The butterfly collection system combines the benefits of the evacuated system and the syringe system. It has a 21- or 23-gauge needle with attached plastic wings on one end. 3 to 12 inch tubing leads from the needle. On the other end of this tubing is a hub that can attach to a syringe. A needle covered by a rubber sleeve can also be attached to this tubing. This covered needle screws into an evacuated tube holder.

The butterfly system is for small veins that are difficult to draw with the other systems. Holding the plastic wings attached to the needle provides easy access into small surface veins on the back of the hand, the arm, or the foot. Instead of entering the vein at the usual 15-degree angle, the winged needle is inserted at approximately a 5-degree angle and then threaded into the vein. This procedure anchors the needle in the center of even a small vein. If the patient moves, the tubing is flexible so the needle stays anchored and does not pull out of the vein. The butterfly collection set works well on children who have both small veins and the tendency to move while blood is being collected. The tubing also works as a pressure relief valve. A large evacuated tube or large syringe can be attached to the tubing, and the vein will not collapse as would normally occur.

The system also offers the flexibility to start drawing blood with a syringe and then finish with the evacuated tube system. A syringe can be drawn for procedures that require a syringe sample, and then the syringe can be removed and the evacuated tube system attached for multiple tube collection. Even with all of these benefits, the butterfly collection set is not used for all collection. It is much more expensive than the needle system. This additional expense is not justified for the majority of venipuncture.

Therapeutic phlebotomy is a relatively safe, minimally invasive treatment for a variety of medical conditions as outlined above.  Minor reactions include pain and bruising at the puncture site, fatigue, nausea and light-headedness. More serious side effects include iron deficiency⁴, anaemia, and thrombocytosis, which can occur with prolonged treatment.

Hypovolemic shock (hypo = low; volemic = volume) is considered a medical emergency and is a serious complication that can occur if too much blood is removed over a short period of time. During hypovolemic shock, there is not enough blood available for the heart to supply the body and a severe drop in blood pressure occurs.  Symptoms include cold hands or feet, diaphoresis (sweating), confusion, weakness, rapid heart rate, light-headedness and loss of consciousness.  Without intervention, hypovolemic shock can lead to kidney and brain damage, multiple organ failure and death.  Treatment generally involves immediate IV administration of blood/ fluids and medication to increase blood pressure.

Therapeutic phlebotomy is an effective approach that is frequently used to treat chronic medical conditions such as haemochromatosis, porphyria, polycythaemia, and sickle cell disease.  While it is safe and beneficial, there are potential complications, and advanced training is required to effectively and competently perform this procedure.

Diagnostic phlebotomy is the extraction of a specific amount of blood to allow the performance of laboratory analysis. Therapeutic phlebotomy is a controlled, periodic removal of a fraction of a patient’s blood volume, and it is used to treat a variety of conditions – usually chronic, inherited disorders where there is a surplus of iron or an excess of red blood cell mass.

Specific medical conditions that are treated using therapeutic phlebotomy include porphyria (a genetic condition involving the abnormal accumulation of certain enzymes), haemochromatosis (a hereditary disease where iron levels in the body are abnormally high), polycythaemia (an elevated level of red blood cells) and sickle cell disease (a genetic disorder involving abnormally shaped red blood cells).

For the treatment of chronic conditions, there is both an induction phase and a maintenance phase for therapeutic phlebotomy. The frequency of sessions during the induction phase depends upon the severity of the patient’s condition and his or her underlying health, but is typically once per week.  During the maintenance phase, session frequency varies widely and may range from once a month to twice a year.  The duration of the induction phase is several months to a year while maintenance sessions are usually done over several years.

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Phlebotomy is the act of drawing blood with either testing or transfusion. It’s a skill employed by physicians and lots of professionals in allied health fields, including medical assistants, paramedics, and clinical laboratory scientists. However most employers would rather employ certified professionals. Medical care is a rapidly expanding industry, plus a new professional, the certified phlebotomist, reduces the workload of doctors and nurses by focusing exclusively on blood collection, particularly in hospitals and blood drives. Maxis health care offers The Amazingly Simple Phlebotomy Competency Certification Course That’s Helping Dozens of Men and Women Achieve Their Dream Of Becoming a Phlebotomist.  The amazing course is split into 2 Parts. Part I is Theory & Dry Lab Training. You’ll Learn Phlebotomy Basics & Practice on Mannequins. Part II of the course is in a medical facility where you take bloods from real patients under supervision. Receive a CERTIFICATE OF COMPETENCY when you pass. Courses meet All 18 NHS Competencies recommended by the NHS Skills for Health Organizations, National Occupational Standards & ‘Pathway to Competency’. Course material has been developed by NHS senior phlebotomists. Maxis health care is The First & Only Phlebotomy Training Company in the UK to Offer Students a 100% Satisfaction Guarantee You Can Bank On. Here’s a promise that No-One (!!!) else in the whole Phlebotomy Training business offers… We want you to know that all risk is on us and you have nothing to worry about. We stand firm behind our standard of training because we have had so many success stories. We take over 99% of students all the way from having Zero Knowledge to becoming Competent in Phlebotomy, even enough to go and get a phlebotomist job. Now state sections of well being services are trying to find phlebotomists. So, receiving a certification may offer you an excellent career.  We are 100% interested in your satisfaction and positive experience so we put our money where our mouth is.

Maxis Healthcare established since 2005, and offer courses for medical and non medical students. We at Maxis are passionate about giving people the essential practical and theoretical experience and knowledge so they can develop new careers or develop their existing career paths. This philosophy is reflected in our training modules which combine real life work experience with classroom education. We achieve this by hiring the right teachers and trainers specialized and experienced in the skills they are training, and then working together with these trainers to develop course modules that are wrapped around the most essential skills needed to become ‘outstanding’ in that job. Our premier course “1 Day Fast Track Intensive Phlebotomy” is taught by practitioners who are practicing phlebotomy within the NHS on a daily basis and the entire course was developed with their input.

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Evacuated Collection Tubes are designed to fill with a predetermined volume of blood by vacuum. Various sizes are available. Blood should never be poured from one tube to another since the tubes can have different additives or coatings. The test tubes are covered with a color-coded plastic cap. They include additives that mix with the blood when collected, and the color of the tube’s plastic cap indicates which additives that tube contains.

The additives may include anticoagulants (EDTA, sodium citrate, and heparin) or a gel with intermediate density between blood cells and serum. Some tubes contain substances that preserve certain chemicals or substances within the blood, such as glucose. When the serum separator tube is centrifuged, the blood cells sink to the bottom of the tube, are covered by a layer of the gel, and the serum is left on top. The gel enables the tube to be tipped upside-down and transported without the blood cells remixing with the serum. When a tube that does not contain gel or a clotting agent is centrifuged, the clear liquid is plasma, which contains platelets.

Manufacturers standardize the colors for additives in collection tubes for Phlebotomy. Gold or ‘Tiger’ Red/Black top: Used in chemistry, immunology and serology determinations. Contain clot activator and gel for serum separation, and no other additives. Orange or Grey/Yellow ‘Tiger’ Top: Used for STAT serum testing. Contain Thrombin, which is a rapid clot activator.

Green – Contains Sodium Heparin or Lithium Heparin, Inactivates thrombin and thromboplastin, used for plasma determinations, for lithium level, use sodium heparin, for ammonia level, use sodium or lithium heparin Light Green or Green/Gray ‘Tiger’: Plasma Separating Tube (PST) with Lithium heparin, anticoagulant is lithium heparin; Plasma is separated with PST gel at the bottom of the tube, Used in blood chemistry.

Purple or lavender: Purple tubes are used when whole blood is required for complete blood counts (CBC) and blood smears or blood typing, and screening in blood banking procedures. Tubes contain EDTA (the potassium salt of EDTA) which is a strong anticoagulant. To prevent clotting and platelet clumping full draw and mixing 8 times is required. Grey: Specifically used for blood glucose determination, requires full draw. Sodium fluoride and Potassium oxalate are present in the tubes. Glycolytic enzymes in the blood are inhibited by Fluoride so glucose is not used up during storage. Anticoagulant used is Oxalate.

Light blue: A reversible anticoagulant Sodium citrate in measured amount is present. Used for coagulation assays (Prothrombin time, Partial Thromboplastin Time). Full draw is essential since dilution factor with liquid citrate should be maintained. Dark Blue: anticoagulant sodium heparin is added, sometimes contain EDTA as an additive or contain no additive. These tubes are used for trace metal analysis and toxicology tests. Pink: contain Potassium EDTA similar to purple tubes, pink tubes are used for blood banking and Molecular/viral load testing .

Red tubes (glass): Tests for antibodies, chemistries, and drugs used these tubes as they contain no additives. Blood cells and serum is separated by centrifugation. Light yellow: Blood culture specimens use tubes which contain sodium polyanethol sulfonate (SPS). Acid-Citrate-Dextrose (ACD) as an additive is used for blood bank studies, HLA phenotyping, and parental testing. Tan: These tubes are certified not to contain lead, hence used for lead determinations. Tubes contain sodium heparin or potassium EDTA.

Phlebotomy training courses, in addition to teaching collection techniques, correct procedures and order of draw as specified by NCCLS, also prepare the phlebotomist for emergencies and help to understand proper laboratory procedures in order to avoid contamination or infection control requirements.

Phlebotomy, also known as venesection, is performed by a nurse or a technician known as a phlebotomist. Blood is usually taken from a vein in the upper forearm (antecubetal fossa) is most often chosen for venipuncture. Arterial blood is required for blood gas measurements. Smaller quantity of blood may be obtained from the capillary bed by puncture of the skin ” a capillary puncture or skin puncture. Capillary blood is often used for point of care tests (POCT).

Depending on the age and condition of the patient, there can be many methods used for blood collection from a vein. Choice of the best method depends also on the tests required and the equipment available to the phlebotomist. Veins from forearm, wrist, or ankle are generally used for venipuncture. Veins in forearm are commonly used since they are larger and more fuller. Cephalic, median cubital, and median basilic are the three main veins in the forearm, and usually the first choice in venipuncture is the median cubital vein if the forearm.

Blood is collected from an appropriate site using either syringe needle system, or an evacuated tube and needle system which were first introduced to market by a company called BD (Becton, Dickinson and company, BD Vacutainer system). For some collections from the back of wrist, syringe with a butterfly needle is used in combination with the evacuated tube method.

Vacutainer system makes use of a double ended hypodermic needle, and a holder covers the second short needle for safety. One end of the needle is inserted into the vein and the other end of the two-way needle is semi attached by a holder to the rubber stopper of vacuum tube. Blood rushes into the vacuum tube due to pressure difference between blood volume and vacuum in the tube. When the first tube gets filled with blood, it is removed and another can be filled in the same manner, thus multiple samples can be collected by single puncture. There are published standards for the use of vacutainer tubes for blood collection by the Clinical and Laboratory Standards Institute (formerly known as NCCLS).

For patients with difficult veins, a syringe and needle system is normally used. BD Vacutainer tubes are used for patients that have small delicate veins which may collapse under vacuum. For elderly patients, or patients with unreliable veins, babies, coagulation studies, obese patients with difficult veins, intravenous therapy patients with scarred veins, and for veins on wrist, back of hand, ankle, foot, or scalp, an infusion set (Butterfly) is used.

The duties as a phlebotomist of technicians vary depending on the workplace. In a hospital, the phlebotomists primary duty is to assist doctors. The technician also coordinates with nurses. One of the duties as a phlebotomist of a hospital technician is to take blood or tissue samples from patients.

The phlebotomist ensures that a patient is appropriately identified before samples are taken. Part of the hospital technicians duties as a phlebotomist is to correctly puncture or incise a patients skin to take specimens. The phlebotomist is responsible for the amount of blood or tissue taken should be enough for the specified test. Another aspect of the hospital technicians duties as a phlebotomist is that samples are properly labeled. The technician also ensures that properly labeled samples are delivered to the laboratory on time.

Phlebotomists can complete either on job training, cross train from another health care profession, or a formal program from phlebotomy training schools to attain these competencies. Phlebotomy certification from professional associations leads to skill refinement and continuous education for practicing phlebotomists.

As per the guidelines from The Centers for Disease Control and Prevention (CDC) several disease-specific precautionary policies for patients known to be or suspected of being infected with certain pathogens are recommended to be followed by phlebotomists. Universal standard precautions assume that all specimens are potentially infectious and should be handled accordingly.

Every direct contact with body fluid is infectious is the assumption in the Standard precautions. To prevent cross-transmission and exposure of the skin and mucous membranes to infectious microbes, avoid direct contact with patient specimens, and when contact is anticipated appropriate barrier precautions should be used ” this is the essential element of standard precautions.

Every phlebotomist should exercise certain consistent precautions on a routine basis. These standard precautions recognize the infectious potential of any patient specimen and prevent cross-transmission of infectious disease to patients and the protect laboratory personnel from infected patients.

Potential exposure to HBV is prevented by recommended use of a licensed inactivated vaccine (HB). As a precautionary step for persons who are at a greater risk for Hepatitis B infection i.e. clinical laboratory workers, phlebotomists, and pathologists, use of this vaccine is recommended by CDCs advisory committee on immunization practices.

Phlebotomists working with blood specimens should follow safe work practices to eliminate the risk of transmitting infectious pathogens like:

- To disrupt transmission of infectious pathogens frequent hand washing according to the procedure – Eating, drinking, smoking should be prohibited in lab area. – Gloves, gowns, lab coats, masks, eye protectors, etc. Personal Protective Equipment used as required – Clean up any infectious fluids/blood spills immediately and minimize aerosolization – Waste disposal measures as recommended by OSHA and NCCLS are followed. Puncture”resistant sharps containers are used to dispose disposable syringes and needles, scalpel blades, and other sharp items. – Needles should not be recapped by hand, purposely bent or broken by hand, removed from disposable syringes, or otherwise manipulated by hand to prevent needle stick injuries. – Prophylactic measures for pre-exposure and post-exposure for handling potential occupational transmission of certain pathogens should be known by phlebotomist.

The knowledge of general safety regulations governing the clinical laboratory, OSHA (Occupational Safety and Health Administration) mandated plans for chemical hygiene and for occupational exposure to blood-borne pathogens, the importance of safety manual, and general emergency procedures is mandatory for a professional phlebotomist.

The disposal of sharps has always been a hazardous procedure for all health care staff. It is important to be aware of the risks involved in venipuncture. It is recommended that all health care professionals who carry out the procedure should be properly trained and makes use of a closed system-letting device, e.g. Vacutainers.

Case of a needle stick injury should be handled by following:

- Encourage bleeding from the affected site – Wash the injured area or irrigate with water or normal saline as appropriate – Cover with a suitable dressing – Record the patients name and ID – Complete an accident form – Inform immediate manager – Go to Occupational Health, GP or Accident and Emergency Department as appropriate

All the necessary techniques and procedures needed to be a competent and skilled phlebotomist are taught by accredited phlebotomist technician programs. Phlebotomy programs cover the subjects like: Anatomy and physiology, Blood and cell composition, Blood sampling procedures, and laboratory safety, and CPR procedures. Professional behavior, Quality control, Legal issues, Computer training are other courses which may be included in phlebotomy training program. Depending on the regulations and training for work settings each phlebotomy training school offers something different.

The art of drawing blood from the veins in the human body is defined as venipuncture. You will need to have proper venipuncture training in order to draw the blood sample and the professional who does it in most cases is the phlebotomist. The blood sample that is collected is used for the purpose of detection and monitoring. You will need to learn the specialized skills of venipuncture and cannulation with due practice which is supported by theoretical knowledge.

If you are interested in Venipuncture training, you should go in for Certificate of competence in Phlebotomy. In Venipuncture training, you will learn how to use basic equipment, various techniques of puncture, complication etc. A good School of phlebotomy will teach you,

*Precautions to observe during the procedure *Preparatory phases *Human anatomy and physiology *Various equipment and supplies used for puncture, blood collection and recording *Various Venipuncture techniques yet recorded *Different ways in which patients react to venipuncture and occasional complications *Interventions to patient reactions and complications *Evaluation of results

These skills will help you gain confidence during the work and establish yourself. To master all techniques, Phlebotomy schools will organize demonstrations with help of experts in the field. These demonstrations will help you in understanding the theory very well. Most Phlebotomy tech schools organize training in hospitals, clinics and labs, where you will get to work with patients.

Phlebotomy certification includes detailed theory lessons in subjects like Anatomy, so that students are familiar with human body and can make sound judgments while working. Some Phlebotomy training schools use virtual reality training systems. This is of great help as you can always practice your technique before actually going in for the live puncture. You can acclimatize to the feeling of inserting needle in human body and vein structure of body. Pressure feedback and the reality of experience can be used to overcome any fear. One can get a Phlebotomy certificate only after getting properly trained in venipuncture. There are training aids as well, which can be used for practicing venipuncture. These aids consist of skin like material and different veins like tubes embedded. This can form a good aid for demonstration and training.

Quality training in venipuncture by a number of good schools in phlebotomy and any search in Google on the internet will yield good results. Choose a school that will provide accredited certification or a degree. You can also check their brochures which will have information about courses offered, duration and fees.

You can work while you study and the certifications will help you establish yourself in the health care sector.

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The Emerging Role of Nurses in GP Surgeries

Summary:

Many GP surgeries now provide patient care in early morning hours, evenings and on weekends.  While these newly expanded hours benefit patients, GPs are already overloaded and often overwhelmed.   It is therefore important to explore ways to maximise the functions of GP surgery support staff. One approach is to train nurses to perform phlebotomy services in house. This provides flexibility in coverage options and may provide advancement opportunities for ancillary staff. Further, since GP surgeries can receive up to £10,000 a year for providing phlebotomy services, there may be the potential to generate additional revenue.  This article outlines the case for delegating certain low-level tasks to support staff, the advantages of providing in house phlebotomy services, and how to properly evaluate phlebotomy training courses.

Given the recent government initiative to expand the hours and coverage of GP surgeries, work hours are considerably longer than before.  Recent statistics (January, 2009) from the UK Department of Health indicate that nearly 70% of GP practices in England are now offering extended hours.  These GP surgeries are providing patient service in early morning hours, as well as in the evenings and on weekends.  While this expansion of hours is certainly a benefit for patients, GPs are typically already overloaded and overwhelmed.  In addition, with longer service hours comes the daunting prospect of obtaining reliable, long-term coverage.  Since service shortfalls can negatively impact patients’ perceptions and experience regarding their quality of care, it is important to continually explore ways to maximise the functions of support staff, thereby providing some much needed relief for GPs.

Advantages of Providing In House Phlebotomy Services:

One approach to providing such relief is to provide structured, systematic phlebotomy training for nurses, or other ancillary staff members, which will enable these workers to competently perform phlebotomy services in house.  This can help off load GPs in larger groups who are already offering phlebotomy services, and can increase the service options of smaller GP groups not currently offering phlebotomy.  Since GP surgeries can receive up to £10,000 a year from the local government for providing in-house phlebotomy services to their patients, these smaller groups may realise additional revenue generation opportunities.  In addition, offering in house phlebotomy can create new promotional or career opportunities within the office’s existing employee group.   The trained support staff can either function as the primary providers of phlebotomy services, or provide back up or secondary coverage during peak periods.  This will serve to accelerate patient care and improve patient experience at the GP surgeries.

They key advantage in providing phlebotomy services in house is the better patient experience and patient reported outcomes. You will be able to tailor your service to your patients’ needs and in instances where there is already an existing provider, you will be able to supplement and provide cover for your patients when there are service shortfalls.