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  • 1. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Phlebotomy and the Health-Care Delivery System Chapter 1 The Clinical Laboratory Chapter 2 Copyright © 2011 F.A. Davis Company
  • 2. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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. Copyright © 2011 F.A. Davis Company
  • 3. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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. Copyright © 2011 F.A. Davis Company
  • 4. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Key Terms  accreditation  decentralization  alternative medicine  diagnostic-related  certification groups (DRGs)  confidentiality  phlebotomy  continuing education  professionalism  cross-training  samples  cultural diversity  specimens  zone of comfort Copyright © 2011 F.A. Davis Company
  • 5. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 6. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 7. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 8. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 9. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Changes in Phlebotomy  Changes in health-care delivery  Efficiency and cost effectiveness  Patient-focused care  Cross-training  Decentralization of phlebotomy services Copyright © 2011 F.A. Davis Company
  • 10. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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) Copyright © 2011 F.A. Davis Company
  • 11. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Professional and Personal Characteristics for Phlebotomists  Service-oriented industry  Phlebotomists are the “face of the laboratory” Copyright © 2011 F.A. Davis Company
  • 12. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Professional and Personal Characteristics for Phlebotomists  Dependable  Honest  Cooperative  Integrity  Committed  Competence  Compassionate  Organized  Courteous  Responsible  Respectful  Flexible Copyright © 2011 F.A. Davis Company
  • 13. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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) Copyright © 2011 F.A. Davis Company
  • 14. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Communication Skills for the Phlebotomist  Verbal skills  Listening skills  Nonverbal skills  Body language Copyright © 2011 F.A. Davis Company
  • 15. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Verbal Skills  Verbal barriers  Hearing impairment  Emotional level  Patient education level  Age  Language barriers  Medications  Health status Copyright © 2011 F.A. Davis Company
  • 16. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Verbal Communication Barriers Copyright © 2011 F.A. Davis Company
  • 17. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 18. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Nonverbal Communication  Positive body language  Smiling  Eye contact  Display confidence  Negative body language  Shuffling  No eye contact  Acting distracted Copyright © 2011 F.A. Davis Company
  • 19. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Zone of Comfort Copyright © 2011 F.A. Davis Company
  • 20. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Cultural diversity  Customs  Beliefs  Religion  Values Copyright © 2011 F.A. Davis Company
  • 21. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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. Copyright © 2011 F.A. Davis Company
  • 22. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 23. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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) Copyright © 2011 F.A. Davis Company
  • 24. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 25. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 26. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Phlebotomy Education and Certification  Certification requirements  Certification examinations  Computer adaptive testing  Professional organization membership  Continuing education  Required for licensure  Maintain certification Copyright © 2011 F.A. Davis Company
  • 27. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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) Copyright © 2011 F.A. Davis Company
  • 28. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Phlebotomist Certification Copyright © 2011 F.A. Davis Company
  • 29. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 30. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 31. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Hospital Patient Care Areas Copyright © 2011 F.A. Davis Company
  • 32. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Hospital Organization Copyright © 2011 F.A. Davis Company
  • 33. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 34. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 35. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Support Services  Food service  Laundry  Grounds care  Maintenance  Housekeeping  Purchasing  Human Resources  Security Copyright © 2011 F.A. Davis Company
  • 36. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Fiscal Services  Accounting  Admitting  Business office  Credit and collection  Data processing  Medical records Copyright © 2011 F.A. Davis Company
  • 37. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Professional Services  Radiology  Occupational therapy  X-ray (OT)  CT scans  Daily living functions  MRI  Pharmacy  Radiation therapy  Medications  Cancer treatment  Nuclear medicine  Organ scans  Laboratory tests Copyright © 2011 F.A. Davis Company
  • 38. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Professional Services  Physical therapy (PT)  Cardiovascular testing  Treatments  ECGs  Respiratory therapy  Stress Tests  Breathing disorders  Imaging  Clinical laboratory  Diagnostic testing Copyright © 2011 F.A. Davis Company
  • 39. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 40. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Chapter 2: Learning Objectives 1. 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. Copyright © 2011 F.A. Davis Company
  • 41. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Laboratory Organizational Divisions Department of Pathology  Anatomical  Cytology  Cytologic specimens  Pap smears  Histology  Surgical specimens  Frozen sections  Biopsies  Autopsies  Cytogenetics  Genetic testing Copyright © 2011 F.A. Davis Company
  • 42. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Laboratory Organizational Divisions Department of Pathology (con’t.)  Clinical  Hematology/Coagulation  Chemistry  Blood Bank  Serology  Microbiology  Urinalysis  Phlebotomy  Specimen processing  Laboratory Information System (LIS) Copyright © 2011 F.A. Davis Company
  • 43. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Clinical Laboratory Organizational Chart Copyright © 2011 F.A. Davis Company
  • 44. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Clinical Laboratory Personnel Organization Chart Copyright © 2011 F.A. Davis Company
  • 45. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 46. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Clinical Laboratory Personnel  Technical Supervisor  MLS/specialty certification  Accountable to the laboratory manager  Responsible for operational functions in specific laboratory departments Copyright © 2011 F.A. Davis Company
  • 47. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 48. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Additional Laboratory Personnel  Laboratory assistant  Education coordinator  Point-of-care (POC) coordinator  LIS manager  Quality assessment coordinator Copyright © 2011 F.A. Davis Company
  • 49. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Hematology--Key Terms  anemia  anticoagulant  leukemia  plasma  serum Copyright © 2011 F.A. Davis Company
  • 50. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Hematology  The study of the formed (cellular) elements of the blood for the purpose of making a diagnosis. Copyright © 2011 F.A. Davis Company
  • 51. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Tests Performed in the Hematology Section Copyright © 2011 F.A. Davis Company
  • 52. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Coagulation  Process of hemostasis is evaluated  Often part of the hematology department Copyright © 2011 F.A. Davis Company
  • 53. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Tests Performed in Coagulation Copyright © 2011 F.A. Davis Company
  • 54. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Sample Collection and Handling  Whole blood (EDTA)  Plasma (liquid portion of nonclotted blood)  Serum (liquid portion of clotted blood) Copyright © 2011 F.A. Davis Company
  • 55. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Chemistry Section  Clinical chemistry is high tech with automated instruments and computers that are designed to work with small volume of specimen. Copyright © 2011 F.A. Davis Company
  • 56. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Chemistry--Key Terms  centrifuge  immunochemistry  electrolytes  lipemic  electrophoresis  toxicology  enzyme  hemolyzed  icteric Copyright © 2011 F.A. Davis Company
  • 57. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Overview of Clinical Chemistry Section  Automated chemistry (core lab)  Electrophoresis  Toxicology  Immunochemistry  Radioimmunoassay  Enzyme immunoassay Copyright © 2011 F.A. Davis Company
  • 58. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Sample Collection and Handling  Serum (SST tubes)  Plasma (heparin)  Urine  Other body fluids  Centrifugation  Special handling Copyright © 2011 F.A. Davis Company
  • 59. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Tests Performed in Chemistry Section Copyright © 2011 F.A. Davis Company
  • 60. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Chemistry Profiles Copyright © 2011 F.A. Davis Company
  • 61. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Blood Bank Section  The blood bank or immunohematology is the section of the laboratory where blood is collected, stored, and processed for transfusion. Copyright © 2011 F.A. Davis Company
  • 62. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Blood Bank--Key Terms  antibody  cryoprecipitate  antigen  fresh-frozen plasma  blood group  immunohematology  compatibility  packed cells (cross-match)  unit of blood Copyright © 2011 F.A. Davis Company
  • 63. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 64. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Tests Performed in the Blood Bank Copyright © 2011 F.A. Davis Company
  • 65. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 66. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Serology--Key Terms  autoimmunity  immunoglobulin  immunology  serology Copyright © 2011 F.A. Davis Company
  • 67. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Tests Performed in Serology Copyright © 2011 F.A. Davis Company
  • 68. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Microbiology Section  Bacteriology  Mycology  Parasitology  Virology  Procedures  Cultures  Stains  Microscopic examination  Biochemical reactions Copyright © 2011 F.A. Davis Company
  • 69. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Microbiology--Key Terms  bacteria  microorganism  bacteriology  mycology  culture and sensitivity  parasitology  Gram stain  virology  microbiology Copyright © 2011 F.A. Davis Company
  • 70. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Sample Collection and Handling  Blood (Phlebotomy collection)  May have to handle or transport  Urine  Throat  Sputum  Genitourinary tract  Wounds  Cerebrospinal fluid  Feces Copyright © 2011 F.A. Davis Company
  • 71. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Tests Performed in Microbiology Copyright © 2011 F.A. Davis Company
  • 72. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION 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 Copyright © 2011 F.A. Davis Company
  • 73. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Urinalysis--Key Terms  cast  ketonuria  first morning sample  proteinuria  glycosuria  reagent strip (dipstick)  hematuria  urinalysis  hemoglobinuria Copyright © 2011 F.A. Davis Company
  • 74. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Collection and Handling  Give instructions for:  First morning sample  Random sample  24-hour sample  Delivery of these samples to the laboratory Copyright © 2011 F.A. Davis Company
  • 75. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Tests Performed in Urinalysis Copyright © 2011 F.A. Davis Company
  • 76. THE PHLEBOTOMY TEXTBOOK, THIRDEDITION Urine Analyzer Copyright © 2011 F.A. Davis Company

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