PMLSLEC Understanding Phleb

Hippocrates and Bloodletting

• Hippocrates (460-377 B.C.) believed that disease was the result of an excess of four substances: blood, phlegm, black bile, and yellow bile.
• He proposed that removal of the excess substance would restore balance to the body.

Venesection and Phlebotomy

• Venesection: the practice of cutting a vein to release blood, also known as phlebotomy.
• Cutting a vein with a sharp instrument was a common method of general bloodletting.
• Bloodletting was thought to:
• rid the body of evil spirits
• cleanse bodily impurities
• bring the body into proper balance

Tools and Methods

• Lancet: a tool used to cut veins during venesection.
• Phlebotomy was a major therapeutic process in the 17th and 18th centuries.
• Cupping: a method that involved applying a heated suction apparatus to the skin to draw blood to the surface.
• Fleams: used for general phlebotomy to open an artery or vein to remove large amounts of blood.
• Leeching: a method that used European medicinal leeches to remove blood from a localized area.

Leeching and Its Value

• Leeches were used for more localized bloodletting and were kept in special vessels.
• Widely practiced in Europe (France) by the mid-18th century.
• Leech therapy value comes from the worm's saliva components:
• a vasodilator
• a local anesthetic
• hirudin, an anticoagulant

Hippocrates and Bloodletting

• Hippocrates (460-377 B.C.) believed that disease was the result of an excess of four substances: blood, phlegm, black bile, and yellow bile.
• He proposed that removal of the excess substance would restore balance to the body.

Venesection and Phlebotomy

• Venesection: the practice of cutting a vein to release blood, also known as phlebotomy.
• Cutting a vein with a sharp instrument was a common method of general bloodletting.
• Bloodletting was thought to:
• rid the body of evil spirits
• cleanse bodily impurities
• bring the body into proper balance

Tools and Methods

• Lancet: a tool used to cut veins during venesection.
• Phlebotomy was a major therapeutic process in the 17th and 18th centuries.
• Cupping: a method that involved applying a heated suction apparatus to the skin to draw blood to the surface.
• Fleams: used for general phlebotomy to open an artery or vein to remove large amounts of blood.
• Leeching: a method that used European medicinal leeches to remove blood from a localized area.

Leeching and Its Value

• Leeches were used for more localized bloodletting and were kept in special vessels.
• Widely practiced in Europe (France) by the mid-18th century.
• Leech therapy value comes from the worm's saliva components:
• a vasodilator
• a local anesthetic
• hirudin, an anticoagulant

Phlebotomy Overview

• Phlebotomy is performed to obtain blood for diagnostic purposes, monitor prescribed treatment, and remove blood for therapeutic purposes.
• Two primary procedures are used: venipuncture (collecting blood by penetrating a vein with a needle and syringe) and capillary puncture (collecting blood after puncturing the skin with a lancet).

Phlebotomist Characteristics

• A competent clinical phlebotomist must have good manual dexterity, special communication skills, good organizational skills, and thorough knowledge of lab specimen requirements and departmental policies.
• Phlebotomy programs are approved by the National Accrediting Agency for Clinical Laboratory Sciences (NAACLS).

Certification and Licensure

• Official Recognition Certification is a voluntary process that grants recognition to an individual who has met certain prerequisites in a particular technical area.
• Licensure is the act of granting a license, which requires specific education and experience requirements, and passing an examination.
• Periodic license renewal by reexamination or proof of continuing education is necessary.

Continuing Education

• Continuing education is designed to update knowledge and skills of participants.
• The American Society for Clinical Laboratory Science (ASCLS), American Medical Technologists (AMT), and American Society for Clinical Pathology (ASCP) sponsor programs that award continuing education units (CEUs).

Patient-Client Interaction

• The phlebotomist is often the only real contact the patient has with the laboratory.
• Positive “customer relations” involves promoting goodwill and a harmonious relationship with fellow employees, visitors, and patients.
• Culturally aware healthcare providers enhance the potential for more rewarding interpersonal experiences.

Professionalism

• Professionalism is defined as the conduct and qualities that characterize a professional person.
• Key factors contributing to a professional image include:
  • Self-confidence
  • Integrity
  • Compassion
  • Self-motivation
  • Dependability
  • Ethical behavior

Patients' Rights

• A patient has rights and must be informed of these rights when care is initiated.
• The American Hospital Association (AHA) published the Patient Care Partnership, which outlines patient rights and responsibilities.

Confidentiality

• Patient confidentiality is seen as the ethical cornerstone of professional behavior in the healthcare field.
• The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires healthcare providers to obtain a patient's written consent before disclosing medical information.

Communication Skills

• Phlebotomy is both a technical and a people-oriented profession.
• Communication involves three components: verbal skills, nonverbal skills, and the ability to listen.
• Effective communication is essential in healthcare, and involves empathy, control, trust, respect, and confirmation.

Communication Components

• Verbal communication: expression through spoken word, involving a sender, receiver, and feedback.
• Active listening: taking positive steps through feedback to ensure the listener understands the speaker's intended message.
• Nonverbal communication: 80% of language is unspoken, and involves kinesics, proxemics, appearance, and touch.

Effective Communication in Healthcare

• Recognizing the elements of healthcare communication, such as empathy, control, trust, and confirmation, helps the phlebotomist interact with the patient successfully.
• Telephone communication involves proper protocol and etiquette to maintain a professional image.

Healthcare Personnel and System

• Healthcare personnel who understand healthcare organization and financing can help consumers navigate the system efficiently and cost-effectively.

Healthcare Facilities

• Two general categories of facilities: inpatient (non-ambulatory) and outpatient (ambulatory)
• Ambulatory care provides medical services on an outpatient basis, including:
  • Freestanding medical care settings and hospital-owned clinics
  • Outpatient departments and urgent care facilities
• Ambulatory care services meet the needs of patients who require nursing care, lab tests, or other follow-up procedures after hospital discharge

Public Health Service

• Principal unit under the Department of Health and Human Services (HHS)
• Mission: to promote the protection and advancement of the nation's physical and mental health

Organization of Hospital Services

• A hospital is a healthcare facility with:
  • Permanent inpatient beds
  • 24-hour nursing service
  • Therapeutic and diagnostic services
  • Organized medical staff
• Hospital services are traditionally arranged by departments or medical specialties

Clinical Laboratory Services

• Perform tests on patient specimens to confirm health, aid in diagnosis, evaluation, and monitoring of medical conditions
• Two major divisions: clinical analysis area and anatomical and surgical pathology area

Clinical Analysis Areas

• Hematology:
  • Performs lab tests to identify diseases associated with blood and blood-forming tissues
  • Most common test: complete blood count (CBC)
  • CBC is a multipart assay reported on a hemogram, performed using automated instruments
• Coagulation:
  • Studies the ability of blood to form and dissolve clots
  • Tests used to discover, identify, and monitor defects in the blood-clotting mechanism
  • Two most common tests: prothrombin time (PT) and activated partial thromboplastin time (APPT)
• Chemistry:
  • Performs most lab tests
  • Often has subsections such as toxicology and radioimmunoassay
  • Computerized instruments used can perform discrete or metabolic panels from a single sample
  • Most common specimen: serum
• Serology or Immunology:
  • Deals with the body's response to bacterial, viral, fungal, or parasitic diseases
  • Testing is done by enzyme immunoassay (EIA), agglutination, complement fixation, or precipitation to determine antibody or antigen presence and concentration
• Urinalysis:
  • May be housed in hematology or chemistry area or in a separate section
  • Specimens may be analyzed manually or using automated instruments
  • Routine urine test includes physical, chemical, and microscopic evaluations
• Microbiology:
  • Analyzes body fluids and tissues for microorganisms
  • Importance of proper specimen collection, transport, and handling
  • Subsections: bacteriology, parasitology, mycology, and virology
• Blood Bank or Immunohematology:
  • Prepares blood products for patient transfusions
  • Blood components dispensed: whole blood, platelets, packed cells, fresh frozen plasma, and cryoprecipitates
  • Blood samples from donors and recipient must be tested pre-transfusion to avoid incompatibility and transfusion reactions

Anatomical and Surgical Pathology

• Histology:
  • Evaluates samples of tissue from surgeries and autopsies under a microscope
  • Two most common histological diagnostic techniques: biopsy and frozen section
  • Role of histologist: processing and staining tissues before evaluation
• Cytology:
  • Concerned with the structure of cells
  • Identifies, counts, and studies cells to diagnose malignant and premalignant conditions
  • Pap smear: for early detection of cancer cells of the cervix and vagina
• Cytogenetics:
  • Examines samples for chromosomal deficiencies related to genetic disease
  • DNA histogram: latest test for genetic and malignant disorders
  • DNA fingerprinting and molecular genotyping: prevalent forms of scientific testing in forensic medicine

Stat Labs and Reference Laboratories

• Stat Labs:
  • Set up in emergency department (ED) or emergency room (ER)
  • Perform tests needed to respond to medical emergencies
• Reference Laboratories:
  • Large independent labs receiving specimens from different facilities
  • Offer fast turnaround times (TATs) and reduced costs due to high volume of tests

Clinical Laboratory Personnel

• Laboratory Director/Pathologist:
  • Physician specializing in diagnosing diseases through lab test results
  • Shares responsibilities with lab administrator for lab management
• Laboratory Administrator/Laboratory Manager:
  • Oversees all operations
  • Supervises ancillary services such as radiology and respiratory therapy
• Technical Supervisor:
  • Responsible for administration of the area
  • Reports to the lab administrator
• Medical Technologist/Medical Laboratory Scientist:
  • Performs all levels of testing in any area
  • Reports results, performs QC, evaluates new procedures, and conducts preventive maintenance and troubleshooting on instruments
• Medical Laboratory Technician:
  • Responsible for performing routine testing, operating equipment, and performing basic instrument maintenance
• Clinical Laboratory Assistant:
  • Assists MLS/MLT with workloads in any area
• Phlebotomist:
  • Trained to collect blood for lab tests
  • Some facilities use phlebotomists as lab assistants or specimen processors

Clinical Laboratory Improvement Act

• Clinical Laboratory Improvement Amendments of 1988 (CLIA '88)
• Federal law regulating all sites performing lab testing in the US
• Mandates all labs to use the same standards regardless of location, type, or size, including personnel standards for labs performing moderate- and high-complexity testing