Phlebotomy Handbook : Blood Collection Essentials

by Garza, Diana; Becan-McBride, Kathleen

Edition:

7th

ISBN13:

9780131133341

ISBN10:

0131133349

Format:

Paperback

Pub. Date:

1/1/2005

Publisher(s):

Prentice Hall

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Summary

This is the most timely and comprehensive source of blood and specimen collection information available on the worldwide market. Provides today's health care professionals with the latest safety guidelines; condensed information about new federal regulations; updates on equipment and supplies; new NCCLS standards and hazard prevention techniques; and extensive coverage on transcultural communication skills for all ages. Medical Technologists, Medical Technicians, Medical Assistants, Specimen collection supervisors, Laboratory Managers/Directors, Nurses. Also, a valuable resource for hospital laboratories, out patient clinics, physicians' office practices, and emergency rooms.

Preface

xxi

Acknowledgments

xxiv

Reviewers

xxv

PART I OVERVIEW

Phlebotomy Practice and Quality Essentials

(42)

Chapter Objectives

(1)

Phlebotomy Practice, Definition, and Duties

(1)

Health Care Organizations

(1)

Professional Competencies and Certifications

(9)

Professional Character Traits

(3)

Role of the Clinical Laboratory in Specimen Collection Services

(1)

Communications Strategies for Phlebotomists

(18)

Verbal Communication

(5)

Communication for Confirming Patient Identification

(2)

Nonverbal Communication

(6)

Active Listening

(1)

Appearance, Grooming, and Physical Fitness

(3)

Nutrition, Rest, and Exercise

(1)

Role of Family, Visitors, and Significant Others

(1)

Quality Improvement and Assessment

(9)

Perceptions of Quality

(2)

Customer Satisfaction

(1)

Tools and Trends for Performance Assessment

(1)

Quality in Specimen Collection Services

(1)

Important Factors Affecting Quality

(3)

Equipment and Preventive Maintenance

(2)

Self Study

(1)

Key Terms

(1)

Study Questions

(1)

References

(2)

Ethical, Legal, and Regulatory Issues

(18)

Chapter Objectives

(1)

Ethics Overview

(1)

Governmental Laws

(1)

Basic Legal Principles

(4)

Legal Terminology

(1)

Negligence

(1)

Malpractice

(1)

Patient Confidentiality

(1)

Confidentiality and HIV Exposure

(1)

Standard of Care

(1)

Informed Consent

(1)

Informed Consent for Research Purposes

(1)

Implied Consent

(1)

Statute of Limitations

(1)

Legal Claims and Defense

(2)

Expert Witness

(1)

Evidence

(1)

Advice to Avoid Lawsuits

(1)

Respondeat Superior

(1)

Medical Records

(2)

HIPAA

(1)

Legal Cases Related to Clinical Laboratory Activities

(1)

Schmerber v. State of California

(1)

Lazernick v. General Hospital of Monroe County (PA 1977)

(1)

Walton v. Providence Hospital

(1)

Helmann v. Sacred Heart Hospital

(1)

Cases Resulting from Improper Technique and Negligence

(1)

HIV-Related Issues

(1)

Malpractice Insurance

(1)

Clinical Laboratory Improvement Amendments (CLIA)

(2)

Self Study

(1)

Key Terms

(1)

Study Questions

(1)

References

(2)

Basic Anatomy and Physiology of Organ Systems

(30)

Chapter Objectives

(1)

Anatomic Regions

(3)

Structural Organization

(4)

Major Organ Systems

(18)

Integumentary System

(1)

Skeletal System

(1)

Muscular System

(2)

Nervous System

(2)

Respiratory System

(4)

Digestive System

(2)

Urinary System

(2)

Endocrine System

(1)

Reproductive System

(1)

Lymphatic System

(1)

Cardiovascular System

(1)

Self Study

(2)

Key Terms

(1)

Study Questions

(1)

References

(2)

The Circulatory System

(32)

Chapter Objectives

(1)

The Heart

(4)

The Blood

(8)

Erythrocytes

(3)

Leukocytes

100

(1)

Thrombocytes or Platelets

101

(1)

Plasma

101

(3)

Serum

104

(1)

The Vessels and Circulation

104

(6)

Arteries

108

(1)

Veins

108

(2)

Capillaries

110

(1)

Hemostasis and Coagulation

110

(2)

Laboratory Tests of the Cardiovascular System

112

(5)

Self Study

117

(1)

Key Terms

117

(1)

Study Questions

117

(1)

References

118

(1)

Case Studies

Career Pathways: Smooth or Stormy

119

(1)

Changing Responsibility in Phlebotomy Practice

119

(1)

Collection from the Dorsal Side of the Hand

120

(1)

Communication and Cultural Sensitivity: Keys to Success

120

(1)

Communication and Consent

120

(1)

An Ethical Dilemma

121

(2)

PART II SAFETY PROCEDURES AND EQUIPMENT

Infection Control

123

(34)

Chapter Objectives

123

(1)

Pathogens and Infection

124

(1)

Personal Safety from Infection during Specimen Handling

125

(2)

Exposure Control

125

(1)

Health Care Providers' Health

125

(2)

Chain of Infection

127

(5)

Source

127

(1)

Mode of Transmission

127

(4)

Susceptible Host

131

(1)

Breaking the Chain

131

(1)

Standard Precautions

132

(12)

Use of Standard Precautions

135

(4)

Hand Hygiene and Gloving

139

(2)

Isolation for Hospital Outbreaks

141

(1)

Protective, or Reverse, Isolation

141

(1)

Infection Control in Special Hospital Units

141

(1)

Infection Control in the Clinical Laboratory

142

(2)

Specific Isolation Techniques and Procedural Steps

144

(1)

Isolation Item Disposal

144

(1)

Prevention of Laboratory-Acquired Infections

145

(1)

Sterile Technique for Health Care Workers

145

(9)

Disinfectants and Antiseptics

151

(1)

Preventing Infections from Glass Capillary Tube Use

152

(2)

Self Study

154

(1)

Key Terms

154

(1)

Study Questions

154

(1)

References

155

(2)

Safety and First Aid

157

(24)

Chapter Objectives

157

(1)

Fire Safety

158

(1)

Classification of Fires

158

(1)

Fire Extinguishers

158

(1)

Emergency Response to Possible Fire

159

(1)

Laboratory Safety

159

(4)

Cleaning Specimen Collection Areas and Biological Spills

161

(2)

Electrical Safety

163

(1)

Radiation Safety

164

(1)

Mechanical Safety

165

(1)

Chemical Safety

165

(5)

Chemical Identification

166

(2)

Safety Showers and the Eyewash Station

168

(1)

Chemical Spill Cleanup

168

(1)

Disposal of Chemicals

169

(1)

Equipment and Safety in Patients' Rooms

170

(1)

Patient Safety Outside the Room

171

(1)

Patient Safety Related to Latex Products

172

(1)

Disaster Emergency Plan

173

(1)

Emergency Procedures

174

(4)

Bleeding Aid

174

(1)

Circulation Aid

175

(1)

Shock Prevention

175

(3)

Self Study

178

(1)

Key Terms

178

(1)

Study Questions

178

(1)

References

179

(1)

Additional Sources for Safety Information

180

(1)

Documentation, Specimen Handling, and Transportation

181

(26)

Chapter Objectives

181

(1)

Fundamentals of Documentation

182

(1)

The Laboratory Communication Network

183

(5)

Policies and Procedures

185

(1)

Continuing Education

185

(1)

Communication Outside the Laboratory

185

(2)

Use of the Telephone

187

(1)

Confidentiality and Privacy

188

(1)

Fax Transmission of Laboratory Information

188

(1)

Computerized Communications

188

(1)

Laboratory Test Requisition Forms

189

(1)

Barcodes

189

(1)

Transmittal of the Test Request to the Laboratory

190

(3)

Specimen Labels and Blood Collection Lists

193

(1)

Specimen Handling

193

(6)

Basic Handling Guidelines

196

(1)

Chilled Specimens

197

(1)

Protection of Specimens from Light

198

(1)

Microbiological Specimens

199

(1)

Warmed Specimens

199

(1)

Specimen Delivery Methods

199

(1)

Hand Delivery

199

(1)

Pneumatic Tube Systems

199

(1)

Transportation by Automated Vehicles

200

(1)

Shipping Infectious Substances

200

(2)

Reporting Laboratory Results

202

(2)

Written Reports

202

(1)

Verbal Reports

202

(1)

Computerized Reports

202

(2)

Self Study

204

(1)

Key Terms

204

(1)

Study Questions

204

(1)

References

205

(2)

Blood Collection Equipment

207

(38)

Chapter Objectives

207

(1)

Introduction to Blood Collection Equipment

208

(1)

Venipuncture Equipment

208

(1)

Blood Collection Tubes and Additives

208

(7)

Gray-Topped Tubes

212

(1)

Green-Topped Tubes

212

(1)

Purple-Topped and Light Blue-Topped Tubes

213

(1)

Red-Topped, Royal Blue-Topped, Brown-Topped, and Tan-Topped Tubes

213

(1)

Black-Topped Tubes

213

(1)

Yellow-Topped Tubes

214

(1)

Serum Separation Tubes (Mottled-Topped, Speckled-Topped, and Gold-Topped Tubes)

215

(1)

Pink-Topped Tubes

215

(1)

Molecular Diagnostics Tubes

215

(1)

Safety Syringes

215

(1)

Safety Needles/Holders

216

(4)

Needles

220

(3)

The Butterfly Needle (Blood Collection Set)

221

(2)

Needle and Other Sharps Disposal

223

(1)

Tourniquets

223

(3)

Bleeding-Time Equipment

226

(1)

Gloves for Blood Collection

226

(2)

Antiseptics, Sterile Gauze Pads, and Bandages

228

(1)

Microcollection Equipment

228

(8)

Lancets and Tubes

230

(4)

Transporting Microspecimens

234

(2)

Blood-Drawing Chair

236

(1)

Infant Phlebotomy Station

237

(1)

Specimen Collection Trays

237

(2)

Web Addresses for Suppliers of Safety Blood Collection Equipment

239

(1)

Self Study

240

(1)

Key Terms

240

(1)

Study Questions

240

(1)

References

241

(1)

Case Studies

Running Late on the Day Shift

242

(1)

A Supervisor's Folly

242

(1)

Stocking Supplies in Phlebotomy Practice

242

(1)

Traumatic Transport

243

(1)

Accidental Injury

243

(1)

Transporting Specimens from Homebound Patients to the Laboratory

244

(1)

PART III PHLEBOTOMY PROCEDURES

Venipuncture Procedures

245

(44)

Chapter Objectives

245

(1)

Blood Collection

246

(1)

Health Care Worker Preparation

246

(1)

Exercising Universal Precautions

247

(1)

Needlestick Prevention Strategies

247

(2)

Assessing, Identifying, and Approaching the Patient

249

(11)

Test Requisitions

249

(2)

Patient Identification Process

251

(6)

Physical Disposition of the Patient

257

(1)

Approaching the Patient

257

(3)

Equipment Selection and Preparation

260

(11)

Supplies for Venipuncture

260

(1)

Positioning of the Patient and Venipuncture Site Selection

260

(7)

Warming the Puncture Site

267

(2)

Tourniquet Application

269

(1)

Decontamination of the Puncture Site

269

(2)

Venipuncture Methods

271

(9)

Evacuated Tube System and Winged Infusion System, or Butterfly Method

271

(4)

Syringe Method

275

(1)

Bandage for the Puncture Site

276

(1)

Proper Disposal

276

(1)

Order of Tube Collection

277

(1)

Specimen Identification and Labeling

278

(1)

Assessing the Patient before Leaving

278

(2)

Prioritizing Patients

280

(5)

Timed Specimens

282

(1)

Specimens for Hormones and Renin

283

(1)

Fasting Specimens

284

(1)

STAT Specimens

284

(1)

Self Study

285

(1)

Key Terms

285

(1)

Study Questions

285

(1)

References

286

(3)

Procedures for Collecting Capillary Blood Specimens

289

(14)

Chapter Objectives

289

(1)

Indications for Skin Puncture

290

(1)

Composition of Capillary Blood

290

(1)

Basic Technique for Collecting Diagnostic Capillary Blood Specimens

291

(1)

Preparation for Skin Puncture

291

(1)

Supplies for Skin Puncture

291

(3)

Skin Puncture Sites

292

(1)

Warming the Skin Puncture Site

292

(1)

Cleansing the Skin Puncture Site

293

(1)

Skin Puncture Procedure

294

(1)

Order of Collection

295

(1)

Blood Films for Microscopic Slides

295

(1)

Microhematocrit

295

(3)

Blood pH and Blood Gas Determinations

298

(1)

Lancet Disposal, Labeling the Specimen, and Completing the Interaction

298

(3)

Self Study

301

(1)

Key Terms

301

(1)

Study Questions

301

(1)

References

302

(1)

Preanalytical Complications in Blood Collection

303

(24)

Chapter Objectives

303

(1)

Overview

304

(1)

Complications Associated with Patient Assessment and Physical Disposition

304

(7)

Diet

304

(1)

Obesity

305

(1)

Damaged, Sclerosed, or Occluded Veins

305

(1)

Allergies

306

(1)

Exercise

306

(1)

Stress

307

(1)

Diurnal Rhythms and Posture

307

(1)

Age

307

(1)

Mastectomy

307

(1)

Edema

308

(1)

Menstrual Cycle

308

(1)

Medications

308

(1)

Interference of Drugs and Other Substances in Blood

309

(1)

Thrombosis

310

(1)

Infections

310

(1)

Vomiting

311

(1)

Other Factors Affecting the Patient

311

(1)

Complications Associated with Test Requests and Identification

311

(1)

Identification Discrepancies

311

(1)

Time of Collection

311

(1)

Requisitions

311

(1)

Complications Associated with the Specimen Collection Procedure

312

(5)

Tourniquet Pressure and Fist Pumping

312

(1)

Failure to Draw Blood

312

(1)

Fainting (Syncope)

312

(1)

Hematomas

313

(1)

Petechiae

313

(1)

Excessive Bleeding

314

(1)

Neurologic Complications

314

(1)

Intravenous Therapy

315

(1)

Hemoconcentration

316

(1)

Hemolysis

316

(1)

Collapsed Veins

317

(1)

Turbid or Lipemic Serum

317

(1)

Improper Collection Tube

317

(1)

Complications Associated with Specimen Transport

317

(1)

Chilled Transport

317

(1)

Exposure to Light

317

(1)

Complications Associated with Specimen Receipt in the Laboratory

318

(2)

Processing Delays

318

(2)

Specimen Rejection

320

(1)

Self Study

321

(1)

Key Terms

321

(1)

Study Questions

321

(1)

References

322

(2)

Case Studies

Ambulatory Health Care Collections

324

(1)

Venipuncture Site Selection

325

(1)

Finding the Right Site

325

(1)

Tricky Complications with an IV

326

(1)

PART IV SPECIAL PROCEDURES AND POINT OF CARE TESTING

Pediatric Procedures

327

(34)

Chapter Objectives

327

(1)

Age-Specific Care Considerations

328

(1)

Preparing Child and Parent

328

(7)

Psychological Response to Needles and Pain

334

Distraction Techniques

332

(1)

Room Location

332

(1)

Equipment Preparation for a Friendlier Environment

332

(3)

Positions for Restraining a Child

335

(1)

Combative Patients

335

(1)

Interventions to Alleviate Pain

336

(1)

Oral Sucrose

336

(1)

Prevention of Disease Transmission---Standard Precautions

336

(1)

Precautions to Protect the Child

336

(1)

Latex Allergy Alert

337

(1)

Pediatric Phlebotomy Procedures

337

(19)

Microcapillary Skin Puncture

337

(4)

Heelstick

341

(4)

Neonatal Screening

345

(1)

Venipuncture

346

(6)

Collecting Blood from IV Lines

352

(4)

Self Study

356

(1)

Key Terms

356

(1)

Study Questions

356

(1)

References

357

(4)

Arterial, Intravenous (IV), and Special Collection Procedures

361

(34)

Chapter Objectives

361

(1)

Arterial Blood Gases

362

(4)

Radial Artery Puncture Site

362

(1)

Brachial and Femoral Artery Puncture Sites

363

(1)

Preparation of Supplies and Patient

363

(3)

Capillary Blood Gases

366

(2)

Bleeding-Time Test

368

(1)

Possible Interfering Factors

369

(1)

Blood Cultures

369

(7)

Site Preparation

372

(3)

Possible Interfering Factors

375

(1)

Glucose Tolerance Test

376

(4)

Postprandial Glucose Test

380

(1)

Lactose Tolerance Test

381

(1)

Therapeutic Drug Monitoring (TDM)

381

(2)

Collection for Trace Metals (Elements)

383

(1)

Genetic Molecular Tests

383

(1)

IV Line Collections

384

(1)

Collecting Blood Through a CVC

384

(1)

Cannulas and Fistulas

385

(1)

Donor Room Collections

385

(5)

Donor Interview and Selection

388

(2)

Collection of Donor's Blood

390

(1)

Therapeutic Phlebotomy

390

(1)

Autologous Transfusion

391

(1)

Self Study

392

(1)

Key Terms

392

(1)

Study Questions

392

(1)

References

393

(2)

Elderly, Home, and Long-term Care Collections

395

(18)

Chapter Objectives

395

(1)

Considerations for the Elderly

396

(1)

Glucose Monitoring

397

(5)

Quality in Point-of-Care Testing (POCT)

401

(1)

Blood Gas and Electrolyte Analysis

402

(3)

Point-of-Care Testing for Acute Heart Damage

405

(1)

Blood Coagulation Monitoring

406

(1)

Hematocrit, Hemoglobin, and Other Hematology Parameters

407

(1)

Cholesterol Screening

408

(1)

Future Trends

409

(2)

Self Study

411

(1)

Key Terms

411

(1)

Study Questions

411

(1)

References

412

(1)

Urinalysis, Body Fluids, and Other Specimens

413

(18)

Chapter Objectives

413

(1)

Urine Collection

414

(5)

Single-Specimen Collection

416

(1)

Timed Collections

416

(3)

Cerebrospinal Fluid

419

(2)

Fecal Specimens

421

(1)

Seminal Fluid

421

(1)

Amniotic Fluid

421

(1)

Other Body Fluids

422

(1)

Culture Specimens

422

(1)

Other Nonblood Procedures

423

(4)

Throat and Nasopharyngeal Culture Collections

423

(2)

Skin Tests

425

(1)

Gastric Analysis

426

(1)

Breath Analysis for Peptic Ulcers

427

(1)

Sweat Chloride by Iontophoresis

427

(2)

Self Study

429

(1)

Key Terms

429

(1)

Study Questions

429

(1)

References

430

(1)

Forensic Toxicology, Workplace Testing, Sports Medicine, and Related Areas

431

(18)

Chapter Objectives

431

(1)

Overview and Prevalence of Drug Use

432

(1)

Forensic Toxicology Specimens

433

(1)

Chain of Custody

434

(1)

Federal Workplace Drug Testing

435

(2)

Tampering with Specimens

437

(1)

Drug Testing in the Private Sector

437

(2)

Drug Use in Sports

439

(1)

Preferred Specimens for Drug Tests

439

(1)

Breath Testing for Alcohol

440

(1)

Collecting Specimens for Alcohol Levels

440

(2)

Neonatal Drug Testing

442

(1)

Self Study

442

(1)

Key Terms

442

(1)

Study Questions

442

(1)

References

443

(2)

Case Studies

Home Care Collections

445

(1)

Bedside Glucose Testing

446

(1)

Newborn Nursery Collections

447

(1)

Collecting Blood from an Infant

447

(1)

Blood Donor Complications

447

(2)

Appendices

449

(79)

Appendix 1: Finding a Job

449

(4)

Appendix 2: The Basics of Vital Signs

453

(9)

Appendix 3: CDC Guideline for Hand Hygiene in Health Care Settings

462

(5)

Appendix 4: Laboratory Assays and the Required Types of Anticoagulants

467

(14)

Appendix 5: Maximum Amounts of Blood to be Drawn from Patients Younger than 14 Years

481

(1)

Appendix 6: OSHA Labeling Requirements

482

(2)

Appendix 7: Whole Blood or Apheresis Donation Procedure

484

(19)

Appendix 8: Units of Measurement and Symbols

503

(3)

Appendix 9: Formulas, Calculations, and Metric Conversion

506

(4)

Appendix 10: Military Time (24-hour clock)

510

(2)

Appendix 11: Basic Spanish for Specimen Collection Procedures

512

(4)

Appendix 12: Answers to Self Study Questions and Cases

516

(12)

Glossary

528

(19)

Index

547

Phlebotomy Handbook : Blood Collection Essentials

9780131133341

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Table of Contents