Dr. Usman Waheed, Islamabad
Medical laboratory technology is among the most rapidly evolving fields within healthcare. The practice of contemporary medicine relies heavily on the analytical processes conducted in clinical laboratories. As automation and computer technology become increasingly dominant, the roles of laboratory technologists and technicians have shifted from hands-on tasks to more analytical functions. However, this shift has led to a disproportionate emphasis on analytical work, often to the detriment of phlebotomy, which is an essential element of laboratory operations. Given the proverb “first impressions are the last impressions,” it is important to consider the often overlooked but crucial role of phlebotomy.
Phlebotomy, a practice originating in ancient Greece, has evolved alongside advances in medicine and has become a crucial diagnostic tool. Today, it serves as a key link between patients and clinical laboratories, effectively bridging the gap between them.
Patient feedback surveys consistently reveal that patients prioritize a painless and pleasant phlebotomy experience over factors such as the speed and accuracy of results or quality control. Consequently, a well-executed phlebotomy process can significantly enhance a laboratory’s reputation by improving patient satisfaction.
Phlebotomy encompasses more than just the technical skill of venipuncture. It also involves aspects such as the design of the phlebotomy area, seating arrangements, visual aesthetics, informational materials, and the attitude of the phlebotomist. Negative experiences in phlebotomy can have a more lasting impact on patients than inaccuracies in test results.
Moreover, pre-analytical errors, which are prevalent in laboratories, are often underestimated in routine practices. The pre-analytical phase is critical to overall laboratory quality, with specimen collection / phlebotomy playing a significant role. Due to frequent staff changes, insufficient knowledge of proper laboratory procedures, and inadequate training, there are many chances for mistakes during phlebotomy. For instance, errors such as incorrect labeling or barcode swapping can be difficult to detect but have significant consequences. Since physicians rely on laboratory results for clinical decision-making, the quality of phlebotomy should be considered vital to the analytical process.
Bioethical considerations are also crucial in phlebotomy. Phlebotomists must provide clear explanations of procedural steps and potential risks to patients, inform them about the diagnostic tests being performed, and ensure that informed consent is obtained prior to venipuncture. While compliance with these ethical standards may be challenging, raising awareness among professionals about this aspect is essential.
Effective and professional phlebotomy can greatly enhance a laboratory’s operational efficiency and reputation. Minimizing Turn-Around-Time (TAT) for investigations is a key success factor, and a well-trained phlebotomist can achieve this through effective pre-phlebotomy counseling, efficient venipuncture, and thorough post-phlebotomy care. Building trust and confidence with patients while performing venipuncture in a safe and reliable manner is critical. Female phlebotomists are often preferred due to their perceived politeness, interaction skills, and precision. Proper training remains crucial for all personnel involved in phlebotomy, including both phlebotomists and other healthcare professionals. They must be accurate, perform well under pressure, and communicate effectively, acting as the “eyes and ears” for clinicians, nurses, and laboratory professionals.
An ancient Roman proverb states “amat victoria curam,” which means “victory lies in careful preparation.” Same is the case with phlebotomy where precise attention in selecting the best site for needle insertion is crucial for a successful procedure and minimizing the risk of injury. Thus, a thorough understanding of anatomy, as well as the use of tools to improve visualization, is essential.
Emphasizing quality over speed in phlebotomy is key to achieving the best outcomes. Over the years, technology has introduced several helpful devices to assist phlebotomists, enhancing both the quality of collected specimens and patient safety. Nonetheless, there is no precise formula for determining the ideal vein, needle, angle, or force for a perfect blood draw. The only certainty is that all the efforts made to ensure the safety of the patients, and the quality of the service allows phlebotomy to bridge the gap between patient and laboratory.
A study from Croatia showed that to achieve a good skill of phlebotomy, i.e. corresponding to a rate of successful venipunctures close to 99% at first attempt; about one year of hands-on practice is necessary. Many developed countries offer specialized diplomas in phlebotomy, which cover both theoretical and practical aspects of the field. Unfortunately, such academic recognition is lacking in our country, resulting in a reliance on ” On-the-job trained” phlebotomists rather than through formal educational programmes or classes. Most of the Medical Laboratory Technology (MLT) programmes do not currently include comprehensive phlebotomy coursework or practical experience. It is therefore recommended that phlebotomy be included as a separate course of at least 4 credit hours in the curriculum for all MLT diploma and degree programmes, ensuring ample time for practical training. Additionally, the assessment of this course have to include both theoretical understanding and practical skills.
It is important to mention that guidelines on the good practice in phlebotomy (correct patient positioning, how to wear gloves, labelling samples, disposing used devices, etc.) can be found on the World Health Organization’s website under the title ‘Guidelines on Drawing Blood: Best Practices in Phlebotomy’ (available at https://www.who.int/publications/i/item/9789241599221). It is also noteworthy that various national societies, such as the Italian Society of Clinical Biochemistry, Turkish Biochemical Society, and the Italian Society of Laboratory Medicine, have issued their own guidelines and recommendations on phlebotomy practice. These guidelines can be tailored to meet local needs for application in Pakistan.
[The writer is associate professor of clinical laboratory sciences at IMDC, and advisor on blood regulation. He can be reached at drusman.waheed1@gmail.com]
