Chapters 1 and 2

THE PHLEBOTOMY TEXTBOOK, THIRD
EDITION

Phlebotomy and the Health-Care
Delivery System
Chapter 1

The Clinical Laboratory
Chapter 2

Copyright © 2011 F.A. Davis Company

EDITION

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.


EDITION

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.


EDITION

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

EDITION

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

EDITION

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

EDITION

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

EDITION

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

EDITION

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


EDITION

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)


EDITION

Professional and Personal
Characteristics for Phlebotomists
 Service-oriented
industry
 Phlebotomists are the
“face of the laboratory”


EDITION

Professional and Personal Characteristics
for Phlebotomists
 Dependable  Honest
 Cooperative  Integrity
 Committed  Competence
 Compassionate  Organized
 Courteous  Responsible
 Respectful  Flexible


EDITION

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)

EDITION

Communication Skills for the
Phlebotomist
 Verbal skills
 Listening skills
 Nonverbal skills
 Body language


EDITION

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

EDITION

Verbal Communication Barriers


EDITION

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


EDITION

Nonverbal Communication
 Positive body language
 Smiling
 Eye contact
 Display confidence
 Negative body language
 Shuffling
 No eye contact
 Acting distracted

EDITION

Zone of Comfort


EDITION

Cultural diversity
 Customs
 Beliefs
 Religion
 Values


EDITION

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.


EDITION

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


EDITION

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)

EDITION

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

EDITION

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


EDITION

Phlebotomy Education and
Certification
 Certification requirements
 Certification examinations
 Computer adaptive testing
 Professional organization membership
 Continuing education
 Required for licensure
 Maintain certification


EDITION

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)


EDITION

Phlebotomist Certification


EDITION

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

EDITION

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

EDITION

Hospital Patient Care Areas


EDITION

Hospital Organization


EDITION

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

EDITION

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

EDITION

Support Services
 Food service  Laundry
 Grounds care  Maintenance
 Housekeeping  Purchasing
 Human Resources  Security


EDITION

Fiscal Services
 Accounting
 Admitting
 Business office
 Credit and collection
 Data processing
 Medical records

EDITION

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

EDITION

Professional Services
 Physical therapy (PT)  Cardiovascular testing
 Treatments  ECGs
 Respiratory therapy  Stress Tests
 Breathing disorders  Imaging
 Clinical laboratory
 Diagnostic testing


EDITION

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

EDITION

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.

EDITION

Laboratory Organizational Divisions
Department of Pathology
 Anatomical
 Cytology
 Cytologic specimens
 Pap smears
 Histology
 Surgical specimens
 Frozen sections
 Biopsies
 Autopsies
 Cytogenetics
 Genetic testing


EDITION

Laboratory Organizational Divisions
Department of Pathology (con’t.)
 Clinical
 Hematology/Coagulation
 Chemistry
 Blood Bank
 Serology
 Microbiology
 Urinalysis
 Phlebotomy
 Specimen processing
 Laboratory Information System (LIS)

EDITION

Clinical Laboratory
Organizational Chart


EDITION

Clinical Laboratory Personnel
Organization Chart


EDITION

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


EDITION

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


EDITION

 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


EDITION

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


EDITION

Hematology--Key Terms
 anemia
 anticoagulant
 leukemia
 plasma
 serum


EDITION

Hematology
 The study of the formed
(cellular) elements of
the blood for the
purpose of making a
diagnosis.


EDITION

Tests Performed in the
Hematology Section


EDITION

Coagulation
 Process of hemostasis is
evaluated
 Often part of the
hematology
department


EDITION

Tests Performed in Coagulation


EDITION

Sample Collection and Handling
 Whole blood (EDTA)
 Plasma (liquid portion
of nonclotted blood)
 Serum (liquid portion
of clotted blood)


EDITION

Chemistry Section
 Clinical chemistry is
high tech with
automated instruments
and computers that are
designed to work with
small volume of
specimen.


EDITION

Chemistry--Key Terms
 centrifuge  immunochemistry
 electrolytes  lipemic
 electrophoresis  toxicology
 enzyme
 hemolyzed
 icteric


EDITION

Overview of Clinical Chemistry
Section
 Automated chemistry (core lab)
 Electrophoresis
 Toxicology
 Immunochemistry
 Radioimmunoassay
 Enzyme immunoassay


EDITION

 Serum (SST tubes)
 Plasma (heparin)
 Urine
 Other body fluids
 Centrifugation
 Special handling


EDITION

Tests Performed in Chemistry
Section


EDITION

Chemistry Profiles


EDITION

Blood Bank Section
 The blood bank or
immunohematology is
the section of the
laboratory where blood
is collected, stored,
and processed for
transfusion.


EDITION

Blood Bank--Key Terms
 antibody  cryoprecipitate
 antigen  fresh-frozen plasma
 blood group  immunohematology
 compatibility  packed cells
(cross-match)  unit of blood


EDITION

 Proper identification is
critical!!
 Lavender top (EDTA)
 Pink top (EDTA with
special labeling)
 Red top (non-additive)
 Serum separator tubes
are not acceptable


EDITION

Tests Performed in the Blood Bank


EDITION

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

EDITION

Serology--Key Terms
 autoimmunity
 immunoglobulin
 immunology
 serology


EDITION

Tests Performed in Serology


EDITION

Microbiology Section
 Bacteriology
 Mycology
 Parasitology
 Virology
 Procedures
 Cultures
 Stains
 Microscopic examination
 Biochemical reactions

EDITION

Microbiology--Key Terms
 bacteria  microorganism
 bacteriology  mycology
 culture and sensitivity  parasitology
 Gram stain  virology
 microbiology


EDITION

 Blood (Phlebotomy collection)
 May have to handle or transport
 Urine
 Throat
 Sputum
 Genitourinary tract
 Wounds
 Cerebrospinal fluid
 Feces

EDITION

Tests Performed in Microbiology


EDITION

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

EDITION

Urinalysis--Key Terms
 cast  ketonuria
 first morning sample  proteinuria
 glycosuria  reagent strip (dipstick)
 hematuria  urinalysis
 hemoglobinuria


EDITION

Collection and Handling
 Give instructions for:
 First morning sample
 Random sample
 24-hour sample
 Delivery of these samples to the laboratory


EDITION

Tests Performed in Urinalysis


EDITION

Urine Analyzer


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