Phlebotomy Introduction PDF

INTRODUCTION TO PHEBOTOMY: The Clinical Laboratory CLINICAL LABORATORY ORGANIZATIONAL DIVISION Anatomical Area Clinical Area Clinical Laboratory Organizational Chart Anatomical Area ► Responsible for the analysis of surgical specimens, frozen sections, biopsies, cytological specime...

INTRODUCTION TO PHEBOTOMY: The Clinical Laboratory CLINICAL LABORATORY ORGANIZATIONAL DIVISION Anatomical Area Clinical Area Clinical Laboratory Organizational Chart Anatomical Area ► Responsible for the analysis of surgical specimens, frozen sections, biopsies, cytological specimens, and autopsies. ► Sections: 1. Cytology Section 2. Histology Section 3. Cytogenetics Clinical Area ► In the clinical sections, blood, bone marrow, microbiology samples, urine, and other body fluids are analyzed. ► Laboratory Information System (LIS) department – responsible for the laboratory computer operations, maintaining records, and documentation for the compliance with accrediting regulations. Clinical Area—cont’d ► Divided into specialized sections: 1. Hematology 2. Coagulation 3. Chemistry 4. Blood bank (Immunohematology) 5. Serology (Immunology) 6. Microbiology 7. Urinalysis **Phlebotomy and Sample processing Clinical Area—cont’d Hematology Section ► Hematology- is the study of the formed (cellular) elements of the blood. o Red blood cells (RBCs) o White blood cells (WBCs) o Platelets (Plts) ► Most common fluid analyzed is whole blood (a mixture of cells and plasma) ► Whole blood is obtained by using a collection tube with an anticoagulant to prevent clotting. ▪ Tubes with lavender stopper ▪ Anticoagulant: Ethylenediaminetetraacetic acid (EDTA) ▪ Requires 8-10 times of immediate tube inversion to activate Hematology Section—cont’d ► Blood is analyzed as whole blood, plasma or serum. ❑ Plasma: liquid portion of the blood obtained from a sample that has been anticoagulated; contains fibrinogen. ❑ Serum: liquid portion of the blood obtained if the sample is allowed to clot; does not contain fibrinogen. Hematology Section—cont’d Common Tests performed in the Hematology Section: ❖ Complete blood count (primary analysis performed) a. Differential b. WBC count c. RBC count d. Hematocrit (Hct) e. Hemoglobin (Hgb) f. Indices such as MCV, MCH and MCHC g. Platelet count h. Red cell distribution width (RDW) Hematology Section—cont’d Common Tests performed in the Hematology Section (cont’d) : ❖ Body fluid analysis ❖ Bone marrow ❖ Erythrocyte sedimentation rate (ESR) ❖ Reticulocyte count ❖ Sickle cell ❖ Special stains Clinical Area—cont’d Coagulation Section ► In this area, the overall process of hemostasis is evaluated; a. Platelets b. Blood vessels c. Coagulation factors d. Fibrinolysis e. Inhibitors f. Anticoagulant therapy (Heparin and Coumadin) ► Tube with a light blue stopper ► Anticoagulant: Sodium Citrate (3-4 times) Coagulation Section—cont’d Common Tests performed in the Coagulation Section: ❖ Prothrombin time (PT) ❖ Activated partial thromboplastin time (APTT) ❖ Thrombin time (TT) ❖ Bleeding time (BT) ❖ Factor Assays Clinical Area—cont’d Chemistry Section ► Most automated area in the laboratory ► Study of components in the blood including enzymes, hormones, electrolytes, chemicals and poisons. ► Tests performed on serum, plasma, urine and other body fluids ► Performed primarily on serum collected in gel barriers, but may also be collected in tubes with red, green, gray, or royal blue stoppers. Chemistry Section—cont’d ► Factors that may affect the test results: *Hemolyzed – specimens that appear red because of the release of hemoglobin from RBCs; *Icteric – specimens that are abnormally yellow due to excess bilirubin *Lipemic – specimens that are too cloudy because of increased lipids. ► Fasting samples are preferred. (8-12 hours) Chemistry Section—cont’d Common Tests performed in the Chemistry Section: ❖ Test for electrolytes like Na, K, Cl, CO 2 ❖ Lipid panel ❖ Total protein ❖ Enzyme immunoassays ❖ Fasting blood sugar ❖ Blood gas analyses ❖ Therapeutic drug monitoring ❖ Blood urea nitrogen ❖ Creatinine Clinical Area—cont’d Immunohematology/Blood Bank Section ► Section of the laboratory where blood may be collected, stored, and prepared for transfusion ► Units of blood are collected from donors, tested for the presence of bloodborne pathogens (Hepatitis and HIV), and stored for transfusions. ► Blood may also be separated into components including packed cells, platelets, fresh frozen plasma, and cryoprecipitate. ► Samples are collected in plain red (serum), lavender, or pink (plasma) stopper tubes. ► Serum separator tubes containing gel are not acceptable ► Patient identification is critical in this section. Immunohematology Section—cont’d Common Tests performed in the Blood Bank Section: ❖ Group and type – ABO and Rh typing ❖ Type and crossmatch – ABO, Rh typing and compatibility testing ❖ Antibody Screening ❖ Direct Coombs Test ❖ Indirect Coombs Test Clinical Area—cont’d Serology (Immunology) Section ► The section that performs tests to evaluate the body’s immune response. ► Detects the presence of antibodies to bacteria, fungi, parasites, viruses, and antibodies produced against body substances (autoimmunity). ► Samples are collected in tubes with red stoppers. Serology (Immunology) Section—cont’d Common Tests performed in the Serology (Immunology) Section: ❖ Hepatitis B surface antigen ❖ Hepatitis Panel ❖ VDRL and RPR for syphilis ❖ Anti-HIV ❖ Western blot confirms HIV ❖ HCG – pregnancy ❖ Antibody titer Clinical Area—cont’d Microbiology Section ► Identification of pathogenic microorganisms, effective antibiotic therapy and infection control in the hospital. ► May be divided into: Bacteriology Mycology Parasitology Virology Microbiology Section—cont’d ►Types of specimens: ❑ Blood ❑ Sputum ❑ Wounds ❑ Feces ❑ Urine ❑ GI tract ❑ Throat Swab ❑ CSF Microbiology Section—cont’d Common Tests performed in the Microbiology Section: ❖ Culture and Sensitivity – primary procedure performed ❖ Gram stain ❖ Blood culture ❖ Acid-fast bacillus (AFB) culture ❖ Fungal Culture ❖ Occult blood ❖ Ova and parasites – performed on stool sample Clinical Area—cont’d Urinalysis Section ► Detect disorders and infections of the kidneys and detect metabolic disorders such as diabetes and liver disease. ► Consists of physical, chemical and microscopic examination of urine. ► Urine samples must not sit at room temperature for longer than 2 hours Urinalysis Section—cont’d Common Tests performed in the Urinalysis Section: ❖ Physical examination ❖ Chemical Examination ❖ Microscopic ❏ Color ❏ pH ❏ Volume ❏ Protein ❏ Glucose ❏ Clarity ❏ Ketones ❏ Blood ❏ Bilirubin ❏ Urobilinogen ❏ Specific gravity ❏ Nitrite ❏ Leukocyte esterase  Clinical Laboratory Personnel I. Laboratory Director (Pathologist) ✔ Physician who has completed a 4-5 year pathology residency. ✔ Works both in clinical and anatomical pathology II. Laboratory Manager (Administrator) ✔ Medical laboratory scientist with a master’s degree and 5 or more years of laboratory experience ✔ Responsible for overall technical and administrative management  Clinical Laboratory Personnel—cont’d III. Technical Supervisor ✔ Medical laboratory scientist with experience and expertise related to the particular laboratory section/s ✔ Reviews all the lab results; consults the pathologist for abnormal results; scheduling of personnel; maintenance of automated machines and provides research and developmental protocols for new test procedures. IV. Medical Laboratory Scientist ✔ A bachelor’s degree in medical technology and 1 year training in accredited laboratory ✔ Performs laboratory testing requiring independent judgment ✔ Minimal supervision  Clinical Laboratory Personnel—cont’d V. Medical Laboratory Technician ✔ 2-year associate degree from an accredited college medical laboratory program ✔ Performs laboratory testing by protocol under supervision VI. Laboratory Assistant ✔ Has a training in phlebotomy, sample receiving and processing, quality control and preventive maintenance of instruments, and computer data entry and can perform basic “waived” laboratory testing  Clinical Laboratory Personnel—cont’d VII. Phlebotomist ✔ High school diploma and a phlebotomy training program ✔ Sample collection and processing Phlebotomy and the Healthcare Field What is phlebotomy? ► Phlebotomy is the collection of blood samples for laboratory analysis to diagnose and monitor medical conditions. ► Phlebotomist is a person trained to obtain blood samples primarily by venipuncture and microtechniques. Duties of the Phlebotomist 1. Correct identification and preparation of the patient before sample collection 2. Collection of the appropriate amount of blood needed 3. Selection of appropriate sample containers 4. Correct labelling of all samples 5. Appropriate transportation of samples 6. Effective interaction with patients and hospital personnel  Duties of the Phlebotomist—cont'd 7. Processing of samples for delivery to the appropriate laboratory departments 8. Performance of computer operations and record- keeping 9. Observation of all safety regulations, quality control checks, and preventive maintenance procedures 10.Attendance at continuing education programs Professional and Personal Characteristics for Phlebotomists ► Dependable, cooperative, committed ► Compassionate, courteous, respectful ► Integrity, honesty, competence ► Organized, responsible, flexible ► Appearance ► Communication a. Verbal b. Listening c. Body language d. Telephone skills  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 must be pulled back ► Proper personal hygiene ► Proper fingernail length and maintenance No artificial nails (Center for Disease Control Guidelines)  Culture 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. Phlebotomy Education and Certification Certification requirements: ✔ Certification examinations ► Computer adaptive testing ✔ Professional organization membership ✔ Continuing education ► Required for licensure ► Maintain certification Phlebotomist Certification  Health-Care Delivery System ► Employment settings: 1. Hospitals 2. Physician Office Laboratories (POL) 3. Health Maintenance Organizations (HMO) 4. Reference laboratories 5. Urgent care centers 6. Nursing homes 7. Home health-care agencies 8. Blood donor centers Hospital Patient Care Areas Regulatory, Ethical, and Legal Issues Agencies: A. CLIA (CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988 – Requirements for persons performing waived, provider- performed microscopy, moderate-complexity, and high-complexity testing. B. JC (JOINT COMMISSION) – Accreditation and certification of health care organizations C. CLSI (CLINICAL AND LABORATORY STANDARDS INSTITUTE)– agency that develops written standards and guidelines for sample collection, handling and processing, and laboratory testing and reporting D. CAP (COLLEGE OF AMERICAN PATHOLOGISTS) – Laboratory accreditation and provision of proficiency testing  Joint Commission Patient Safety Goals 1. Improving the Accuracy of Patient Identification 2. Improving the Effectiveness of Communication among Healthcare Givers 3. Reduce the Risk of Healthcare-Associated Infections 4. Encourage Patients’ Active Involvement in Their Own Case as a Patient Safety Strategy Patient’s Bill of Rights / Patient Care Partnership Require the phlebotomists to: ✔ Be respectful of their patients ✔ Refer patients to their healthcare provider for information on their tests and condition ✔ Recognize that a patient can refuse treatment ✔ Maintain the confidentiality of patient information. Ethics versus Medical Law ► Ethics are recommended standards of right and wrong. ► Medical law specifies legally required conduct of health-care providers. Legal Issues related to Medicine - Tort Law ► A wrongful act committed by one person against another that causes harm to the person or his or her property is called a tort. ► Intentional 1. Assault 2. Battery 3. Defamation ► Unintentional 1. Negligence 2. Malpractice  Tort Law ► Assault – is the treat to touch another person without his or her consent and with the intention of causing fear of harm. ► Battery – is the actual harmful touching of a person without his or her consent. ► Defamation – is spoken or written words that can injure a person’s reputation.  Tort Law—cont’d ► Malpractice - misconduct or lack of skill by a health- care professional that results in injury to the patient. ► Negligence – defined as failure to give reasonable care by the health-care provider. Must be proven in a malpractice suit.  Sentinel event ► An unexpected occurrence resulting in death or serious physical (such as loss of a limb) or psychological injury. ► A report including the event, a root cause analysis, and an action plan must be developed for the JC. ► Phlebotomists can cause a sentinel event by patient misidentification and sample mislabeling.  THANK YOU! Reference: STRASINGER, S.K. & DI LORENZO, M.S. (2011). THE PHLEBOTOMY TEXTBOOK (3 RD ed.) PHILADELPHIA; FA DAVIS