Phlebotomy is the removal of blood through the puncture of a vein. The history of phlebotomy has its roots in bloodletting to cure multiple ailments. Today, the removal of blood as a therapeutic intervention is limited to a few conditions, but phlebotomy is widely performed to obtain blood for laboratory tests.

The most common indication for phlebotomy is to obtain a blood sample for laboratory testing. In pediatrics, the most common therapeutic reasons for phlebotomy are to reduce the hematocrit in infants with polycythemia and to perform exchange transfusions in patients with sickle cell disease and hemolytic disease of the newborn.

There are virtually no absolute contraindications to phlebotomy. Relative contraindications are the existence of a bleeding disorder and severe anemia, but even in those circumstances, blood studies are needed for the evaluation of the patient. One should avoid drawing blood in areas where trauma or infection is a concern, and from surgically placed fistulas used for dialysis.

Table 194-1 lists the equipment needed for phlebotomy.