Phlebotomy Course Material National Exam

What are the National Patient Safety Goals?

1. Identify Patients Correctly
2. Improve Staff Communication
3. Prevent Infection

What are the Key Healthcare Governing Agencies?

**OSHA, CDC, CLIA, and CLSI

JCAHO
CMS
CAP
CDPH
COLA

What is OSHA and it's role?

Occupational Safety And Health Administration = manages worker injuries and workplace safety

What is the CDC and its role?

Center for Disease Control = reporting infectious diseases

What is CLIA and it's role?

Clinical Laboratory Improvement Amendments = federal law for clinical lab testing

What is CLIA's alternate name?

CLIA88, marked for CLIA's signing into federal law in 1988

What is CLSI?

Clinical and Laboratory Standards Institute = gold standard on rules on how to draw blood.

Does CLSI have an alternate name? If so, what is it?

Yes, NCCLS

What are the 3 Regulating Agencies for Safety?

1. OSHA
2. CDC
3. NFPA

What is the NFPA and it's role

National Fire Protection Association = responsible for fire safety in the workplace

What are the minimum OSHA standards to be considered "in compliance"?

Hand Hygiene
Hazardous Waste Disposal
Engineering Controls
Annual Employee Safety Training
Bloodborne Pathogen Training

What are the things or papers that deal with chemicals? What does its acronym stand for?

MSDS = Material Safety Data Sheet = information related to safely handle chemicals in the lab

What are the NFPA Diamond/Label?

Blue = health hazard
Red = Fire/Flammability Hazard
Yellow = Reactivity hazard/explosive potential

What is medical asepsis?

practices to reduce infection risk

What is the most common and best disinfectant/asepsis tool used (according to National Standards)?

Bleach

Does Bleach have an alternate name? If so, what is it?

Sodium Hypochlorite

Can you just use 100% bleach? What concentration can you use bleach at?

Most common concentration is 1 Liter of 10% bleach to 90% water, so 100 mL of bleach to 900 mL water.

How long do you keep bleach for?

Can only be kept for up to 24 hours. A new batch must be made

What are some standard cleanup principles and procedures, specifically what is the most important step?

Decontaminate with 10% bleach solution

Concentrate on absorbing the spill and keep it from spreading.

How do you clean small blood spills?

Moisten the area with disinfectant to not create an aerosol and disperse infectious material into the air.

What is an organism?

A living thing

What is a microorganism?

Living thing but microscopic

What are examples of microorganisms?

Microbes or germs, bacteria, virus

What is a pathogenic microorganism or pathogen?

microbes that can cause disease

Examples of pathogens

TB, hepatitis, influenza, HIV, COVID

What are the standard precautions of patient infection?

1. Treat all patients, regardless of disease/infection status, as if they are potentially infectious

2. Treat all blood, body fluids, and unattached, non-intact tissue as potentially infectious

What is the minimum PPE required to satisfy the standard precaution guidelines?

Gloves

What are engineering controls?

Devices that promote safety

What are the phlebotomy engineering controls?

Needle safety devices, sharps containers, and syringe transfer device

How does a needle safety device work?

The device is used to cover the needle to prevent accidental punctures to self or others after use.

Do needle safety devices go by any other names?

Needle guard, needle lock, needle sheathe

When and How do you activate a needle safety device?

Immediately after one single use on a patient. In class, push the guard with your thumb and point the needle downward.

How does a sharps container work? Can you throw anything in there?

Sharps containers are puncture resistant, tamper proof, spill proof, lockable containers where you throw away used needles. Do not throw other things in there if you can.

Can you fill a sharps container to the rim?

No, you only fill the container to the fill line as seen on the sticker on the container.

What is a syringe transfer device and how does it work?

A device that can safely transfer blood from syringe to collection tubes w/o lower risk of needle stick.

1. Collect blood, lock needle, and discard into sharps container
2. Attach transfer device to syringe to allow blood to collect in tubes, without uncapping the transfer device tube.
3. Syringe and transfer device are discarded into sharps container after blood collection.

What gloves are used in the phlebotomy setting?

Nitrile gloves

What if you put on latex gloves and someone with a latex allergy is your patient?

Ask if patient has latex allergy, remove them, wash your hands thoroughly, then put on nitrile gloves.

What masks may be used and how do you use them?

N95 mask/respirator. Forms a complete seal and blocks up to 95% of airborne particles. Keep it on the entire time you're working in the healthcare setting for max effectiveness.

Order for donning PPE

Gown, mask, gloves

Order for doffing PPE

gloves, gown, mask

Can you put your hands anywhere when using gloves?

Keep hands in front of you after gloving to prevent contamination.

What is a nosocomial infection?

Hospital acquired/healthcare-associated infections. Infections that happen during a stay at a healthcare facility like a hospital.

Examples of nosocomial infections? Are they fatal?

C. Diff or Clostridum Difficile

Methicillin-resistant staphylococcus aureus (MRSA)

They can be fatal, highly dangerous.

What is the chain of infection? Give examples of each and their definition.

Infectious agent = infectious disease, ex: COVID
Reservoir/source = body that makes more infection and s/sx show
Exit pathway = way that infection leaves reservoir of host, ex: mouth
Means of Transmission = way that infection leaves reservoir, ex: through the air thru droplets
Entry pathway = way that disease enters next host, ex: mouth
Susceptible host = person at risk of infection.

What must everyone do with infections?

Break chain of infection

CDC recommendation to break spread of infection

Thorough handwashing is the single most important means of preventing disease spread.

What is proper hand hygiene practices?

Wash before and after every patient
When gloves are contaminated/torn
before handling food and drink
before and after restroom use

Wash hands thoroughly every 20 seconds (**national exam says at least 15 seconds)

What are the 4 Categories of Special Transmission Based Precautions? And their examples

1. Droplet Infections

2. Airborne Infections

3. Contact infections

4. Protective/Reverse Isolation

What is the circulatory system? And its function

Heart, blood vessels, and blood.

Main function, transportation

What are aspects of the heart?

2 atrium and 2 ventricles. Carries oxygenated and deoxygenated blood. Runs nonstop.

What are the major blood vessels?

Arteries, Veins, and Capillaries

Arteries and their aspects?

Vessels that carry blood away from heart. Carries oxygenated blood. Has thicker walls due to ventricular contraction pressure which causes pulses.

Arterioles

Smallest arteries

Veins and their aspects

Have no pulse, return deoxygenated blood back to heart. Thinner walls and can collapse. Has valves to prevent backflow.

Venules

Smallest veins

Capillaries and their aspects

Smallest blood vessels, microscopic, connects arteries and veins. Carries mixed blood of arterial and venous origin. Thin walls allow for gas exchange.

What is gas exchange?

Capillary blood carrying oxygen and nutrients given to cell while CO2 and waste is taken away from cells.

What part of the arm is mainly for phlebotomy?

The Antecubital Fossa is the space where venipunctures are done.

What are the best places to venipuncture? In order.

1. Median cubital vein is the first choice with no vital areas and is well anchored

2. Cephaluc Vein is second choice, decent anchoring but can roll

3. Basilic Vein, last choice and is right next to brachial artery and median nerve

What is a capillary puncture?

Finger sticks for adults and older children. Heel sticks for infants under 6 months.

Blood and its aspects

1. Plasma, 55% of blood, liquid portion of blood, has fibrinogen. 90% H2O, 10% dissolved nutrients

2. Cellular portion: solid formed elements made of red, white blood cells, and platelets

What are red blood cells and their aspects?

Also called erythrocytes, RBCs transport O2 to body tissue, transports CO2 to lungs for exhaling. Contains hemoglobin (Hgb) which are proteins that make RBCs red and carry O2. RBC life span is 120 days

White Blood Cells, alternate name, and aspects

Leukocytes. Immune system cells that protect body against infection. 5 types: Monocyte, Eosinophil, Lymphocyte, Neutrophil, Basophil.

What are platelets and their function?

Plt, Thromboycytes. Produced in bine marrow, help in cogulation (blood clotting). Main function: stop bleeding of injured blood vessels. Life span = 10 days

What is hemostasis?

It’s clotting, or blood going from liquid to solid. Blood naturally clots outside of the body. There is hemostasis, coagulation, and thrombosis. Helps prevent blood loss.

2 Definitions of Hemostasis

1. Blood vessels maintaining natural state.

2. Process that stops body’s leakage of blood from vascular system after injury.

4 Processes of Hemostasis

1. Vasoconstriction

2. Platelet Plug Formation

3. Fibrin Clot Formation

4. Fibrolysis

Vasoconstriction

Narrowing of blood vessel to lessen blood flow

Platelet Plug Formation

Plt form plug at leakage site, small damage can stop bleeding

Fibrin Plug Formation

Fibrinogen converts to Fibrin to cause all blood cells to be trapped in a solid blood clot

Fibrinolysis

Breakdown of clot, with no fibrinogen.

Contents of clotted blood

2 components:

Serum: liquid portion of blood, no fibrinogen

Blood clot: solid portion of blood, only has all 3 formed elements

3 types of blood specimen

Whole blood, plasma, serum

Whole blood

Same blood as body, unclotted blood, has plasma fluid with fibrinogen and formed elements. Needs special preservatives to stay unclotted.

Plasma Sample

Solely the liquid part of unclotted blood, contains fibrinogen, acquired through centrifuging whole blood. Has yellow appearance.

Serum Sample

Liquid portion of clotted blood, has no fibrinogen, centrifuged.

Layers of Serum Sample

1. Top layer of serum fluid with no fibrinogen

2. Clot with solid form of all 3 formed elements bonded to fibrin.

Layers of Plasma Specimen

1. Plasma, fluid and has fibrinogen

2. Buffy Coat, WBC and platelets

3. RBC Layer, heavier at the bottom

What are needles and their aspects?

Hollow metal tubes with pointed tips to puncture skin and draw blood

Bevel: Angled Portion of Needle Tip

Lumen or Bore: hole seen at the bevel

Gauge: Size of hole

**All needles must always be inserted in the bevel up position

aspects of the gauge

Higher numbers = smaller bore hole, so 21 G is bigger than 23 G

Standard sizes for adult needles

21 G

Standard size of child needles

23 G

What do shorter needles have?

Shorter needles means more control so 23 G ¾ is easier than 23 G 1 ½

Syringe system and its components

Needle: 21-23 G, 1 - 1 ½ inch length

Barrel: with plunger that allows for manual suction control. Graduated to measure drawn fluid

Syringe Transfer Device

Used for fragile veins, rolling veins, and ABG collection

Evacuated Tube System and Its Components

Multi-Sample Needle allows for multiple samples in one venipuncture

Plastic Holder ( Hub): Also called adapter, needle holder, tube holder. Holds needle in place with flanges that are extensions on the side of the hub that keep the needle steady.

Vacutainer (evacuated) tubes: have vacuums that automatically take in blood.

Closed system - blood from vein goes directly from vein into specimen tube.

Winged Infusion Set and its atributes

Butterfly

For Small or difficult veins, children, or hand veins

Most commonly associated with accidental needle sticks

Main benefit is that blood will immediately go through the tube.

Aspects of Infant Venipuncture

Challenges: small veins, non-cooperative child and/or parent, crying can cause raised WBC levels, requires assistance

Special Equipment: 23G Butterfly needle, smaller pediatric tubes, warming pads to increase local blood flow up to sevenfold

Heel stick, or heel puncture, preferred for kids <6 months old

Aspects of Geriatric Venipuncture

Challenges: Collagen loss causes skin to be loose, fragile, prone to ripping, translucent, rolling veins, collapsing

Special Equipment: Put tourniquet over clothing, dry washcloth, gauze, or coban.

To prevent vein collapse: 23G butterfly w/ pediatric tubes or 23G butterfly with syringe to control suction level

Apply heat to venipuncture site.

Phlebitis

Inflammation of vein

Edema

Fluid in the tissues

Hematoma

Blood in tissues

Hemoconcentration

Excessive RBCs in specimen

Tortuous

Winding or curvy veins

Sclerotic

Hardened or scarred veins

Fomite

Inanimate objects that harbor pathogens

Lipemia

Excessive fat in blood

Thrombus

Blood Clot

Parenteral

An infection that enter the body through any pathway other than oral

Nosocomial

Hospital acquired infection

Pathogen

Disease-causing microorganism