INTRODUCTION-TO-PHLEBOTOMY

Introduction to Phlebotomy

Modern Phlebotomy

• Used for:

  • Diagnosis and management of disease

  • Blood removal for transfusions

  • Therapeutic reasons (e.g., Polycythemia, Hemochromatosis)

Blood Function

1. Supplies nutrients to tissues (O2, hormones, glucose)

2. Removes metabolic waste (CO2, urea, creatinine)

3. Provides defense (WBCs, antibodies)

4. Prevents blood loss (platelets, coagulation proteins)

Blood Composition

• Formed Elements:

  • Plasma

  • Leukocytes (Buffy coat)

  • Platelets

  • Erythrocytes

• Composition Breakdown:

  • Formed elements (~45%)

  • Fluid component (~55%)

  • Water (~92%), Protein (~7%)

Coagulation

• In vivo: Blood is fluid and clots protect injured vessels

• In vitro: Clotting may be due to poor technique or sample triggering

Anti-coagulants

• Function: Remove calcium or neutralize thrombin

• Types: Whole blood, Plasma, and Serum

Blood with Anticoagulant

• Clotting is prevented: mix thoroughly

• Components: Whole blood, Plasma (contains fibrinogen), Blood cells

Blood without Anticoagulant

• Spontaneous clotting occurs

• Components: Serum (lacks fibrinogen), Clot, Blood cells

Appearance of Blood

• Normal: Clear and yellow

• Abnormal:

  • Hemolyzed (pink/red)

  • Icteric (orange-yellow)

  • Lipemic (cloudy)

Blood Collection Tubes

• Contain vacuum for drawing blood

• Universal color-coded stoppers indicate contents

• Expiration date present

Tubes with No Anti-coagulant

• Description of components (Ca, Fibrin, Thrombin)

Red-Top Tube

• No additive; activates clotting sequence

• Use for Serum and TDM (therapeutic Drug Monitoring)

Gold or Mottled-Red-Gray Top Tube

• Contains clot activator and gel

• Used for Serum separation

Royal Blue-Top Tube

• Trace metal-free for specific analyses

  • Red: No additive = Serum

  • Purple: EDTA = Whole blood

  • Green: Heparin = Whole blood

Tubes with Anticoagulant

• Description of components (Ca, Thrombin, Fibrinogen)

Light Blue-Top Tube

• Contains Sodium Citrate; critical blood: anticoagulant ratio

• Use in coagulation studies

Green-Top Tube

• Contains Heparin; inhibits thrombin formation

• Must be full and on ice if testing is delayed

Purple-Top Tube

• Contains EDTA; used for hematology studies like CBC

Grey-Top Tube

• Contains Potassium Oxalate and Sodium Fluoride

• Limited use, mainly for glucose testing

Fibrin-Split Products Tube

• Light blue Tube with 2 yellow bands; causes immediate clotting

Yellow-Top Tube

• Contains ACD for paternity testing and DNA

  • SPS for special blood cultures

Type and Amount of Specimen

• Depends on test requirements

Valid Test Results

• Require trained personnel and quality control

Safety Practices

• Infection spread requires:

  1. Infectious substance

  2. Mode of transmission

  3. Susceptible host

Modes of Transmission

• Parenteral methods

• Intramuscular, intravenous, subcutaneous, etc.

Infection Control

• Goal: Stop the spread of infection

Infection Control Methods

• Handwashing (15 seconds minimum)

• PPE requirements

Infection Control Equipment

1. PPE: Gloves, lab coat, mask

2. Cleaning agents: alcohol, iodine, soap

3. Cotton balls, gauze

Equipment

4. Bandage and tape

5. Sharps container for disposal

6.Tourniquet Guidelines

• Do not leave on for longer than 1 minute

• Avoid vigorous hand clenching

Tying on the Tourniquet

• Practical demonstration or description (not included)

7. Needles

• Never reuse or recap needles

• Sizes for common use

• never use if shield is broken

Needle Features

• Description of bevel, shaft, hub, sleeve

Multi-sample Needle

• Used with syringe and vacutainer systems

Butterfly Needle

• does not use for routine draw cuz expensive

• Used for small, fragile veins

• Increased risk of needle stick injury

8.Tube Holder/Vacutainer Adapter

• threaded, flanges

Equipment

9. syringe

10. black proof pen

Labeling Blood Collection Tubes

• Black marker (waterproof) required

• Five items to include:

  1. Patient name

  2. ID number

  3. Date and time of draw

  4. Phlebotomist signature

Vacutainer vs. Syringe

• Vacutainer is economical and quick; syringe offers control

The Patient

• Approach,

• communication,

• empathy,

• handling situations

• patient identification; arm band, legal document

• prepare patient for blood draw

Blood Drawing Technique

• Needle positioned at 15° angle for optimal venipuncture

FILL TUBES : Order of Draw

• Blood culture

• red top

• blue

• green

• purple

• grey

Phlebotomy History

• During Stone Age, crude tools were used to puncture blood vessels and allow excess blood to drain out of the body. It is thought that this was an effort to rid the body of evil spirits or cleanse the body of impurities.

• 1400 BC, A painting in a tomb showing the application of a leech to a patient is evidence of bloodletting in Egypt.

• 460 to 377 BC, A Greek physician named Hippocrates had a major influence on early medicine and is recognized to this day as the “Father of Medicine.”

Hippocrates

• An early medical theory developed by Hippocrates stated that good health required a balance in the body of four substances—blood, phlegm, black bile, and yellow bile—which he called body “humors.”

• Removing blood was called bloodletting, and the most common surgical technique used for bloodletting was called venesection (cutting a vein), which comes from the Latin words vena, “vein” and sectio, “cutting.” 

• Middle Ages (medieval period) of Europe lasted from the 5th to the 15th century. Barbers, who were already skilled in using sharp instruments, were often called upon to perform bloodletting and other surgical duties. 

• By 1210, the Guild of Barber-Surgeons had been formed in Paris; it divided the surgeons into Surgeons of the Long Robe and Surgeons of the Short Robe. Soon the Short Robe surgeons were forbidden by law to do any surgery except bloodletting, wound surgery, cupping, leeching, shaving, tooth extraction, and enema administration.

• During the 17th and early 18th centuries, phlebotomy was considered a major therapeutic (treatment) process, and anyone willing to claim medical training could perform phlebotomy

• FYI: Excessive phlebotomy is thought to have contributed to George Washington’s death in 1799, when he was diagnosed with a throat infection and the physician bled him four times in two days

Cupping Therapy

• application of a heated suction apparatus, called the “cup,” to the skin to draw the blood to the surface. Then, the capillaries in that area were severed by making a series of parallel incisions with a lancet or a fleam.

Leeches in Treatment

• Historical use and modern resurgence in medicine

• Leeching involved placing a drop of milk or blood on the patient’s skin to entice a European medicinal leech called Hirudo medicinalis to attach to the spot chosen for bloodletting.

• The value of leech therapy s found in the worm’s saliva. 

• After declining in the early 1900s, medicinal use of leeches has made a comeback since the 1980s as an aid in microsurgery procedures such as skin grafts and reattachment of severed limbs and digits.

Phlebotomy Present

• obtain blood for screening and diagnostic purposes

• Phlebotomy is primarily accomplished by one of two procedures:

  • Venipuncture, which involves collecting blood by penetrating a vein with a needle attached to a blood collection device or syringe. 

  • Capillary puncture, which involves collecting blood after puncturing the skin with a lancet or special incision device. 

Quality of a Competent Phlebotomist

• Manual dexterity, communication, organization

Page 57: Duties of a Phlebotomist

• Preparing, collecting, and transporting specimens

• Adhere to all HIPAA and confidentiality guidelines, including all Code of Conduct and Integrity programs

• Transport and dispatch samples efficiently by prioritizing specimens to ensure desired turnaround times. 

• Comply with safety rules, policies, and guidelines for the area, department, and institution. 

• Provide quality customer service for all internal and external customers.

Patient Interaction

• the only real contact the patient has with the laboratory.

Recognizing Diversity

• Awareness of cultural differences in healthcare

Benefits of Cultural Awareness

• Improved patient satisfaction and teamwork

Key Factors for Diverse Healthcare

• Understanding beliefs and customs related to health

Professionalism

• conduct and qualities that characterize a professional person.

• general appearance and grooming directly influence whether the phlebotomist is perceived as a professional. It has been said that people form opinions of each other within the first three seconds of meeting, and this judgment of the superficial aspect of a person sets an image in the observer’s mind that can affect the interaction.

Characteristics of Professional Phlebotomists

• Self-confidence, integrity, compassion, motivation, dependability

Self-Confidence

• able to trust his or her own personal judgment.

• A phlebotomist’s perception of self has an enormous impact on how others perceive him or her, and “perception is reality.”

Integrity

• feeling of “wholeness” derived from honesty and consistency of character that can be seen in the person’s actions, values, and beliefs.

Compassion

• Understanding and responsiveness to patient needs

• being sensitive to a person’s needs and willing to offer reassurance in a caring and humane way. 

Self-Motivation

• Taking initiative for patient care

• a direct reflection of a person’s attitude toward life

Dependability Importance

• An individual who is dependable and takes personal responsibility for his or her actions

Ethical Behavior

• moral principles or standards that govern conduct and the distinction between right and wrong

• FYI: The Latin phrase primum non nocere which means “first do no harm” describes one of the fundamental principles of healthcare. Although it does not include this exact phrase, the promise “to abstain from doing harm” is part of the Hippocratic oath given to new physicians and other healthcare professionals as they begin their practice. 

Patients’ Rights

• Overview of rights regarding privacy and healthcare access

The Patient Care Partnership

• what to expect in a hospital stay

1. high quality hospital care

2. clean and safe environment

3. involvement in care

4. protection of privacy

5. help when leaving hospital

6. help with billing

Confidentiality

• Ethical obligation to protect patient information

The Healthcare Setting

Levels of Medical Care

1. Primary care: routine medical care by primary providers

2. Secondary care: specialized care via referrals

3. Tertiary care: advanced specialized treatment

Categories of Healthcare Facilities

Ambulatory vs. Non-Ambulatory Services

• AMBULATORY (OUTPATIENT) -requires the patient to stay over one or more nights. 

• NONAMBULATORY (INPATIENT)-receive treatment or care but do not stay overnight

Divisions in Clinical Laboratory

• Clinical Analysis Areas

Specimen processing, hematology, chemistry, microbiology, blood bank/immunohematology, immunology/serology, and urinalysis 

• Anatomical and Surgical Pathology

Tissue analysis, cytologic examination, surgical biopsy, frozen sections, and performance of autopsies 

Clinical Laboratory Services

• Purpose and functions of clinical laboratories

• perform tests on patient specimens

Traditional Laboratories

• two major divisions in the clinical laboratory; the clinical analysis area and the anatomic and surgical pathology area.

Clinical Analysis Areas

• usually the largest area of a medical laboratory, performing the most tests, and consequently producing the most test results

Clinical Chemistry

• concerned with the detection and measurement of chemical substances in body fluids. typically performs the most laboratory tests. It may have subsections such as toxicology, therapeutic drug monitoring, and molecular diagnostics.

• Highly automated computerized instruments used in this area can perform discrete (individualized) tests or metabolic panels (multiple tests) from a single sample.

Clinical Hematology Overview

• Focus on blood and blood-related diseases

Coagulation Studies

• ability of blood to form and dissolve clots.

• Testing for blood clotting and anticoagulant therapy monitoring

• two most common coagulation tests are the prothrombin time (PT), used to monitor warfarin therapy, and the activated partial thromboplastin time (aPTT), for evaluating heparin therapy.

• Most coagulation tests are performed on plasma that has been separated from a whole blood sample collected in a tube with a light-blue stopper.

Clinical Serology and Immunology

• Understanding serum and immune system testing

• term “serology” means the study of serum

• Serology tests are used to identify antibodies and antigens that are the body’s response to the presence of bacterial, viral, fungal, or parasitic diseases.

• Immunology tests investigate immune system problems such as autoimmune reactions, in which autoantibodies produced by B lymphocytes attack normal cells. Also used to determine the compatibility of organs, other tissues, and bone marrow for transplant purposes

CLINICAL MICROSCOPY

• The UA department, which is often housed in the hematology or chemistry area, performs tests on urine specimens.

• specimens may be analyzed manually or using automated instruments

• physical examination assesses the color, clarity, and specific gravity of the specimen.

Clinical Microbiology

• analyzes blood and other body fluids and tissues for the presence of microorganisms, primarily by means of culture and sensitivity (C&S) testing

• Subsections of microbiology; bacteriology (the study of bacteria), parasitology (the study of parasites), virology (the study of viruses), and mycology (the study of fungi)

Blood Banking or Immunohematology

• prepares blood products to be used for patient transfusions

• Blood components dispensed include whole blood, platelets, packed cells, fresh frozen plasma, and cryoprecipitates.

Anatomic and Surgical Pathology

• Role of pathology in diagnosing disease through examination of organs and tissues by a pathologist

Histopathology

• study of the microscopic structure of tissues

• pathologists evaluate samples of tissue from surgeries and autopsies under a microscope to determine if they are normal or pathological (diseased)

• Two of the most common diagnostic techniques used in histology are: (1) biopsy, obtaining samples by removal of a plug (small piece) of tissue from an organ and examining it microscopically; and (2) frozen section, obtaining tissue from surgery, freezing it, and then examining it while the patient is still in the operating room to determine whether more extensive surgery is needed

Cytology

• cytology tests are concerned with the structure of cells

• cells in body tissues and fluids are identified, counted, and studied to diagnose malignant and premalignant conditions.

Clinical Laboratory Personnel

• standards for most laboratory are set by CLINICSL LABORATORY IMPROVEMENT AMENDMENTS of 1988 (CILIA ‘88)

Laboratory Director Role

• specializes in diagnosing disease using lab test results by analyzing tissues removed during operation

Technical Supervisors

• responsible for the administration of the area who reports at lab administrator

Medical Technologist/ Medical Lab Scientist

• performs all level of testing in lab in any area

Phlebotomist

• collect blood for blood test