Pre-hospital phlebotomy and point of care testing: Relevance and implications for professional emergency care practice

Abstract

The drawing or sampling of blood refers to the procedure whereby blood is obtained via arterial or venous cannulation from a patient for various diagnostic tests. The Health Professions Council of South Africa (HPCSA), Professional Board for Emergency Care (PBEC) scope of practice encompasses for what may be diagnostically possible for a person in an emergency situation. The HPCSA ethical rules stipulate that no professional act may be performed by emergency care personnel if it falls outside their scope of clinical practice. This implies an emergency context and the presence of criterion referenced guidelines (in the form of protocols) to support the safe implementation of scope. Phlebotomy may appear to be a simple and uncomplicated procedure for pre-hospital emergency care providers given that the intermediate and advanced categories can already perform intravenous therapy. However, any invasive procedure and human tissue sampling creates the potential for ethical compromise, particularly in vulnerable or high-risk patients. Therefore, various regulatory, clinical and system directives are needed in order for any invasive procedure to be effective, efficient, ethical and sustainable. This paper aims to provide a perspective on phlebotomy (applicable to all allied health professionals), with regard to regulation, clinical and system requirements against any claim of biomedical need. In the interest of accountable practice, a model of mitigation for the scope of clinical practice and a model for health technology regulation are presented. The emergency care context is presented as a case study. The relevance for the discipline of biomedical technology is that the determination of need, methodology and the bona fides (and experience) of the clinician has bearing on the admissibility, quality and ethics of phlebotomy. Phlebotomists are integral to the medical laboratory. The question this paper addresses is: what are the considerations for pre-hospital phlebotomy and point of care testing by emergency care providers should they undertake the role of the phlebotomist in emergency and non-emergency cases.