Intro to phleb lec

• In 1799, 1st US president, George Washington, had a severe throat infection and was bled for more than 9 pints of blood in less than 24 hours, resulting in his death
• In the middle of the 19th century, the discovery of microorganisms as the causative agent of disease started to change thinking on how to treat diseases
• Leeches


  • Limited uses today
  • Problem: leech has to be changed from time to time because it easily gets full
  • Are used for amputations to remove excess blood and prevent clotting when an appendage is reattached
• Therapeutic phlebotomy usually removes 500 mL of blood from the patient
• Bleeding in the form of therapeutic phlebotomy is done today for diseases like polycythemia vera and hereditary hemochromatosis
• Phlebotomist


  Is part of the laboratory team and dispatched to hospital units to collect blood samples
• Decentralized blood collection

  All members of the healthcare team share responsibility to collect blood samples
• Cupping

  1. A heated glass cup was placed on a person’s back

  2. As the cup is cooled, it created a suction that pulled blood to the capillaries under the cup

  3. Then a spring-loaded box containing multiple blades cut the area to produce massive bleeding
• Venesection

  1. Sharp lancet-like instrument pierced the veins to bleed

  2. Often used to reduce fever or to produce a faint so an expectant mother would deliver her baby by the time she recovered
• Areas of nursing

  • Neonatal, Obstetrics, Oncology, Orthopedics, Pediatrics, Intensive Care, Coronary Care, Emergency, Nephrology, Geriatrics
• Areas of the hospital

  • Electroencephalography (EEG), Electrocardiology (EKG), Radiology, Pharmacy, Physical Therapy, Occupational Therapy, Nursing, Laboratory, Environmental Services, Administration, Food Service, Medical Record
• Phlebotomist


  • Multiskilled
  • Known as laboratory representative
  • Handles patient-focused care and more duties than just phlebotomy
  • Must work with all areas of any organization
• Areas of the laboratory

  • Phlebotomy, Chemistry, Hematology, Coagulation, Histology, Urinalysis, Microbiology, Immunology, Immunohematology (blood bank), Cytology, Molecular Diagnostics
• Patient-focused care concept takes the laboratory out of the physical location and brings it to the patient
• Phases of sample testing

  • Preexamination, Examination, Postexamination
• Preexamination


  Includes all processes from collecting the sample to having it ready for testing
• Examination

  Previously known as analytical phase
• Preexamination


  • Previously known as preanalytical phase
  • Includes all processes from collecting the sample to having it ready for testing
• Laboratory Staff


  • Pathologist
  • Medical laboratory scientist
  • Medical laboratory technician
  • Phlebotomy technician
  • Cytotechnologist
  • Histotechnologist
• Postexamination


  • Previously known as postanalytical phase
  • Process in which the results of the testing are communicated to the health care provider
• Affordable Health Care Act was enacted to help those who could not afford insurance
• Charles Swindoll: 'The'
• 5 Stages of Emotions

  1. Denial

  2. Anger

  3. Bargaining

  4. Depression

  5. Acceptance
• Patient Rights

  • Patient has right to considerate and respectful care
  • Patient has right to receive understandable information
  • Patient has right to make decisions about plan of care and refuse treatment
  • Patient has right to have an advanced directive
  • Patient has the right to privacy
  • Patient has the right to confidentiality of his or her medical records
  • Patient has the right to review records
  • Patient has 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
  • Patient has the right to information regarding hospital business relationships that might impact his or her care
  • Patient has the right to consent or decline to participate in proposed research studies
  • Patient has the right to expect continuity of care
  • Patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities
• Managed Care

  • Coordinates providing health services and health benefits
  • Health maintenance organization (HMO)
  • Preferred provider organization (PPO)
• Phases of sample testing

  1. Preexamination

  2. Examination

  3. Postexamination
• Ethical Considerations

  • Ethics is hard to define as it consists of more than a written set of rules or guidelines varying by individual, religion, social status, or heritage
  • For phlebotomist-ethics requires responsibility to provide high-quality patient care
• Affordable Health Care Act requires all people to have health insurance
• Examination

  • Previously known as analytical phase
  • Includes all processes done to sample to achieve result
• Patient Rights
• Professional Attitude


  • Everyone must follow professional code of conduct in treatment of patients
  • Includes professional approach to all aspects of job and professional grooming and dress
• Professional Grooming

  1. No visible tattoos

  2. No body piercing other than a maximum of two in the ears

  3. No fingernails longer than one-quarter inch

  4. No blue jeans or casual attire

  5. No T-shirts or sweatshirts
• Professional Attitude


  1. Everyone must follow professional code of conduct in treatment of patients

  2. Includes professional approach to all aspects of job and professional grooming and dress
• Quality Improvement Items


  • Phlebotomist response time (for inpatients)
  • Patient waiting (for outpatients)
  • Time it takes to perform phlebotomy procedure
  • Number of redraws due to inappropriate amount of specimen
  • Number of incorrect tubes drawn
  • Number of patients requiring a second attempt
  • Number and size of hematomas
• Regulatory Agencies


  • The Joint Commission
  • CAP (College of American Pathologists)
  • State Board of Health
  • CLSI (Clinical Laboratory Standards Institute)
  • CLIA (Clinical Laboratory Improvement Act of 1988)
  • OSHA (Occupational Safety and Health Administration)
  • NAACLS (National Accrediting Agency for Clinical Laboratory Sciences)
• Advanced Directives


  • Documents written before incapacitating illness that give instructions about a person's health care, if in the future, they cannot speak for themselves
• Charles Swindoll: 'The longer I live, the more I realize the impact of attitude on life.<|>Attitude, to me, is more important than the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do.<|>It is more important than appearance, giftedness, or skill.<|>It will make or break a company... a church... a home.<|>The remarkable thing is we have a choice every day regarding the attitude we embrace for that day.<|>We cannot change our past.<|>We cannot change the inevitable.<|>The only thing we can do is play on the one string we have, and that is our attitude.<|>I am convinced that life is 10% what happens to me and 90% how I react to it.<|>And so, it is with you.<|>We are in charge of our attitudes'
• Author: 'Rowen Palalulu'
• Quality Assurance

  1. Quality is phlebotomist's responsibility

  2. Result of test sent to physician depends on quality of sample obtained

  3. Laboratories must have certain levels of patient satisfaction to continue receiving payments from insurance companies

  4. All programs work to ensure the quality of the samples and result as a method of improving patient satisfaction

  5. Must have quality assurance program, total quality management program, and continuous quality improvement program