THE FEAR FACTOR: APPROACHES ADMINISTERED BY MEDICAL

TECHNOLOGISTS TOWARDS TRYPANOPHOBIC PATIENTS DURING BLOOD

WITHDRAWAL

INTRODUCTION

Everyone has experienced getting their blood withdrawn or injection shots at least

a couple of times in their lifetime, not only in the Philippines, but also people of all ages

around the world. Even newborn infants get vaccinations regularly to boost their immunity

to certain diseases. However, even if one has already experienced getting these shots

multiple times, the physical and internal response of most patients to blood withdrawal

still remains the same: their hands tremble, face grows pale, heartbeat goes wild, body

tension increases as they become restless, and even some get dizzy or faint. This

indicates that most patients still get nervous or afraid at the sight and thought of blood,

needles, and blood withdrawal in varying degrees – a condition also known as

trypanophobia or the fear of needles.

Matthews (2011) has also stated in his study that some patients neglect receiving

health care due to the main reason of the prevalence of fear of needles. Even in the local

setting of Batac, there are a group of people who display symptoms of distress whenever

they have to get their blood collected. Handling patients like these require vital knowledge

and background on the part of the phlebotomist or medical technologist to avoid risks and

complications during the procedure. Doing so would be beneficial to both health worker

and patient.

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Nature of the Work of Medical Technologists

The job description of medical laboratory technologists includes performing a

variety of laboratory tests and procedures to assist physicians in diagnosing, monitoring,

treating and preventing disease. These tests have a wide range of areas; blood banking,

chemistry, hematology, immunology, and microbiology” (Medical Laboratory

Technologist, 2012) in a “laboratory environment that optimizes patient safety with

minimal medical/health care errors. Aside from these, they also perform routine

phlebotomy services as needed” (Medical Technologist, 2012).

To be a successful medical technologist or phlebotomist, practical and relevant

knowledge, skills, and abilities should be acquired. These include knowledge of medical

technology services and strong organizational and interpersonal skills (Medical

Technologist, 2012). Furthermore, medical technologists who perform phlebotomy must

have the physical proficiency to master practical and procedural parts necessary to carry

out phlebotomy techniques while keeping the patient safe. Competent energy and

endurance is also needed as the job involves sitting or standing for a long period of time

(Bellingham Technical College [BTC], n.d.).

Communicating effectively with patients is another must, including appropriate

information-gathering, explaining and interpreting medical information in a patient-

centered manner, listening well, distinguishing and responding to feelings, and exhibiting

sensitivity to social and cultural differences (BTC, n.d.).

In addition to this, the National Center for O*NET Development (2011) also

published a list of essential skills and abilities to be in the said profession:

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 Table 1. List of Skills and Abilities Required.
Skills
 Active Listening  Speaking
 Critical Thinking  Instructing Judgment and Decision
 Reading Comprehension Making
 Science Operation Monitoring  Time Management
 Active Learning  Writing
 Complex Problem Solving  Coordination Mathematics
 Monitoring  Service Orientation
 Quality Control Analysis  Social Perceptiveness

Abilities
 Near Vision  Selective Attention
 Written Comprehension  Speech Clarity
 Inductive Reasoning  Speech Recognition
 Oral Comprehension  Visual Color Discrimination
 Deductive Reasoning  Far Vision
 Information Ordering  Finger Dexterity
 Problem Sensitivity  Manual Dexterity
 Category Flexibility  Mathematical Reasoning
 Oral Expression  Number Facility
 Arm-Hand Steadiness  Perceptual Speed
 Control Precision  Speed of Closure
 Flexibility of Closure  Visualization
 Written Expression

As for the physical requirements and environmental conditions, medical

technologists work during irregular hours and including call hours. It is physically

exhausting since the job involves pushing and pulling hefty objects, a handful of full-body

motions which include “reaching, bending, stooping, and handling objects with hands

and/or fingers, talking and/or hearing, and seeing”. Aside from these, the job is situated

in a stressful setting where the is risk of “exposure to blood and body fluids, communicable

diseases, chemicals, radiation, and repetitive motions” which is why necessary protocols

should be followed to avoid complications which may affect medical technologists’ job

performance (Medical Technologist, 2012).

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 These requirements and work environmental conditions are considerable since we

have established that professionals from this line of work perform blood banking,

chemistry, hematology, immunology, and phlebotomy services.

Phlebotomy and Venepuncture

Taking a look at its background, phlebotomy is the procedure of drawing blood

from patients for laboratory testing which has been practiced for ages and is still

considered to be “one of the most common invasive procedures in health care”. During

the procedure, the well-being of health workers and patients are prioritized which is why

“guidance for staff on best practice is critical”.

Blood sampling is most-commonly used for “laboratory tests for clinical

management and health assessment”. Blood collection, on the other hand, is used to

“obtain blood from donors for various therapeutic purposes” (Dhingra et al., 2010).

In a study conducted by Buowari (2013), venepuncture is defined as the “act of

puncturing the vein for giving a drug or removal of blood” which is considered as the “most

common invasive medical procedure performed by health care workers”. In this

procedure, the health care provider should communicate with the patient effectively and

implement best phlebotomy practice to avoid grave complications that could put the

patient in risk. McFarland & Grant (1982) also stated in their book that patients should

also know how and why their blood is to be collected and that they would feel an

uncomfortable sting as the needle is inserted. Below is an illustration about the best

practice and procedures in phlebotomy:

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Figure 1. Venepuncture in Adults (Dingra et al., 2010).

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Complications During Blood Withdrawal

When best practice in phlebotomy or venepunture is not implemented, several

complications during the blood withdrawal could arise. Hematoma is caused when

inflammation occurs around the puncture spot which indicates that blood is seeping to the

tissues (Buowari, 2013). Community Hospital Anderson (n.d.) stated that:

When the area around the puncture site starts to swell, this usually indicates that

blood is leaking into the tissues causing a hematoma. This can happen when the

needle has gone completely through the vein, the bevel opening is partially in the

vein, or when no enough pressure is applied to the site after puncture. If a

hematoma begins to form, the tourniquet and needle should be removed as quickly

as possible and pressure should be applied to the site.

Fainting or syncope is a complication caused because of the “rapid fall in the blood

pressure and it is an autonomic nervous system reaction (psychomatic trigger) usually

based on fear. Syncope and fainting can procure during venipuncture” (Buowari, 2013).

Some factors which causes the health care provider to “miss the vein” and fail to

draw blood include “not inserting the needle deep enough, inserting the needle all the

way through the vein, holding the needle bevel against the vein wall, or losing the vacuum

in the tube”. During the procedure, the phlebotomists finger can be used to help detect

where the vein is located. In cases like this, transferring and or withdrawing the needle

may be needed to position it correctly (Community Hospital Anderson [CHA], n.d.,).

Petechiae occurs due to “coagulation problems or abnormalities” which may cause

the puncture site to bleed excessively after the phlebotomist collects blood. If this occurs,

the patient should not be left unattended until the bleeding ceases (Buowari, 2013).

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 Edema, on the other hand, “is the abnormal accumulation of fluids in the

intercellular spaces of the body and it can be localized or diffused. Collection of blood

should be avoided from these sites, which will contaminate specimen with tissue fluid”

(Buowari, 2013). Obesity usually hinders the health care providers to locate and examine

the veins of the patient. Phlebotomists must “phlebotomist must be careful not to probe

excessively with the needle because it causes rupture of RBC’s, increased concentration

of intracellular contents, and releases some tissue clotting factors” (CHA, n.d.).

Damaged, sclerosed, and occluded veins may also obstruct procedure. When

the vein is blocked, blood does not pass through which makes it unsuitable for the site

of venipuncture. On the other hand, “sclerosed or hardened veins are a result of

inflammation and disease of the interstitial substances” while scarring occurs when the

patient’s vein is punctured repetitively.

Another complication that may arise is haemoconcentration. “It can be caused by

prolonged tourniquet application, massaging, squeezing or probing a site, long-term

intravenous fluid therapy, scleroses or occluded veins, dehydration and certain diseases”

(Buowari, 2013). Veins in burned or scarred areas are difficult to examine. These are

delicate and prone to infections which is why these areas should not be punctured during

blood withdrawal (CHA, n.d.).

Additionally, cleaning the puncture site before and after the procedure should

always be practiced to avoid infection which can lead to the formation of phlebitis and

thrombus formation. To prevent this complication, the phlebotomist must always observe

good sanitation in the location where they perform phlebotomy as well as the patient’s

puncture site (Buowari, 2013).

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 In addition to these complications, nerve damage is a rare venepuncture

complication that could pose as a serious risk to the patient. This is may be caused when

the phlebotomist punctures the site multiple times or can be obtained when hematoma

forms. It is extremely painful and patient’s may feel “sharp electric feeling when a nerve

is hit.” If the patient express severe pain, the procedure should be stopped immediately.

Extravasations occur when a cannula pulls out of the vein or becomes partly

occluded by venous construction causing backflow of the infusate through the

puncture site into the surrounding tissues. The patient may complain if tightness,

burning and discomfort around the intravenous site and there may be swelling and

blanching of the tissues. In extravagation, the cannula enters the tissues rather

than the vein. In this condition, flushing will be difficult and swelling/pain may be

noted the cannula should be removed immediately.

Patients who have fear or phobia of needles also tend to suddenly move during

phlebotomy which may cause the needle to hit an artery instead of the vein. In cases like

this, the needle should be withdrawn and pressure should be applied to the puncture site.

Thrombosis may also arise during blood withdrawal if proper procedure is not

administered. “Thrombus is a solid mass derived from blood clot constituents in the

vessels that is a clot. Thrombus may partially or fully occlude a vein or artery making

venepuncture difficult” (Buowari, 2013).

In some cases, phlebotomists may puncture an artery instead of the vein which is

a complication also known as arterial puncture. The procedure should be immediately

stopped and pressure should be applied to the puncture site. It is a given that blood

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withdrawal will make the patient uncomfortable to some degree. However, if the patient

complains about uneasiness and extreme pain, the procedure should be stopped at once

Some patients may also be allergic to the solutions or the substances used to

disinfect the puncture site therefore it is necessary to ask the patient if they have a

particular allergy that could cause complications during the phlebotomy first. Furthermore,

“when large volumes of blood are withdrawn from the patient for laboratory tests, this

complication may occur. Iatrogenic Anemia is common in infants” (Buowari, 2013).

Strategies and Best Practices in Phlebotomy

To avoid the above-mentioned complications that can occur during phlebotomy,

strategies and best practices implemented in blood withdrawal. First, the medical

technologist or phlebotomist should plan ahead. Planning ahead even before phlebotomy

starts is the most vital part of performing any procedure (Dhingra et al., 2010). Aside from

this, they should use and provide an appropriate location for the procedure. Dingra et. al

(2010) stated that:

The phlebotomist should work in a quiet, clean, well-ventilated area, whether

working with outpatients or inpatients. In an outpatient department or clinic, provide

a dedicated phlebotomy cubicle containing: (1) a clean surface with two chairs (one

for the phlebotomist and the other for the patient); (2) a hand wash basin with soap,

running water and paper towels; and (3) alcohol hand rub. In the blood-sampling

room for an outpatient department or clinic, provide a comfortable reclining couch

with an arm rest. On the other hand, in inpatient areas and wards, these should be

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 applied: (1) at the patient’s bedside, close the bed curtain to offer privacy; and (2)

ensure that blood sampling is done in a private and clean manner.

During the procedure, these strategies must be followed to prevent and control

infection.

Table 2. Infection Prevention and Prevention Practices.

From these, it can be deduced that trypanophobia or the fear of needle is relatively

prevalent in the country which could cause potential risk as well as distress to the patient.

However, studies on this subject are only minimal; thus, this research is conducted to

determine how to manage these kinds of patients.

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Main Problem

This study investigates the approaches administered by Medical Technologists

towards trypanophobic patients during blood withdrawal. It seeks to answer the following

specific sub questions:

1. How do medical technologists administer the different approaches towards

trypanophobic patients during blood withdrawal?

2. What are the common characteristics of trypanophobic patients?

Significance of the Study

This study would be beneficial to the following:

Medical Technologists. The results of this research would help widen their

knowledge about the different approaches or tactics that could be administered towards

trypanophobic patients during blood withdrawal. They would be able to identify

characteristics of patients with trypanophobia that would help them handle the situation

more effectively and logically. This would allow them to perform blood withdrawal more

successfully.

Hospital Administrators. This study would help hospital administrators guide

their Medical Technologists in general on how they approach trypanophobic patients. It

would also improve blood collection for laboratory tests and from blood donors, thus

making the hospitals be more prestigious for their excellency in handling patients with

said phobia.

Trypanophobic Patients. Utilizing the knowledge about the different approaches

or tactics that could be administered by medical technologists towards trypanophobic

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patients during blood withdrawal would substantially reduce the risks to both patients and

staff, and would improve blood collection for laboratory tests and from blood donors.

Complications in blood withdrawal would also be avoided due to the preparedness and

keen eye of medical technologists performing the phlebotomy.

Future researches. Future researchers would be able to use this study as a

reference for future researches related to the topic. This research also serves as an

additional knowledge to come up with new information and ideas in the same field.

Scope and Limitations

It focuses on the approaches administered by Medical Technologists towards

trypanophobic patients during blood withdrawal. It also focuses on the characteristics of

patients with trypanophobia and the different approaches administered by medical

technologists towards the patients.

This is a qualitative research in which the researcher will use guide questions in

the interviews for the data-gathering. An interview code will also be used for the interview

with the 4 informants.

This study will be conducted in the City of Batac, Ilocos Norte during the months

June to August, 2017.

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 THE FEAR FACTOR: APPROACHES ADMINISTERED BY MEDICAL

TECHNOLOGISTS TOWARDS TRYPANOPHOBIC PATIENTS DURING BLOOD

WITHDRAWAL

Caballero, Mary Grace S.

Practical Research 1

July 2017

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