The origin of the term Phlebotomy

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The word phlebotomy is an ancient Greek word, and which means “lancing a vein. it indicates the practice of causing a loss of blood (blood taking) for therapeutic purposes.In this deference, the term “vein puncture” is significantly more recent, since it refers to the practice of drawing blood (by penetrating the vein’s wall with a needle rather than cutting it with a lancet) for collection and analyses. Nowadays the terms phlebotomy, vein puncture and blood draw are identical. However, the first should be used to generally address any procedure which involves the iatrogenic accessioning to the vein lumen, the second for special cases in which the procedure is performed by means of a needle, and the third for vein accessioning aimed to blood collection (parapia 2008).

So the term phlebotomist is suitable to select the operator in all of the abovementioned situations. If we compare ancient phlebotomy versus modern vein puncture, we found a clear relationship with modern medicine. In the past, phlebotomy was fundamentally a therapeutic resource to cure many ailments, whereas nowadays it is the diagnostic basis which medicine relies on to approach most of the known diseases (Foreman 1996)

Thus, phlebotomy found its origins before the time of Hippocrates, in the fifth century B.C., when the essentials of all medical treatment relied on the four bodies “humors”: blood, phlegm, yellow bile, and black bile Blood taking was done in sick patients to restore the proper balance among the “humor”. By the middle ages, surgeons and barbers were specializing in this bloody practice since the doctors were discouraged by the fact that feudal lords could have them executed in cases of malpractice. These practices achieved unexpected heights in the 18th and early 19th centuries when a variety of methods were employed. The most common one was phlebotomy or venesection, in which blood was drawn from one or more of the larger external veins, such as those in the forearm or neck. In arteriotomy, an artery was punctured, although generally only in the temples. In scarification the “superficial” vessels were attacked, often using a syringe, a spring-loaded lancet, or a glass cup that contained heated air, producing a vacuum within.By the end of the 19th century, phlebotomy evolved through the use of the fleam and was declared quackery. It was only by the beginning of the 20th century that the use of the safer and effective needle and syringe system became commonplace for drawing blood Until the early 1980s, blood collection for analytical purposes continued to be carried out by ordinary straight needles and syringes. (Seigworth 1980).

The blood was then transferred into sample tubes after needle removal. The introduction of disposable needles and evacuated tube collection systems represented a substantial progress. These devices consist of a double-pointed needle, a plastic holder or adapter, and a series of vacuum tubes with stoppers. Blood collection by this procedure produces the best quality samples for laboratory testing, ensuring greater safeness for phlebotomists since the patient’s blood flows directly into appropriate test tubes (Godolphin 1990).

Additionally, a needle-retractable sheath allows sequential drawing of several tubes, thus preventing leakage of blood as tubes are changed. Although the introduction of disposable straight needles and evacuated tube systems has allowed collection of specimens of suitable quality, with additional general advantages from both a safety and a practical point of view, the overall procedures linked to blood sample collection, and the phlebotomy success rate itself, are as yet influenced by several aspects. The main reason for such a high prevalence of problems is that it is currently difficult to monitor most of the pre-analytic variables, including phlebotomy, which is not always under direct control or supervision of the laboratory staff. The phlebotomy activity is rather heterogeneous worldwide; in the German-speaking area of Europe only physicians are presently allowed to draw venous and arterial blood and are therefore trained and supervised by the elder colleagues in the ward. In Britain, phlebotomists are educated like technicians and are partially supervised by laboratory professionals (Dobson 2004).

Owing to the expanding trend towards consolidation of laboratory testing, which will inevitably entail outsourcing plans for specimen collection and transportation, the improved vigilance of decentralized phlebotomy procedures is expected to gain further relevance in the future (Bologna 2002).

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