Phlebotomy Essentials

Halftitle Page
Title Page
Copyright Page
Dedication
Reviewers
About the Author
Preface
Brief Contents
Detailed Contents
List of Procedures
User’s Guide
1 Phlebotomy: Past and Present and the Healthcare Setting
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Phlebotomy: The Past
	Phlebotomy: The Present
	The Changing Role of the Phlebotomist
	Education Standards
	Official Recognition
		Certification
		Licensure
		Continuing Education
	Patient Interaction
		Recognizing Diversity
		Professionalism
		Patients’ Rights
		Confidentiality
		HIPAA
	Communication
		Interpersonal Communication Components
		Effective Communication in Healthcare
	The Healthcare Setting
	Healthcare Delivery
		Nonambulatory Care and Inpatient Services
		Ambulatory Care and Outpatient Services
		Public Health Service
	Healthcare Financing
		Third-Party Payers
		Diagnosis and Billing Codes
		Reimbursement
		Accountable Care Organizations
		Managed Care
	Clinical Laboratory Services
		Traditional Laboratories
		Satellite Laboratories
		Reference Laboratories
	Clinical Laboratory Personnel
		Laboratory Director/Pathologist
		Laboratory Administrator/Laboratory Manager
		Technical Supervisor
		Medical Technologist/Medical Laboratory Scientist
		Medical Laboratory Technician
		Clinical Laboratory Assistant
		Phlebotomist
		Other Laboratory Personnel
	Study and Review Questions
	Case Studies
	References
	Media Menu
2 Quality Assurance and Legal Issues in Healthcare
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Quality Assurance in Healthcare
	National Standard Organizations and Regulatory Agencies
		The Joint Commission
		The Institute for Healthcare Improvement
		Clinical Laboratory Improvement Amendments of 1988
		College of American Pathologists
		Clinical and Laboratory Standards Institute
		National Accrediting Agency for Clinical Laboratory Sciences
		International Organization for Standardization
	Quality Assurance in Phlebotomy
		QA Processes
		Quality Indicators
		Thresholds and Data
		Process and Outcomes
		Quality Control (QC)
	Areas of Phlebotomy Subject to QA
		Patient Preparation Procedures
		Specimen Collection Procedures
		Delta Checks
	Documentation
		The Patient’s Record
		Test Catalogs and Reference Manuals
		The Procedure Manual
		The Safety Manual
		The Infection Prevention and Control Manual
		QA Forms
	Risk Management
	Sexual Harassment
	Legal Issues in Healthcare
	Tort
	Malpractice Insurance
	Avoiding Lawsuits
	Patient Consent
		Informed Consent
		Expressed/Express
		Implied Consent
		HIV Consent
		Consent for Minors
		Refusal of Consent
	The Litigation Process
	Legal Cases Involving Phlebotomy Procedures
		Case 1: A Negligence Case Settled through Binding Arbitration
		Case 2: A Negligence Case Settled through Binding Arbitration
		Case 3: A Negligence Case Settled through Binding Arbitration
		Case 4: Congleton Versus Baton Rouge General Hospital
		Case 5: Jury Verdict Affirmed on Appeal by Kentucky Supreme Court
	Study and Review Questions
	Case Studies
	References
	Media Menu
3 Infection Control, Safety, First Aid, and Personal Wellness
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Infection Control
	Infection
		Communicable Infections
		Nosocomial and Healthcare-Associated Infections
		Antibiotic-Resistant Infections
	The Chain of Infection
		Chain-of-Infection Components
		Breaking the Chain of Infection
	Infection Control Programs
		Employee Screening
		Employee Immunization
		Evaluation and Treatment
		Surveillance
	Infection Control Practices
		Hand Hygiene
		Personal Protective Equipment
		Sequence for Donning and Removing PPE
		Asepsis and Aseptic Technique
		Nursery and Neonatal ICU Infection Control Technique
	Isolation Procedures
		Protective/Reverse Isolation
		Universal Precautions
		Body Substance Isolation
		Guideline for Isolation Precautions
	Safety
	Biosafety
		Biohazard
		Bloodborne Pathogens
		OSHA Bloodborne Pathogens Standard
		Needlestick Safety and Prevention Act
		Exposure Control Plan
		BBP Exposure Routes
		Exposure Incident Procedure
		Surface Decontamination
		Cleanup of Body Fluid Spills
		Biohazard Waste Disposal
	Chemical Safety
		OSHA Hazard Communication Standard
		Department of Transportation Labeling System
		National Fire Protection Association Labeling System
		Safety Showers and Eyewash Stations
		Chemical Spill Procedures
	Electrical Safety
	Fire Safety
		Fire Components
		Classes of Fire
		Fire Extinguishers
	Radiation Safety
	First Aid
	External Hemorrhage
	Shock
		Common Symptoms of Shock
		First Aid for Shock
	Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
		American Heart Association CPR and ECC Guidelines
		AHA ECC Adult Chains of Survival
	Personal Wellness
	Proper Nutrition
	Rest and Exercise
	Personal Hygiene
	Back Protection
	Stress Management
	Study and Review Questions
	Case Studies
	References
	Media Menu
4 Medical Terminology
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Word Roots
	Prefixes
	Suffixes
	Combining Vowels/Forms
	Discrepancies in the Classification of Word Elements
	Unique Plural Endings
	Pronunciation
	Abbreviations and Symbols
	The Joint Commission’s “Do Not Use” List
	Study and Review Questions
	Case Studies
	References
	Media Menu
5 Human Anatomy and Physiology Review
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Body Positions
		Anatomic Position
		Other Positions
	Body Planes
	Body Directional Terms
	Body Cavities
	Body Functions
		Homeostasis
		Metabolism
	Body Organization
		Chemicals
		Cells
		Tissues
		Organs
	Body Systems
		Integumentary System
		Muscular System
		Skeletal System
		Nervous System
		Endocrine System
		Digestive System
		Reproductive System
		Urinary System
		Respiratory System
	Study and Review Questions
	Case Studies
	References
	Media Menu
6 The Circulatory System
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	The Heart
		Heart Structure
		Heart Function
		Heart Disorders and Diagnostic Tests
	The Vascular System
		Functions
		Structures
		Blood Vessel Structure
		The Flow of Blood
		Phlebotomy-Related Vascular Anatomy
		Vascular System Disorders and Diagnostic Tests
	The Blood
		Blood Composition
		Blood Type
		Blood Specimens
		Blood Disorders and Diagnostic Tests
	Hemostasis and Coagulation
		Hemostasis
		Coagulation
		The Hemostatic Process In Vivo
		The Role of the Liver in Hemostasis
		Hemostatic Disorders and Diagnostic Tests
	The Lymphatic System
		Functions
		Structures
		Lymph Flow
		Lymphatic System Disorders and Diagnostic Tests
	Study and Review Questions
	Case Studies
	References
	Media Menu
7 Blood Collection Equipment, Additives, and Order of Draw
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Blood Collection Equipment
	General Blood Collection Equipment and Supplies
		Blood-Drawing Station
		Phlebotomy Chairs
		Equipment Carriers
		Gloves and Glove Liners
		Antiseptics
		Disinfectants
		Hand Sanitizers
		Gauze Pads
		Bandages
		Needle and Sharps Disposal Containers
		Biohazard Bags
		Slides
		Pen
		Watch
		Patient Identification Equipment
	Venipuncture Equipment
		Vein-Locating Devices
		Tourniquet
		Needles
		Evacuated Tube System
		Syringe System
		Blood Collection Sets
		Combination Systems
	Blood Collection Additives
	Anticoagulants
		EDTA
		Citrates
		Heparin
		Oxalates
	Special-Use Anticoagulants
		Acid Citrate Dextrose
		Citrate Phosphate Dextrose
		Sodium Polyanethol Sulfonate
	Antiglycolytic Agents
	Clot Activators
	Serum or Plasma Separator Tubes
		Thixotropic Gel Separator
		Nongel Separator
	Trace Element-Free Tubes
	Order of Draw
	CLSI Order of Draw
	Carryover/Cross-Contamination
	Tissue Thromboplastin Contamination
	Microbial Contamination
	Study and Review Questions
	Case Studies
	References
	Media Menu
8 Venipuncture Procedures
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Patient Registration
	Requests for Testing
	The Test Requisition
		Manual Requisitions
		Computer-Generated Requisitions
		Barcode Requisitions
	Venipuncture Steps
		Step 1: Receive, Review, and Accession Test Request
		Step 2: Approach, Greet, and Identify the Patient
		Step 3: Explain the Procedure and Obtain Consent
		Step 4: Verify Collection Requirements, and Identify Sensitivities and Potential Problems
		Step 5: Sanitize Hands and Put on Gloves
		Step 6: Position Patient, Apply Tourniquet, and Ask the Patient to Make a Fist
		Step 7: Select a Vein, Release the Tourniquet, and Ask the Patient to Open the Fist
		Step 8: Clean and Air-Dry the Site
		Step 9: Prepare Collection Equipment
		Step 10: Reapply the Tourniquet, and Uncap and Inspect the Needle
		Step 11: Ask the Patient to Remake a Fist, Anchor the Vein, and Insert the Needle
		Step 12: Establish Blood Flow, Release the Tourniquet, and Ask the Patient to Open the Fist
		Step 13: Fill, Remove, and Mix Tubes in Order of Draw, or Fill Syringe
		Step 14: Withdraw the Needle, Place Gauze, Activate the Needle Safety Feature, and Apply Pressure
		Step 15 (ETS): Discard Blood Collection Unit
		Step 15 (Syringe System): Discard Needle, Attach Transfer Device, Transfer Blood, and Discard Syringe and Transfer Device Unit
		Step 16: Label and Prepare Tubes for Handling and Transport
		Step 17: Check the Patient’s Arm, and Apply a Bandage
		Step 18: Dispose of Used Materials, and Reposition Moved Items
		Step 19: Thank the Patient, Remove Gloves, and Sanitize Hands
		Step 20: Transport Specimen to the Lab Promptly
	Routine ETS Venipuncture Procedure
	Blood Collection Set Procedure
	Syringe Venipuncture Procedure
	Procedure for Inability to Collect Specimen
	Pediatric Venipuncture
		Challenges
		Iatrogenic Anemias in Infants and Children
		Dealing With Parents or Guardians
		Dealing With the Child
		Involvement of the Child Life Specialist
		Pain Interventions
		Selecting a Method of Restraint
		Equipment Selection
		Procedures
	Geriatric Venipuncture
		Challenges
		Safety Issues
		Patients in Wheelchairs
		Blood Collection Procedures
	Dialysis Patients
	Long-Term Care Patients
	Home Care Patients
	Hospice Patients
	Study and Review Questions
	Case Studies
	References
	Media Menu
9 Preexamination/Preanalytical Considerations
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Reference Ranges/Intervals
	Basal State
	Physiologic Variables
		Age
		Altitude
		Dehydration
		Diet
		Diurnal/Circadian Variations
		Drug Therapy
		Exercise
		Fever
		Sex
		Intramuscular Injection
		Jaundice
		Position
		Pregnancy
		Smoking
		Stress
		Environmental Factors
	Problem Sites
		Burns, Scars, and Tattoos
		Damaged Veins
		Edema
		Hematoma
		Mastectomy
		Obesity
		Paralysis
	Vascular Access Devices and Sites
		Intravenous Line
		IV Catheter Lock
		Previously Active IV Sites
		Arterial Line
		Arteriovenous Shunt, Fistula, or Graft
		Blood Sampling Device
		Central Vascular Access Devices
	Patient Complications and Conditions
		Allergies to Equipment and Supplies
		Excessive Bleeding
		Fainting
		Nausea and Vomiting
		Pain
		Petechiae
		Seizures/Convulsions
	Procedural Error Risks
		Hematoma Formation and Bruising
		Iatrogenic Anemia
		Inadvertent Arterial Puncture
		Infection
		Nerve Injury
		Reflux of Additive
		Vein Damage
	Procedural Error and Specimen Quality Concerns
		Hemoconcentration
		Hemolysis
		Partially Filled Tubes
		Specimen Contamination
		Wrong or Expired Collection Tube
	Troubleshooting Failed Venipuncture
		Tube Position
		Needle Position
		Collapsed Vein
		Tube Vacuum
	Study and Review Questions
	Case Studies
	References
	Media Menu
10 Capillary Puncture Equipment, Principles and Procedures
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Capillary Puncture Equipment
		Lancets/Incision Devices
		Microcollection Containers/Microtubes
		Microhematocrit Tubes and Sealants
		Capillary Blood Gas Equipment
		Microscope Slides
		Warming Devices
	Capillary Puncture Principles
		Composition of Capillary Specimens
		Reference Values
		Indications for Capillary Puncture
		Tests That Cannot Be Collected by Capillary Puncture
		Order of Draw
	General Capillary Puncture Steps
		Step 6: Position the Patient
		Step 7: Select the Puncture Site
		Step 8: Warm the Site if Applicable
		Step 9: Clean and Air-Dry the Site
		Step 10: Prepare Equipment
		Step 11: Grasp the Finger or Heel Firmly
		Step 12: Position the Lancet, Puncture the Site, and Discard the Lancet
		Step 13: Lower the Finger or Heel, and Apply Gentle Pressure Until a Blood Drop Forms
		Step 14: Wipe Away the First Blood Drop
		Step 15: Fill and Mix the Tubes/Containers in Order of Draw
		Step 16: Place Gauze, Apply Pressure, and Elevate the Site
		Step 17: Label and Prepare Specimens for Handling and Transport
		Step 18: Check the Site, and Apply a Bandage
		Step 19: Discard Used Materials, Thank the Patient, Remove Gloves, and Sanitize the Hands
		Step 20: Transport the Specimen to the Lab Promptly
	Capillary Puncture Procedures
		Capillary Blood Gases
		Neonatal Bilirubin Collection
		Newborn/Neonatal Screening
		Routine Blood Film/Smear Preparation
		Thick Blood Smear Preparation
	Study and Review Questions
	Case Studies
	References
	Media Menu
11 Special Collections and Point-of-Care Testing
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Special Collections
	Blood Bank Specimens
		Identification and Labeling Requirements
		Special Identification Systems
		Specimen Requirements
		Type, Screen, and Cross-Match
	Blood Donor Collection
		Donor Eligibility
		Lookback Program
		Autologous Donation
		Cell Salvaging
	Blood Cultures
		Sepsis
		Indications of Septicemia
		Specimen Requirements
		Timing Considerations
		Recommended Volume
		Specimen Collection
		Initial Specimen Diversion
		Media Inoculation Methods
		Blood Culture Collection Procedure
		Antimicrobial Neutralization Products
		Pediatric Blood Culture Considerations
		Catheter Considerations
	Coagulation Specimens
	Two-Hour Postprandial Glucose
	Glucose Tolerance Test
		GTT Preparation and Procedure
	Oral Glucose Challenge Test
	Lactose Tolerance Test
	Molecular Genetic Testing
	Parental/Paternity Testing
	Therapeutic Drug Monitoring
	Therapeutic Phlebotomy
		Polycythemia
		Hemochromatosis
	Toxicology Specimens
		Forensic Specimens
		Blood Alcohol (Ethanol) Specimens
		Drug Screening
	Trace Elements
	Tuberculosis Blood Tests
		Interferon-Gamma Release Assays
	Point-of-Care Testing
	POCT Quality Control
	POCT Infection Control Issues
	POC Coagulation Monitoring
		Activated Clotting Time
		Prothrombin/International Normalized Ratio
		Platelet Function
	Arterial Blood Gases and Electrolytes
		Arterial Blood Gases
		Electrolytes
	Multiple-Test-Panel Monitoring by POCT
	Other POC Tests
		B-Type Natriuretic Peptide
		Bilirubin Testing
		Cardiac Troponin T and I
		Complete Blood Count
		C-Reactive Protein
		Glucose
		Glycohemoglobin/Hemoglobin A1c
		Hematocrit
		Hemoglobin
		Lactate
		Lipid/Cholesterol Testing
		Rapid Syphilis Test
	Study and Review Questions
	Case Studies
	References
	Media Menu
12 Computers and Specimen Handling and Processing
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Computers
	Computerization in Healthcare
		Computer Literacy
		Computer Components
		Computer System Elements
		Computer Networks
		Computer Security
	Laboratory Informatics
		Laboratory Information System
		General Laboratory Computer Skills
		Computerized Analyzers
		Interfacing and Integrating
		Connectivity Industry Consortium
		Computerization and Connectivity
	Specimen Handling and Processing
	Specimen Handling
		Transporting Specimens
		Special Handling
	Specimen Processing
		OSHA-Required Protective Equipment
		Specimen Suitability
		Specimens Not Requiring Further Processing
		Specimens That Require Centrifugation
		Precentrifugation
		Centrifugation
		Postcentrifugation
		Secondary Tube or Aliquot Preparation
		Platelet-Poor Plasma
		Specimen Storage
		Reporting Results
	Study and Review Questions
	Case Studies
	References
	Media Menu
13 Urine and Other Nonblood Specimens and Tests
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Nonblood Specimen Types
	Nonblood Specimen Labeling
	Nonblood Specimen Handling
	Nonblood POCT Quality Control
	Urine
		Types of Urine Specimens
		Common Urine Tests
	Other Nonblood Body Fluids
		Amniotic Fluid
		Cerebrospinal Fluid
		Gastric Fluid/Gastric Analysis
		Nasopharyngeal Secretions
		Saliva
		Semen
		Serous Fluid
		Sputum
		Sweat
		Synovial Fluid
	Other Nonblood Specimens
		Bone Marrow
		Breath Samples
		Buccal/Oral Specimens
		Cervical Smear/Pap Test
		Feces (Stool)
		Hair
		Nail Clippings
		Skin Tests
		Throat Swabs
		Tissue Specimens
	Study and Review Questions
	Case Studies
	References
	Media Menu
14 Arterial Puncture Procedures
	NAACLS Entry Level Competencies
	Key Terms
	Objectives
	Personnel Who Perform Arterial Puncture
	Site-Selection Criteria
	Arterial Puncture Sites
		The Radial Artery
		The Brachial Artery
		The Femoral Artery
		Other Sites
	Arterial Blood Gases
	ABG Specimen Collection
		Test Requisition
		Equipment and Supplies
		Patient Preparation
		Radial ABG Procedure
		ABG Collection From Other Sites
	Hazards and Complications of Arterial Puncture
		Arteriospasm
		Artery Damage
		Discomfort
		Infection
		Hematoma
		Numbness
		Thrombus Formation
		Vasovagal Response
	Sampling Errors
		Air Bubbles
		Delay in Analysis
		Improper Mixing
		Improper Syringe
		Obtaining Venous Blood by Mistake
		Use of Improper Anticoagulant
		Use of Too Much or Too Little Heparin
	Criteria for ABG Specimen Rejection
	Study and Review Questions
	Case Study
	References
	Media Menu
Appendix A Laboratory Tests
Appendix B Laboratory Mathematics
Appendix C Conversational Phrases in English and Spanish
Appendix D Work Restrictions for Healthcare Employees
Appendix E Answers to Study and Review Questions and Case Studies
Appendix F Tube Guides
Glossary
Index