Applied Phlebotomy

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ISBN: 9780781750554 | 0781750555
Cover: Paperback
Copyright: 5/20/2005

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Geared specifically to short courses in blood collection, this concise full-color text teaches the skills necessary to obtain blood specimens effectively and safely, in accordance with Clinical and Laboratory Standards Institute (formerly NCCLS) and Occupational Safety and Health Administration guidelines. The book presents step-by-step procedure instructions and explains why these procedures are important to blood specimen collections. "It Could Happen To You" case studies discuss actual phlebotomy-related injuries. "Tips From the Trenches" offer practical phlebotomy pointers. "In the Lab" describes what happens to blood in the lab and underscores the importance of key collection concepts. Each chapter ends with multiple-choice review questions.

Preface

Phlebotomy: Not Just a Procedure Anymore

(38)

Introduction

(1)

Evolution of Phlebotomy in Healthcare

(6)

Staffing Strategies

(1)

Phlebotomy in a Multiskilled Work Force

(5)

Phlebotomy's Role in Healthcare

(1)

Identifying and Managing the Risks

(6)

Instituting a Comprehensive Phlebotomy Training Program

(1)

Legislating Phlebotomy Certification

(1)

Drafting Safe Phlebotomy Procedures

(1)

Clinical and Laboratory Standards Institute

(1)

Engineering and Work Practice Controls

(1)

Maintaining High Standards of Performance

(1)

Inspiring Professionalism: Strategies for Managers

(11)

Patients' Perception of Care

(4)

Threats to Professionalism

(1)

Inspiring Professionalism

(1)

Step 1: Coach Yourself First

(1)

Step 2: Identify Motivators

(1)

Step 3: Implement Motivators

(2)

Nurturing a Culture of Customer Service

(1)

Skill and Professionalism

(1)

Code of Conduct

(1)

Rewarding Customer Service Excellence

(1)

Scripting Techniques

(1)

Professional Development and Behavior

(13)

Personal Appearance

(1)

Attitude

(1)

Telephone Etiquette

(4)

Certification, Education, and Professional Affiliation

(1)

Patient Courtesies

(6)

Selecting and Assembling Equipment

(20)

Introduction

(1)

Test Orders

(2)

Direct Access Testing

(1)

Supplies and Equipment

(13)

Tubes and Additives

(1)

Sodium Citrate Tube---Blue Stopper

(3)

Clot Activator (Serum) Tube

(1)

Heparin Tube---Green Stopper

(1)

EDTA Tube---Lavender Stopper

(1)

Sodium Fluoride/Oxalate Tube---Gray Stopper

(1)

Needle Selection

(1)

Syringes, Tube Holders, and Winged Collection Sets

(3)

Equipment Assembly

(5)

Tube Holders

(1)

Syringes

(1)

Winged Collection Sets

(4)

Performing the Venipuncture

(39)

Introduction

(1)

Safety

(2)

Preanalytical Errors

(1)

Patient Identification

(4)

Inpatient Identification

(2)

Outpatient Identification

(1)

Confirm Test Requests

(1)

Position the Patient

(1)

Outpatient

(1)

Inpatient

(1)

Venipuncture Procedure

(3)

Site Selection

(1)

Necessity for Restraint

(1)

Mastectomy Patients

(1)

Availability of Veins

(1)

Collector's Skill

(1)

Presence of Edema

(1)

Injuries

(1)

Infusion of Intravenous Fluids

(1)

Vein Selection

(17)

Order of Draw

(2)

Recovering the Failed Venipuncture

(2)

If Using a Tube Holder

(1)

If Using a Syringe

(1)

If Using a Winged Infusion Set

(1)

Complications

(7)

Fainting and Nausea

(1)

Seizures

(1)

Hematoma Formation

(1)

Pain

(1)

In the Lab

(5)

Difficult Draws, Alternative Sites, Pediatric Venipunctures

(32)

Introduction

(1)

Difficult Draws

(12)

Needle-Phobic Patients

(4)

Age

102

(3)

Mastectomy

105

(1)

Skin Injuries and Disorders

106

(1)

Edema/Obesity

106

(1)

Scarred and Sclerosed Veins

106

(1)

Fistulas

106

(1)

Heparin/Saline Locks

106

(1)

IV Therapy

107

(1)

Drawing Below an IV Site

107

(1)

Drawing Above an IV Site

107

(3)

Language Barriers

110

(1)

Alternative Sites

110

(8)

Hand and Wrist Veins

112

(1)

Veins of the Ankles and Feet

113

(1)

Capillary Blood Collection

113

(1)

Vascular Access Devices

113

(4)

Femoral Artery

117

(1)

Arterial Punctures

117

(1)

Pediatric Venipunctures

118

(7)

Newborns and Infants

118

(1)

Iatrogenic Anemia

119

(2)

Age: 1 to 3 Years

121

(1)

Calming Fears

122

(1)

Age: 4 years to Adolescence

122

(1)

Calming Fears

123

(2)

In the Lab

125

(5)

Special Collections: Arterial, Capillary, and Blood Culture Collection

130

(32)

Introduction

130

(1)

Capillary Blood Collection

130

(10)

Equipment

131

(2)

Site Selection

133

(1)

Birth to 12 Months

133

(1)

1 year to Adult

133

(1)

Procedure

134

(1)

Prewarming

134

(1)

Perform the Puncture

135

(2)

Order of Draw for Capillary Specimens

137

(1)

Neonatal Screening

138

(2)

Arterial Punctures

140

(8)

Acceptable Sites

141

(1)

Supplies

142

(1)

Procedure

142

(1)

Radial Artery

143

(1)

Brachial Artery

144

(2)

Completing the Procedure

146

(1)

Complications

146

(1)

Missed Artery

146

(1)

Nerve Involvement

147

(1)

Hematoma

147

(1)

Syncope

147

(1)

Specimen Transport

148

(1)

Blood Culture Collection

148

(9)

Preventing False Negatives

149

(1)

Preventing False Positives

150

(1)

Designated Blood Culture Collection Team

151

(1)

Commercial Skin Prep Kits

152

(1)

Disinfectants

152

(1)

Collector Feedback

153

(1)

Specimen Collection Procedure

154

(1)

Syringe Draws

155

(1)

Vacuum-Assisted Draws

155

(1)

Draws Through Vascular Access Devices

156

(1)

In the Lab

157

(5)

Specimen Handling, Storage, and Transportation

162

(20)

Introduction

162

(1)

General Considerations

163

(3)

Preventing Glycolysis and Ion Exchange

164

(2)

Handling

166

(9)

Centrifugation

166

(1)

Serum Separators

167

(2)

Transfer Tubes

169

(1)

Analytes Unstable After Separation

170

(1)

Handling Coagulation Specimens

170

(2)

Handling Whole Blood Specimens

172

(1)

Add-On Tests

173

(1)

Effects of Light

173

(2)

Storage and Transportation

175

(3)

On-Site Testing Facilities

175

(1)

Off-Site Testing Facilities

175

(1)

EDTA Tubes

175

(1)

Serum Tubes

176

(1)

Heparin Tubes

176

(1)

Sodium Citrate Tubes

177

(1)

Specimen Processing Reminders

177

(1)

In the Lab

178

(4)

Why Do Some Tests Take So Long?

178

(4)

Phlebotomy Liability

182

(25)

Introduction

182

(1)

Phlebotomy Liability

182

(25)

Standard of Care

183

(2)

Injuries That Bring Lawsuits

185

(1)

Nerve Injuries

186

(1)

Arterial Nicks

187

(1)

Venous Hemorrhage

188

(1)

Drawing from Mastectomy Patients

189

(1)

Injuries from Loss of Consciousness

189

(1)

Death

190

(2)

Technical Errors

192

(5)

Administrative Errors

197

(1)

Training and Evaluation

197

(10)

Managing Exposures to Bloodborne Pathogens

207

(23)

Introduction

207

(1)

Preexposure Management

208

(3)

Understanding Bloodborne Pathogens

208

(1)

Prevention

209

(1)

Preexposure Immunizations

210

(1)

Postexposure Management

211

(12)

Percutaneous Wound Care

212

(1)

Exposure Evaluation

212

(1)

Postexposure Prophylaxis

213

(1)

Hepatitis B

213

(1)

Hepatitis C

214

(2)

HIV

216

(5)

Postexposure Testing and Counseling

221

(1)

Testing the Employee

221

(1)

Counseling the Employee

222

(1)

Testing and Counseling the Source Patient

223

(1)

Summary of Exposure Protocol

223

(1)

Hepatitis B

223

(1)

Hepatitis C

224

(1)

HIV

224

(1)

Elements of a Comprehensive and Functional Exposure Control Plan

224

(6)

Assessing Effectiveness

225

(5)

Practices and Products for Exposure Prevention

230

(17)

Introduction

230

(1)

Safe Practices

231

(7)

Standard Precautions

231

(2)

Use of Personal Protective Equipment

233

(3)

Proper Protocol for Accidental Blood Spills

236

(1)

Proper Handling of Contaminated Needles

237

(1)

Safe Centrifuge Use

238

(1)

Safety Products

238

(9)

Engineered Sharps Injury Protection

239

(1)

Needle Disposal Units

240

(2)

Needle Destruction Units

242

(1)

Laser Skin Perforation Devices

242

(5)

Appendix I: Clinical and Laboratory Standards Institute (formerly NCCLS) Documents

247

(2)

Appendix II: Recommended Certification Organizations

249

(3)

Appendix III: Educational Resources

252

(3)

Appendix IV: Phlebotomy Tip of the Month

255

(12)

Appendix V: Resources for Managers

267

(6)

A. Minimum Content of any Specimen Collection-Training Programs

257

(11)

B. Sample Inpatient Script

268

(2)

C. Sample Calling Card

270

(1)

D. Sample Postvenipuncture Care Instructions

270

(1)

E. Sample Code of Conduct

271

(1)

F. Sample Motivator Assessment Sheet

272

(1)

G. Traffic Jam Team-Building Exercise

272

(1)

Appendix VI: Additional Resources

273

(2)

Index

275

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Applied Phlebotomy

Summary

Table of Contents

Supplemental Materials