Phlebotomists in Hospitals

[victorrpiercing]

Hey, I'm writing about a phlebotomist working in a hospital, and while I have done a bit of research on how the actual process of poking a vein works, I need a bit of help on the work environment.

So some questions I have are:

-What is your work schedule? Do you do 8, 10, 12 hour shifts? Do you have first, second, and third shifts? How often does it change?
-Who is typically your boss? Do you work directly under a doctor?
-From my understanding, it seems like you mostly draw blood, take it to a lab, maybe help organize, rinse and repeat. What else do you do? Do you ever come into work and get asked "Hey joe, you're going to the blood drive today"?
-What's your worst fear on the job?
-How do most people react to giving blood? I know how I react but I may not be the average.
-If you were to draw your own blood by yourself, how would you do it?
-What are some things that if you were asked to do, would be completely out of your job description but is something a bad boss or coworker could get away asking?
-What are the long-term body aches you could get? So for example, I do office work so I get back pain from sitting all day. What do you feel after long shifts?
-How accommodating is a hospital at letting you take time off after a traumatic event?
-What are the different places in a hospital you can work at? (like the ER vs. ICU etc,etc)
-How many other phlebotomists do you work with?
-How long is your lunch break and what is the type of stuff that you talk about? Do you ever gossip about patients and if so, is it usually like "omg you would not believe what this guy told me"?
-If you were to work at an ER, what is the typical process of drawing blood and what do nurses and other people do there as you draw blood?
-This is the weirdest question so far, but how easy would it be to steal blood? As in maybe taking a vial extra, putting one in your pocket for later? I PROMISE THIS IS FOR WRITING, IT'S A VAMPIRE NOVEL
-Could you, theoretically, steal supplies so you could draw blood outside of the hospital?
-Are those supplies ever threatened by shortages?
-How does being a phlebotomist affect your everyday life? I know some people will notice the veins of strangers, but is there anything else?
-What are some of the wildest things you have seen?
-Are you exposed to some pretty gruesome stuff? Like bad car accident victims, for example.
-Is there anything else I could add that would help make my main character feel like they actually are a phlebotomist and not just written by someone who doesn't know anything about hospitals?


Thank you so much. <3

Thanks for the responses everyone! I’ll get to them when I have time irl.

Comments

[kiki_eng]

What country is your story set in? Is your hospital rural or urban - how big is it?

[victorrpiercing]

Urban city in USA

[pallas_rose]

-What is your work schedule? Do you do 8, 10, 12 hour shifts? Do you have first, second, and third shifts? How often does it change?

When I was a phlebotomist in college I worked per diem, and our shifts were 5a-2p. We started early to get the morning lab draw done before the doctors came in to round at 8 or so, so the results would be there. (Now I am a surgeon and we often round at 6:30 or 7 and the labs aren't back... the hospital is set up for medicine doctors.) Nurses and some techs can also draw blood, so often there isn't 24/7 coverage of phlebotomists, but it depends on the hospital. After the AM draw was done, we carried pagers and could be paged to draw one-offs until we left at 2p.

-Who is typically your boss? Do you work directly under a doctor?

No, you work under like, the head phlebotomist. Ultimately the boss is a laboratory technician, maybe far up the chain a pathologist who runs the lab.

-From my understanding, it seems like you mostly draw blood, take it to a lab, maybe help organize, rinse and repeat. What else do you do? Do you ever come into work and get asked "Hey joe, you're going to the blood drive today"?

Draw blood, label the tubes, put the tubes (or blood culture bottles) in little biohazard bags, and pop those in the vacuum tube system and send them to the lab. I think red cross staff usually do the blood drives? I don't know about that.

-What's your worst fear on the job?

Sticking someone several times, blowing their veins, hurting them, and not getting the blood that we need to run tests to help them.

-How do most people react to giving blood? I know how I react but I may not be the average.

Most people were resigned to it but let me do it. But I am also a bubbly and cheerful girl so that might help.

-If you were to draw your own blood by yourself, how would you do it?

Tourniquet up on L arm (I am R handed) and stick myself backwards with a butterfly needle. Same moves basically as an IV drug user injecting. I would try for the AC (elbow armpit) and I would use the butterfly since the long tube allows me to swap the tubes facing myself rather than away from myself.

-What are some things that if you were asked to do, would be completely out of your job description but is something a bad boss or coworker could get away asking?

Putting in IVs. More on the line would be an arterial instead of venous blood draw. Only MDs and respiratory therapists are usually allowed to do those.

-What are the long-term body aches you could get? So for example, I do office work so I get back pain from sitting all day. What do you feel after long shifts?

Low back pain. If you don't raise the bed or sit down next to the patient, you bend over to get the draw. I always sat down since it was a friendly move.

-How accommodating is a hospital at letting you take time off after a traumatic event?

I was per diem so I only worked when I wanted; I was an undergrad student. I imagine if you were fulltime you'd need to run through PTO and then FMLA.

-What are the different places in a hospital you can work at? (like the ER vs. ICU etc,etc)

I covered psych and the grab bag wards. ICUs: mostly nurses do the draws, probably no phlebotomist.

-How many other phlebotomists do you work with?

I worked with two others, but we only covered 3 of the maybe 10 wards, and that was all inpatient. Probably a lot more in the outpatient lab.

-How long is your lunch break and what is the type of stuff that you talk about? Do you ever gossip about patients and if so, is it usually like "omg you would not believe what this guy told me"?

I remember being made fun of for wanting to eat a whole bowl of olives from the salad bar. Sometimes I talked about sad cases. I was an undergrad and my two coworkers were a med student and a late middle aged woman who had been a phlebotomist for years and years. Not a lot of work talk! Not like doctors.

-If you were to work at an ER, what is the typical process of drawing blood and what do nurses and other people do there as you draw blood?

I think it varies. In the ER, often times you need an IV put in, which is a nursing job. They usually draw the blood you need for initial tests from that IV when they place it. Some ERs may use phlebotomists, but I bet many have nurses draw the blood.

-This is the weirdest question so far, but how easy would it be to steal blood? As in maybe taking a vial extra, putting one in your pocket for later? I PROMISE THIS IS FOR WRITING, IT'S A VAMPIRE NOVEL

So easy. Unbelievably easy. You can draw as many as you like, the patient probably wont ask. Then put them in the bag and the bag into your cart, pocket it when you're out the door. The key is: which kind of tube? You'd want the kind with a blood thinner in it to keep the blood from clotting until you could drink it ;)

-Could you, theoretically, steal supplies so you could draw blood outside of the hospital?

100%. Easy.

-Are those supplies ever threatened by shortages?

Not to my knowledge, having worked in 4 major academic hospitals in the US, one of them a safety net hospital.

-How does being a phlebotomist affect your everyday life? I know some people will notice the veins of strangers, but is there anything else?

Don't tell other phlebotomists that you are one when they're trying to draw your blood. They'll get psyched out about it.

-What are some of the wildest things you have seen?

Well, I'm a trauma surgeon now, so pretty wild stuff. But again, phlebotomists will probably be limited to the wards, where people aren't sick enough for an ICU, and they'll have been stabilized in the ED. But people get delirious and crazy all the time, especially overnight. And sometimes people bleed or get sick or even die on the wards. So your character will have seen CPR and codes (brutal) and dead bodies, for sure.

-Are you exposed to some pretty gruesome stuff? Like bad car accident victims, for example.

After they're stabilized and cleaned up and their fractures splinted and some surgeries done, yes. It's ER nurses and ER techs (some of whom draw blood, actually) who see that stuff fresh and nasty.

-Is there anything else I could add that would help make my main character feel like they actually are a phlebotomist and not just written by someone who doesn't know anything about hospitals?

Them doing little things like setting up mise-en-place when they draw: the alcohol prep pad torn and ready, the tubes set in a row, the gauze and tape pre-prepped and ready to be placed one-handed. I've seen some tear off the tip of the finger of one glove so they can palpate the vein directly before swabbing and sticking it with their gloved hands (frowned upon). They could complain about how frequent the doctors order labs :)

happy to answer other questions.

source: current trauma surgeon, former phlebotomist (2005-6)

[azurelunatic]

A couple months ago I saw a sign in my usual lab saying that there was a shortage of butterfly needles and that you might not get one even if you asked for one because they were trying to save them for children, but that's the first and only time I've seen anything like that.

Do hospital bosses get on your case about excessive supply use and how often they have to restock things?

[pallas_rose]

They've never gotten on my case about it, no! But there have been all kinds of supply chain shenanigans in the COVID era. If we retcon no COVID, I imagine in you're in a US hospital, probably not a problem. And if the pilfering is onesey twosies of supplies, and not whole boxes, probably no one would notice.

[azurelunatic]

(Cancer patient with a history of giving plasma)

These days, it seems like it could be a lot harder to get away with stealing a vial of blood, because of the precautions designed to avoid lab mistakes (getting the wrong label for the wrong person) but here's how I would do it:

Line one pocket with a little plastic hazmat bag, beforehand.
(assuming the fill vials from the syringe method)
Draw a little more blood than needed into the syringe. Even when I'm watching the procedure I'm a little shaky on how much is actually needed.
Fill vials. Make "a mistake" with one, grumble to yourself, go to dispose of it in the appropriate bin & block view with your body while actually putting it in your bagged pocket.
Grab another vial from the supply (in my experience there is usually a supply nearby in case of various kinds of oops) and continue filling vials.
Label the vials after all of them are filled properly, sticking the label on lightly along one long side, showing each to the patient so the patient can confirm that their name and birthdate are correct on each label, then sticking the label firmly down.

The syringe with whatever leftover amount of blood might also fit in the conveniently lined pocket.

Patients who get blood drawn frequently will have opinions about how to best get blood out of them. It seems like the times I encounter phlebotomists as a specialist are either when I'm in a lab or when I'm in the hospital and a regular nurse has looked at my veins and gone "yeah no I'm calling in the phlebotomist". (The "internist vein" (so nicknamed because it's usually easy enough that even an internist couldn't miss it) on the thumb side of my wrist is NOT good for IVs and the person who thought they could use it for my chemo infusion was, alas, very wrong.)


The other way that I (as a patient) might not notice blood being stolen is by coming when I'm asleep or really groggy, pausing whatever's in my IV, and screwing a syringe to the attachment point nearest to me and drawing from there. Give a little medical babble and tell me that "just this once" you won't make me wake up enough to verify the labels for the lab, and I might not remember in the morning. Or, heck, generally they give you a saline flush before drawing blood out of the IV, and these days that's a wrapped preloaded syringe of saline that they screw on, then once it's empty of saline they draw blood back out into the saline syringe, then discard it and pull a fresh syringe to do the blood draw. The blood in the saline syringe might not be good for lab tests but it'll sure be tasty to a vampire.


I don't know the process for printing out duplicate labels, but I bet there is one because humans are going to human. If our vampire conveniently "lost" a sheet of labels and had to go reprint them, then they could arrive to the patient with twice the number of labels that were needed and could choose the vial size/type they wanted and take the spares.

[michelel72]

Yup, I work in hospital laboratory software, and the capability 100% exists. The process would either be simple or irksome, depending how the specific software works and possibly how the hospital's IT department has configured it. In our software, there are routines that can be used to reprint a selected label, and the IT department can give access to it to anyone reasonable ... or they can restrict access and make the phlebotomist/nurse have to call the lab to request a reprint.

Label printers are finicky little beasts. And even when they're not, labels can easily be torn, dropped, dropped in biohazardous materials (blood, feces, vomit ...), stained/made illegible by those same materials, picked up by the wrong person, and so on.

Modern handheld phlebotomy devices likely have an inherent reprint function.

(Of course, the OP doesn't necessarily need labels at all for excess vials being drawn, if they're confident they can keep colleagues and savvy patients from noticing draws into unlabeled tubes.)

[azurelunatic]

I will compliment people on particularly good sticks, where they get it in one try (straight in, without having to wiggle it around more than maybe drawing it back slightly) and I barely feel a thing. This is easier with smaller needles.

As a retired plasma donor, I have a scar right over the good vein in my right inner elbow. It's a slightly wrinkled indentation in my skin just below the elbow crease.

[lattice_frames]

I'm a lab tech who previously worked at a major blood center, so even though I haven't done more than a clinical rotation as a phlebotomist I work closely with a lot of them. So I'm answering the ones that I actually have answers for!

-What is your work schedule? Do you do 8, 10, 12 hour shifts? Do you have first, second, and third shifts? How often does it change? My lab does 8s and 10s where day shift can start between 3am and 5am and folks have their usual schedule but can pick up extra shifts (sometimes short shifts like 4-7am to get some extra hands during morning draws). We have 24 hour coverage but it goes from about 4-6ish people on day shift (depending on day of the week) to 2 people overnight.

-Who is typically your boss? Do you work directly under a doctor? we have a pre-analytics supervisor who is in charge of phlebotomists both for the hospital and the outpatient draw sites we run, but also the people who processed samples coming in from clinics (checking samples against paper orders, making sure labels were correct & samples are in the correct container for the tests ordered) and people doing accessioning (logging in samples that already have in-house labels and making sure they meet acceptability criteria). A lot of the people who aren't actively drawing blood are licensed as phlebotomists so they can cover in a pinch.

-From my understanding, it seems like you mostly draw blood, take it to a lab, maybe help organize, rinse and repeat. What else do you do? Do you ever come into work and get asked "Hey joe, you're going to the blood drive today"? Like pallas_rose mentioned, hospital phlebotomists don't really do blood donation collection these days. The regional blood center (eg, Red Cross) will have their own team of phlebotomists doing collections both at permanent donation centers and mobile blood drives. That all gets boxed up and sent to a central processing location where whole blood gets split into plasma and packed red blood cells (and sometimes platelets) and some testing is performed. Then once testing is complete that blood gets released to distribution and hospitals place orders for the units they need for their inventory.

-How accommodating is a hospital at letting you take time off after a traumatic event? depends on hospital policy, if there's a traumatic event at work they might have a special policy exception (eg, coworker died on shift), but for the most part it'd be PTO or FMLA or sick leave and how hard that is to get will depend on HR policies, potential union contracts, and how understanding your direct boss is.

-What are the different places in a hospital you can work at? (like the ER vs. ICU etc,etc) Most of the phlebotomy work will be the medical floors or outpatient but sometimes there's requests for a phlebotomist to draw a specific patient for various reasons. Usually in my experience it's because the ER can't manage to draw a patient without hemolyzing the sample or L&D has already placed the IV and either don't want to or can't draw it themselves. ICU & related is less common, mostly because a lot of the patients will have a central line that nurses will draw from. If a code is called on a patient, a phlebotomist will respond and get whatever samples the care team needs run in response to it and bring it to the lab.

-How many other phlebotomists do you work with? Depends on the shift and the size of the hospital. The place I work at has about 220 in-patient beds max and sees 160 or so outpatients, so our weekday day shift is 4 or 5 early morning phlebotomists and a couple more that come in at 6 or so to cover the outpatient draws.

-How long is your lunch break and what is the type of stuff that you talk about? Do you ever gossip about patients and if so, is it usually like "omg you would not believe what this guy told me"? norms vary from lab to lab, but lunch is usually 30 minutes and everyone's lunch is staggered so there's adequate coverage. Gossip usually is just "there's a dude in the ER who's refusing to wear pants" or "517 is extra cranky today" or "605 was refusing but let me draw her because I look like her grandson"

-This is the weirdest question so far, but how easy would it be to steal blood? As in maybe taking a vial extra, putting one in your pocket for later? I PROMISE THIS IS FOR WRITING, IT'S A VAMPIRE NOVEL extremely easy, especially if the patient isn't paying close attention (you draw an extra tube with the additive you want). At a blood center, it might be easier to just keep an eye on what units are getting discarded (either due to expiration at 28 or 42 days or because the donor testing didn't meet standards) and just grab one before it goes into the biohazard bin.

-Could you, theoretically, steal supplies so you could draw blood outside of the hospital? very easily

-Are those supplies ever threatened by shortages? there are so many places that they get stored (in carts, in draw caddies, in lab coats against policy, in 4 different cabinets) that nobody would notice a handful but would probably notice a case going missing, especially if one goes missing every month.

-How does being a phlebotomist affect your everyday life? I know some people will notice the veins of strangers, but is there anything else? it makes small talk about work kinda weird if you don't know how chill someone is about medical stuff or blood

[arctowardthesun]

I used to work in a stand alone blood bank as an MLT, and had many thoughts of how easy it would be for a third shift vampire to steal discarded blood. Especially since we had a window to an alley for couriers to use, so it was *almost* a drive-through that it would be really easy to shove blood out of.

[passingbuzzards]

[All this RE: in the US]

-This is the weirdest question so far, but how easy would it be to steal blood? As in maybe taking a vial extra, putting one in your pocket for later?

Not a phlebotomist, but I’ve certainly had an extra vial of blood taken by mistake when there were a lot of labs and a nurse misread the labels (I always think of this as my donation to the Überwald League of Temperance…) so collecting blood this way seems like it would be extremely simple for a vampire with a bit of sleight of hand, lol. (That being said, the vials the vampire would use would presumably need to be without additives/preservative medium at the bottom if your vampire rules include not consuming anything other than blood.) Here’s a paper about how some hospital labs apparently take extra vials of blood as a routine thing, may have useful details for you since it talks about discards / supplies / shortages due to COVID: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10632880/

-What are the different places in a hospital you can work at? (like the ER vs. ICU etc,etc)

Probably the most obvious location for a phlebotomist to be working at a hospital would be its outpatient lab (where the specialty practices within the hospital will usually send their patients to get their blood drawn, especially if it needs to be sent somewhere for testing). That way they’d be doing specifically blood draws all the time.

-How do most people react to giving blood? I know how I react but I may not be the average.

People who get blood draws regularly obviously tend to be pretty blasé about it, but for people with either “rolly” or just small / hard-to-see veins it’s often quite painful when done through a needle rather than an IV port, so it’s not like it’s pleasant even if you’re not afraid of needles. (I can’t speak to people who don’t get blood draws regularly since I usually get mine done at infusion facilities, i.e. in the company of other people who get IVs on the regular, lol. Personally I hate getting blood draws outside of infusion centers because of the needle-rather-than-IV-port thing, plus ime phlebotomists are substantially worse at not butchering your arm in the process than are infusion nurses.) Also, I know plenty of people who are deathly afraid of needles but still need blood draws, so that’s presumably not fun for the phlebotomists. :,)

Some additional detail about complicated blood draws in case that sort of minutiae might be useful to you: people who do have issues with their veins being difficult to see/reach tend to have a much better time with this if they apply a heat patch to their inner elbow for several minutes before having their blood drawn, since that makes the vein dilate/expand and brings it to the surface. Consequently places that do blood draws usually have a bunch of single-use heat packs that you crack like a glow stick and shake to activate so that patients who have this issue can limit how much the phlebotomist has to dig around in their arm. (They may also use vein finders sometimes, those are great—it’s basically a light that gets held over your arm and all the veins show up through the skin. I’ve only had one used on me once, though, so I suspect they’re kind of last-resort.)

[azurelunatic]

I've also only had various kinds of vein finder once or twice. The last time it was mentioned as some kind of ultrasound.

[lilacsigil]

Not a phlebotomist but someone who has a ton of blood draws. When you're not actually a patient in hospital it's usually done in a small room off the waiting room of the pathology clinic, so nothing is being directly supervised by anyone. Sometimes the pathology clinic is in a hospital, sometimes it's in a doctor's clinic, sometimes it's a separate venue.

It would be incredibly easy to steal small amounts of blood. It's really common to have multiple tests done on a single blood draw, so the needle goes in once then a number of little vacuum vials are attached to the other end and the blood goes in. Usually it's 2-3 vials but once when my gastroenterologist and rheumatologist and endocrinologist all needed results at the same time it was 8 vials. The technician sticks a label on each one from a pre-printed sheet of about 20 labels and I absolutely wouldn't notice if they stuck on a different label or didn't stick one on while I was leaving, or only stuck one on lightly then took it off or pocketed it.

There's whole carts of supplies available and sometimes multiple supplies are needed for one patient (I have terrible veins except for one really great one in my left arm - phlebotomists and nurses listen when I tell them to use that one, doctors always think they can get a more convenient vein, but they can't. My record is 8 separate attempts). The only time supplies were short was early in the pandemic when all supply chains were messed up.

[wyld_dandelyon]

When my partner was on warfarin, and needed regular blood draws to check clotting speed, she used to joke that it was her day to go in and flirt with the vampires.

Oh, speaking of that, I was so happy when they took her off that because it caused an unpleasant smell, faint but (to me) very noticeable. You might have your vampire avoid patients with certain types of blood draw because the medications they are on or the medical conditions they have make the blood less pleasant to drink and/or less nutritious for them.