Phlebotomy Handbook : Blood Collection Essentials

by Garza, Diana; Becan-McBride, Kathleen

• ISBN13: 9780131133341
• ISBN10: 0131133349
• Edition: 7th
• Format: Paperback
• Copyright: 2005-01-01
• Publisher: Prentice Hall

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.

Table of Contents

Preface	xxi
Acknowledgments	xxiv
Reviewers	xxv
PART I OVERVIEW
Phlebotomy Practice and Quality Essentials	1	(42)
Chapter Objectives	1	(1)
Phlebotomy Practice, Definition, and Duties	2	(1)
Health Care Organizations	3	(1)
Professional Competencies and Certifications	3	(9)
Professional Character Traits	9	(3)
Role of the Clinical Laboratory in Specimen Collection Services	12	(1)
Communications Strategies for Phlebotomists	13	(18)
Verbal Communication	14	(5)
Communication for Confirming Patient Identification	19	(2)
Nonverbal Communication	21	(6)
Active Listening	27	(1)
Appearance, Grooming, and Physical Fitness	27	(3)
Nutrition, Rest, and Exercise	30	(1)
Role of Family, Visitors, and Significant Others	30	(1)
Quality Improvement and Assessment	31	(9)
Perceptions of Quality	31	(2)
Customer Satisfaction	33	(1)
Tools and Trends for Performance Assessment	33	(1)
Quality in Specimen Collection Services	34	(1)
Important Factors Affecting Quality	35	(3)
Equipment and Preventive Maintenance	38	(2)
Self Study	40	(1)
Key Terms	40	(1)
Study Questions	40	(1)
References	41	(2)
Ethical, Legal, and Regulatory Issues	43	(18)
Chapter Objectives	43	(1)
Ethics Overview	44	(1)
Governmental Laws	44	(1)
Basic Legal Principles	45	(4)
Legal Terminology	45	(1)
Negligence	45	(1)
Malpractice	46	(1)
Patient Confidentiality	47	(1)
Confidentiality and HIV Exposure	47	(1)
Standard of Care	47	(1)
Informed Consent	48	(1)
Informed Consent for Research Purposes	48	(1)
Implied Consent	49	(1)
Statute of Limitations	49	(1)
Legal Claims and Defense	49	(2)
Expert Witness	50	(1)
Evidence	50	(1)
Advice to Avoid Lawsuits	51	(1)
Respondeat Superior	51	(1)
Medical Records	51	(2)
HIPAA	53	(1)
Legal Cases Related to Clinical Laboratory Activities	54	(1)
Schmerber v. State of California	54	(1)
Lazernick v. General Hospital of Monroe County (PA 1977)	54	(1)
Walton v. Providence Hospital	54	(1)
Helmann v. Sacred Heart Hospital	55	(1)
Cases Resulting from Improper Technique and Negligence	55	(1)
HIV-Related Issues	56	(1)
Malpractice Insurance	56	(1)
Clinical Laboratory Improvement Amendments (CLIA)	56	(2)
Self Study	58	(1)
Key Terms	58	(1)
Study Questions	58	(1)
References	59	(2)
Basic Anatomy and Physiology of Organ Systems	61	(30)
Chapter Objectives	61	(1)
Anatomic Regions	62	(3)
Structural Organization	65	(4)
Major Organ Systems	69	(18)
Integumentary System	69	(1)
Skeletal System	70	(1)
Muscular System	71	(2)
Nervous System	73	(2)
Respiratory System	75	(4)
Digestive System	79	(2)
Urinary System	81	(2)
Endocrine System	83	(1)
Reproductive System	84	(1)
Lymphatic System	85	(1)
Cardiovascular System	86	(1)
Self Study	87	(2)
Key Terms	87	(1)
Study Questions	88	(1)
References	89	(2)
The Circulatory System	91	(32)
Chapter Objectives	91	(1)
The Heart	92	(4)
The Blood	96	(8)
Erythrocytes	97	(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