Phlebotomy and Hospital Services Notes

What Is Phlebotomy?

  • Phlebotomy is derived from Greek words:
    • phlebosphlebos means “vein”.
    • −tomy-tomy means “to make an incision”.

Modern Phlebotomy: Job Skills

  • Technical knowledge.
  • Organization and attention to detail.
  • Good interpersonal skills.
  • Ability to handle stress.

Job Duties of a Phlebotomist

  • Collect blood samples according to established procedures.
  • Adhere to safety and infection control regulations.
  • Effectively interact with both patients and healthcare professionals.
  • Maintain accurate records and demonstrate knowledge of computer operations in the laboratory.
  • Develop other healthcare skills needed for day-to-day patient care in your job setting.

Personal Characteristics of a Phlebotomist

  • Dependability: Report to work on time and avoid absences or tardiness.
  • Honesty and integrity: Report errors when they are made.
  • Positive attitude: Create a positive environment for those around you.
  • Empathy and compassion: Be sensitive to patients’ concerns and reassure anxious patients.
  • Professional detachment: Maintain sympathy and understanding while retaining professional distance for efficient job performance.
  • Professional appearance: Cleanliness and grooming are critical.
  • Interpersonal skills: Communicate effectively with patients and coworkers.

Telephone Skills for Phlebotomists

  • Answer the phone promptly.
  • Smile when speaking.
  • Identify yourself and your department, and ask how you can help.
  • Write everything down:
    • Name and phone number of the person calling.
    • Date and time of the call.
  • Speak slowly and clearly.
  • Ask questions if you are unsure of what the caller means.
  • Do not put the person on hold until you determine it is not an emergency call.
  • Only give accurate information.

Professionalism in Phlebotomy

  • Accreditation: Approval from an organization by meeting established standards.
  • Certification: Demonstrated proficiency in a particular area of practice by passing an exam; some states require certification.
  • Continuing Medical Education (CEU): Earn CEUs to remain certified.

Legal Issues in Phlebotomy

  • Informed Consent: A patient must be informed of intended treatments and their risks before they are performed.
  • Patient Right of Refusal: The patient has the right to refuse any and all medical treatments, including phlebotomy.
    • Follow the institution’s policy so that the physician is notified promptly.
  • Confidentiality: All information regarding a patient’s condition, tests ordered, or results is confidential.
  • Health Insurance Portability and Accountability Act (HIPAA): A law that requires procedures to be in place to protect the privacy of personal health information (PHI).

Hospital Organization

  • Fiscal and Information Services: Responsible for admissions, medical records, billing, accounting, and other financial aspects.
  • Support Services: Responsible for all aspects of the physical plant of the facility.
  • Nursing Services: Responsible for direct patient care.
  • Professional Services: Personnel provide services at the request of licensed practitioners who aid in patient diagnosis and treatment of patients.

Support Services

  • Responsible for all areas of the physical plant of the hospital, including:
    • Cleaning
    • Maintenance
    • Security
    • Food service
    • Purchasing

Nursing Services

  • Personnel in this service provide direct patient care.
  • Personnel vary depending on education and training.
  • Examples:
    • RN: Registered Nurse
    • LPN: Licensed Practical Nurse
    • CNA: Certified Nursing Assistant
    • PCA/PCT: Patient Care Assistant/Technician
    • Ward clerks or unit secretary

Professional Services

  • Cardiac catheterization
  • Clinical laboratory
  • Nuclear medicine
  • Occupational therapy
  • Pharmacy
  • Physical therapy
  • Radiation therapy
  • Radiology or medical imaging
  • Respiratory therapy

Cardiac Catheterization

  • Treats patients with cardiovascular diseases by inserting devices into the bloodstream.

Clinical Laboratory

  • This service area analyzes patient samples from blood, urine, other body fluids, cells, or tissues to make a diagnosis, monitor treatment, or determine a patient’s prognosis.

Nuclear Medicine

  • This service area uses radioisotopes to perform tests and treat diseases.
  • Radioisotopes are used as tracers that are injected into the patient’s bloodstream and tracked to reveal the structure and function of internal organs.

Occupational Therapy

  • This service assesses patients and designs adaptive aids or compensatory strategies to help perform tasks of daily living.

Pharmacy

  • Prepares and dispenses drugs that have been prescribed by the physician.

Physical Therapy

  • This service assesses patients before and after treatment.
  • The physical therapist must design a program or other treatments to aid in patient rehabilitation.

Radiation Therapy

  • Uses x-rays or other high-energy radiation sources to destroy tumors.

Radiology or Medical Imaging

  • Interprets a range of diagnostic and therapeutic procedures using various forms of radiant energy.

Respiratory Therapy

  • This service provides treatment for respiratory disorders.

Laboratory Personnel

  • Laboratory personnel vary depending on training and education, just like nursing personnel.
  • The supervisor is usually a pathologist, a physician with specialized training in laboratory analysis of tissues and fluids.
  • The laboratory manager directs the administrative functions of the laboratory.
  • Section supervisors monitor personnel, equipment maintenance, and test results.
  • Medical laboratory scientists
  • Medical laboratory technicians: Run routine tests, perform equipment maintenance, collect specimens.
  • Clinical Laboratory Technologist (CLT) or Medical Technologists (MT)
    • Must obtain certification from a nationally recognized agency
    • A CLS/MT does lab testing and equipment maintenance and can collect specimens

Anatomic and Surgical Pathology Area

  • Cytogenetics section examines chromosomes for evidence of genetic disease.
  • Cytopathology section processes and stains cells present in body fluids or tissues.
    • Cytopathology examines the cells for the presence of cancer or other diseases.
  • Histology section prepares tissues from autopsy, surgery, or biopsy for microscopic examination by a pathologist.
    • Special stains are used to highlight certain cell morphology.

Clinical Pathology Area

  • Blood banking or immunohematology
  • Chemistry
  • Specimen processing
  • Coagulation and hemostasis
  • Hematology
  • Flow cytometry
  • Microbiology
  • Molecular diagnostics
  • Serology or immunology
  • Urinalysis or clinical microscopy
  • Phlebotomy
  • Referrals

Blood Bank or Immunohematology

  • Deals with blood used for transfusions
    • Identify blood type of both patient and donor
    • Compatibility testing is done to ensure donor blood is not rejected
  • Patients can donate their own blood for use later
  • Components of blood include: Packed cells, fresh frozen plasma, platelets, cryoprecipitates

Chemistry

  • Perform tests on chemical components of blood
    • Toxicology: Analyze plasma for drugs and poison
    • Immunochemistry: Use antibodies to detect a range of substances in blood
    • Electrophoresis: Separates chemical components based on electrical charge

Specimen Processing

  • Serum collected in a tube without anticoagulants or serum separator tube (SST)
    • Plain red top tubes need 45 to 60 minutes for full clot activation
    • SST needs a minimum of 30 minutes
  • Serum is usually a clear, pale, yellow fluid
    • Color depends on the patient’s condition and collection technique

Coagulation and Hemostasis

  • Coagulation tests are performed on plasma
    • Contain anticoagulant citrate
  • Tests performed to monitor anticoagulant therapies in a patient who has had a thrombotic stroke, heart attack, or thrombophlebitis
  • Drugs to prevent the formation of clots help avoid recurrence of stroke

Hematology

  • This section analyzes blood for diseases affecting the blood-forming tissues and cells produced by those tissues
    • Examples: Anemia and leukemia
  • Common tests
    • Complete blood count (CBC)
    • Other hematology tests
  • Flow cytometry: Identifies cellular markers on white blood cells (WBCs)

Microbiology

  • This section isolates and identifies pathogenic microorganisms in patient samples
  • Most common tests are culture and sensitivity (C&S) tests
  • Microbiology includes bacteriology, parasitology, and virology

Serology or Immunology

  • This section evaluates a patient’s immune system through the detection of antibodies
    • Antibodies are formed in response to bacteria, fungi, parasites, and viruses
  • Common tests
    • Human immunodeficiency virus (HIV) antibody
    • HBV (hepatitis B virus antibody)

Urinalysis and Clinical Microscopy

  • Urine is examined to assess kidney disease and metabolic disorders that alter levels of substances
  • Many urine tests are done with plastic dipsticks with pads embedded with reagents
    • Feces tested for blood
    • Urine sediment is examined microscopically for parasites

Phlebotomy

  • Collection of blood samples from inpatients and outpatients
  • Responsible for the proper handling and timely delivery of samples

Referrals

  • This section processes and ships specimens for any tests not done by the laboratory
  • Some of the tests may be new or for research purposes only
  • Physicians call the referral department to request information on uncommon tests

Molecular Diagnostics

  • Used to diagnose genetic disorders, analyze forensic evidence, track disease, and identify microbiologic pathogens
    • Used commonly to identify infectious agents (HIV) and genetic diseases (cystic fibrosis)
  • Special tubes and handling procedures required for specimens

Standards and Accreditation for the Clinical Laboratory

  • Clinical Laboratory Improvement Act of 1988 (CLIA ’88, or CLIA) mandated regulations of all facilities that perform patient testing
  • Clinical and Laboratory Standards Institute (CLSI), formerly known as the NCCLS, establishes standards for laboratory procedures; if followed, accreditation may be received
  • Accreditation required for Medicare and/or Medicaid reimbursement
  • The Joint Commission (TJC) accredits healthcare facilities every 2 years
  • College of American Pathologists (CAP) inspects and accredits laboratories only every 2 years
    • If a laboratory is CLIA inspected, it will receive an exemption from a CAP inspection

Other Healthcare Settings for Phlebotomists

  • Health maintenance organizations (HMOs) are full-service outpatient clinics with services under one roof
  • Preferred provider organizations (PPOs) are groups of doctors and hospitals who offer services to employers
  • Urgent care centers provide walk-in services to patients who cannot wait for an appointment
  • Physician office laboratories (POLs) send specimens to be analyzed at a separate reference lab or, if the facility is large enough, in an on-site laboratory
  • Reference laboratories are independent labs that analyze specimens from other healthcare facilities or outpatients sent by providers
  • Nursing homes may employ phlebotomists to obtain specimens from residents for analysis at a reference lab
  • Blood donor services or health fairs