phleb prelims

• History & Evolution of Phlebotomy:

  • Phlebotomy is “the act or practice of bloodletting as a therapeutic measure”
  • Basic methods: venesection (using a lancet to bleed the vein) and cupping (placing a heated glass cup on a person’s back)
  • Discovery of microorganisms as the causative agent for many diseases started to change the thinking of how to treat diseases in the 19th century
  • Blood began to be examined for diagnostic purposes during medieval times
• The Changing Role of the Phlebotomist in the Emerging Healthcare Environment:

  • Decentralized phlebotomy allows for blood collection anytime, while centralized phlebotomy may be scheduled
  • Patient-focused care includes "point of care testing" to speed up treatment processes
  • Phlebotomists should use plain language, avoid medical jargon, and employ visual aids to enhance understanding
  • Important skills for a phlebotomist: hand-eye coordination and compassion
• Professional Code of Conduct in the Treatment of Patients:

  • Skills and attitude in laboratory sections culture samples to determine if pathogens are present
  • Laboratory sections include hematology, clinical chemistry, microbiology, immunohematology, immunology, serology, histopathology, and cytology
• Health Care Delivery System:

  • In the Philippines, the health care system is a complex set of organizations interacting to provide an array of health services
  • Components of the health care delivery system include the formulation and development of national health policies, guidelines, standards, and manual of operations for health services and programs
• Venous blood is collected from a vein, typically in the arm, and is the most common type of blood sample collected for medical testing

  
• Clinical laboratory services are cost-effective, provide objective health information, improve patient outcomes, assure patient safety, and fulfill essential public health surveillance functions
• Laboratory staff roles include medical technologists, laboratory technicians, administrative staff, IT personnel, phlebotomists, and pathologists
• The Clinical Laboratory Improvement Act of 1988 requires all clinical laboratories to perform quality testing with proven statistical accuracy to protect patients from receiving inaccurate results
• The Occupational Safety and Health Act of 1970 ensures a safe work environment in clinical laboratories and issues fines for violations
• The Clinical Laboratory Standards Institute establishes laboratory guidelines and procedures to maintain uniformity of laboratory procedures on a national basis
• Sample testing involves three phases: pre-examination (collection of the sample), examination (performing the test on the sample), and post-examination (communicating results to the physician)
• Order of checking the best available site for blood collection:

  1. Upper arm

  2. Hand

  3. Wrist

  4. Ankle or foot
• Minimum information needed for labelling blood samples:

  • First and last name of patient
  • Date of birth
  • Collection date
  • Time collected
  • Initials or name of the phlebotomist
• Hemolysis is the breaking or rupturing of the membrane of red blood cells
• Causes of hemolysis include:

  • Drawing from hematoma
  • Using a needle with high gauge
  • Alcohol on the site of venipuncture
  • Leakage of air and frothing of blood
  • Pulling back the plunger of the syringe too forcibly
  • Extreme temperature
• Transillumination:

  • Inspecting an organ by passing light through its walls
  • Uses high intensity LED or infrared light
  • Hemoglobin in the blood absorbs light so that the veins stand out as dark lines
• Tips to manage pain during medical procedures:

  • Reposition the needle slightly and release the tourniquet
  • Avoid deep probing venipunctures
  • Immediately discontinue if sharp piercing pain is indicated
• Tips to manage pain during medical procedures:

  • Reposition the needle slightly and release the tourniquet
  • Avoid deep probing venipunctures
  • Immediately discontinue if sharp piercing pain is indicated
• Nerve damage symptoms:

  • First felt as tingling or numbing of the arm or hand
  • Permanent numbness results if the nerve is damaged
• Syncope symptoms:

  • Preceded by the patient turning pale, perspiring, and starting to breathe shallowly
  • Immediate actions: remove the needle and lower the head and arms
• Immediate response to syncope: remove the needle and lower the head and arms
• Steps to manage nausea:

  • Make the patient comfortable
  • Instruct the patient to breathe slowly and deeply
  • Apply a cold compress to the forehead
  • Prepare an emesis basin
• Syncope symptoms:

  • Preceded by the patient turning pale, perspiring, and starting to breathe shallowly
  • Immediate actions: remove the needle and lower the head and arms
• Diabetic shock/hypoglycemia can occur due to fasting or too much insulin in the bloodstream
• Treatment for diabetic shock/hypoglycemia: give the patient a glass of orange juice or cola
• Convulsions can present as:

  • Being unconscious with violent or mild convulsive motions
• In case of convulsions, it's important not to restrain the patient but to move objects out of the way to prevent injuries
• Cardiac arrest signs:

  • Unconscious with no pulse, respiration, dilated eyes, blue or gray skin tone
  • Immediate actions: perform CPR and announce code blue
• To manage continued bleeding, apply pressure to the site for at least 15 minutes
• Hematoma:

  • Leaking blood under the skin at the site of venipuncture
  • Procedure: discontinue the procedure and apply heavy pressure to the site
• Skin allergies can include reactions to substances like latex, iodine, and others
• Patients should be asked about allergies before any medical procedure
• Anemia is characterized by:

  • Decrease in red blood cells (RBC) or hemoglobin
  • Deficiency in hemoglobin
  • Presence of abnormal hemoglobin
• Iatrogenic anemia is anemia caused by drawing excessive quantities of blood from a patient during care, usually a concern with premature infants
• Iatrogenic anemia is a specific type of anemia related to medical procedures
• Iatrogenic anemia is particularly a concern with premature infants
• Needle components:

  • Bevel: end that pierces the skin to avoid coring
  • Shaft: long cylindrical portion
  • Hub: end that connects to the blood collecting device
  • Lumen: the internal part of the needle
• Needle size (Gauge):

  • Indicated by a number related to the diameter of the lumen
  • The needle gauge is inversely related to the diameter of the needle
  • 21 gauge is considered standard for most routine adult venipuncture
• EDTA stands for Ethylene diamine tetra-acetic acid
• EDTA tubes are identified by their lavender/purple top