Chapters 1 and 2

Copyright © 2011 F.A. Davis Company

THE PHLEBOTOMY TEXTBOOK, THE PHLEBOTOMY TEXTBOOK, THIRD THIRD EDITIONEDITION

Phlebotomy and the Health-Care Delivery System

Chapter 1

The Clinical Laboratory

Chapter 2



Chapter 1: Learning Objectives

1. State the traditional and expanding duties of the phlebotomist.2. Describe the professional characteristics that are important for a

phlebotomist.3. Discuss the importance of communication and interpersonal skills

for the phlebotomist within the laboratory, with patients, and with personnel in other departments of the hospital.

4. State and describe the three components of communication.5. List the barriers to communication and methods to overcome

them.



Chapter 1: Learning Objectives (cont.)

6. Describe a phlebotomist using correct listening and body language skills.

7. State six rules of proper telephone etiquette.8. Define cultural diversity and discuss the actions needed by a

phlebotomist when encountering cultural diversity.9. State the competencies expected of a certified phlebotomist.10. Describe the functions of the nursing, support, fiscal, and

professional hospital service areas and the functions of the departments contained in these services.

11. Describe the different types of health-care settings in which a phlebotomist may be employed.



Key Terms accreditation alternative medicine certification confidentiality continuing education cross-training cultural diversity

decentralization diagnostic-related

groups (DRGs) phlebotomy professionalism samples specimens zone of comfort



History of Phlebotomy “Phleb”-vein “-otomy”-incision Phlebotomy, defined

Incision into a vein One of the oldest medical procedures

Blood-letting Devices Leeches

Significance of “barber pole” Therapeutic phlebotomy



Role of the Phlebotomist Collection of blood specimens for laboratory

analysis Has become a specialized area of clinical

laboratory practice Key player, no longer someone who just

“takes blood” Expanded role



Traditional Duties and Responsibilities

Correct identification of the patient prior to sample collection Collection of the appropriate amount of blood by venipuncture

or dermal puncture for the specified tests Selection of the appropriate specimen containers for the

specified tests Correct labeling of all samples with the required information Appropriate transportation of samples back to the laboratory in

a timely manner Effective interaction with patients and hospital personnel



Other Important Duties Processing of samples for delivery to the

appropriate laboratory departments Performance of computer operations and record

keeping pertaining to phlebotomy Observation of all safety regulations, quality

control checks, and preventive maintenance procedures

Attendance at continuing education programs



Changes in Phlebotomy

Changes in health-care delivery Efficiency and cost effectiveness Patient-focused care Cross-training Decentralization of phlebotomy services



Changes in Phlebotomist Duties Additional Duties

Training other health-care personnel to perform phlebotomy Monitoring the quality of samples collected on the units Evaluating protocols associated with sample collection Performing basic bedside laboratory tests Performing electrocardiograms Performing measurement of patient’s vital signs Collecting arterial blood samples (see Chapter 14) Collection of samples from central venous access devices

([CVADs]; see Chapter 11)



Professional and Personal Characteristics for Phlebotomists

Service-oriented industry

Phlebotomists are the “face of the laboratory”



Professional and Personal Characteristics for Phlebotomists

Dependable Cooperative Committed Compassionate Courteous Respectful

Honest Integrity Competence Organized Responsible Flexible



Appearance Guidelines Clean and unwrinkled clothing Clean, appropriate footwear Conservative jewelry and makeup Perfume/cologne not recommended Hair/facial hair clean, neat, and trimmed

Long hair pulled back Proper personal hygiene Proper fingernail length and maintenance

No artificial nails (Center for Disease Control guidelines)



Communication Skills for the Phlebotomist

Verbal skills Listening skills Nonverbal skills Body language



Verbal Skills Verbal barriers

Hearing impairment Emotional level Patient education level Age Language barriers Medications Health status



Verbal Communication Barriers



Listening Skills Active listening

Looking directly at the patient Allowing patient time to express feelings Allowing the patient time to describe why they are

concerned Providing feedback to the patient through

appropriate responses Encouraging patient communication by asking

questions



Nonverbal Communication Positive body language

Smiling Eye contact Display confidence

Negative body language Shuffling No eye contact Acting distracted



Zone of Comfort



Cultural diversity

Customs Beliefs Religion Values



Cultural Diversity Guidelines Smile and use a friendly tone of voice. Be alert to patients reactions. Do not stereotype. Be mindful of personal space. Take time to explain procedures.

Make sure instructions are understood. Show respect for their diversity.



Telephone Skills Telephone manners

Promptness Politeness

Transferring calls Attempt to help first, give patient transfer number

Provide accurate information Placing calls on hold

Check for emergency Speak clearly

Ask for read-back of information provided Read-back National Patient Safety Goal



Importance of Phlebotomy Education

Structured programs—Combining classroom (didactic) with clinical practice Hospitals Community college Technical institutions

Use national training guidelines National Accrediting Agency for Clinical Laboratory

Sciences (NAACLS)



NAACLS Phlebotomy Competencies

Knowledge of the health-care system and medical terminology

Knowledge of infection control Knowledge of basic anatomy and physiology and

anatomic terminology related to the laboratory and the pathology of body systems

Understanding of the importance of sample collection and integrity for patient care



NAACLS Phlebotomy Competencies

Knowledge of collection equipment, tube additives, special precautions, and interfering substances associated with laboratory tests

Performance of standard operating procedures in collecting samples

Understanding of requisitions, sample transport, and sample processing

Understanding of quality assurance and quality control in phlebotomy

Use of effective and appropriate communication skills



Phlebotomy Education and Certification

Certification requirements Certification examinations

Computer adaptive testing Professional organization membership Continuing education

Required for licensure Maintain certification



Phlebotomy Certifying Organizations

American Society for Clinical Pathology (ASCP) American Medical Technologists (AMT) American Society of Phlebotomy Technicians

(ASPT) National Phlebotomy Association (NPA) National Healthcareer Association (NHA)



Phlebotomist Certification



Continuing Education Required for licensure

Licensure in only two states Louisiana California

Maintain certification ASCP-Certified Maintenance (CM)

Requires nine Certified Maintenance Points per 36-month cycle



Health-Care Delivery System Employment settings

Hospital Physician office laboratories (POL) Health maintenance organizations (HMO) Reference laboratories Urgent care centers Nursing homes Home health-care agencies Blood donor centers



Hospital Patient Care Areas



Hospital Organization



Hospital Services

Nursing Services--Direct patient care Support Services--Maintain the physical

hospital building and services Fiscal Services--Business management of

hospital services Professional Services--Assist in diagnosis and

treatment of disease



Nursing Services Cardiac Care Unit (CCU), Emergency Department

(ED), Intensive Care Unit (ICU), Nursery, and Operating Room (OR)

Health-care Members Registered Nurse (RN) Licensed Practical Nurse (LPN) Certified Nursing Assistant (CNA) Unit clerk Surgical technologist



Support Services Food service Grounds care Housekeeping Human Resources

Laundry Maintenance Purchasing Security



Fiscal Services

Accounting Admitting Business office Credit and collection Data processing Medical records



Professional Services Radiology

X-ray CT scans MRI

Radiation therapy Cancer treatment

Nuclear medicine Organ scans Laboratory tests

Occupational therapy (OT) Daily living functions

Pharmacy Medications



Professional Services Physical therapy (PT)

Treatments Respiratory therapy

Breathing disorders

Cardiovascular testing ECGs Stress Tests Imaging

Clinical laboratory Diagnostic testing



Other Health-Care Settings Physician office laboratories (POLs) and group

practices Health maintenance organizations (HMOs) Reference laboratories Government- and hospital-sponsored clinics

Specialty clinics Wellness clinics Alternative medicine clinics

Home health care



Chapter 2: Learning Objectives1. Describe the qualifications and functions of the

personnel employed in a clinical laboratory.2. Discuss the basic functions of the hematology,

chemistry, blood bank, serology/immunology, microbiology, and urinalysis sections.

3. Describe the appropriate collection and handling of specimens analyzed in the individual clinical laboratory sections.

4. Identify the most common tests preformed in the individual clinical laboratory sections, and state their functions.



Laboratory Organizational DivisionsDepartment of Pathology

Anatomical Cytology

Cytologic specimens Pap smears

Histology Surgical specimens Frozen sections Biopsies Autopsies

Cytogenetics Genetic testing



Laboratory Organizational DivisionsDepartment of Pathology (con’t.)

Clinical Hematology/Coagulation Chemistry Blood Bank Serology Microbiology Urinalysis Phlebotomy Specimen processing Laboratory Information System (LIS)



Clinical Laboratory Organizational Chart



Clinical Laboratory Personnel Organization Chart



Laboratory Management• Laboratory Director (Pathologist)

– Credentials• Medical doctor (MD)

– Functions• Anatomic pathology• Clinical pathology

• Laboratory Manager (Administrator)– Credentials

• Master’s degree and 5 or more years of laboratory experience– Functions

• Technical and administrative management



Clinical Laboratory Personnel

Technical Supervisor MLS/specialty certification Accountable to the laboratory manager Responsible for operational functions in specific

laboratory departments



Clinical Laboratory Personnel Medical Laboratory Scientist (MLS)

Bachelor of science degree (4 year) Performs laboratory testing requiring independent judgment Minimal supervision

Medical Laboratory Technician (MLT) Associate degree (2 year) Performs laboratory testing by protocol under supervision

Phlebotomist (PBT) High school diploma

Phlebotomy training program Sample collection and processing



Additional Laboratory Personnel

Laboratory assistant Education coordinator Point-of-care (POC) coordinator LIS manager Quality assessment coordinator



Hematology--Key Terms

anemia anticoagulant leukemia plasma serum



Hematology The study of the formed

(cellular) elements of the blood for the purpose of making a diagnosis.



Tests Performed in the Hematology Section



Coagulation Process of hemostasis is

evaluated Often part of the

hematology department



Tests Performed in Coagulation



Sample Collection and Handling Whole blood (EDTA) Plasma (liquid portion

of nonclotted blood) Serum (liquid portion

of clotted blood)



Chemistry Section Clinical chemistry is

high tech with automated instruments and computers that are designed to work with small volume of specimen.



Chemistry--Key Terms centrifuge electrolytes electrophoresis enzyme hemolyzed icteric

immunochemistry lipemic toxicology



Overview of Clinical Chemistry Section

Automated chemistry (core lab) Electrophoresis Toxicology Immunochemistry

Radioimmunoassay Enzyme immunoassay



Sample Collection and Handling Serum (SST tubes)

Plasma (heparin) Urine Other body fluids Centrifugation Special handling



Tests Performed in Chemistry Section



Chemistry Profiles



Blood Bank Section The blood bank or

immunohematology is the section of the laboratory where blood is collected, stored, and processed for transfusion.



Blood Bank--Key Terms antibody antigen blood group compatibility

(cross-match)

cryoprecipitate fresh-frozen plasma immunohematology packed cells unit of blood



Sample Collection and Handling Proper identification is

critical!! Lavender top (EDTA) Pink top (EDTA with

special labeling) Red top (non-additive) Serum separator tubes

are not acceptable



Tests Performed in the Blood Bank



Serology Section The serology (immunology) section performs

tests to evaluate the body’s immune response. It analyzes for the presence of antibodies

produced against foreign antigens and antibodies produced against oneself (autoantibody).

No serum separator tubes Interference with antigen/antibody reactions



Serology--Key Terms

autoimmunity immunoglobulin immunology serology



Tests Performed in Serology



Microbiology Section Bacteriology Mycology Parasitology Virology Procedures

Cultures Stains Microscopic examination Biochemical reactions



Microbiology--Key Terms bacteria bacteriology culture and sensitivity Gram stain microbiology

microorganism mycology parasitology virology



Sample Collection and Handling Blood (Phlebotomy collection)

May have to handle or transport Urine Throat Sputum Genitourinary tract Wounds Cerebrospinal fluid Feces



Tests Performed in Microbiology



Urinalysis Urinalysis is a routine

screening procedure to detect disorders and infections of the kidney and to detect metabolic disorders such as diabetes mellitus and liver disease.

May be part of hematology or chemistry



Urinalysis--Key Terms cast first morning sample glycosuria hematuria hemoglobinuria

ketonuria proteinuria reagent strip (dipstick) urinalysis



Collection and Handling

Give instructions for: First morning sample Random sample 24-hour sample

Delivery of these samples to the laboratory



Tests Performed in Urinalysis



Urine Analyzer

Chapters 1 and 2

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Transcript of Chapters 1 and 2