3 INTRO TO PHLEB

• “To cut a vein”; Greek “Phleb” (Vein) and “Tomia”

  (To cut)
• The concept of phlebotomy is young (1900)
• Egyptians has already done bloodletting that is

  quite different from phlebotomy (1400 BC)

  • They believed that sickness are in our blood

  (partly true, but not all)

  • They know at 1400 BC the concept of extracting

  blood that was called as bloodletting

  • Bloodletting today is known as blood

  transfusion

  • During 1628, there were attempted procedures

  of blood transfusion, but are not quite

  successful

  • Such attempts were made by William Harvey,

  and it was done human to animal
• Hippocrates (460-377 BC) – Four humors (Yellow

  Bile, Black Bile, Phlegm, Blood)
• Draining blood, in ancient times, was considered

  one way to effectively cure the body of most ills

  (often described as “bad spirits”) and was often

  performed using a lancet tool.
• 1163 - Pope Alexander III prohibited clergyman

  from performing these bloodlettings. Barbers took

  over as they were naturally skilled with sharp

  objects. (Called Barber-Surgeons.)

  • Before, clergyman were the only people who

  are allowed to perform bloodletting for they are

  known to be educated people
• In 1900, Karl Landsteiner (German) was the first to

  discover blood groups; ABO blood groups
• • After these progress, the preservation of blood was

  also known, anti-coagulants was also discovered

  later on

  Before, the syringes were made of glass that is

  sharpened and sterilized in heat for reuse, but was

  later on produce a disposal syringe
• GOALS OF PHLEBOTOMY

  1. Diagnosis and treatment of blood samples

  2. Blood Transfusion

  3. Removal of Blood for therapeutic services
• CREDENTIALS NEEDED TO BE A MEDICAL

  TECHNOLOGIST

  • License (RA 5527)

  • Continuing Profession/Training

  • However, these two does not apply to being a

  phlebotomist in this country. You just have to

  graduate a medtech, public health, and other

  related programs and complete training hours.

  Although, if you want to work abroad, license

  and training are required to become a

  phlebotomist.

  • There are other professions once you failed the

  licensure board exam such as: being a

  laboratory technician, phlebotomist, and etc.
• Traditional Duties and Responsibilities of the

  Phlebotomist include:

  1. Correct identification and preparation of

  the patient before sample collection.

  2. Collection of the appropriate amount of

  blood by venipuncture or dermal puncture for the

  specified tests.

  3. Selection of the appropriate sample

  containers for the specified tests.

  4. Correct labeling of all samples with the

  required information.

  5. Appropriate transportation of samples

  back to the laboratory in a timely manner.
• ADDITIONAL DUTIES OF PHLEBOTOMISTS

  • Training other health-care personnel to perform

  phlebotomy

  • Monitoring the quality of samples collected on the

  units

  • Evaluation of protocols associated with sample

  collection

  • Performing and monitoring point-of-care testing

  (POCT)

  • Sometimes, the nurses do these kinds of tests

  (glucometer testing, etc.)

  • Performing electrocardiograms

  • Performing measurement of patient’s vital signs

  • Collection of arterial blood samples

  • Collection of samples from central venous access

  devices (CVADs)
• CHARACTERISTICS OF PHLEBOTOMISTS

  • Dependable, cooperative, committed

  • Compassionate, courteous, respectful

  • Integrity, honesty, competence

  • Organized, responsible, flexible

  • Appearance (Clothing, Hygiene)

  Avoid unnecessary dirt

  • Communication

  Verbal Skills

  Nonverbal Skills (Body Language)

  • Respecting Cultural Diversity

  • Respect beliefs, culture, and other traditions of

  patients
• HOSPITAL ORGANIZATIONS

  • Phlebotomists may be scheduled to work at one of

  these areas or patients from these areas may be

  referred to the laboratory for sample collection.

  • May range in size (in terms of bed capacity) from 50

  to more than 300 beds.

  • May vary in extent of services provided
• CLASSIFICATION OF HOSPITALS

  1. According to Ownership
  2. According to Scope of Services
  3. According to Functional Capacity
• ACCORDING TO OWNERSHIP

  1. Government or Public Hospitals
  2. Private Hospitals
• GOVERNMENT OR PUBLIC HOSPITALS

  • Created by law

  • May be under: National Government, LGU, DOH,

  State Universities and Colleges

  • Offer low or free services; heavy workload
• PRIVATE HOSPITALS

  • Owned, established, and operated with funds from

  donation, principal, investment, or other means by

  any individual, corporation, association, or

  organization

  • Entrepreneurial; businesses; often linked to HMOs
• ACCORDING TO SCOPE OF SERVICES

  1. General Hospitals
  2. Specialty
• GENERAL HOSPITALS

  • equipped with the service capabilities supporting

  board certified/ eligible medical specialists in, but

  not limited to the following:

  Clinical Services

  Emergency Services

  Outpatient Services

  • Ancillary and Support Services
• SPECIALTY

  • May be devoted to the treatment of the following:

  Particular illness/condition requiring a range of

  treatment. (Cancer Institutions)

  Patients suffering from diseases of a particular

  organ/group of organs (Heart Center)

  • Patients belonging to a group such as children,

  women, elderly or others
• ACCORDING TO FUNCTIONAL CAPACITY: GENERAL HOSPITALS

  1. Clinical Services for in-patients
  2. Ancillary Services
• FOUR TRADITIONAL HOSPITAL SERVICES

  1. Nursing Services
  2. Support Services
  3. Fiscal Services
  4. Professional Services
• • Nursing Services

  Delas directly with patient care

  • Support Services

  communications systems, food, housekeeping

  • Fiscal Services

  Business Aspect (Accounting, Admitting, Data

  Collection and Health Information

  Management)

  • Professional Services

  Assist the physician in the diagnosis and

  treatment of disease.

  Radtechs, Physical therapists, medtechs

  80% of the diagnosis, are verified in the

  laboratory.

  Medtechs provide more information for

  accurate diagnosis
• PROFESSIONAL SERVICE DEPARTMENTS

  • Radiology and Diagnostic Imaging

  • Radiation Therapy

  • Respiratory therapy

  • Nuclear Medicine

  • Occupational Therapy

  • Pharmacy

  • Physical Therapy

  • Cardiovascular Testing

  • Clinical Laboratory
• CLINICAL LABORATORY

  Provides data to the healthcare team to aid in

  determining the diagnosis, treatment, and

  prognosis of a patient

  Stand-alone clinics

  • Test specimens, but does not fixate their

  signatures.

  • Clinics are understaffed, so you may be

  requested to do more work than what was

  written in your job description
• PHYSICIAN OFFICE LABORATORIES

  • Consist of several primary care physicians or may

  specialize in a particular medical specialty such as

  pediatrics or cardiology.

  • Made up of a combination of family practice

  physicians and specialists.
• HEALTH MANAGEMENT ORGANIZATIONS (HMO)

  • Managed care group practice centers that provide a

  large variety of services. Physicians’ offices, a

  clinical laboratory, radiology, physical therapy, and

  outpatient surgery are often available at one

  location.

  • Members are charged a prepaid fee for all services

  performed during a designated time period.

  • Phlebotomists are employed as part of the clinical

  laboratory staff

  • Insurance; partner with hospitals to provide

  services for free; can extend to dependence (family)

  • Philhealth (government HMO) which we all are a

  member of
• REFERENCE LABORATORIES

  • Large, independent reference laboratories contract

  with health-care providers and institutions to

  perform both routine and highly specialized tests.

  • Phlebotomists are hired to collect samples from

  patients referred to the reference laboratory.

  • Found in hospitals; training grounds

  • Has gold standard methods for specialists
• 1. National Kidney Transplant Institute – Hematological Procedures and Blood Banking
  2. Research Institute for Tropical Medicine – Microbiology and emerging diseases
  3. Lung Center of the Philippines – Clinical Chemistry
  4. East Avenue Medical Center – Toxicology and Drug testing
  5. STD-AIDS Cooperative Central Laboratory (SACCL) – All STIs are tested here; maximum confidentiality (people are wearing jackets, sunglasses, masks, and cap for anonymity)
• BLOOD DONOR CENTERS

  • Phlebotomists collect, label, and prepare blood,

  plasma, and other components for transfusions

  • Consistently interact with the public, conducting

  interviews and testing samples to screen potential

  donors.

  • The only duty of phlebotomists in these centers is

  to screen blood donors; weight, height, blood

  pressure, and blood typing
• RIGHT TO APPROPRIATE MEDICAL CARE AND

  HUMANE TREATMENT

  • …Without any discrimination and within the limits of

  the resources...”

  • “…Human dignity, convictions, integrity, individual

  needs and culture shall be respected...”

  • “…If any person cannot immediately be given

  treatment that is medically necessary he shall,

  either be directed to wait for care, or be referred

  …elsewhere, where the appropriate care can be

  provided...”

  • How a patient wants to do tests, no matter how

  unnecessary
• RIGHT TO INFORMED CONSENT

  • “Clear, truthful and substantial explanation, in a

  manner and language understandable to the

  patient, of all proposed procedures, whether

  diagnostic, preventive, curative, rehabilitative or

  therapeutic…”

  • “…Person who will perform the said procedure shall

  provide his name and credentials to the patient…”

  • Ask for permission. If not of legal age or of sound

  mind, get consent from legal guardian or a parent

  • Consent are most needed for research or non-

  routine procedures
• RIGHT TO PRIVACY AND CONFIDENTIALITY

  • “…The patient has the right to demand that all

  information, communication and records pertaining

  to his care be treated as confidential… “

  • Knock before you enter

  • All patient record are confidential; unless, it was

  requested by a jury, this right can be overruled or

  for the sake of public health
• RIGHT TO INFORMATION

  • “…Right to be informed of the result of the

  evaluation of the nature and extent of his/her

  disease…”

  • Patients can request for their results
• RIGHT TO CHOOSE HEALTH CARE PROVIDER AND

  FACILITY

  • “…The patient has the right to discuss his condition

  with a consultant specialist, at the patient’s request

  and expense...”

  • “…He also has the right to seek for a second

  opinion…from another health care provider…”
• RIGHT TO SELF-DETERMINATION

  • “…The patient has the right to avail himself/herself

  of any recommended diagnostic and treatment

  procedures

  • “...Any person of legal age and of sound mind may

  make an advance written directive for physicians to

  administer terminal care when he/she suffers…

  terminal illness…”

  • The patients can have their second opinion or

  request for it
• RIGHT TO RELIGIOUS BELIEF

  • “…The patient has the right to refuse medical

  treatment or procedures which may be contrary to

  his religious beliefs…Provided, that such a right shall

  not be imposed by parents upon their children who

  have not reached the legal age in a life threatening situation as determined by the attending physician

  or the medical director of the facility…”

  • Some faith prohibits people from letting medical

  procedures be done to them; however, this can be

  overruled if it is for public concerns
• RIGHT TO MEDICAL RECORDS

  • Patients can request for their results immediately;

  hospitals should not delete medical records (must

  contain them in an online data base)
• RIGHT TO LEAVE

  • Patients have the right to leave and refuse

  treatments