in a specimen that isn't sterile. This can happen if a patient is not adequately "prepped" -- if the site where the needle goes in is not properly cleaned in advance. An unsterile sample can result in a false positive for certain conditions, meaning a healthy patient may think he is sick. Or a doctor may prescribe medication for a patient based on an incorrect blood test result. "That," Ernst said, "can have life-threatening consequences."
This was the concern a few years ago at the Alameda Country Medical Center in California, where a lab manager noticed an unusually high rate of contaminated blood cultures. Senior lab staff members recognized the problem and brought in trained phlebotomists to take over.
They recruited new people and trained them beyond what was considered "routine." Within two years, the contamination rate for blood cultures in the lab had dropped 70 percent. With fewer false positives triggering unneeded treatment, the hospital's costs went down, too.
Under-trained phlebotomists can also be a hazard to themselves. When a phlebotomist accidentally jabs himself, or has contact with blood and other bodily fluids, he can be exposed to HIV, hepatitis or other pathogens.
The Mayo Clinic in Rochester, Minn., takes such risks very seriously. A training program that was begun there in 1994 reduced "occupational exposures" for phlebotomists from a high of 1.5 exposures per 10,000 sticks, to 0.2 per 10,000.

Certifying What?

Consumers have a right to demand that a qualified professional draw their blood, said Ernst. But how to know when you've found one?
A diploma hanging on the clinic wall is no guarantee. In an unregulated field, said Ernst, "there are some entities that claim to certify phlebotomists" but have substandard eligibility requirements. "It is one thing to mandate certification," he explained, "but without minimum standards for what that certification entails, it's just window dressing."
The only alternative may be to ask the phlebotomist, point blank, about her credentials. "That way," said Ernst, "the patient can protect themselves from the unskilled until the legislators make it a given that all specimens are drawn by qualified personnel."
At NVCC, Harris-Lyne discourages students from seeking certification by any but the most highly regarded and widely accepted certifying bodies. The American Certification Agency, for example, requires applicants to have completed either a year of on-the-job training or an accredited training program, to have documented at least 100 successful venipunctures and to have passed a two-hour written and practical test.
In California, where certification has been required since last spring, consumers appear to be benefiting. According to Robert Miller of the California Department of Health, the number of phlebotomy complaints has decreased "from 17 percent of the total [number of medical complaints of all kinds] we receive each year to about 5 percent of the total" since the new regulations went into effect.
Why don't more states follow California's example? Gaynor thinks the reason is simple: Quality costs money. Phlebotomists are generally paid from $8 to $12 an hour, depending on location, demand and training. Higher personnel costs for well-trained workers are eventually borne by the consumer in terms of higher prices or less covered care.
But Ernst thinks there's another reason the field remains so unchecked: People either don't know or don't care who is sticking needles in their arms, and governments reflect that complacency.
"Does every state have to have a phlebotomist caught reusing needles in order for them to act and implement legislation?" he asked. "Of course, the answer should be no."•

Your Professional Title/Credentials: RPT/RMA

Are You Still In School? No

Are You Working? Not in a while

Thank you RPT for this very detailed repsponse to my post. It was clearly worth your effort to me, and I am sure hundreds of others; a real eye-opener... and yes, in reading I realized more and more, we see eye-to-eye on this issue.

Again, thank you for your participation and feedback.
I hope may will read it.

Danni

RPT,
I found your contribution to be extremely useful, coming directly from someone who has been there, done that, and gotten the T-shirt, so to speak.


As a matter of fact when I said that I hope that many will read it (sorry for the typo on this in the previous post), I really meant that. Therefore, I have taken an excerpt of your comment, and worked it right into the PhlebotomyPages.com website, under "On the Job Training", and I hope you don't mind.


I have given you credit by adding "Posted by RPT" but if you'd like for me to remove this reference, please let me know. Also, if you feel something else should be added/removed...


Please take a moment to check it out.
http://www.phlebotomypages.com/on_the_job_training.htm


Thanks!

Danni R.

Your Professional Title/Credentials: Website Owner/Site Admin

Danni-The more you print about phlebotomy,the better. I hope that those who look at this board and are performing many blood draws will look on "Phlebotomy Pages".

As for the YouTube video-The one on that page is at a blood drive,training I have never received but I can't imagine they are taught to saw back and forth into a person's arm. I watched the other "phlebotomy" videos on YouTube and was shocked and dismayed at how many were slapping on a bandage before checking the site first. You NEVER do that in case the patient is on blood thinners or a hematoma is forming. A lot of these videos had students doing this right in front of an instructor,who didn't say a word. I would urge all those that are getting their blood drawn to speak up if you see that,or,worse yet,no gloves(like in a few of those videos). To put it bluntly,don't let anybody stick a needle into you after they have touched the vein with what could be dirty fingers!

Your Professional Title/Credentials: RMA/RPT