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Bloody pharmacy – in the name of patient care

Peter Kelly started to question why he decided to undertake phlebotomy training but he soon had the answers…
 

I recently did something I could never have imagined doing when I first qualified as a pharmacist 15 years ago. I took blood samples from a person’s vein and it was much easier than I imagined.

The definition of phlebotomy is the surgical opening or puncture of a vein in order to withdraw blood. Today this is mainly done to capture blood for diagnostic testing but the history of phlebotomy is much more interesting and, through the lens of modern medicine, seems utterly bizarre.

Humans have been bloodletting for thousands of years. It began with the Egyptians and spread to the Greeks and Romans before reaching Asia and Europe. The idea was that you could treat ailments by removing ‘bad’ blood. It was used to treat a wide variety of medical conditions such as fever, headache, loss of appetite and digestion issues.

George Washington, the first president of the United States, died from bloodletting he was receiving treatment for fever in 1799. His doctors drained 40 per cent of his blood, affectively killing him. Needless to say, I don’t plan on ever taking out that much blood from a patient. So why was I doing the training?

We recently starting offer a blood testing service in the pharmacy in partnership with a local testing laboratory. Many of the tests can simply be done by pricking a finger and filling up a couple of small vials that way but some of them require more blood.

When more blood is needed taking it from a vein in the arm may actually be easier as the blood flow is more guaranteed. Getting enough blood from a finger prick can be difficult if the person whose finger you are pricking has cold hands. I have even had to send a patient away and get them to come back the next day as they had been outside working all day and their hands were freezing.

In my opinion, the biggest difficulty in taking blood samples in the pharmacy is the fear of hurting the person you are taking the sample from. I found this same difficulty when I first started giving the flu vaccine and the chickenpox vaccine for children.

When I first started administering flu vaccine, I was very intimidated by the idea of having a needle in my hand. I definitely had a fear of needles to some degree. I grew up in a town outside Dublin in the 80s and 90s and there was a lot of fear of what was seen as a heroin epidemic in the city. The danger of the drug was drilled into us as children. I remember ex-addicts coming to my school to talk to us about the dangers and the reality of the drug. In my childhood mind, needles became primarily synonymous with heroin. This association has probably only really diminished by doing hundreds of flu vaccinations.

When I first started doing flu vaccinations I was quite nervous about it. I think we probably all over-think these things at the start. You certainly do not want to hurt someone or injure them but the more vaccinations you do, the more you realise that the psychological anguish of having an injection tends to be greater than the actual physical pain.

I once gave a flu vaccination to a gentleman who started screaming slightly before I had even stuck the needle in. The moment I took it out I asked him whether it hurt. He said he didn’t feel a thing ... and we both laughed. After the a few years of administering flu vaccines it became a task as mundane as making a cup of tea. I have little to no anxiety about doing it now.

I don’t worry about hurting the patient because I feel I am so steady and sure of what I am doing that the pain is minimal. After doing flu vaccinations for a few years we started doing chickenpox vaccine for small children. Initially I was absolutely terrified doing these. All my original fears of giving flu vaccines were heightening. If I was worried about hurting an adult, I was terrified of hurting or injuring a small child in front of their parent.

Initially, when giving children chickenpox vaccinations we used to spend a lot of time trying to get the child as relaxed as possible. We were trying to minimise any discomfort or pain, but we soon realised through practice that this was quite unrealistic and actually the best course of action was just to get on with it and get it over with as quickly as possible. The child will often cry but they can snap out of it just as quickly.

Which brings me back to phlebotomy and finger pricking for blood tests: if you are too anxious about hurting the person you are much more likely to be unsuccessful in your attempt to get the job done. If you take out the human factor the actual process is quite simple.

Now I have only bled one patient so far and have to do quite a few more supervised takes before I am fully trained, and that prospect is still a little nerving. But in time, just as with flu vaccinations, the process will become as mundane as making a cup of tea.
 

Peter Kelly is a community pharmacist based in London and occasional stand-up comedian.




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