She Draws a Lot of Needling

Salina Sullivan is charming and gregarious. But when she shows up in the doorways of patients’ rooms clutching her tray of supplies--a tourniquet, rubber gloves, test tubes and lots of needles--watch out for the scowling and cringing and name-calling. Not hers--theirs.

“Vampire!”

It’s all part and parcel of her job as a phlebotomist--better known as a blood drawer.

All day long, Sullivan, 20, visits patients’ rooms and the emergency department at Simi Valley Hospital to draw blood for testing. In an effort to make people less uncomfortable about it, she often plays on the vampire slur, as in “OK, the vampire’s gone!” as she scurries off to the next patient.

But she is mindful, too, of how fearful some patients are about needles. “Do it well,” pleads one of them, Oscar Montemayo. “I sometimes pass out.”

In general, Sullivan says, men are more squeamish about having blood drawn than women.

Children and the elderly often are a challenge, she says, regardless of gender. When dealing with children, “I get down to their level,” Sullivan says, lowering her petite frame to demonstrate. Once she’s made eye contact, “I tell them, ‘Make a muscle, like Popeye.’ ” She also uses a smaller needle on children.

The elderly, especially, can be “hard draws”--a phlebotomist’s term for someone whose blood does not flow easily. “Blown” veins--as in collapsing--are a blood drawer’s nightmare.

Sullivan’s most difficult cases, however, are folks with good veins and bad attitudes. That would describe one woman on this shift--an 84-year-old hoping to go home and whose doctor had just ordered a few more blood tests. As soon as the woman sees Sullivan and her supplies, she sets her jaw and draws back her arm.

“No,” the woman declares. “No more blood. Call the doctor’s office. He’s got gallons of it.”

Despite coaxing from Sullivan, the floor nurse, her assistant and even the woman’s roommate, the woman isn’t budging. Then help arrives unexpectedly: a maintenance worker pops in to empty the wastebaskets and the patient grouses to him: “They want to take blood.” With a disarming smile, he shoots back, “Let them.” And suddenly, this battle is over.

During this four-hour shift, Sullivan collects blood from 20 patients. During her usual eight-hour shift, which begins at 5 a.m., it’s common for her to take blood from about 50 patients.

As soon as it’s collected, she carts it carefully back to the lab, where she must be sure the tubes are correctly labeled. She also enters information in the computer about which tests have been completed. Next, the lab technicians take over, evaluating the tests and entering results in the same database.

Besides people skills and a strong stomach, phlebotomists need a head for details. They must keep straight which test is which, no easy task when working with so many patients and so many tests during a shift.

On this particular morning, Sullivan collects blood for a variety of tests, from blood counts to liver panels. Before drawing the blood, she must double-check to be sure a patient consent form is on file. And she must be sure to draw enough blood for each test so it can be properly done.

The chilling downside to the job, of course, is the risk of sticking oneself with a needle that has been used to draw blood from a patient infected with HIV, hepatitis or other diseases. Phlebotomy has been associated with 20 of the 51 documented cases of occupationally acquired HIV infection in the United States, according to a report published earlier this year in the federal Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The concern, according to Sullivan and her colleagues, motivates them to practice universal precautions such as always wearing gloves. Improvements in the design of needles and collection systems are helping reduce the risk, too.