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The Zen of Phlebotomy

The phlebotomist's Grail is the vein and every venipuncture is a walk through darkness.

by Dennis Ernst • October 22, 2021

Professionalism


Sticking a needle into someone's vein seems a simple enough procedure... until the new phlebotomist has to actually do it. Practicing on oranges is one thing, flesh is another.

Yet once that fear has been conquered, success is not automatic. If all the antecubitals of the population were identical, phlebotomy would be as simple as falling off a log. But they aren't and it isn't. Only through repetition will the student become proficient; only through more experience will the proficient become talented; and only through a relentless pursuit of perfection will the talented become masters of the craft.

Becoming talented is not enough. The ultimate pinnacle of achievement in the process has not been reached unless the master defies the limitations and removes the most distasteful aspect of the procedure from the patient's experience: pain. Painless phlebotomy may sound like an oxymoron, but it needn't be. As with most lost arts, it is still sought by the purist, those who relish the euphoria derived from the relentless pursuit of, and a fleeting dance with, perfection.

The Greeks sought reason. The Romans sought truth. Phlebotomists ought to pursue the perfect venipuncture, which when properly executed is not felt by the patient in the least.

Witness on your rounds, if you will, the battlefields that have been made of the antecubital areas upon which our kind have applied their skills... or weaved their rugs, as the case may be. Battlefields littered with bruises of all colors needlessly because of the neglect of one or more of the basic rules of blood procurement. Rules that have been ignored, rejected, or just not taught in the first place.

In teaching the art of phlebotomy, it is wise to dispose of the traditional references to ancient bloodletting practices, stale (and getting staler) vampire remarks, and tacky allusions to bloodsucking. There are plenty of comedians on the other end of your needles who think themselves hilarious when they spill these worn out one liners upon you. It would be prudent to keep these bedridden jokers from getting under your skin while you're getting under theirs.

The mastery of the perfect phlebotomy carries with it an air of distinction and perfection. When one collects blood on the first try from the impossible patient by a delicate blend of instinct, skill, and raw intuition, it changes a person. 

With such fleeting success, one may feel moments of triumph: like Luke Skywalker shutting down the weapons guidance system and relying on raw instinct to destroy the Empire's Command Ship, or like Indiana Jones making the leap of faith to reach the Holy Grail. The phlebotomist's Grail is the vein and every venipuncture is a walk through darkness. What lies between the point of the needle and the vein is only tissue. Pierce the right tissue to the right depth, at the right speed, and at the precise angle, and the Grail is yours. It may not give you everlasting life but it will secure your position in the profession and earn you the respect of your patients and colleagues. Do it painlessly and you will be respected by your peers and requested by patients. You will come to know the feeling of complete mastery of the art of phlebotomy that can only be achieved by becoming one with the needle.

In becoming a master of the art of phlebotomy, it is important to leave a little room for humility. No matter how long one practices or succeeds in the pursuit of the perfect "10" in a venipuncture, there will be failures on the simplest veins. These veins have been put in place randomly throughout the population by a higher authority to keep the skillful artist from becoming a legend in his/her own mind. So, unless you like the taste of crow, don't consider yourself the ultimate phlebotomist. It is certain that, should you yield to the temptation to flaunt your well earned reputation, you will find yourself face-to-face with one of these veins at the precise moment your brag needs to be followed by your wizardry. Humble Pie tastes a lot better than Flaming Crow.

In conclusion, only by applying those few critical techniques that go beyond the basics will you find yourself piercing the impossible vein painlessly. 

  • Only the conscientious humanitarian who refuses to settle for the mere adequacy of simply being talented will become the artist. 
  • Only the phlebotomist who is committed to eliminating the trauma of our purpose will dance with perfection. 
  • Only the phlebotomist who fixes the mind's eye to the bevel, becomes one with the needle, and is motivated to the mastery of all the elements will become the frequent beneficiary of the five most satisfying words in the business:  "I didn't even feel that."

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