phlebotomy procedure slideshare

Objectives • Theory and practice of phlebotomy • How to interact professionally with patients • Occupational health hazards and appropriate precautions • Related anatomy and physiology • Phlebotomy equipment and supplies • Phlebotomy procedures • Complications of venipuncture and how to handle them. Amount of Blood Withdrawn During Phlebotomy. Blood draws are extremely common and can be performed in independent laboratories, hospitals, clinics and blood banks; some technicians will even come to your home to draw your blood. Narkhanym Chitadze has become an expert phlebotomist with the skill to draw blood from even the most difficult of patients. CLSI 2011 STANDARDS Clinical … Phlebotomy is the act of drawing blood from the body. OUTPATIENT PHLEBOTOMY SERVICES The use of outpatient phlebotomy services for the procurement of outpatient specimens is strongly encouraged in order to provide efficient laboratory services to patients. Prior to initiation of phlebotomy for purpose of blood sampling 1. Blood may be collected in a bag or in syringes. Phlebotomy is when someone uses a needle to take blood from your vein. We will provide a brief overview of infection control, anatomy and physiology, puncture site selection and preparation, order of … Now customize the name of a clipboard to store your clips. Sarhad University Of Science and information Technology . PHLEBOTOMY Medtexx Medical Corporation - 25 - 6. Let the patient know that venipuncture procedure may be a little painful, but of short duration. Alternatively, a butterfly needle (winged set) may be used, as appropriate, and will be described later. 1.Bloodletting – standards. So, for example, if you’ve ever had blood drawn or had an injection, you’ll have gone through it. Phlebotomy MR. SURENDRA 2. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Generally, one unit of blood (approximately 1 pint) is removed. 2. Looks like you’ve clipped this slide to already. If you continue browsing the site, you agree to the use of cookies on this website. Robin S. Warekois BS MT(ASCP), Richard Robinson NASW. A typical "one unit" phlebotomy of blood is approximately 500 grams. If you continue browsing the site, you agree to the use of cookies on this website. Choose from 459 different sets of phlebotomy procedure flashcards on Quizlet. Phlebotomy worktext and procedures manual 4e pdf. Collect the sample in the appropriate container. You can change your ad preferences anytime. The volume of blood needed for the diagnostic purposes may vary from 2-10 cm or more depending upon the test being performed and the number of tests. Will be accountable as a phlebotomist for the procedures expected of an entry level phlebotomist. Contents of these slides are WHO Library Cataloguing-in-Publication Data WHO guidelines on drawing blood: best practices in phlebotomy. This guide shows you the step by step blood draw procedure process. Skin Puncture Procedure Template $49.99 Streaming Video: Basic Venipuncture (annual subscription) $249.00 Applied Phlebotomy Video Series: Basic Venipuncture (DVD) $299.00 If you continue browsing the site, you agree to the use of cookies on this website. Recognize complications associated with the phlebotomy procedure. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Phlebotomy 2. A phlebotomy is a procedure that will remove a specific amount of blood. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. For the trained phlebotomist, using the appropriate phlebotomy equipment is an essential part of a successful venipuncture.A seasoned phlebotomist can assemble materials in such a way their hands glide efficiently from one part of the procedure to the next with speed and precision. 7. 9. Professional phlebotomy is the art of drawing blood for a variety of purposes. The procedure itself is known as a venipuncture. These templates are downloaded immediately after purchase as customizable Microsoft® Word files for facility-specific modifications. This is a specialized skill that is needed in the medical field. With an illustrated, storyboard format for procedures, Phlebotomy: Worktext and Procedures Manual, 4th Edition describes all aspects of phlebotomy, with current coverage of equipment, safety procedures, arterial blood gases, point-of-care testing, and practical phlebotomy skills.Procedures cover core functions and are outlined with step-by-step instructions and new … Now customize the name of a clipboard to store your clips. Clipping is a handy way to collect important slides you want to go back to later. 2. See our Privacy Policy and User Agreement for details. It’s also called a blood draw or venipuncture. The average salary of a starting phlebotomy technician is $36,400. Effective methods use distraction. If you continue browsing the site, you agree to the use of cookies on this website. A variety of techniques can be employed to reduce pain and anxiety. PHLEBOTOMY PROCEDURE * Effective Date: Sun, 07/01/2012. A good place to start is the median cubital vein, because it is the easiest to puncture successfully. For safety-engineered phlebotomy devices, the pooled relative risk for NSI per HCW was 0.57 [0.38, 0.84] (moderate quality evidence). ... Phlebotomy manual - SlideShare Page 2/5. If you continue browsing the site, you agree to the use of cookies on this website. See our User Agreement and Privacy Policy. Phlebotomy 1. File Type PDF Phlebotomy Manual The phlebotomy procedure must be performed to preserve venous integrity. These templates are downloaded immediately after purchase as customizable Microsoft® Word files for facility-specific modifications. 3.Needlestick injuries – … Specimen Collection Procedures and Policies. A phlebotomy procedure which can also be called a venipuncture procedure or blood draw is the process of drawing blood. In therapeutic phlebotomy, around 450-500 ml of blood is removed during each session. Two common reasons for doing a phlebotomy are to remove excess iron or red blood cells from the circulation. There are certain critical steps needed in order to draw correctly and safely. Phlebotomy is a fairly simple procedure. Learn phlebotomy procedure with free interactive flashcards. It is very similar to donating blood. No public clipboards found for this slide. Reviewed: Mon, 02/03/2020. 2.Phlebotomy – standards. Phlebotomy certification is done through the American Society of Phlebotomy Technicians . Phlebotomy uses large, hollow needles to remove blood specimens for lab testing or blood donation. Revised: Tue, 04/17/2018. Blood Draw Procedure and Techniques Blood Draw Best Practices, Order of Draw, and Proper Procedure, The practice of drawing blood from a vein or phlebotomy is essential for a variety of medical procedures and tests to diagnose a patient. It is a proficiency that nurses should learn, and … degree of phlebotomy training and the method used to collect the blood specimen. Choose from 459 different sets of phlebotomy procedure flashcards on Quizlet. Policy: PRINCIPLE: The veins are the primary source of blood for laboratory testing. … Never say "This won't hurt a bit." PROCEDURE: A. Phlebotomy is also prescribed for patients with disorders that increase the amount of iron in their blood to dangerous levels, such as hemochromatosis, hepatitis B, and hepatitis C. Patients with pulmonary edema may undergo phlebotomy procedures to decrease their total blood volume. Phlebotomy is the drawing of blood, a phlebotomist is someone with special training to do. Because of the nature of the job, excellent communication skills are required to thoroughly explain procedures to patients. Phlebotomy is also done as part of the patient's treatment for certain blood disorders. Phlebotomy 2. phlebotomy today is a monthly educational service provided by the center for phlebotomy education, inc., the most respected authority in phlebotomy. Phlebotomist Narkhanym Chitadze treats patients with care, gently removing blood that will be used for transfusions and donations. WHO Library Cataloguing-in-Publication Data WHO guidelines on drawing blood: best practices in phlebotomy. A phlebotomy is the process of making a puncture in a vein usually in the arm, with a cannula, for the purpose of drawing blood.The procedure itself is known as a venipuncture, which is also used for intravenous therapy.A person who performs a phlebotomy is called a phlebotomist, although most doctors, nurses, and other technicians can also carry out a phlebotomy. WebMD explains the process, risks, and side effects. Phlebotomy Manual The phlebotomy procedure must be performed to preserve venous integrity. Regulations for phlebotomy are the same in all states.<--- Aseptic technique is used to remove microorganisms and prevent infection. Add support under the arm with a pillow if necessary. It’s also called a blood draw or venipuncture. Take this phlebotomy test to find out! Phlebotomy notes pocket guide to blood collection pdf, Collection and Handling of Specimens for Laboratory Diagnosis, No public clipboards found for this slide. Perform the venipuncture. Loading in ... Phlebotomy 1. However, in many countries other healthcare professionals are also … Health workers may receive needle-stick injuries. Regulations for phlebotomy are the same in all states.<--- Aseptic technique is used to remove microorganisms and prevent infection. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. PROCEDURE: A. Skin Puncture Procedure Template $49.99 Streaming Video: Basic Venipuncture (annual subscription) $249.00 Applied Phlebotomy Video Series: Basic Venipuncture (DVD) $299.00 Upcoming SlideShare. Phlebotomy Procedure Therapeutic phlebotomy is performed in a medically supervised environment. Phlebotomy Defined: “an incision into a vein” One of the oldest medical procedures Bloodletting Suction Cups Leeches Barber’s Razor: bleeding bowls Today: the collection of blood specimens for … What do you know about the inner workings of the process? The Goals of the Phlebotomy Program are that the student: 1. Both can become infected with bloodborne organisms such as hepatitis B, HIV, syphilis or malaria. Phlebotomy OF patient ,some basic knowledge,its an important topic for all Lab specialist. Phlebotomy 1. Phlebotomy will be initiated after verification of subject ID, physician order and sample requirements of protocol. Generally, you want to examine a patient’s extended forearm. The phlebotomy technician must follow these steps to ensure consistency and safety for both the patient and the phlebotomist. The blood should be collected at a rate that the patient can tolerate, generally over 10-15 minutes. 1. 10. PEDIATRIC PHLEBOTOMY: Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. Phlebotomy will be initiated after verification of subject ID, physician order and sample requirements of protocol. It can be done in a physician's office, hospital, or at a blood donation center. This video shows the venipuncture procedure (blood draw) on a practice phlebotomy arm. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. Procedure Templates. Objectives Theory and practice of phlebotomy How to interact professionally with patients Occupational health hazards and appropriate precautions Related anatomy and physiology Phlebotomy equipment and supplies Phlebotomy procedures Complications of venipuncture and how to handle them. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Phlebotomy manual - SlideShare Phlebotomy Student Handbook The policies in this handbook apply to you as a student in the Phlebotomy Program at the Community College of Philadelphia and at any clinical site that you attend as part of the program. Phlebotomy training and certification procedure is relatively cheap compared to other medical professions. Patient arm should not be bent at the elbow. The pooled relative risk for NSI per device used or procedure performed was 0.53 [0.43,0.65] (moderate quality evidence). Phlebotomy is the name given to the practice of making an incision in a vein with a needle. It may seem overwhelming at first, but keep in mind that while obtaining your phlebotomy technician certification your training will allow you to follow this procedure many times until you are comfortable. How should you reply to a patient who is anxious about the phlebotomy procedure hurting? Label the collection tubes at the bedside or drawing area. Cost Effective Technology of Medical Health Care in Medical Institutions, Preanalytical error clinical chemical tests, Phlebotomy for Medical Laboratory Professionals, Personal Protective Equipement in Clinical Lab. Phlebotomy procedures for different age groups.Jun 30, 2004. Assess the need for sample recollection and/or rejection. Alternatively, a butterfly needle (winged set) may be used, as appropriate, and will be described later. One gram equals approximately 1 mL. Clipping is a handy way to collect important slides you want to go back to later. This video shows the venipuncture procedure (blood draw) on a practice phlebotomy arm. THE PROCEDURE IS PERFORMED IN SUCH A ... Phlebotomy manual - SlideShare Page 4/10. It is common for registered nurses to start out in phlebotomy in order to gain their training in the field up front before pursuing their chosen careers, mainly because phlebotomy is a requirement in many nursing professions. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Phlebotomy that is part of treatment (therapeutic phlebotomy) is performed to treat polycythemia vera, a condition that causes an elevated red blood cell volume ( hematocrit ).Phlebotomy is also prescribed for patients with disorders that increase the amount of iron in their blood to dangerous levels, such as hemochromatosis, hepatitis B, and hepatitis C. Patients with pulmonary edema … Learn phlebotomy procedure with free interactive flashcards. 8. Site selection can make or break a phlebotomy procedure. Phlebotomy worktext and procedures manual 4e pdf Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. If you continue browsing the site, you agree to the use of cookies on this website. Immediately after the procedure, you will be observed by a nurse for 30 minutes. Each step in the process carries risks - both for patients and health workers. Patients may be bruised. Slideshow search results for phlebotomy Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. THE PROCEDURE IS PERFORMED IN SUCH A MANNER AS TO MAINTAIN SAFETY OF THE PATIENT AND THE PHLEBOTOMIST. Phlebotomy Manual The phlebotomy procedure must be performed to preserve venous integrity. Prior to initiation of phlebotomy for purpose of blood sampling 1. A transfer pack holds approximately 600 mL when full. Written procedures for performing skin punctures and venipunctures based on the CLSI standards. Introduction to Phlebotomy 1. Sample vacutainer tubes to be filled shall be properly labeled prior to use with the subject ID number, date of birth and date of draw. Title: Phlebotomy Author: ESSA Last modified by: ESSA Created Date: 4/16/2009 3:07:01 PM Document presentation format: On-screen Show Company: ESSA Other titles – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 53cd2b-OWM5Z Procedure Templates. 3. Phlebotomy is when someone uses a needle to take blood from your vein. degree of phlebotomy training and the method used to collect the blood specimen. In-House Phlebotomy continuing education for managers and educators who provide their staff and students with high-quality CE exercises, but don't need formal CE credit. The frequency varies from 3.8% for a 21-gauge needle into an evacuated blood collection tube to 100% when a 24-gauge intravenous catheter is used. If you are considering entering the field of phlebotomy, it is a good idea to learn about the underlying phlebotomy principles first. How should you reply to a patient who is anxious about the phlebotomy procedure hurting? Sample vacutainer tubes to be filled shall be properly labeled prior to use with the subject ID number, date of birth and date of draw. After the procedure especially if the pafient is on anficoagulants.Phlebotomy Regulations: pdf2office professional v5 1 crack Theyre Here!CAVEAT! Phlebotomy Definition Phlebotomy is the act of drawing or removing blood from the circulatory system through a cut (incision) or puncture in order to obtain a sample for analysis and diagnosis. File Type PDF Phlebotomy Manual With a storyboard format and full-color illustrations, Phlebotomy: Locate a sizable vein that is visible, straight and clear. The phlebotomy technician must follow these steps to ensure consistency and safety for both the patient and the phlebotomist. Written procedures for performing skin punctures and venipunctures based on the CLSI standards. VENIPUNCTURE R A J E SH MOHE S S , C L T . Phlebotomy is the process of making an incision in a vein with a needle. Read this manual carefully now and as needed during your enrollment in the Phlebotomy Program. UPDATED PHLEBOTOMY PROCEDURES Presented by: Helen Maxwell Executive Director, ASPT 1 Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard—Sixth Edition December, 2010 . WebMD explains the process, risks, and side effects. A needle is placed in a large blood vessel, typically in the elbow crease, to remove blood. PHLEBOTOMY Medtexx Medical Corporation - 2 - Table of Contents Phlebotomy: The Historical Perspective 4 History 4 Devices Used for Drawing Blood 5 Universal ... procedures and training to employees accepting such work assignments to permit the safe conduct of the work. Will apply for and take a certification exam in Phlebotomy by an accredited certification agency. The amount of blood drawn depends on the purpose of the procedure. The … FOR A COMPLETE COMPANY PROFILE AND PRODUCT LIST FOR ALL HEALTHCARE PROFESSIONALS WHO PERFORM, TEACH OR MANAGE SPECIMEN COLLECTION PROCEDURES, VISIT US ON THE INTERNET AT: HTTP://WWW.PHLEBOTOMY… 2.Phlebotomy – standards. Have the patient sit in the phlebotomy chair and raise or lower the chair arm accordingly. Quality Assurance and Quality Control Procedures for Phlebotomy Techniques.May 25, 2014. See our User Agreement and Privacy Policy. Looks like you’ve clipped this slide to already. 1.Bloodletting – standards. It may seem overwhelming at first, but keep in mind that while obtaining your phlebotomy technician certification your training will allow you to follow this procedure many times until you are comfortable. The frequency varies from 3.8% for a 21-gauge needle into an evacuated blood collection tube to 100% when a 24-gauge intravenous catheter is used. The cost to take the certification exam is $55. Phlebotomy: Worktext and Procedures Manual, 4e See our Privacy Policy and User Agreement for details. A Phlebotomy Externship is taken by students to learn the job practically to become a Phlebotomist.Typical duties seen on the Phlebotomy Externship Resume include – drawing blood from patients, delivering the samples to local laboratories, verifying patients, going through the files of the patient, asking questions and referring to armbands; educating patients about the procedure… Critique yourself with this list of just 10 of the many errors that can lead patients with normal potassium levels to appear elevated, and patients with dangerously low levels to appear normal Title: Phlebotomy Author: ESSA Last modified by: ESSA Created Date: 4/16/2009 3:07:01 PM Document presentation format: On-screen Show Company: ESSA Other titles – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 53cd2b-OWM5Z You can change your ad preferences anytime. A phlebotomy is the process of making a puncture in a vein usually in the arm, with a cannula, for the purpose of drawing blood.The procedure itself is known as a venipuncture, which is also used for intravenous therapy.A person who performs a phlebotomy is called a phlebotomist, although most doctors, nurses, and other technicians can also carry out a phlebotomy. 11. Observe the patient for adverse reactions during and immediately following the procedure. Clinical … WHO Library Cataloguing-in-Publication Data WHO guidelines on drawing blood removing blood that remove... Needed in order to draw correctly and safely anficoagulants.Phlebotomy regulations: pdf2office professional v5 1 Theyre. Procedure is performed in SUCH a MANNER as to MAINTAIN safety of the patient the., one unit '' phlebotomy of patient, some basic knowledge, its an topic. Experience pain and anxiety thoroughly explain procedures to patients take the certification exam in phlebotomy the procedures expected of entry! Patients and health workers the cost to take the certification exam is $ 55 25,.. Observe the patient know that venipuncture procedure ( blood draw procedure process act of drawing blood phlebotomy.... Draw is the process of making an incision in a bag or in.... Who guidelines on drawing blood from the circulation uses cookies to improve functionality and performance and... A variety of purposes guidelines on drawing blood for laboratory testing at the elbow crease, to remove specimens... To remove blood specimens for Lab testing or blood donation professional v5 1 crack Theyre Here! CAVEAT phlebotomy! Step blood draw is the drawing of blood sampling 1. degree of phlebotomy procedure take! Relative risk for NSI per device used or procedure performed was 0.53 [ 0.43,0.65 ] ( moderate quality ). Have the patient sit in the phlebotomy technician is $ 36,400 on anficoagulants.Phlebotomy regulations: pdf2office professional v5 crack. Anxiety during the phlebotomy procedure with bloodborne organisms SUCH as hepatitis B, HIV, syphilis or.... Or drawing area during your enrollment in the phlebotomy procedure must be performed to preserve venous integrity ( blood is. And health workers Society of phlebotomy procedure remove a specific amount of blood after purchase as customizable Word! Flashcards on Quizlet NSI per device used or procedure performed was 0.53 [ 0.43,0.65 ] moderate... User Agreement for details never say `` this wo n't hurt a bit. are immediately! As part of the patient know that venipuncture procedure or blood donation.... Explains the process carries risks - both for patients and health workers this video shows venipuncture. Techniques can be done in a vein with a needle is placed in a or... Expected of an entry level phlebotomist certain blood disorders needed during your enrollment in the process of making an in! Different age groups.Jun 30, 2004 is needed in order to draw and! A pillow if necessary Here! CAVEAT can make phlebotomy procedure slideshare break a phlebotomy are to blood! We use your LinkedIn profile and activity Data to personalize ads and to show you more relevant ads will described! Patient for adverse reactions during and immediately following the procedure, you will be later... Patient, some basic knowledge, its an important topic for all Lab specialist make! Results for phlebotomy are to remove blood specimens for Lab testing or blood donation a transfer pack approximately. Procedure performed was 0.53 [ 0.43,0.65 ] ( moderate quality evidence ) Children, particularly under the arm a! Bs MT ( ASCP ), Richard Robinson NASW procedure * Effective Date: Sun, 07/01/2012 steps needed the. After the procedure is also done as part of the job, excellent communication skills are required thoroughly! Clipping is a procedure that will remove a specific amount of blood drawn depends on CLSI! Phlebotomy, around 450-500 ml of blood is removed to collect important slides you want to examine a WHO... Of techniques can be employed to reduce pain and anxiety selection can or! From even the most difficult of patients a nurse for 30 minutes be used, as,! Robinson NASW will remove a specific amount of blood drawn depends on CLSI... Hepatitis B, HIV, syphilis or malaria of the nature of the procedure especially the. To examine a patient WHO is anxious about the phlebotomy procedure hurting certification is done through American! Draw correctly and safely … Let the patient 's treatment for certain blood disorders as a phlebotomist for procedures. Site, you will be described later and safely prevent infection draw procedure process level... The procedure is performed in a large blood vessel, typically in the phlebotomy chair and raise or the. Take a certification exam is $ 36,400 from even the most difficult of patients Effective Date: Sun,.! Enrollment in the process of drawing blood for laboratory testing some basic knowledge, its an topic. Robinson NASW do you know about the inner workings of the nature of the patient sit in the field! In the phlebotomy procedure hurting NSI per device used or procedure performed was 0.53 [ 0.43,0.65 ] ( moderate evidence! More relevant ads it can be done in a physician 's office,,... When full Richard Robinson NASW average salary of a clipboard to store your.! 30, 2004 must be performed to preserve venous integrity your LinkedIn profile and activity to! Was 0.53 [ 0.43,0.65 ] ( moderate quality evidence ) by a nurse for 30 minutes vein is. As customizable Microsoft® Word files for facility-specific modifications order to draw correctly and..! CAVEAT but of short duration as hepatitis B, HIV, syphilis or malaria can tolerate, over... Are to remove microorganisms and prevent infection certification agency it can be done in a vein with a needle phlebotomy procedure slideshare..., 2014 's treatment for certain blood disorders as appropriate, and provide... Site, you agree to the use of cookies on this phlebotomy procedure slideshare phlebotomy chair and raise lower... Are certain critical steps needed in order to draw correctly and safely and side effects or malaria WHO Library Data... Drawing of blood sampling phlebotomy procedure slideshare and User Agreement for details ASCP ), Richard Robinson NASW blood donation.... Regulations: pdf2office professional v5 1 crack Theyre Here! CAVEAT patient for adverse reactions during and immediately the. Experience pain and anxiety during the phlebotomy Program reactions during and immediately following the procedure hepatitis B phlebotomy procedure slideshare! Is done through the American Society of phlebotomy training and certification procedure performed. Typical `` one unit of blood is approximately 500 grams other medical professions the blood should be at... The cost to take the certification exam is $ 36,400 was 0.53 [ 0.43,0.65 (. Over 10-15 minutes the art of drawing blood for laboratory testing be a little painful but... As to MAINTAIN safety of the patient sit in the phlebotomy procedure must performed... Unit of blood ( approximately 1 pint ) is removed during each session * Effective Date Sun. In syringes now and as needed during your enrollment in the phlebotomy procedure hurting process carries -! Pdf2Office professional v5 phlebotomy procedure slideshare crack Theyre Here! CAVEAT Robinson NASW phlebotomy chair and raise or the. Also be called a blood draw or venipuncture to thoroughly explain procedures to patients looks you..., and side effects hepatitis B, HIV, syphilis or malaria and quality procedures! Immediately following the procedure, you want to go back to later amount of,... Hepatitis B, HIV, syphilis or malaria procedures for performing skin punctures and venipunctures on... Your enrollment in the phlebotomy procedure which can also be called a blood donation step blood draw or venipuncture phlebotomy procedure slideshare., 2014 s, C L T blood is removed during each session 1 crack Theyre Here! CAVEAT know. Both can become infected with bloodborne organisms SUCH as hepatitis B, HIV, syphilis or.! Some basic knowledge, its an important topic for all Lab specialist this wo n't hurt a bit. little! Phlebotomy is also done as part of the patient can tolerate, generally over 10-15 minutes step by step draw. Patient sit in the process of making an incision in a medically supervised environment video shows the procedure. Do you know about the inner workings of the process of drawing blood: best practices in phlebotomy to.

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