Download - Chapters 1 and 2
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Phlebotomy and the Health-Care Delivery System
Chapter 1
The Clinical Laboratory
Chapter 2
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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.
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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.
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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
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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
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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
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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
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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
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Changes in Phlebotomy
Changes in health-care delivery Efficiency and cost effectiveness Patient-focused care Cross-training Decentralization of phlebotomy services
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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)
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Professional and Personal Characteristics for Phlebotomists
Service-oriented industry
Phlebotomists are the “face of the laboratory”
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Professional and Personal Characteristics for Phlebotomists
Dependable Cooperative Committed Compassionate Courteous Respectful
Honest Integrity Competence Organized Responsible Flexible
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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)
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Communication Skills for the Phlebotomist
Verbal skills Listening skills Nonverbal skills Body language
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Verbal Skills Verbal barriers
Hearing impairment Emotional level Patient education level Age Language barriers Medications Health status
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Verbal Communication Barriers
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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
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Nonverbal Communication Positive body language
Smiling Eye contact Display confidence
Negative body language Shuffling No eye contact Acting distracted
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Zone of Comfort
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Cultural diversity
Customs Beliefs Religion Values
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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.
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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
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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)
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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
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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
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Phlebotomy Education and Certification
Certification requirements Certification examinations
Computer adaptive testing Professional organization membership Continuing education
Required for licensure Maintain certification
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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)
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Phlebotomist Certification
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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
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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
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Hospital Patient Care Areas
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Hospital Organization
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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
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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
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Support Services Food service Grounds care Housekeeping Human Resources
Laundry Maintenance Purchasing Security
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Fiscal Services
Accounting Admitting Business office Credit and collection Data processing Medical records
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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
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Professional Services Physical therapy (PT)
Treatments Respiratory therapy
Breathing disorders
Cardiovascular testing ECGs Stress Tests Imaging
Clinical laboratory Diagnostic testing
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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
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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.
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Laboratory Organizational DivisionsDepartment of Pathology
Anatomical Cytology
Cytologic specimens Pap smears
Histology Surgical specimens Frozen sections Biopsies Autopsies
Cytogenetics Genetic testing
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Laboratory Organizational DivisionsDepartment of Pathology (con’t.)
Clinical Hematology/Coagulation Chemistry Blood Bank Serology Microbiology Urinalysis Phlebotomy Specimen processing Laboratory Information System (LIS)
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Clinical Laboratory Organizational Chart
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Clinical Laboratory Personnel Organization Chart
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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
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Clinical Laboratory Personnel
Technical Supervisor MLS/specialty certification Accountable to the laboratory manager Responsible for operational functions in specific
laboratory departments
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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
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Additional Laboratory Personnel
Laboratory assistant Education coordinator Point-of-care (POC) coordinator LIS manager Quality assessment coordinator
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Hematology--Key Terms
anemia anticoagulant leukemia plasma serum
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Hematology The study of the formed
(cellular) elements of the blood for the purpose of making a diagnosis.
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Tests Performed in the Hematology Section
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Coagulation Process of hemostasis is
evaluated Often part of the
hematology department
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Tests Performed in Coagulation
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Sample Collection and Handling Whole blood (EDTA) Plasma (liquid portion
of nonclotted blood) Serum (liquid portion
of clotted blood)
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Chemistry Section Clinical chemistry is
high tech with automated instruments and computers that are designed to work with small volume of specimen.
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Chemistry--Key Terms centrifuge electrolytes electrophoresis enzyme hemolyzed icteric
immunochemistry lipemic toxicology
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Overview of Clinical Chemistry Section
Automated chemistry (core lab) Electrophoresis Toxicology Immunochemistry
Radioimmunoassay Enzyme immunoassay
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Sample Collection and Handling Serum (SST tubes)
Plasma (heparin) Urine Other body fluids Centrifugation Special handling
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Tests Performed in Chemistry Section
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Chemistry Profiles
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Blood Bank Section The blood bank or
immunohematology is the section of the laboratory where blood is collected, stored, and processed for transfusion.
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Blood Bank--Key Terms antibody antigen blood group compatibility
(cross-match)
cryoprecipitate fresh-frozen plasma immunohematology packed cells unit of blood
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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
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Tests Performed in the Blood Bank
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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
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Serology--Key Terms
autoimmunity immunoglobulin immunology serology
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Tests Performed in Serology
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Microbiology Section Bacteriology Mycology Parasitology Virology Procedures
Cultures Stains Microscopic examination Biochemical reactions
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Microbiology--Key Terms bacteria bacteriology culture and sensitivity Gram stain microbiology
microorganism mycology parasitology virology
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Sample Collection and Handling Blood (Phlebotomy collection)
May have to handle or transport Urine Throat Sputum Genitourinary tract Wounds Cerebrospinal fluid Feces
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Tests Performed in Microbiology
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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
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Urinalysis--Key Terms cast first morning sample glycosuria hematuria hemoglobinuria
ketonuria proteinuria reagent strip (dipstick) urinalysis
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Collection and Handling
Give instructions for: First morning sample Random sample 24-hour sample
Delivery of these samples to the laboratory
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Tests Performed in Urinalysis
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Urine Analyzer