More private practices are offering in-house lab services. Instead of sending patients to outside labs to have blood drawn, samples are taken in the office. It’s a technical skill requiring both clerical and clinical expertise, making it an ideal assignment for a medical assistant.
What Is Phlebotomy?
Phlebotomy is the process of obtaining a blood sample from a patient. Also called venipuncture, it’s both art and science.
Blood is tested to diagnose and treat diseases, disorders, and conditions such as these.
- High cholesterol
- Lyme disease
- Nutritional deficiencies
- Liver and kidney disorders
- Clotting abnormalities
Samples are also used to type and crossmatch blood for donation or to monitor levels of therapeutic drugs, including warfarin (a blood thinner), antiseizure medications, and select antibiotics. Blood samples from veins may be drawn by medical assistants.
The Medical Assistant’s Role
Phlebotomy is a responsibility that a medical assistant can handle from start to finish. Vocational schools teach the basics of venipuncture, and the skill can be perfected quickly with experience.
Steps in the phlebotomy process include these responsibilities.
Step 1—Reviewing Orders
Blood is drawn only with a doctor’s order. The physician specifies which tests are ordered and assigns each a matching diagnostic code. A medical assistant should check an order for completeness and request clarification if something isn’t clear.
Step 2—Screening the Patient
Patients must prepare for some blood tests in advance by fasting or taking medication. Not following these instructions can result in abnormal tests that give doctors the wrong clinical picture. Before performing venipuncture, these are steps a medical assistant should follow.
- Verify the patient’s identity
- Ensure the patient complied with restrictions
- Screen the patient for allergies to skin disinfectants and bandage adhesives
- Review patient history for issues with previous blood draws
- Determine if medications could cause the patient to bleed or bruise excessively
- Obtain consent
It’s a medical assistant’s role to educate patients. Patients have a right to know why their blood is being tested, how the sample will be drawn, and when to expect results. A medical assistant should not proceed without consent from the patient or from a parent or guardian if the patient is a minor. Most offices collect signed consent forms at check-in.
Step 3—Gathering Equipment
Phlebotomy is a sanitary process where medical assistants wear masks and gloves, so gathering all necessary supplies in advance is a must. The medical assistant use these pieces of equipment.
Personal Protective Equipment (PPE)
PPE (personal protective equipment) provides protection from blood-borne pathogens. PPE may include masks, gloves, gowns, shoe and head coverings, respirators, and other face and eye protection. Their use is an OSHA requirement designed to keep a medical assistant safe. Medical assistants should use a face shield to cover their eyes and mouth if there’s potential for splatters.
They should discard used needles only in puncture-proof biohazard containers labeled for “sharps,” which are any contaminated items that can puncture the skin. Special lids allow for safe, one-handed disposal.
Patients’ skin is cleansed with an alcohol pad before venipuncture to prevent infection. It doesn’t sterilize the area, but it removes dirt and reduces the bacteria count enough to ensure a safe draw.
Stronger disinfecting agents, such as chlorhexidine or betadine, are required for select tests or if someone is allergic to rubbing alcohol. The medical assistant should use a brisk scrubbing motion for optimal results.
Needles come in a wide range of sizes for patients with different needs. Diameter is measured in gauge from 18 to 32, the larger the gauge, the smaller the bore.
Mid-size needles are ideal for adults, but children and patients who are elderly or dehydrated require a smaller size. Large diameter bore sizes exert significant vacuum pressure on weak veins and can cause them to collapse.
Needles come in different lengths. Most blood is drawn with a 1-inch needle from the medial cubital vein inside the elbow, but a medical assistant should choose sizes based on depth and condition.
Blood draws were once performed with syringes. Today, vacuum tubes take the guesswork out of the process. Dual-ended needles are threaded onto the front of plastic tube holders and vials are pressed in, perforating the rubber stopper and allowing the vacuum to pull blood in.
Tubes come in various sizes and are color coded to reflect additives they may contain. Additives are small amounts of anticoagulant or clot activator, which are required for some types of tests. Samples should be collected in the smallest number of vials. The medical assistant should avoid oversize tubes and large diameter needles, because they exert more pressure on veins.
Applied to the upper arm, a tourniquet forces blood to stay below the elbow, pumping up the vein and making it easier to feel. For comfort, a medical assistant can loosen it as soon as blood shows in the vacuum tube.
After completing a venipuncture, medical assistants compress the site firmly with clean gauze or a cotton ball to stop the bleeding and prevent bruising. They then apply a small bandage to keep any leaks off patients’ clothing.
Step 4—Performing the Venipuncture
After verifying an order, the medical assistant screens the patient and gathers supplies. The actual venipuncture process takes less than a minute, following these steps.
- Wash hands and apply gloves.
- Cleanse the patient’s skin.
- Place the tourniquet 3 to 6 inches above the target vein.
- Brace the vein with thumb and forefinger and insert the needle.
- Push in the collection tube.
- Loosen the tourniquet when blood begins to flow.
- Withdraw the needle and apply pressure to the site.
- When the bleeding has stopped, cover the wound with a small adhesive bandage.
- Ensure the patient knows whom to call if there are side effects or questions.
Step 5—Processing Samples
Once the sample collection is received, vials are labeled with the patient’s name and the date and time of collection. Labels must be error free, or they will be rejected by outside labs and will have to be redrawn.
Samples for use in in-house labs can be processed and tested. Some must be centrifuged to separate plasma, the liquid portion of blood, from cells. Vials shipped to outside laboratories may require refrigeration or freezing. Printed or online test catalogs detail the requirements for each test.
Phlebotomy Skills for Medical Assistants
There are many skills that will help a medical assistant with phlebotomy. They include compassion, critical thinking, hand-eye coordination, attention to detail, and confidence.
The fear of needles is real. Adults can be fearful of injections or suffer from extreme fear called trypanophobia. The rate is as high in adolescents and young adults as it is in older adults.
Phlebotomists will draw blood from all age groups, so being able to put themselves in their patients’ shoes and appreciate the anxiety they feel is critical to success. Only by understanding the risks can a medical assistant keep the patient safe.
Patients with a history of fainting during venipuncture should be carefully positioned to ensure they have the best experience possible.
Skill 2—Critical Thinking
Phlebotomy requires good clinical judgment. From questioning vague orders to determining how best to obtain a sample from a frightened child, the process is technically complex. A medical assistant should feel confident evaluating orders and analyzing patient needs, making sound decisions based on knowledge, experience, and evidence.
Skill 3—Hand-Eye Coordination
Drawing blood for more than one test may require filling multiple vacuum tubes. It takes significant hand-eye coordination to hold needles firmly in place while removing and replacing vials. Just a slight change in position could pull the needle out of the vein or force it through the other side, halting blood flow and causing discomfort for the patient. The good news for the dexterity challenged is that proper preparation makes the process virtually foolproof, and it gets easier with experience.
Skill 4—Attention to Detail
Laboratory errors can occur before blood is analyzed. Poor quality samples, labeling mistakes, and processing errors contribute to high rates of rejected vials, reporting inaccuracies, and the need to repeat venipunctures. Medical assistants with a keen eye for detail prevent those issues.
Fearful patients can tell when a phlebotomist is uneasy about a draw. It’s essential to project confidence. Phlebotomy isn’t difficult, but it takes practice to get the technique right. Students learn the essential skills in school and will gain experience to feel completely comfortable.
Few duties are as exciting for a medical assistant as phlebotomy. It’s a chance to spread your wings and make the most of your administrative and clinical training.
You’ll work hands-on with patients, utilizing your soft skills and scientific know-how to bring them better health. It’s a meaningful and lasting contribution.
Did learning about phlebotomy interest you? Ready for an exciting new career in the medical assisting field?
The Medical Assistant program at Hunter Business School prepares competent, entry-level medical assistants in the cognitive (knowledge), psychomotor (skills), and affective (behavior) learning domains required for professional practice.
The Medical Assistant program provides hands-on experience in a real medical setting where you can foster professional relationships with actual patients. Medical Assistant students spend 160 hours in an externship at a professional medical facility where they are supervised and taught in order to gain valuable on-the-job training.