Allied Health Career Training, LLC Phlebotomy A how-to guide for drawing blood Compiled by: Brandy Thimesch August 2016 / Revised November 2018 TABLE OF CONTENTS Chapter 1. Introduction to Phlebotomy Page 1 Chapter 2. Ethics and Laws Page 15 Chapter 3. Medical Terminology Page 21 Chapter 4. Safety and Infection Control Page 33 Chapter 5. Laboratory Testing Page 43 Chapter 6. Collection Methods Page 51 Chapter 7. Variables and Complications Page 67 Chapter 8. Venipuncture Procedures Page 75 Chapter 9. Indications for Skin Punctures Page 83 Chapter 10. Pediatric & Geriatric Patients Page 89 Chapter 11. Special Collections Page 97 Case Studies Page 107 Common Laboratory Tests Page 113 Terms and Definitions Page 123 NHA Study Guide Page 133 References Page 147 CHAPTER ONE – INTRODUCTION TO PHLEBOTOMY CHAPTER 1. Introduction to Phlebotomy So, you’ve decided you want to become what we jokingly refer to as a certified vampire and draw blood for a living. What is more commonly known as a phlebotomist, these individuals are also known as specimen handlers or blood collectors (but not blood drinkers ). Why is it necessary to draw blood? What do we do with all this body fluid? Well, phlebotomists play a very big part in treating and diagnosing patients. If it wasn’t for lab testing, doctors would just be guessing! Lab results are critical to patient care. Some of the most important aspects of lab tests are: • Diagnostic and screening – to figure out what is wrong with a patient • Therapeutic assessment – to develop the correct treatment or choose right drugs • Monitoring health – to make sure the therapy or treatment is working Phlebotomy Origins The word “phlebotomy” (and most medical terminology) is derived from the Greek language. Phleb – A prefix meaning veins or blood vessels tomy – A suffix meaning to cut or make an incision The most common methods of today for blood collecting are: • venipuncture - withdrawing venous blood sample using a needle. • skin puncture - puncturing the skin (usually on a finger or heel) for a small amount of capillary blood (*Skin punctures are also referred to as dermal sticks, capillary draws, finger sticks, and heel sticks.) The practice of phlebotomy has been documented as far back as the Stone Age. Markings on tombs found in Egypt show men applying leeches for bloodletting purposes. Bloodletting was a common medical practice that extended from those ancient times until the late 19th century, spanning nearly 2,000 years. The death of our country’s first president, George Washington, in 1799 is attributed in part to the several liters of blood that were drawn after he developed an infection from weather exposure. In the early 1900’s it was generally barbers who practiced phlebotomy and also tooth extraction in their shops. This is where the red and white striped barber shop poles come from. The white represented bandages and the red represented blood. Many crude tools and objects have been used over the centuries, but modern medicine has come a long way! 1 CHAPTER ONE – INTRODUCTION TO PHLEBOTOMY Necessary Character Traits There are certain character traits a person needs in order to work in the healthcare field. Some of the most important traits are: • Do not harm anyone intentionally • Ability to perform according to job description and use good judgment • Respect for patients’ rights • Have regard for dignity of all human beings Let’s start with the first one: Do not harm anyone intentionally. When dealing with the public in healthcare, let’s face it: you will not see people at their best. Many of your patients may be dealing with chronic pain or illness, so naturally they may be grumpy. They may take it out on you, or blame you for things that are out of your control. It is not appropriate to cause the phlebotomy procedure to be even more painful just because they might have hurt your ego. Show compassion. When dealing with the public you must not take things personally. Always follow the golden rule: “Treat people the way you would want to be treated.” As a phlebotomist your duties are limited to what is outlined in your job description. Your supervisor and healthcare facility will have a job description for you to follow. This description will comply with state and federal laws. You must be properly trained and adhere to these laws when working in the healthcare field. If an accident occurs while you were working outside of your job description, there could be severe consequences, such as injury to yourself or patients, loss of your job, or lawsuits. When working in a hospital setting you need to be aware of your limitations. This does not mean you should ignore a patient’s needs; always get a nurse or aid to assist them. It will not be in your job description to: • Start IV’s • Administer medications • Transfer patients (this includes helping patients to the restroom) • Feed patients Patients have the right to refuse medical treatment, which includes having their blood drawn. You do not have the right to do any procedure, phlebotomy or otherwise, without the consent of the patient and/or their medical guardian. You must respect the patient’s rights. If a patient should refuse treatment, document the refusal and notify the nurse. When performing a phlebotomy procedure, make sure to do it with as much privacy and regard for the patient’s dignity as possible. It is not appropriate to perform a blood draw on a patient while they are on the toilet or commode. If a patient is being bathed, wait for a better time. Wait for patients to be fully clothed, if at all possible. Patients have the right to dignity and privacy, regardless of their condition. 2 CHAPTER ONE – INTRODUCTION TO PHLEBOTOMY Certification Eligibility After reading about the characteristics needed for working in the healthcare field, let’s talk about the necessary qualifications to become certified as a phlebotomist. To be eligible to sit for the National Healthcareer Association’s CPT (Certified Phlebotomy Technician) Exam you must meet the following criteria: 1. You must have a High School Diploma or GED, OR you must expect to earn a High School Diploma or GED in the next 12 months. 2. You must have successfully performed 30 venipunctures and 10 capillary sticks on live individuals. 3. You must have completed a phlebotomy training program in the past five years. Specimen Testing Phases The process of specimen testing happens in three distinct phases, pre-analytical, analytical, and post-analytical. • Pre-Analytical Phase - A phlebotomist’s duties are part of the pre-analytical and pre- examination phase of testing. Pre-analytical and pre-examination have the same meaning, and refer to specimen collection. This process occurs before actual testing begins and is one of the most important roles in clinical testing. Most mistakes take place in the pre-analytical phase of testing. Things can go from good to very bad in this phase of testing if not done correctly. This phase includes the following: . Correctly identifying the patient and labeling the specimen . Accurately performing the collection . Transporting the specimen(s) to the lab in a timely manner A phlebotomist’s main goal is to assist the healthcare team in accurate, safe, and reliable collection and transportation of specimens for testing. When collecting specimens for testing make sure to identify your patient. It is important for the phlebotomist to be detailed-oriented when performing the tasks. Avoid distractions when labeling, have the patient spell his or her last name and first, and always ask for a date of birth. After obtaining your specimen, clearly label the specimen tube and/or container. Time can be of the essence in healthcare! It is very important to transport the specimen back to the lab in a timely manner. Kind of like delivering a pizza, it must be done in 30 minutes or less! • Analytical Phase - The analytical phase is when testing of the specimen begins; more than likely your laboratory technicians will be involved with this phase (those are the ones in the lab coats). The specimen is transported to the lab and processed, after which testing begins. When the tests are complete the results are given to the doctor. 3 CHAPTER ONE – INTRODUCTION TO PHLEBOTOMY • Post-analytical Phase - Once results from the specimen testing are given to the doctor, the doctor then uses these results to determine a patient’s diagnosis and the patient is treated accordingly. This is why it is important that the patient and specimen are both correctly identified all the way back in the pre-analytical phase. Here is an example of what can happen when errors occur in the process: Mrs. Yappy is being treated for a blood clot. The doctor is treating Mrs. Yappy with a blood thinner. Routine lab tests are ordered every week to make sure her blood is not too thin or thick. One Monday, Mrs. Yappy and Mrs. Happy come to the lab at the same time. The phlebotomist mislabels Mrs. Yappy’s tube with Mrs. Happy’s tube. The specimens are tested and results are given to the doctor. Mrs. Yappy’s blood appears to not be thin enough, so the doctor orders a higher dose of blood thinner. Later in the week Mrs. Yappy ends up in the hospital with internal bleeding because her blood was way too thin. Figure 1 shows an overview of how all three phases work together: 4 CHAPTER ONE – INTRODUCTION TO PHLEBOTOMY Good Standard of Care Which speaks louder, actions or words? Action always speaks louder than words. If you are taking on this job in hopes to be popular, I hate to disappoint you, but no one is excited to see a needle.