Phlebotomy

By Group 1
Cejas, Lequerica, Zambrano, Milian, Joseph
NMT 1312
Marshel

Objectives
Define phlebotomy and describe
phlebotomy services
List professional competences for
phlebotomists
List skills for effective
communication
Describe basic principles of quality
and list examples of quality
assessments for phlebotomy
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Definitions
Phlebotomy is derived
from the Greek words
phlebo, which relates to
veins, and tomy, which
relates to cutting.
Phlebotomy is the
incision of a vein for the
purpose of collecting
blood
A phlebotomist is the
individual who performs
phlebotomy
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Duties
Primary Function
To assist the health care team in the
accurate, safe, and reliable collection
and transportation of specimens for
clinical laboratory analyses

Other functions
Assist in the collection and
transportation of specimens other than
venous blood such as

Arterial blood
Urine
Tissues
Sputum
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Typical Clinical Duties

Identify the patient correctly

Assess the patient before blood collection
Prepare the patient accordingly
Perform the puncture
Withdraw blood into the correct
containers/tubes
Assess the degree of bleeding & pain
Assess the patient after the phlebotomy
procedure

Typical Technical Duties

Manipulate small objects,
tubes, and needles
Select and use appropriate
equipment
Perform quality control
functions
Transport the specimens
correctly
Prepare/process the
sample(s) for
testing/analysis
Assist in laboratory testing
procedures, washing
glassware, and cleaning
equipment
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Typical Clerical Duties

Print/collate/distribute laboratory
requisitions and reports
Answer the telephone
Answer all queries as appropriate
Demonstrate courtesy in all patient
encounters
Respect privacy and confidentiality

Job Sites for Phlebotomists

Hospital Settings
Acute Care Hospitals
Specialty Hospitals such as psychiatric, pediatric
or cancer centers
Hospital based clinics

Ambulatory Care

Health department clinics

Community health centers
School based clinics
Prison health clinics
Home health agencies
Insurance companies
Physician practices
Mobile vans for blood donations
Rehabilitation centers
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Competency
Phlebotomists must be able to
Apply knowledge of:

Principles of basic and special procedures

Potential sources of error
Standard operating procedures
Fundamental biological characteristics

Select appropriate:
Course of action
Equipment/methods/reagents

Prepare patient and equipment

Evaluate

Specimen and patient situation

Possible sources of error or inconsistencies
Quality control procedures
Common procedural/technical problems
Appropriate actions and methods
Corrective actions
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Other responsibilities
Adherences to organizational policies
Safety
Infection control
Fire & safety

Communication skills
Verbal
Nonverbal
Listening skills

Efficiency and quality

Productivity
Quality
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Standards of Ethical
Conduct for Health Care
Professionals
Do no harm to anyone
intentionally
Perform according to sound
technical ability and good
judgment
Respect patient rights
Have regard for the dignity of all
human beings
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Expected Character
Attributes

Sincerity and compassion

Emotional stability and maturity
Accountability for doing things right
Dedication to high standards of
performance and precision
Respect for patients dignity, privacy,
confidentiality, and the right to know
Propensity for cleanliness
Pride, satisfaction, and self fulfillment in
the job
Working with team members
Take pleasure in communicating with
patients
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Competencies &
Certifications
Phlebotomists must
obtain
A high school
diploma or
equivalent
Phlebotomy
training via
hospital,
community college,
or technical school
Employers require
phlebotomy
certification via
national
certification
examination
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Organizations

American Society for Clinical Pathology (ASCP)

National Phlebotomy Association (NPA)
American Society for Clinical Laboratory Science (ASCLS)
National Credentialing Agency for Laboratory Personnel
(NCA)
American Medical Technologists (AMT)
American Society of Phlebotomy Technicians (ASPT)
National Accrediting Agency for Clinical Laboratory
Sciences (NAACLS)
National Healthcare Association (NHA )

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These Organizations

Have an interest in promoting and improving the practice of phlebotomy

Develope competency statements
Provide guidelines for healthcare organizations to provide standard
operating procedures
Provide professional standards and code of ethics

Provide annual or other certification examinations

ASCP
ASCLS

Accrediting of phlebotomy educational programs

NPA
ASCP
ASCLS
NCA
AMT
ASPT
NHA

Provide educational programs

NPA

NAACLS

Credentialing for laboratory personnel

NCA

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Communication
Consists of:

10 to 20% verbal messages

80 to 90% non verbal
messages

Face to face
communication is the
most effective form of
communication and is a
part of a phlebotomists
job every day
Verbal interactions can be
depicted as a
communication loop.
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Basic Communication
Requires:
Sender
Receiver
Message

Is complete:
when the sender receives
feedback

Involves:

Showing empathy
Showing respect
Building trust
Establishing rapport
Listening actively
Providing specific feedback
Conveying the right message
Using a professional tone of
voice
Using appropriate language

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Communication Loop

Starts when the message leaves the sender and reaches the
receiver
The receiver completes the loop by providing feedback to the
sender
Without feedback the sender has no way of knowing whether the
message was accurately received or was somehow blocked by
extraneous factors that can filter out meaning from a message
Filters can be damaging to effective communication because they
do not allow the loop to be completed
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Communications 3
Components
Verbal communication
The actual words that are spoken,
the tone of voice

Nonverbal communication
Body language, gestures

Active listening
Using verbal & non verbal
information to assess the situation
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Verbal Communication

Must use simple, everyday vocabulary particularly with children

Avoid complex medical jargon
Pts must not be told this wont hurt.
Patient should be forewarned and prepared for pain.
Efforts must be made to insure that sensory impairments such as
deafness or blindness are overcome
Ask Do you understand? or Do you want me to explain the
procedure again? to verify that you are being heard &
understood
Must make efforts to communicate with patients who speak other
languages
Locate translators or translation services
Tone of voice should match the words that are spoken.
Avoid sarcasm
Use calm soothing confident tones
In emergency situations
Require extra speed and accuracy without jeopardizing
personal touch
Be conscious of a patients privacy, dignity and individual
needs
Bedside manner
Pleasant facial expression
Neat appearance
Minimize negative effects of the situation

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Basic Procedures When

Encountering A Patient For
The First Time in Hospital
Knock gently on the patients door
Introduce yourself and state that you are from the
hospital or laboratory, whichever is the case
Inform the patient that his or her specimen must be
collected for a test order by the physician

Indicate that this is a routine hospital procedure

Avoid lengthy discussion of why a test was ordered. Refer
this to the physician

Remain calm, compassionate, and professional and limit

conversations to essential information
Let the patient know how the procedure is going

This is going well

it is almost over

Do not be distracted from the phlebotomy procedure by

excessive talk or unrelated issues
Before leaving the room, thank the patient for
cooperating
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In A Clinic Or Home
You must also
Direct patient to sit in a chair with sides and arms or
recline during the procedure
Take time to find the nearest bathroom and bed in
case of complications
Find a phone or bring a cell phone to clarify lab
orders
Puncture site must be cared for appropriately and
assurance must be made that patient is not bleeding.

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Patient Identification
Is essential
In a Hospital
Must be accomplished by
two of the following:

Checking if the test

requisition labels and a
unique identification
number on the pts
armband match
Verbal confirmation from
the patient
Positive confirmation by a
unit nurse

In a clinic or home
Should done meticulously
and cautiously by:
Using drivers license or
identification cards
Confirming birthday, home
address or social security

This process should be well

documented
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Telephone Communications

Incoming Calls

Answer no later than 3rd Ring

Try to smile & reflect positive phone
voice
Speak clearly and courteously
Identify the department or doctors
office
Identify yourself stating your name &
title
Ask how you may help the caller
Acquire information from the caller &
record date & time
If you cannot provide the proper
response ask for assistance
Ask the caller before putting them on
hold
Do not leave on hold for more that n 30
seconds without checking back
Read back message to caller to ensure
that you have the correct info
Allow caller to hang up first

Outgoing

Do not call to socialize

State your name, where you are calling
from & the purpose of your call
Leave preferred times & phone
numbers where you can be reached
Thank receiver for taking your message

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Nonverbal Communication
Composes 80 to 90% of
Communication
Can be
Positive
Facilitates understanding

Negative
Hinders communication

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Positive Body Language

Includes:
Face to face positioning
Relaxed hands, arms,
shoulders
Erect posture
Eye contact, eye level
Smiling
Appropriate zone &
comfort

Its Effects:
Aids communication
Can make interactions
more pleasant
Can set stage for open
lines of communication
Promotes a sense of
trust and honesty
Prevents from making
the patient feel
neglected
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Zone of Comfort
Is the area of space around a patient where they feel
comfortable in an interaction.
If that zone is crossed, feeling of uneasiness may occur
For most western cultures, there are four zones

Intimate space
Direct contact up to 18 inches
For close relationships and health care workers who bathe, feed,
dress, and perform venipunctures

Personal space
18 inches to 4 feet
For interactions among friends and for many patient encounters

Social space
4 feet to 12 feet
For most interactions of everyday life

Public space
More than 12 feet
Lectures, speeches, etc.

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Negative Body Language

Includes

Slouching, shrugged shoulders

Rolling eyes, wandering eyes
Staring blankly or at the ceiling
Rubbing eyes, excessive blinking
Squirming, tapping foot, pencil, etc.
Deep signing, groaning
Crossing arms, clenching fist
Wrinkling forehead
Thumbing though books or papers
Stretching yawning
Peering over eyeglasses
Pointing finger at someone

Its Effects

Is distracting
Prevents effective communication
Caused discomfort, uneasiness
Can convey boredom, negative or defensive
emotions
Can make patients nervous, hurried or anxious

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Active Listening
Helps close the communication loop by ensuring that
the message sent can indeed be repeated and
understood
May have important ramification in the test results
Steps include
Get Ready by concentrating on the speaker
Pause occasionally to mentally summarize what you
have said
Verify that you are listening by letting the speaker
know using phrases such as Oh very interesting I
see
Avoid making hasty judgments
Verify the conversation with feedback
Pay attention to body language
Maintain eye contact
Use encouragement
Practice, practice , practice

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Cultural Sensitivity
Culture influences
decisions and behaviors in
many aspects of life
If a healthcare worker is
unsure or unaware of
acceptable patterns of
behaviors for a patient,
the recommended action
is to follow the patients
lead
Observe mannerisms,
gestures and facial
expressions.
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Professional Appearance
Good Posture
Erect posture conveys
confidence and pride in job
performance
Poor posture conveys
laziness and apathy

Grooming
Instills confidence in a
person
Examples:
Neatly combed hair
Clean fingernails
Pressed uniform

Hygiene
Is important in preventing
the spread of infectious
disease
Examples:
Clean teeth, hair and body
Clean, wrinkle free clothes
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Nutrition, Rest, & Exercise

Good Health Improves
the health care
workers:

Appearance
Attitude
Job performance
Ability to cope with
stress

Good health can be

achieved by:
Appropriate eating
habits
Rest during lunch &
break periods
Off-duty exercising
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Family & Visitors

Family members & Visitors are

often more difficult to deal with
than the patient.
Any requests made beyond your
scope of work should be referred to
the appropriate health care team
member
If there are several visitors in the
room while blood specimens are
being drawn they may be asked to
step into the hall
Family members can be asked to
stay during a procedure if the
patient feels they need emotional
support
Children should be accompanied by
a parent of legal guardian
Blood should not be drawn when a
physicians, priests, or chaplain is
meeting in private with the
patient, unless it is a timed or
STAT specimen.
Family and visitors are NOT
permitted in the laboratory
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Quality Assurance
The area where phlebotomists have
the greatest impact is on constantly
improving services that are provided
to stake holders or customers
Quality improvement efforts of
phlebotomy services often involve
evaluating the following:
The health care workers technique
Complications, such as hematomas
Recollection rates resulting from
contamination
Multiple sticks on the same patient
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Stakeholders(Customers)

External

Local community
Insurance companies that pay for
services
Employers who pay for services for
their employees
Grant agencies and/or foundations
that provide funding
Federal or state agencies
OSHA,CDC, etc.
Accrediting agencies- Joint
Commission for the Accreditation of
Healthcare Organizations (JCAHO),
CAP
Advocacy groups AARP

Internal

Inpatients & outpatients

Patient families and friends
Patient support groups
Clinical laboratory staff
Pathologists and other medical
doctors
Students
Research staff
Volunteers
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Quality Assessment
Quality Assessment for phlebotomy involves
reviewing:
Structures
Physical structure
Facilities where service is provided
Supplies & equipment

Personnel structure
Staff
directors & supervisor

Management & administrative structure

Procedural manuals
Record keeping

Processes

What is done to the patient or client

Involves evaluation of patient records for complications,
correct technical skills, correct documentation
procedures, etc.

Outcomes

What is accomplished for the patient

Involves chart reviews

Customer satisfaction
Via questionairre, mailout, or telephone call
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Tools & Exercises for Performance

Assessment

Flow Charts

Breaks process into components

Pareto Charts
Shows frequency of problematic events

Cause and Effect (Ishikawa) Diagrams

Identify interactions between equipment, people
methods, supplies, etc.

Plan-Do-Check-Act cycle (PDCA)

For assessing and making positive changes

Line graphs, histograms, scatter diagrams.

Represent performance trends

Brainstorming
Used to stimulate creative solutions in a group

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Phases of Specimen Collection

Preanalytical Phase
Happens before testing

Analytical Phase
Happens during testing

Post Analytical Phase

Happens after testing

Phlebotomists are
primarily involved in the
preanaylitical phase
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Preanalytical Phase
Outside the laboratory
Patient identification and
information
Correct venipuncture or skin
puncture

Isolation techniques
Appropriate use of supplies
and equipment

Standard precautions
Appropriate transportation
and handling

Inside the laboratory

Sample treatment

Identification of aliquots

Specimen registration and

distribution
Appropriate storage

Centrifugation
39

Analytical & Postanalytical

Phases
Analytical
Testing the
specimen

Postanalytical
Reporting
results
Appropriate
follow-up
repeat testing

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Basic Requirements for a

Quality Control Specimen

Use universal standard precautions

Identify, assess, and properly prepare the patient
Avoid medication interference if possible
Collect specimens from the correct patients and label
appropriately
Use correct anticoagulants and preservatives
Collect a sufficient amount of blood
Use devices that minimize accidental needle sticks
Handle specimens carefully
Collect fasting specimens in a timely fashion and verify that they
are actually fasting samples
Allow specimens without anticoagulants to stand 30 minutes
Transport specimens to the clinical laboratory in a timely fashion
Document

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Quality Assessment For Specimen

Collection Services
Worker response time
Patient waiting time
Time required for completion of the phlebotomy
procedure
Percentage of successful blood collections on the first
attempt
Number of successful blood collections on the second
attempt
Daily blood loss per patient due to venipunctures
Number and size of hematomas
Number of patients who faint
Amount of time spent and number of telephone calls
needed to acquire appropriate identification
Number of redraws due to inadequate specimens
Turnaround times of designated laboratory tests
Number of incomplete forms, documents, logs, etc.
number of specimens received in incorrect tubes
Contamination rate for blood cultures
Patient satisfaction questionnaires
Frequency complaints

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Important Factors Affecting Quality

Anticoagulants and preservatives

Phlebotomists are responsible for

filling specimen tubes in the correct order so that carryover of
anticoagulants to other tubes will not occur
mixing the specimens wit the anticoagulant promptly after blood is drawn

When restocking
collection tubes with a shelf life nearest the current date at the front of
the shelf so that these tubes are first
be cognizant of expiration dates

Number of blood collection attempts

Phlebotomists should know how to store or preserve specimen tubes if

the blood specimen is not to be tested immediately
if consecutive unsuccessful attempts on different patients, his her
technique must be reviewed, modified, or improved

Blood loss due to phlebotomy

when too much blood is taken for laboratory analysis, the patient
may become anemic, so blood conservation become priority

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Equipment & Preventative

Maintenance
Phlebotomist must
participate in quality
control checks and
preventative
maintenance of
laboratory
instruments such as
Thermometers
Sphygmomanometers
Centrifuges
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Summary

A phlebotomist is someone who collects blood specimens primarily

via venipuncture
Phlebotomists duties include clinical duties such as the venipuncture
& patient care, technical duties such as quality control & specimen
transport, and clerical duties such as answering phones & filling out
proper documentation
A phlebotomist must have proper training, at least a high school
diploma and carry national certification
Phlebotomists must be mature, accountable, work with the highest
ethical standards, adhere to organizational policies, and be able to
apply their knowledge correctly, efficiently, and precisely
Communication involves sender, receiver & message and is complete
when the sender receives feedback from the receiver
Verbal & nonverbal communication as well as active listening are the
components of communication
Verbal communication should be face to face, in calm & confident
tones, avoiding negative language and should be used effectively
when: encountering & identifying the patient and using the
telephone.
Nonverbal communication should be positive not negative and makes
up 80-90% of all communication
Personal hygiene, zone of comfort and culture should also be
factored when dealing with a patient
Quality assurance is the area where phlebotomists have the greatest
impact on their field
Phases of specimen collection include the preanalytical, analytical &
postanalytical phases with the preanalytical phase being the one
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most relevant to phlebotomy

Questions
Phlebotomy is derived from the greek words phlebo
which relates to ________ and tomy which relates
to cutting.
Veins
To become a phlebotomist you must have at least a
high school diploma, training, and ___________.
National certification
The three components of communication are
verbal, nonverbal and _________.
Active listening
When do you know a message has been
communicated?
When the senders receives feedback
Non verbal communication makes up __________ %
of all communication.
80 90 %
Phlebotomists are usually involved in which phase of
specimen collection?
Preanalytical
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Sources
Phlebotomy Handout
Chapter 1 Phlebotomy Practice
and Quality Assessment Basics

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THANK YOU
HAVE A GREAT DAY!

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