Mary Encarnacion
Hostos Community College
English 202: Technical Writing
Professor Pamela Stembug
March 20, 2022

Table of Contents
Title Page………………………….………………………….………………………….. Page 1
Table of Content…………………………..………………………………………………Page 2
Introduction……………………………………………………………..……….……..Page 3-4
1.1: Bloodletting, Leches and Barbers……………….Page 3
1.2: Historical Background…………………………..Page 3-4
Body…………………………………………………….…………………….…………..Page 4
1.1: The Vacutainer System………………………….Page 4-5
1.2: Blood Collection Process……………………….Page 5-7
Conclusion…………………………………………………………………………………Page 7
Reference Page……………………………………………………………………………Page 8
Reflection………………………………………………………………………………Page 9-10

Introduction-1.1: Bloodletting, Leches and Barbers:

Phlebotomy is the practice of blood collection through the incision of a vein for laboratory testing. Prior to today’s sound and modernized approach of blood drawing, bloodletting was the traditional method used by many with the help of a sharp material. Bloodletting revolved around the ideology that in order to rid the individual of diseases in the body, blood needed to be removed. Bloodletting, however, is no longer used because of the extremity it exerted on an individual’s life. In this paper, you will learn about the history of blood drawing, the vacutainer system, and the blood collection process.
Figure 1.0: The practice of bloodletting; letting blood flow. A woman is seen catching her blood in a plate as the person next to her is vigilant.

Introduction-1.2: Historical Background:

Ancient Egyptians introduced bloodletting which later on spread to Greece, Rome, India, and the Arab kingdom (Cohen, 2012). In the second century CE (Common Era), Hippocrate, who was the father of medicine, was credited for developing the Humors system which basically separated the body into four quads; each “humor” had certain organ groups. If an individual was sick, blood was taken from the humor with the closest proximity to the area of the sickness as a way to purge them from the illness. Another fundamental influencer to the study of phlebotomy was Greek physician, Galen of Pergamon, who in the second century CE discovered that arteries and veins both carry blood. Galen believed in order for an individual to have good health, perfect balance of the four “humors” —blood, phlegm, yellow bile and black bile—was required (Cohen, 2012). Galen built on Hippocrates’ ideology by developing a plan that would explain the parts of the body where blood should be drawn from and the amount of blood to draw as well.

Whether it was with leeches that blood was taken out, barbers are said to have played a role in the history of bloodletting as well. For example, priests and monks were entrusted with bloodletting; however, in 1163 the church made an order prohibiting them from practicing it (Cohen, 2012). As a result, Barbers began to offer different types of services: bloodletting, cupping, tooth extractions, lancing, amputations; in addition to trims and shaves. In fact, the barber pole is linked to bloodletting; with red being a representation of blood and white of the bandages used (Cohen, 2012). The 18th century brought innovations like the lancet which began to revolutionize the field of medicine, enhancing the practice of phlebotomy into a safer, more evolved one.

Body- 1.1 The Vacutainer System
The Vacutainer system was introduced in 1949 by Joseph Kleiner and Becton Dickinson. It is a blood collection tube using a sterile glass or plastic tube to collect blood for laboratory testing (Mahajan, 2021). These tubes have a predetermined amount of blood to be collected because of the closure that is created by a vacuum inside the tube. Because there are different tests that measure different blood substances present in the blood, it is important to highlight the distinct additives in each tube (Mahajan, 2021). An anticoagulant, for instance, is an additive that prevents the blood from clotting. Similarly, there are coagulants to speed this process up.

Fig 1.1 represents the different kind of rubber stopper used on a universal spectrum.
The vacutainer systems allow for multiple tubes to be filled with one single puncture. The vacuum present in the tube is what determines how much blood will enter it. A Vacutainer ® needle is double-ended meaning the exposed end of the needle goes in the patient’s vein and the other end is enclosed in a thin rubber coating (Mahajan, 2021). The mechanism of this system is understood when a vacutainer tube is inserted into the plastic holder and the rubber coating is punctured by the inner needle. This will prompt the vacuum in the tube to draw the blood through the needle and flow into the tube (Mahajan, 2021).

As previously mentioned some exams require additives, meaning the tubes need to be gently inverted. In some circumstances, the tubes need to be centridged where the components of the blood are separated. It is important for a professional to become associated with the guidelines of each tube before performing a venipuncture to avoid errors like such. The vacuum system in the tube expires as well making it no good after a while; the suction will no longer be there. Due to cross contamination of additives from the needle, the order of draw for tubes is important to follow as a means of precaution in avoiding the repeat of lab orders. Fig 1.2: The most common types of veins in the upper extremities of the arm are found in the median cubital area; it is preferred because the chance to find veins are likely.

Body:1.2 Blood Collection Process
Before starting any medical procedure, thorough hand washing needs to be performed with disinfecting soap followed by a new pair of gloves. In most cases, the median cubital area is the preferred area of puncture because it is less painful, closer to the skin and easier to locate (Alexander Street, 2014). The location of the site is essential considering blood can be drawn from an arm, back of a hand, or even a foot. For larger veins, a 23 gauge needle is attached to a vacutainer holder with luer adaptor (the system that allows the two needles to meet) in a vacuum tube (Alexander Street, 2014). The needle gauge, the size of the hole of the needle, can vary in size; the smaller the number of the gauge, the bigger the needle will be.

When a phlebotomist or nurse finds a strong vein that springs back when it is palpated (touched), a tourniquet is tied at the bicep or at least a few inches above the area of puncture to stop the blood flow followed by a tight fist. The area is cleansed with a 70% isopropyl alcohol wipe from center to the periphery (center and away) and allowed to dry. The veins travel upward, in a cord-like manner making a 15-30 degrees the preferred angle for puncture. The bevel of the needle (the head) must face upward or pointing toward the professional drawing the blood. The skin can be pulled slightly to anchor it precisely. With the pressure from the torniquete, the blood should flash down right away into the body of the needle; this is an indication to insert the tube into the tube holder. Once the butterfly needle is inserted, it remains attached, freeing up the non-dominant hand that can be used to hold the tube. It is important to note the pressure of the blood coming down can push the tube come out causing a massive blood spill if it is not held.​

Figure 1.3 and 1.4: Butterfly needle with double-ended feature vs Butterfly needle with double-ended feature with attached plastic needle holder.
As the bottle gets filled, the tourniquet is released in order to allow the bleeding to stop and avoid the formation of a hematoma (accumulation of blood in an area). This is where the patient is asked to apply pressure over the site by the help of a gauze. Meanwhile, the professional disposes of the needle in the sharps container (a box with sharp materials that remains locked) to avoid a needle stick injury. A bainaid is placed over the site with a new gauze. The blood collection tubes are then labeled with the proper specimen tube collection labels before being centrifuged (spun) if needed (Alexander Street, 2014) and sent to a lab to get processed.

In conclusion, Phlebotomy is the practice of blood collection through the incision of a vein. The bloodletting practice began with Egyptians and it is used today as a main aspect of the medical field in the treatment and prevention of diseases. The advancement made in Phlebotomy was a significant turning point in the way diseases are diagnosed; having the potential to protect and save lives in a faster, easier and safer way than ever before. Overall, the blood collection process is one that requires a deep understanding of the science, patient care and methodology behind it. It may look simple, yet the process involves precise knowledge and care.

References
American Academy of Pediatrics (Producer), & . (2014). Venipuncture. [Video/DVD] American Academy of Pediatrics. Retrieved from https://video.alexanderstreet.com/watch/Venipuncture-2
Cohen, J. (2012, May 30). A brief history of bloodletting. History.com. Retrieved March 18, 2022, from https://www.history.com/news/a-brief-history-of-bloodletting
Savoie, L. (2020, September 22). The importance of phlebotomy in medicine. Career Options, Inc. https://www.careeroptionscenter.com/the-importance-of-phlebotomy-in-medicine
Figure: ​​https://medcaretips.com/vacutainer-use-in-blood-sampling/
Figure:https://www.researchgate.net/figure/Bloodletting-in-Vaermland-Sweden-1918-Bloodletting-was-used-as-a-cure-for-epilepsy_fig2_269337092
Figure: https://www.sciencedirect.com/topics/neuroscience/median-cubital-vein
Figure:https://en.wikipedia.org/wiki/Venipuncture
Figure:https://supplyusonline.com/product/tube-vacutainer-4ml-lavender-rubber-stopper-7-2mg-k2edta-100-bx/
Figure:https://www.globalnmd.com/it/products/bd-vacutainer-blood-collection-23g-x-0-75-x-7
Figure:​​https://www.4mdmedical.com/index.php/catalog/product/view/id/288285/s/sample-needles-collection-sets-collection-sets?CAWELAID=120141310000056386&CAGPSPN=pla&gclid=CjwKCAjw_tWRBhAwEiwALxFPoW23LhSTLhAwQUxYBbIlJQS_Ih3h6mksYO392gpwvy8RabqkYOlibRoCKzwQAvD_BwE

Reflection:
While I wrote this paper, I acquired useful skills and pointers for my next papers. I learned that if I read it over and I am not following then there is something wrong. When I first wrote my draft, I had to read it carefully and start almost entirely over because I realized I was not catering to my audience. I feel as if this paper taught me better than any other paper to understand what I am really addressing; it was the purpose of the task. I learned that research is extensive. At first, I only had 2 sources of information which included a video and the historical background aspect of blood drawing. I realize that I was only addressing the first part of the assignment which discusses the history but, I left the most important part out which was the methodology. I had to become detail-oriented while I wrote this paper. As a medical assistant, I usually do not think much of the process of blood drawing as I just do it; however, having been working on this assignment for a month has shown me how complex what I am doing really is. One of the most important things I learned while doing this assignment was to really focus on the audience and the purpose. I referenced the textbook’s chapter 5 and 19 to help refresh my thoughts on the information learned in class. Once I read it, I would read it constantly until something in my brain clicked. I wanted to make sure to grasp the task rather than doing it to do it. I wanted to obtain the skill. I say this because this is an important skill as I can make use of it in my next research paper. The first part of the assignment, the outline, came in hand for me. I am not accustomed to doing outlines. Having done it though, saved me from a lot of thinking. I knew I wanted to produce a good piece but now I know how to get there without working so hard because I structure it before writing it. I will definitely be devoting more time to the planning aspect of my paper to build on the structure thereby, enriching the content. This assignment addressed the objective of presenting technical topics to lay audiences. We had to dig deep to how we wanted to present the information while keeping many factors at play. Overall, this paper changed my approach to writing. I can say that moving forward I will pay more attention to the audience, purpose, structure and research.