Phlebotomy: Lecture 04 - Clinical Lab Testing

• Phlebotomy is the process of incision into a vein
• Lecture 04 focuses on understanding phlebotomy flow in clinical laboratory testing
• Mr. Lordiel M. Miasco is the lecturer for this topic

Course Outline

• The course covers the history of phlebotomy, professional characteristics, communication, education, certification, healthcare delivery systems, and clinical laboratory aspects.

Learning Objectives

• Describe the evolution of phlebotomy and the changing role of a phlebotomist.
• Explain traditional and expanding roles
• It covers communication, interpersonal skills, healthcare settings, and common tests in clinical labs.

History of Phlebotomy: Then

• Defined as the incision into a vein, phlebotomy is one of the oldest medical procedures dating back to early Egyptians
• Bloodletting was used to maintain health

The beliefs of Hippocrates

• He believed that disease occurred due to an excess of body fluids like blood, bile, and phlegm
• Removing excess fluids restored health

Techniques for Bloodletting:

• Included suction cups with lancets and leeches
• Barber surgeons collected blood in a bleeding bowl using a barber's razor
• The red and white barber pole symbolizes blood and bandages

Last period of Stone Age

• Authorities believed phlebotomy was practiced then
• Crude tools drained excess blood

Early Middle Ages

• Barber surgeons were divided into long-robed and short-robed surgeons
• Short-robed surgeons were tasked with bloodletting, wound surgery, cupping, leeching, shaving, tooth extraction, and enema administration
• A striped pole with a bleeding bowl distinguished short-robed surgeons
• The white stripe on the pole also corresponded to bandages

Towards the End of the 19th Century

• The treatments were discredited when doctors finally admitted that depleting the body's blood supply can be risky
• Risks include cardiac arrest, losing too much blood, dangerously low blood pressure, infections, and anemia
• Phlebotomy was also done by cupping and leeching
• Cupping involved heated suction cups and incisions

Within the Last Decade

• Leeches have made a comeback as defenders from the complications of microsurgical replantation
• Application of leeches in bloodletting is called therapeutic phlebotomy

Venesection

• From the Latin words "vena" (vein) and "sectio" (cutting), meaning "an incision to the vein"
• It was the most common method of general bloodletting
• The method involves cutting a vein to rid the body of "evil spirits"
• In Hippocrates' time, it brings the body into balance
• Another word for phlebotomy, from the Greek "phlebos" (vein) and "tome" (incision).

History of Phlebotomy: Now

• It's now limited to treating specific blood disorders and uses aseptic techniques to minimize discomfort

Role of Phlebotomy Today:

• Collecting samples for lab analysis to diagnose and monitor medical conditions
• Performing blood removal for transfusions and therapeutic purposes.
• Therapeutic now unlike before, only when needed, like for polycythemia vera.

Polycythemia Vera

• Is the overproduction of red blood cells
• Opposite of anemia

Phlebotomy Procedures

• Can be accomplished by either:
• Venipuncture: Collecting blood using a needle and syringe.
• Capillary puncture: Collecting blood after puncturing the skin with a lancet.

Phlebotomist

• The individual trained to obtain blood specimens primarily through venipuncture and capillary puncture

Clinical Laboratory Practice of Phlebotomy:

• With more complex lab tests, it's now a specialized area
• Phlebotomy is still part of medical laboratory training programs.
• Rapidly expanding role, more than just taking blood

Expanded Role

• A Phlebotomist must be familiar with healthcare systems
• Must know anatomy, physiology, collection, and transport
• Must be familiar with documentation, patient records, interpersonal skills, and quality patient care
• Development of strong organizational skills for handling a heavy workload efficiently
• Must maintain accuracy often under stressful conditions

Significance of Phlebotomists:

• Structured training and certification has replaced on-the-job training
• They are often a patient's only personal contact with the laboratory and healthcare setting

Traditional Duties and Responsibilities

• Correctly identify and prepare the patient before collecting samples.
• Collect the appropriate amount for specified tests
• They must select the appropriate sample container
• There must be correct labeling of all samples
• They must facilitate appropriate and timely transportation of samples

Personal Skills

• Interact effectively, projecting competence and assuring patients of proper use of samples.
• Process samples for lab departments

Lab Operations

• Performance of computer operations and record-keeping pertaining to phlebotomy
• Observation of safety regulations, quality control checks, and preventive maintenance procedures.
• Must attend continuing education programs
• Perform and monitor bedside point-of-care testing.

Professional and Personal Characteristics

• Phlebotomists are the face of the laboratory, requiring service-oriented personal and professional traits.
• Dependable, cooperative and committed to teamwork
• Compassionate, courteous, and respectful in their attitude and communication.
• Integrity, honesty, and competence in maintaining patient safety
• Organized, responsible, and flexible in managing stations and patient needs.
• Maintain clean and professional appearance
• Skilled communicators

Components of Communication

• Verbal skills enabling clear introductions, explanations, and reassurance
• Active listening and empathy

Telephone Skills

• Requires promptness, politeness, knowledge, accurate information provision, and proper call handling.

Phlebotomy Education and Certification:

• In healthcare teams is essential for quality, cost-effective care
• It involves training in techniques for blood collection with high standards.

Health Care Delivery System

• Phlebotomists need knowledge of healthcare setting and employment settings
• Additional opportunity and employment and a vital role

Hospital Organization

• Hospital size and multiple services impact the phlebotomist needs and workload.
• Varied classifications: community, teaching, non-profit, profit, and specialty hospitals.

Hospital Departments

• The phlebotomist must travel to different hospital departments to collect samples.

Traditional Hospital Services

• Nursing, support, fiscal, and professional services.

Hospital Organizational Chart

• It shows employee positions
• Includes authorities, responsibilities and accountabilities and job descriptions.

Professional Services Department

• Interact often with phlebotomists
• They need to know the location and nature of each department, relevant risks, and safety precautions.

Radiology

• X-rays, CT scans, MRI, etc
• The phlebotomist must observe precautions

Radiation Therapy

• Radiation therapy is used to stop cancer and blood tests are often performed by the lab

Nuclear Medicine

• Uses radioactive substances in the treatment of disease
• Observe radiation exposure precautions

Other Healthcare Settings

• Physicians Office Laboratories (POLs) and Group Practices
• Health Management Organizations (HMOs)
• Government and Hospital Clinics
• Home Health Care

The Clinical Laboratory

• Divided into an anatomical and surgical pathology area and clinical analysis area
• Analyzes tissue and surgical specimens
• Also involved with biopsies and autopsies
• Clinical section covers blood, bone marrow, microbiology samples, urine, and other body fluids.

Surgical Pathology

• Consists of Ο Cytology Ο Histology Ο Cytogenetics

Cytology

• Analyzes tissue and body fluids for cancer
• Papanicolaou test is a common test

Histology

• The process and stain tissue is obtained by biopsies from surgery

Cytogenetics

• Chromosome studies detect genetic disorders

Hematology

• Identifies diseases of blood
• Complete blood count is the most common test

Coagulation

• Assesses blood clotting
• Used to find defects

Clinical Chemistry

• Performs most of the tests
• Electrolytes such as Sodium, Potassium, Calcium, Chloride, Albumin, Creatinine, Bilirubin, Blood Urea, Nitrogen, Uric Acid

Clinical Laboratory Personnel

• Employs a large number of personnel whose qualifications vary with their job descriptions
• The following are some of the personal
  • Laboratory Director (Pathologist)
  • Laboratory Manager (Administrator)
  • Technical Supervisor
  • Medical Laboratory Scientist (MLS)
  • Medical Laboratory Technician (MLT)
  • Laboratory Assistant
  • Phlebotomist