Phlebo - PMLS LEC PDF

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PHLEBOTOMY Lesson 1: Introduction to Phlebotomy Key Terms: 1. Advance Directive- document stipulating the kind of life prolonging medical care permitted for a patient. 2. Centralized Phlebotomy- sample collection where the phlebotomist is part of the laboratory team and dispatched to hospital units ...

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PHLEBOTOMY Lesson 1: Introduction to Phlebotomy Key Terms: 1. Advance Directive- document stipulating the kind of life prolonging medical care permitted for a patient. 2. Centralized Phlebotomy- sample collection where the phlebotomist is part of the laboratory team and dispatched to hospital units to collect blood samples. 3. Compatible- substances that can be mixed without reacting to one another. 4. Decentralized Phlebotomy- sample collection where all members of the health care team share responsibility to collect blood sample. 5. Demeanor- the outward behavior of an individual.

of a substance, the results maybe positive and negative. 15. Quality Assurance- the health care facilities guarantee that all areas of the program provides the highest quality and most appropriate level of care. 16. Quality Control- methods to monitor process and confirm that processes are within the pre-established limits. 17. Quantitative Analysis- analysis of the substance to determine the amount or proportions of the substance. - Results will be released as an amount, such as grams or liters. 18. Root Cause- analysis of an event to determine the actual reason for the incident and corrective action needed to prevent an occurrence.

6. Esoteric- type of laboratory tests that are not routinely done.

19. Sentinel Event- an unexpected occurrence involving death or serious physical and psychological injury.

-these tests are often sent to other laboratories that specializes in a specific test.

20. Threshold- acceptable level of performance.

7. Ethics- professional code of conduct.

21. Venipuncture- collection of blood from vein with a needle.

- the moral philosophy of how the phlebotomist treats the patient. 8. Examination- all processes that are done to perform the tests on the sample to achieve a result.

History of Phlebotomy

9. Failure- a case when the system does not meet user or customer expectation.

-The act or practice of bloodletting as a therapeutic measure (Websters)

10. Pathology- study of nature and cause of diseases.

Two Basic methods:

11. Phlebotomy- act or practice of bloodletting as a therapeutic or diagnosis measure. 12. Post-examination (Post-analyticalprocess in which the result of the testing are communicated to the health care provider. 13. Pre-examination (Pre-analytical)- all the processes that it takes to collect the sample and get to the point in which the testing of sample can occur. 14. Qualitative Analysis- chemical analysis designed to identify the components

Phlebotomy- The process of collecting blood. “Phlebos & Tomy”

1. Venesection- Most common - A sharp lancet-type instrument pierced the veins and made them bleed. - Lacing- thought to eliminate the “bad blood”, remove the disease. - Used to reduce fever. 2. Cupping- A heated glass was placed on a person’s back. - Cooled- created suction that pulled blood to the capillaries.

- Multiple blades cut the area: Massive bleeding.

Phlebotomy’s Role in Health Care Phlebotomist

George Washington

- Primary Role- collect blood for accurate and reliable test results.

- The 1st president of US

- Represents the laboratory.

- Severe throat infection

- In direct contact with the patients.

- That time; the cure- HEAVY Bleeding

- Traditionally; ONLY ONE job- Collect blood

- Bled more than 9 pints of blood in less than 24 hours - Died December 14. 1799

Centralized vs. Decentralized Phlebotomy

- Philosophy of bleeding as the cure to disease began to change.

Centralized Phlebotomy

Mid 19th Century

- Starts as early as 4:30 am – due to fasting patients.

- Discovery of microorganism as the causative agent for many diseases. - Blood began to be examined for diagnostic purposes.

-Phlebotomist is dispatched from laboratory to either nursing units (wards) or OPD.

- Blood collection is done purely by the phlebotomist, by batch if needed, depending on the bulk of patients in line for extraction.

-Finally, bloodletting was no longer considered the cure of all illnesses.

Decentralized Phlebotomy

- Urine & Feces: examined since medieval times

- More people are able to collect blood samples during the BUSY TIMES.

Modern Times -Leeches - Application: prevent disease

- Everyone who has contact with the patient needs to become multi-skilled. - Nurses needs to learn how to collect blood samples, and the phlebotomist needs to learn some of the nursing duties.

- Problem: get full rapidly & have to be changed after several hours.

Today -Bleeding of Individuals to reduce the patients amount of blood- used to treat PCV (polycythemia vera ) and hereditary hemochromatosis.

Which one do you think is more common? Centralized Phlebotomy- 85% Decentralized Phlebotomy- 15%

- Contemporary Phlebotomy- blood is extracted to find cure.

Therapeutic ----- Diagnostic

Areas of the Hospital and Health care Setting

Ancillary Hospital Areas and their Purposes

Coronary Care Unit (CCU)

Increased care of a patient due to a heart condition

Emergency Department

Emergency treatment of patient

Geriatric

Care for elderly patients

Home Health Care

Follow-up care of a patient at home

Intensive Care Unit (ICU)

Increased care due to the critical needs of the patient

Neonatal

Newborn care

Nephrology

Care for patients on dialysis

Obstetrics

Care for patients in labor or childbirth

Oncology

Care for patients with cancer

Administration

Keeps hospital in compliance

Electrocardiogra phy (EKG) Electroence phalography(EE G) Environmental Services

Monitor patients with cardiovascular disorder

Food Service (dietary)

Provides diet to patient

Gastrointestinal Laboratory

Diagnose Gastrointestinal disorders

Laboratory

Provides testing of patient samples

Orthopedics

Care for patients with broken bones

Medical Records

Maintains patient record

Pediatrics

Care for patients who are infant and children

Nursing

Provides direct patient care

Recovery

Recovery treatment of patients (usually postoperation)

Occupational Therapy

Provides therapy to help maintain living skills

Pharmacy

Dispenses drugs; and advises on drug usage

Physical Therapy

Provides therapy to restore mobility

Radiology

Uses imaging for diagnosis and treatment

Respiratory Therapy

Provides therapy to evaluate lungs

Speech Therapy

Provides therapy to restore speech

Diagnosis of neurophysiological disorders Maintains a clean facility

THREE PHASES OF SAMPLE TESTING A. Pre-examination (Previously known as Pre-analytical) B. Examination (Previously known as Analytical) C. Post-examination (Previously known as Post-analytical)

PHASE 1: PRE-EXAMINATION 1. Clinical request 2. Patient ID and Information 3. Correct sample collection 4. Correct use of all equipment 5. Sample preparation or centrifugation 6. Proper preparation of sample aliquots

Types of Patient Care

PHASE 2: EXAMINATION 1. Sample testing

2. Maintaining testing equipment and reagents PHASE 3: POST-EXAMINATION 1. Reporting of results 2. Ensuring Accuracy and reliability of delivery of results 3. Follow-up to repeat testing or address physician concerns 4. Storage of samples after examination

LABORATORY STAFF Patient Care Partnership: Patient Rights 1. Right to considerate and respectful care 2. Right to and is encouraged to obtain from physicians and other direct caregivers relevant, current and understandable information concerning diagnosis, treatment, and prognosis. 3. Right to make decisions about the plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. 4. Right to have an advanced directive ( such as a living will, health proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy. 5. Right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patients privacy. 6. Right to expect that all communications and records pertaining to his or her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public hazards when reporting is permitted or required by law. 7. Right to review the records pertaining to his or her medical care and to have the information explained or interpreted as necessary, except when restricted by law. 8. Right to expect that, within its capacity and policies, a hospital will make reasonable

response, to the request of a patient for appropriate and medically indicated care and services. 9. Right to ask and be informed of the existence of business relationships among hospital, educational institutions, other health care providers, or payors, that may influence the patients treatment and care. 10. Right to consent to or decline to participate in proposed research, studies or human experimentation affecting care and treatment or requiring direct patient involvement and to have those studies fully explained prior to consent. 11. Right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate. 12. Right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities.

Professional Attitude of a Phlebotomist Patients- usually apprehensive about the procedure we perform. IMPORTANT! – obtain a good sample; with as minimal trauma to the patient possible “Patients must be treated like anyone else would like to be treated”

Professional Grooming of a Phlebotomist - No visible tattoos - No body piercing other than a minimum of two in the ears (one for each ear) - No fingernails longer than ¼ inch - No blue jeans or casual attire - No open-toed shoes - No T-shirt or sweatshirt Often the phlebotomist will be most comfortable and acceptable wearing scrub suit. In some health organizations, the scrub outfit is furnished.

Lesson 2: Safety in Phlebotomy Infection Control Nosocomial Infection- Also known as Health Care Associated infection and Hospital-Acquired infection. -patient who comes to the hospital and develops infection 48 hours or more after administration or within 30 days after discharge from a hospital or healthcare facility. Local Infection- If the infection occurs before 48 hours after admission. - Infection is restricted to one area of the body. Systemic Infection- Affects the entire body Communicable Disease- If the organism that causes this infection spreads from person to person. Infection- a condition that results when a microorganism (microbe for short) is able to invade the body, multiply, and cause injury or disease.

MEANS OF TRANSMISSION Is the method an infectious agent uses to travel from a reservoir to a susceptible individual include airborne, contact, droplet, vector, and vehicle. The same microbe can be transmitted by more than one route. Airborne Transmission - involves dispersal of infectious agent that can remain infective for long periods of time in particle that are typically less than 5m in diameter and can be inhaled, such as droplet nuclei (residue of evaporated droplets) Contact Transmission - is the most common means of transmitting infection - Direct and Indirect Direct: is the physical transfer of an infectious agent to a susceptible host through close or intimate contact such as touching or kissing.

CHAIN OF INFECTION

Indirect: can occur when a susceptible host touches contaminated objects such as patients bed linens, clothing, dressings, and eating utensils.

Six key components

Droplet Transmission

INFECTIOUS AGENT or causative agent

- is the transfer of an infectious agent to the mucous membranes of the mouth, nose, conjunctiva of the eyes of a susceptible individual via infectious droplet (particles 5m in diameter or larger) generated by coughing, sneezing, or talking through procedures such as suctioning or throat swab collection

The pathogenic microbe responsible for causing an infection. RESERVOIR The source of an infectious agent. It is a place where the microbe can survive and grow or multiply, includes; humans, animals, food, water, soil, and contaminated articles and equipment. PORTAL OF EXIT/EXIT PATHWAY Is a way an infectious agent is able to leave a reservoir host. Infectious agent can exit a reservoir host in secretions from the eyes, nose or mouth; exudates from wounds; tissue specimens; blood from venipuncture and skin puncture sites; and excretion of feces and urine.

Vector Transmission - is the transfer of an infectious agent carried by an insect, arthropod, or animal Vehicle Transmission - transmission through contaminated water, food or drugs ENTRY PATHWAY The way an infectious agent is able to enter a susceptible host.

Includes body orifices; mucous membranes of the eyes, nose, or mouth; and breaks in the skin.

5. Place intact needle/syringe and sharps in designated sharp containers. Do not bend, break or cut needles.

Patients entry pathway can be exposed during invasive procedures such as catheterization, venipuncture, finger sticks, and heel puncture.

REDUCING RISK EXPOSURE

Entry pathways of health care personnel can be exposed during spills and splashes of infectious specimen or created by needle sticks or injuries from other sharp objects.

1. Engineering Controls

Six major tactics to reduce the risk of exposure to blood-borne pathogens:

2. Work Practices

SUSCEPTIBLE HOST

3. Housekeeping

Is someone with a decreased ability to resist infection.

4. HBV Vaccination

Factors that affects susceptibility include age, health and immune status.

BREAKING THE LINK UNIVERSAL PRECAUTIONS - Developed in 1985 by CDC as a response to the increase in blood-borne diseases such as AIDS and HepB - States that any patient has the potential to be infected with these blood-borne pathogens. - Assumed that all blood and most body fluids were potentially infectious. - Evolved into a system called Body Substance Isolation; required that gloves be worn when healthcare provider is in contact with any body substance.

5. PPE 6. Private Rooms

Engineering Controls Physical and mechanical devices that are available to the healthcare associate to reduce or eliminate the potential to transfer infectious diseases. 1. Puncture-resistant containers 2. Safety needles/self-sheathing needles 3. Autoclaves 4. Biohazard Bags 5. Splash Guards 6. Volatile liquid carriers 7. Centrifuge safety buckets 8. Biological safety cabinets

STANDARD PRECAUTIONS Five Main Points: 1. Wash hands when changing gloves and between patients.

9. Fume hoods 10. Mechanical Pipetting devices 11. Computer wrist/ arm pads 12. Sensor-controlled sinks

2. wear gloves when likely to touch body substances, mucous membranes, and during all blood drawing.

13. Foot/knee/elbow-controlled faucets

3. Wear protective cover when clothing is likely to be soiled.

15. Safety Showers

4. Wear a mask and eye protection in addition to a protective body cover when likely to be splashed with a body substance.

Work Practice Controls

14. Eyewash stations

HOUSEKEEPING

- Responsibility of all health care associates

Mask

- Involves cleaning up spills and decontaminating soiled areas immediately with a disinfectant such as 10% bleach that has been made up fresh daily

Used to prevent transmission of infectious agent through air

- Broken glass should not be picked up with hands

-Fluid-proof Mask: available for work conditions when spattering of body fluids is likely (should be worn once)

PRIVATE ROOMS

Should never be worn around the neck and moved up to cover the nose and mouth as you enter another room.

- Reduces the possibility of transmission of infection by separating the patient with a disease from other patients and health care associates.

-Paper Mask: most economical and efficient

No longer effective one they become moist from breathing. Gowns

- Should have an anteroom where anyone entering or leaving can wash their hands and change protective garments.

Necessary when soiling of clothes is possible while taking care of patients.

Hand Washing

Should be fluid resistant

Single most important way to prevent spread of infection.

Should only be used once

- Must be performed after each patient contact even when gloves are used

ISOLATION TECHNIQUES

- Disinfectant alcohol based hand cleaners may be used in place of handwashing unless hands are visibly soiled.

1. Category-specific Isolation 2. Disease-specific Isolation 3. Transmission-based Isolation

Personal Protective Equipment (PPE) - Used to protect the phlebotomist from infectious material contacting street clothes, skin, mucous membranes - Employers must provide this equipment free of charge and must maintain and clan the equipment with no charge to the phlebotomist.

Gloves Three reasons to wear gloves: 1. Prevent health care associates from transmitting their own microflora to the patient 2. Prevent transmission of microorganism from one patient to another 3. Prevent the associate to be infected with what is infecting the patient

1. Category-specific Isolation Strict Isolation: patients with a contagious disease such as chicken pox, diphtheria or pneumonia Contact Isolation: diseases that are transmitted through direct contact with the patient such as scabies Respiratory Isolation: patients with diseases transmitted through air such as mumps, pertussis or rubella Tuberculosis Isolation: isolation of patients with tuberculosis

Drainage/Secretion Precautions: sometimes called wound and skin precaution, used for patients with open wounds which are usually results of abrasions, accidental skin cuts, surgery incisions or bedsores that have become infected Enteric Precautions: for patients with severe diarrhea due to contagious bacteria such as Salmonella, Shigella, or Vibrio cholera Protective/Reverse Isolation: protecting patient from health care associates

OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION (OSHA) STANDARDS Investigates the possibility of unsafe practices in the work environment. Goal: to promote safety for health care workers and their environment. Functions: Develop promote health and safety standards for all occupations. Develop and issue regulation.

2. Disease-specific Isolation

Determine the level of co...