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Phlebotomy and the Health Care Setting Part 1


Phlebotomy and the Health Care Setting Part 1 Terry Kotrla, MS, MT(ASCP)BB General Practice of Phlebotomy There are over 25,000 possible laboratory tests, with around ... – PowerPoint PPT presentation

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Title: Phlebotomy and the Health Care Setting Part 1

Phlebotomy and the Health Care Setting Part 1
  • Terry Kotrla, MS, MT(ASCP)BB

General Practice of Phlebotomy
  • There are over 25,000 possible laboratory tests,
    with around 500 performed in most institutions.
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  • Phlebotomists allow technicians and technologists
    to focus on testing blood.
  • POCT testing at bedside, may be performed by

  • On the job trained leads to bad habits being
    handed to next generation
  • Due to complexity formal training programs
  • National certification available

History (continued)
  • Phlebotomy from Greek words, phlebo, relates to
    veins, tomy, relates to cutting.
  • Opening a vein to collect blood

Three purposes for collection and analysis of
laboratory samples
  • Diagnostic testing whats wrong with the
  • Therapeutic assessment is the drug at the right
    therapeutic level?
  • Monitoring patients condition is the patient
    getting better?

Professional Ethics
  • Principles of right and wrong conduct for the
  • Do no harm intentionally
  • Perform according to sound ability and
  • Do what youre trained to do, no more.
  • Deal with patients assigned, not those youre
    curious about.
  • Keep all patient information confidential.

National Phlebotomy Association
  • Represents the laboratory.
  • Gain and apply knowledge.
  • Maintain accuracy, reliability and
    reproducibility of results.
  • Respect patients bill of rights.
  • Perform specified skills as defined by the
    hospital or laboratory standards

Professional Behavior
  • Character attributes for phlebotomists include
  • Sincere interest in health care.
  • Accountability for doing things right.
  • Dedication to high standards of performance.
  • Propensity for cleanliness.
  • Pride, satisfaction, and self-fulfillment in the
  • Professional behavior involves doing the right
    thing when no one is watching.

Working with Health Care Team Members
  • Improving technical skills.
  • Effective communication skills
  • Participation in decision making
  • Problem solving

Communication Skills in the Patient Care
  • Patients will in first 30 seconds make a
  • Critical to have all supplies available
  • pleasant facial expression, neat appearance, and
    professional manner.
  • Introduce yourself and state your mission
  • Remain calm, compassionate and professional
  • Thank patient

Communication issues in the home and ambulatory
  • More length introduction and explanation.
  • Location of sample collection area
  • Must know location of restroom and bed.
  • May need a phone to clarify orders.
  • Procedure must be fully explained.
  • Meticulous patient identification.
  • Must ensure care of puncture site.

Patient Interview
  • Inpatient MUST use 3-way ID
  • Ask patient their full name
  • Compare to information on requisition
  • Compare requisition to armband
  • No armband NO draw
  • Outpatient settings require some additional
  • DOB
  • DL
  • Social Security Number

Teaching Patients
  • Patient must cooperate for successful procedure
  • Must be given instructions, best to do verbal and
  • Must have questions answered
  • Define fasting or NPO if necessary and
  • Timed testing must be clearly explained

Communication Strategies
  • communication loop
  • sender,
  • receiver
  • and filters.
  • Filters are damaging to effective communication

Verbal Communication
  • Language barriers.
  • Must translate medical terminology
  • Use simple, honest terms
  • look for facial expression indicating
  • If patient extends arm indicates understanding
    and agreement

Verbal Communication
  • Hearing disabilities/impairments
  • write down instructions
  • Learn sign language
  • English as a second language
  • Use non-verbal cues like sign language
  • Find an interpreter
  • Use Age appropriate language
  • Be aware of tone of voice and inflection
  • Emergency situations require exceptional
    communication skills.

Nonverbal communication.
  • Positive body language
  • Smiling
  • Good grooming
  • Erect posture
  • Face to face
  • Zone of comfort

Negative body language/distracting behaviors.
  • Rolling eyes
  • Nervous behaviors
  • Deep sighs
  • Crossed arms,
  • Wrinkled forehead
  • Throwing things around
  • Chewing gum
  • Yawning

Name the Emotion
Listening skills
  • Lets patient know that your are truly interested.
  • Does not depend on intellect or intelligence

Tips for active listening.
  • Concentrate on speaker
  • Use the silent pause
  • Use phrases such as I see, Oh, periodically
  • Keep personal judgments to yourself.
  • Verify with feedback, paraphrase.
  • Mentally summarize
  • Sense and address non-verbal signs
  • Maintain eye contact
  • Encourage patient to expand
  • Paraphrase to ensure understanding

  • Phlebotomy is done standing up, good posture
    essential to protect back and neck.
  • Stand erect, avoid slouching.
  • Appear relaxed.

  • Physical appearance communicates impression.
  • Neat, clean hair.
  • Clean, well groomed fingernails/hands.
  • Uniform or business casual clothing.
  • Clean, pressed lab coat.

Personal hygiene.
  • Bathe regularly
  • Wash hair
  • Use deodorant
  • Brush teeth, use mouth spray or breath mints
    through out the day.
  • No perfume or after shave

Good health habits
  • Nutrition- eat right
  • Exercise regularly
  • Get enough rest
  • Benefits
  • improves attitude,
  • Improves appearance
  • helps reduce stress.

Quick Tips for Dealing with Stress
  • Follow the "G-E-T S-T-R-E-S-S F-I-T" plan for a
    healthier, more enjoyable life. Here are 12
    easy-to-remember tips on how you can bring stress
    and fitness into your life. Keep them handy and
    review them often.
  • Give yourself a break. Get a good night's sleep.
    Get away from it all.
  • Eat a healthy diet.
  • Talk it out.
  • Spend time with family and friends. Take a
    course. For fun or self improvement.
  • Relax with a good book, a great movie or your
    favorite music.
  • Exercise. Walk. Jog. Swim. Go to the gym. Set
    priorities. Schedule your time.
  • Find alternative sources of satisfaction.
    Increase your awareness of what causes you
    stress. Take action! Address the person or
    situation that's causing you stress. And, if
    you're still not sure how to manage, talk to your
    health care professional

Protective Equipment and Clothing
  • PPE is NOT optional
  • Employers MUST provide
  • Includes
  • gowns,
  • gloves,
  • masks,
  • laboratory coats and
  • face shields.
  • Safety equipment for processing and disposing of
  • Due to latex sensitivity, a variety of gloves in
    appropriate sizes must be provided.

Patients Bill of Rights
  • Respectful and considerate care
  • Accurate information
  • Informed consent.
  • Patient refusal of blood test
  • Privacy
  • Strict confidentiality
  • Advance directives
  • Information about the identity and role of
    personnel involved in his or her care.
  • Information about research procedures involved in
    his or her care
  • Billing

Issues in Specimen Collection
  • Deliver quality of care regardless of the
    demeanor of the patient.
  • Laboratory tests and results are strictly
  • All records must be secured and accessed only by
    those individuals who need them.
  • Patient has the right to know your name, position
    (especially if you are a student), description of
    procedure, and ultimately has the right to
  • Document any unusual occurrences, especially

Family, visitors and significant others
  • May be more difficult to deal with than the
  • Make requests or demands that are not part of
    your job duties.
  • Refuse requests to get food or water, as patient
    may be NPO, have them contact the nurse.
  • Ask there cooperation in reassuring the patient.
  • You can ask family/visitors to step outside
    during blood collection if necessary.

Physicians, priests, chaplains
  • Have right to privacy with patient
  • Leave and come back later.
  • If timed or STAT request ask permission to
    collect specimen.

Health Care Organizations
  • Primary care facilities maintain and monitor
    normal health and prevent diseases through
  • Secondary care have doctors who are specialists
    in a particular group of diseases, organ systems
    or one organ.
  • Tertiary care provides highly specialized care,
    geared to treating unusual or complex problems
    and utilize sophisticated diagnostic instruments.
  • Acute care hospital, hospital stay of 30 days or
  • Long term care, stays longer than 30 days
  • Ambulatory care.
  • Home health services

Classification of Hospitals
  • Mission
  • Bed size
  • Ownership federal, state, teaching or
  • Length of stay
  • Type of care provided.
  • Location.
  • Relationship to other health facilities.

Department of Clinical Laboratory Medicine
  • Composed of two major areas
  • Clinical pathology analyzes blood, body fluids,
    and biopsy materials
  • Anatomic pathology involved in autopsies,
    cytology and surgical pathology.

Clinical Laboratory Improvement Act of 1988
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  • Established regulations concerning qualifications
    of personnel, periodic inspections, proficiency
    testing, and investigation of complaints
  • Laboratory testing classified according to
    complexity and personnel standards.
  • Waived
  • Moderate complexity tests
  • High complexity tests

Laboratory Director - medical director
  • A pathologist with extensive education in
  • Aid the patient's physician in the correlation of
    laboratory results with disease states.
  • Assist in setting up lab protocols and
    determining the "menu" of laboratory testing to
  • Involved with interpretation of tissues such as
    those obtained during biopsy, surgery, autopsy
    and bone marrow.
  • All problems or abnormal results obtained by the
    techs are referred to the pathologist.

Laboratory Director - Administrative Technologist
  • Title held will be dependent on facility - Lab
    Manager, Chief Technologist, Technical Director.
  • May be OJT or have additional education in
    management and administration.
  • Oversees administrative and technical services
    such as
  • establishing lab policies and procedures,
  • hiring lab workers,
  • maintaining the budget,
  • providing orientation/training of new employees,
  • providing continuing education (CE) for staff and
  • assigning duties based on qualification of the

Technical Supervisors
  • Larger hospitals have large laboratory sections
    requiring a supervisor with extensive experience
    and education in a lab specialty.
  • They aid the lab directory by
  • preparing work schedules for their department,
  • ordering departmental supplies,
  • providing training,
  • maintaining Standard Operating Procedure (SOP)
  • assist in budget preparation,
  • perform employee evaluations,
  • discipline, hiring and firing of personnel.

Clinical Laboratory Scientist (CLS), Medical
Technologist (MT)
  • B.S. in laboratory science or biologic science
    which must include didactic and clinical training
    in laboratory medicine.
  • B.S. plus one additional year in a hospital based
  • B.S. which includes clinical laboratory science
    education, either a 31 or 22.
  • These individuals perform all bench work using
    basic to advanced techniques.
  • Perform preventive maintenance (PM) on equipment,
    troubleshooting, performs and evaluates quality
    control (QC), participates in continuing
    education, and teaches CLS and CLT students.

Clinical Laboratory Technician (CLT), Medical
Laboratory Technician (MLT)
  • Has obtained education through a hospital based 2
    year certificate program or associate degree at
    the college level.
  • Under the direct supervision of a CLS performs
    routine tests and procedures.
  • CLTs free up the CLS to trouble shoot equipment
    or perform advanced or complex procedures on
    patient samples.

  • H.S. graduate or equivalent.
  • Training varies - OJT or structured program.
  • Collects blood specimens from adults, children
    and babies using appropriate technique and
  • Identification of the patient is the most
    critical step.
  • Must understand and follow to the letter all
    precautions related to the collection of blood
    specimens, whether others follow or not.
  • May also be responsible for starting and
    collecting specimens for glucose tolerance tests
    (GTT), bleeding times, blood cultures,
    instructing patients on these procedures as well
    as the proper collection of urine and semen
    samples, as well as delivering and processing
    specimens in the lab.
  • Must be able to deliver specimens in a timely
    fashion, maintain accurate records/logs, and
    exhibit professional conduct and attitude at all