PMLS 1-7

• Phlebotomy


  An incision into a vein
• Phlebotomy


  • Oldest medical procedure, dating back to the early Egyptians
  • Used to cure disease and maintain the body
  • Techniques included suction cup devices, leeches, and barber surgery
• Bloodletting


  Now called "therapeutic phlebotomy" and is used as a treatment for only a small number of blood disorders
• Phlebotomist


  A person trained to obtain blood samples primarily by venipuncture and microtechniques
• Traditional duties of a phlebotomist

  • Correct identification and preparation of the patient before sample collection
  • Collection of the appropriate amount of blood
  • Selection of the appropriate sample containers
  • Correct labeling of all samples
  • Appropriate transportation of samples
  • Effective interaction with patients and hospital personnel
  • Processing of samples for delivery
  • Performance of computer operations and record-keeping
  • Observation of all safety regulations, quality control checks, and preventive maintenance procedures
  • Attendance at continuing education programs
• Additional duties of a phlebotomist

  • Training other healthcare 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)
  • Performing electrocardiograms
  • Performing measurement of patient's vital signs
  • Collection of arterial blood samples
  • Collection of samples from central venous access devices (CVADs)
• Professional characteristics important for a phlebotomist

  • Dependable
  • Cooperative
  • Committed
  • Compassionate
  • Courteous
  • Respectful
  • Honest
  • Integrity
  • Competent
  • Organized
  • Responsible
  • Flexible
• General appearance guidelines for a phlebotomist

  • Clothing and lab coats must be clean and unwrinkled
  • Shoes must be clean, polished, closed-toed, and skid-proof
  • Jewelry must be conservative
  • Perfume and cologne must be kept to a minimum
  • Hair must be clean, neat, and trimmed
  • Personal hygiene is extremely important
  • Fingernails must be clean and short
• Nonverbal skills


  Body language, including facial expressions, posture, and eye contact
• Verbal skills


  Enable phlebotomists to introduce themselves, explain the procedure, reassure the patient, and help assure the patient that the procedure is being competently performed
• Listening skills


  A key component of communication, involving looking directly at the patient, encouraging the patient to express feelings and concerns, allowing the patient time to describe their concerns, providing feedback, and encouraging patient communication
• Verbal communication barriers


  • Hearing impairment
  • Patient emotions
  • Age and education levels
  • Non-English speaking
• Methods to overcome verbal communication barriers

  • Speak loudly and clearly
  • Look directly at patient to facilitate lip-reading
  • Communicate in writing
  • Speak calmly and slowly
  • Avoid medical jargon, use age-appropriate phrases
  • Locate a hospital-based interpreter, use hand signals and show equipment
• General cultural diversity guidelines for phlebotomists

  • Approach all patients with a smile and use a friendly tone of voice
  • Be alert to patient reactions and accommodate them
  • Do not stereotype a particular culture
  • Remember the amount of personal space varies among cultures
  • Plan to spend additional time explaining procedures and patient instructions
  • Show respect for their diversity
• Rules of proper telephone etiquette

  • Answer the phone promptly and politely
  • Check for an emergency before putting someone on hold
  • Keep writing materials beside the phone
  • Make every attempt to help callers, and transfer them if needed
  • Provide accurate and consistent information
  • Speak clearly and verify understanding
• Diurnal variation is normal daily fluctuations in body chemistry related to hormonal cycles, sleep-wake cycles, and other regular patterns of change
• Tests affected by diurnal variation

  • Hormones
  • Iron
  • Acid phosphatase
  • Urinary excretion of most electrolytes such as sodium, potassium, and phosphate
• Tobacco smoking


  • Increases carboxyhemoglobin, catecholamines, cortisol, free fatty acids, hemoglobin, red blood cells, white blood cells, lactate, insulin, growth hormone, urinary secretion of 5-Hydroxyindole Acetic Acid, thiocyanate, immunoglobulin E (IgE)
  • Decreases eosinophils, vitamin B12, immunoglobulins (IgA, IgG, and IgM), sperm count and motility
• Hemolysis


  • Causes false increase in potassium, magnesium, iron, lactate dehydrogenase, phosphorus, ammonium, total protein
• Hemoconcentration


  Increased concentrations of analytes and cellular components caused by extended application of tourniquet
• Hemodilution


  Decreased concentration of cells and commonly tested constituents in the blood resulting in a gain of plasma or serum, usually caused by a short draw of blood during venipuncture
• Icterus


  A serum or plasma sample that appears bright to dark yellow due to increased bilirubin
• Lipemia


  Turbidity of the serum or plasma caused by increased lipids, specifically the lipoprotein
• The test order


  • One of the most frequent preanalytic errors involves selecting the wrong laboratory test or panel of tests, leading to inappropriate interpretation of results
  • Lab tests are usually ordered electronically or in writing
  • Verbal test orders may be done in "emergency" cases only and should be documented
  • A test order should have complete patient demographics
• Time of collection


  • Samples have to be collected at a specific time, failure to follow the planned time schedule can lead to erroneous results and misinterpretation of a patient's condition
  • "ASAP" means "As soon as possible" and have to prioritize
  • "Stat" means "Immediately" and STAT specimens are given the highest priority
  • Timed specimens are ordered for monitoring purposes
• Reasons for specimen rejection

  • Hemolysis/Lipemia
  • Clot present in an anticoagulated specimen
  • Non-fasting specimen when test requires fasting
  • Improper Blood Collection Tube
  • Short draw, wrong volume
  • Improper transport conditions
  • Discrepancies between requisition
  • Unlabeled or mislabeled specimen
  • Contaminated specimen or leaking container
• Policy for handling mislabeled specimen

  • Do not assume any information about the specimen
  • Do not relabel an incorrect labeled specimen
  • Do not discard the specimen until investigation is complete
  • Leave specimen exactly as you received it; put it in the proper storage area until errors are resolved
  • Notify floor, nursing station, doctor's office, etc, of problem and why it must be corrected for analysis to continue
  • Identify problem on specimen requisition with date, time, and your initials
  • Make person responsible for specimen collection participate in solution problem(s). Any action taken should be documented
  • Report all mislabeled specimens to the quality assurance board
• Blood collection devices


  • Needles (multisample, hypodermic, and winged blood collection needle) with safety shield
  • Needle holder/adapter
  • Sharps Disposal Container
  • Collection tubes (evacuated tubes, microtainer tubes, capillary tubes)
  • Syringe
  • Winged blood collection set
• Specimen Collection Overview


  1. Notify floor, nursing station, doctor's office, etc, of problem and why it must be corrected for analysis to continue

  2. Identify problem on specimen requisition with date, time, and your initials

  3. Make person responsible for specimen collection participate in solution problem(s). Any action taken should be documented

  4. Report all mislabeled specimens to the quality assurance board
• Venipuncture


  Performed using a needle/adapter assembly attached to an evacuated glass/plastic test tube with a rubber/plastic stopper. Blood may also be collected in a syringe and transferred to the appropriate specimen container
• Blood is the most common specimen received in the lab
• Blood Collection Devices


  • Needles (multisample, hypodermic, and winged blood collection needle) with safety shield
  • Needle holder/adapter
  • Sharps Disposal Container
  • Collection tubes (evacuated tubes, microtainer tubes, capillary tubes)
  • Syringe
  • Winged blood collection set
  • Blood transfer device
• Tube Additives


  Placed inside evacuated tubes and may function as anticoagulant, antiglycolytic, clot activators, anti-complement, anti-phagocytosis. Some tubes may contain thixotropic gel and antibiotic removing device (ARD)
• Order of draw must be followed to prevent invalid results due to bacterial contamination, tissue fluid contamination and carryover of one additive/anticoagulant from one tube to another
• Specimen must be mixed thru INVERSION
• Ethylenediaminetetraacetic acid (EDTA)


  Prevents clotting by chelating Calcium. Anticoagulant of choice for hematology cell counts and cell morphology. Commonly available in LAVENDER-TOP tubes as a liquid or spray-dried dipotassium EDTA (K2EDTA) or tripotassium EDTA (K3EDTA)
• Sodium Citrate


  Prevents clotting by chelating Calcium. Available in BLUE-TOP tubes containing 0.105M (3.2%) or 0.129M (3.8%) Sodium Citrate. Blue-top is used in coagulation studies (e.g. Prothrombin Time and Activated Partial Thromboplastin Time) because it preserves the labile clotting factors
• Heparin


  Prevents clotting by binding to Thrombin. Available in GREEN-TOP as Lithium Heparin (LiHep) or Sodium Heparin (NaHep). Preferred anticoagulant for Plasma Potassium measurement, Arterial Blood Gas, Ammonia Determination and other routine chemistry tests
• Sodium Fluoride


  It is NOT an anticoagulant, but a preservative with antiglycolytic property. Prevents glycolysis of glucose for 72 hours. Available in GRAY-top tube
• Plain/non-Additive tubes


  Available in RED-TOP tubes. NO anticoagulant is present so blood collected from this tube clots. Can be used for most chemistry, blood bank, and immunology assays. Yields a SERUM sample after a complete clotting of 60 mins.