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UNIT 1 Introduction to Phlebotomy
1 Introduction to Phlebotomy, 1
2 Health Care Structure, 12
3 Safety, 26
4 Infection Control, 38
UNIT 2 Phlebotomy Basics
5 Medical Terminology, 55
6 Human Anatomy and Physiology, 65
7 Circulatory, Lymphatic, and Immune Systems, 95
UNIT 3 Specimen Collection
8 Venipuncture Equipment, 113
9 Routine Venipuncture, 128
10 Capillary Collection, 151
11 Venipuncture Complications, 166
12 Blood Collection in Special Populations, 181
13 Arterial Blood Collection, 195
14 Special Collections and Procedures, 206
15 Special Nonblood Collection Procedures, 222
UNIT 4 Specimen Handling
16 Specimen Handling, Transport, and Processing,
233
17 Point-of-Care Testing, 243
UNIT 5 Professional Issues
18 Quality Phlebotomy, 255
19 Legal Issues in Phlebotomy, 267
APPENDIXES
A Metric System Measurements, 279
B Common English-Spanish Phrases for Phlebotomy,
280
C Competency Checklists, 282
D Common Abbreviations, 297
E Mock Certification Exam, 299
F Answers to Chapter Questions and Mock
Certification Exam, 315
Glossary, 343
Index, 353

UNIT 1 Introduction to Phlebotomy

CHAPTER 1 Introduction to Phlebotomy

The modern phlebotomist is a professional trained to
draw blood who has a variety of job skills and personal
characteristics, including communication skills,
organizational skills, and compassion. After initial
training, the phlebotomist may become certified by
one or more professional organizations. Continuing
OUTLINE education courses keep the phlebotomist up
to date on the latest changes in techniques and
regulations in the field. The phlebotomist must also be
aware of important legal issues, including patient
confidentiality, in formed consent, and Health
Insurance Portability and Accountability Act (HIPAA)
regulations.
What Is Phlebotomy?
Modern Phlebotomy Job Skills Job Duties Personal
Characteristics OBJECTIVES Professional
Organizations and Standards Accreditation
Certification State Licensure Continuing Education
Legal Issues in Phlebotomy Informed Consent
Confidentiality HIPAA Review for Certification After
completing this chapter, you should be able to: 1.
Define phlebotomy.
2. List at least five job skills that are important for
phlebotomists to have, and explain why each is
important.
3. Describe the major duty of phlebotomists, and
discuss four other responsibilities that are important.
4. List six personal qualities that characterize a
professional, and explain how phlebotomists
demonstrate these qualities.
KEY TERMS 5. Differentiate accreditation and
certification.
6. Identify professional organizations with an interest
in phlebotomy.
7. Explain why informed consent and confidentiality
are important legal issues for phlebotomists.
accreditation approval certification ABBREVIATIONS
continuing education units (CEUs) informed consent
phlebotomy protected health information standards
ACA American Certification Agency for Healthcare
Professionals AMT American Medical Technologists
ASCLS American Society for Clinical Laboratory
Science ASCP American Society for Clinical Pathology
ASPT American Society of Phlebotomy Technicians
CEUs continuing education units CPT certified
phlebotomy technician HIPAA Health Insurance
Portability and Accountability Act NAACLS National
Accrediting Agency for Clinical Laboratory Sciences
NHA National Healthcareer Association NPA National
Phlebotomy Association PBT phlebotomy technician
by AMT PHI Protected health information RPT
registered phlebotomy technician WHAT WOULD YOU
DO?
You’ve been hired by Central Hospital for your first job
as a phlebotomist. You start next Monday, but first you
need to read the employee handbook, which includes
a description of personal characteristics for the
successful phlebotomist. Dependability? Check—
you’ve been holding down a steady job for more than 2
years. Positive attitude? Check—your nickname at the
warehouse is “Can do.” Professional appearance?
Uh-oh—no piercings, no visible tattoos, no artificial
nails. You've got them all. When Monday rolls around,
what should you do? Forget about the job? Tell your
supervisor, “This is me—deal with it”? What would
you do?
WHAT IS PHLEBOTOMY?
Phlebotomy is the practice of drawing blood. The word
phlebotomy is derived from the Greek phlebo-, which
means “vein,” and -tomy, which means “to make an
incision.” Phlebotomy is an ancient profession, dating
back at least 3500 years to the time of the ancient
Egyptians. The earliest phlebotomists drew blood in
an attempt to cure disease and maintain the body in a
state of well-being. In Europe during the Middle Ages,
barber surgeons performed bloodletting to balance
the four humors, or bodily fluids, because an
imbalance of the humors was thought to underlie dis
ease. The familiar stripes on the barber's pole date
from this period, with red symbolizing blood and white
symbolizing bandages. Early phlebotomists’ tools
included lancets (called fleams) and suction cups
(Figure 1-1), and they used ornate ceramic bowls to
collect the blood. Phlebotomists also applied leeches
to patients' skin for hours at a time to remove blood.
Today, removal of a prescribed volume of blood
(“therapeutic phlebotomy”) is used to treat a small
number of blood disorders.
MODERN PHLEBOTOMY Modern phlebotomy shares
little more than a name with these ancient practices.
Today, phlebotomy is performed primarily for
diagnosis and monitoring of a patient's disease
condition. It involves highly veloped and rigorously
tested procedures and equipment, all meant to
ensure the safety and comfort of the patient and the
integrity of the sample collected.
Job Skills Today’s phlebotomist is highly trained and
uses a variety of skills in the workplace. Technical
skills are required to collect specimens for analysis,
and developing these skills will constitute a large part
of your training. A phlebotomist also needs to be
highly organized and detail-oriented in order to deal
with the large number of samples that may be col
lected in a short time, while ensuring that each
sample is properly labeled and correctly handled. The
successful phlebotomist is able to prioritize multiple
tasks and match his or her pace to the vol ume of
work. Equally important are interpersonal skills. As a
phlebotomist, you will spend a large part of your
working day interacting with people, in cluding
patients, their families, and medical person nel.
Another important job skill is being able to handle
stress. A phlebotomist must occasionally deal with
difficult patients, fainting patients, mal functioning
equipment, or demands for immediate action. As your
technical skills increase, these situ ations will
become less stressful, but the job will always carry
some stress. Being able to cope with this in a calm,
professional manner is vital to being a successful
phlebotomist. Job Duties The principal purpose of
phlebotomy is to obtain blood samples, at the request
of a physician or a qualified health care professional
such as a nurse practitioner, for analysis in the
laboratory. Perform ing these duties correctly ensures
that patients re ceive prompt and complete medical
care. Failure to perform these duties correctly can
lead to signifi cant adverse consequences for the
patient, including improper care and even death. Later
chapters cover the details of how to perform each
step of each pro cedure you will be required to
perform. In brief, the steps in a routine collection are
as follows: 1. Obtain a requisition from a licensed
practitioner. 2. Correctly and positively identify the
patient by asking the patient to state his or her name.
3. Choose the appropriate equipment for obtaining the
sample. 4. Select and prepare the site for collection.
5. Collect the sample, ensuring patient comfort and
safety. 6. Correctly label the sample with patient’s
name, date, and time of collection. 7. Transport the
sample to the laboratory in a timely manner, using
appropriate handling procedures. 8. Adhere to all
safety and infection control regula tions throughout
the process. In addition to collecting patient blood
samples, phlebotomists must also: 1. Effectively
interact with both patients and health care
professionals. 2. Keep accurate records and be
knowledgeable about the computer operations of the
laboratory. 3. Develop other health care skills, such as
per forming blood pressure determinations, collect ing
nonblood specimens, processing specimens,
instructing patients on collecting nonblood spec
imens (such as urine), performing point-of-care
testing and quality-control procedures, maintain ing
point-of-care instruments, and performing some basic
laboratory tests. A trained phlebotomist can also be
employed as a medical assistant, a laboratory
assistant, or an acces sioner, after receiving
specialized training. A medical assistant works in a
clinic or hospital to assist other staff in patient care
and facility preparation. A medi cal assistant requires
training in medical billing and coding with a specific
certification process. A labora tory assistant assists in
performing routine laboratory testing. An accessioner
performs a variety of tasks related to specimen
preparation in the clinical labora tory. A phlebotomist
may be cross-trained to perform clerical duties such
as patient registration. Personal Characteristics As a
phlebotomist, you will often be the first medical
professional a patient meets. You therefore represent
not only yourself or the laboratory but the entire health
care facility. This public relations aspect of your work
is important because it sets the tone for the patient‘s
stay in the health care facility and the patient’s
satisfaction with the service the facility provides. How
you present yourself has an effect on everyone with
whom you interact. The quality of care you provide has
a direct effect on the patient’s health and satisfaction,
as well as on the health care facility’s reputation in the
health care setting. In ad dition, your interaction with a
patient also affects scoring on patient satisfaction
surveys. These survey results are monitored by The
Joint Commission and influence the quality rating of
the health care system. The phlebotomist is a member
of the health care profession and must display
professional behavior at all times (Figure 1-2).
Professionalism is both an attitude toward your work
and a set of specific char acteristics. A professional
displays the following characteristics.
Dependability The phlebotomist plays a crucial role in
the health care institution and is depended on to
perform that role skillfully, efficiently, and without
constant su pervision. The phlebotomist must report
to work on time and avoid all unnecessary absences
or tardi ness. Failure to do so can affect patient care.
A late or absent phlebotomist decreases the overall
func tion of the laboratory and may even prevent a pa
tient from having a sample collected in a timely
manner for monitoring of medication, for example.
Honesty and Integrity Because the phlebotomist often
works without su pervision, unquestioned integrity is
crucial. Every one makes errors, and you will be no
exception. It is vital for the health and safety of your
patients that you admit to errors when they are made.
Unreported errors can result in patient injury and
death. Positive Attitude Your attitude affects everyone
you interact with, and having a positive attitude
toward your job makes others around you more
positive as well. This is especially important in your
interactions with patients and their families as well as
other health care professionals. Empathy and
Compassion The phlebotomist is often called on to
interact with patients experiencing health crises or
undergoing painful or unpleasant treatments. Patients
may be worried about the procedure being performed,
the condition for which they are being treated, or the
cost of their care. By being sensitive to patients’
concerns and taking the time to reassure anxious
patients, you can help make their stay less stressful
(Figure 1-3). Professional Detachment Conversely, it is
important to remain emotionally detached from
patients. You will encounter many distressing
situations in your career. Becoming emo tionally
involved on a personal level does not help your
patients and can lead to stress and burnout. Your
approach to patients in distress must be sympa thetic
and understanding, but you must retain enough
professional distance to allow you to do your job
efficiently. Developing this balanced approach is a
significant step in your professional growth.
Professional Appearance Appearance has a
significant effect on how the phle botomist is thought
of by patients and treated by coworkers, including
superiors. First impressions are often lasting ones.
Cleanliness and scrupulous grooming is critical, with
conservative clothing, hair, and makeup the general
rule. Avoid long, dan gling jewelry and earrings;
exposed piercings other than in ears; strong perfume;
and gaudy makeup. Employers usually set specific
standards. In addi tion, keep your fingernails short,
avoid artificial nails, and if you use nail polish, use
neutral shades and avoid chips. Long nails and
chipped polish breed bacteria and fungi, which may
affect patients’ health.
Interpersonal Skills The phlebotomist must be able to
communicate effectively with patients and coworkers.
Patients may be fearful, uncooperative, or excessively
talk ative. In all cases, the phlebotomist must be able
to communicate clearly to patients what is to be done
and to obtain consent for the procedure. Speaking
slowly, clearly, and in a courteous tone will help you
gain the patient’s trust, which is necessary to perform
the procedure effectively. Nonverbal com munication
is important as well. By making eye contact, smiling,
and appearing relaxed, calm, and prepared, you
communicate confidence and profes sionalism to
patients. Reading patients’ nonverbal
communication, or body language, will let you know
when you need to take extra steps to put them at ease.
For example, anxious patients often fidget, tap their
fingers, or bounce their legs. Fearful pa tients may
have their eyes “glazed over,” unable to focus. Take
the time to reassure anxious patients by listening to
their needs. Take the time to answer questions.
Patients need empathetic attention—they are people,
not just names on requisition forms. Treat all patients
as if they are a family member. BOX 1-1 Answering the
Phone Here is an example of the correct way to
answer the phone in the clinical laboratory: Telephone
Skills The phlebotomist is often required to answer
calls and take messages in the laboratory. The
informa tion that comes in over the phone may be
critical for patient care or for the operation of the
laboratory. It is essential that you display the same
high level of professionalism in answering the phone
as in deal ing directly with patients and coworkers. If
you are staffing the desk, do the following: • Answer
the phone promptly. • Smile when speaking, even
though you can’t be seen; it will positively affect your
voice tone. • Identify the department and yourself, and
ask how you can help. • Write everything down,
including the name of the person calling, their phone
number, and the date and time of the call. Be
prepared to take a message by having writing
materials at hand. • Speak slowly and clearly. • Do not
put the caller on hold until you determine it is not an
emergency call. • Make every attempt to help, but give
only ac curate information. If you do not know the an
swer to a question, find out and call back, if
necessary. An example of these telephone skills steps
is illustrated in Box 1-1. [Phone rings] Phlebotomist:
Good afternoon, this is the clinical laboratory at Mercy
Hospital. Sandy speaking. How may I help you? Caller:
This is Dr. Tom Watson from Fairview Clinic. Can you
tell me if the results from the fecal test on a patient on
Three West are ready yet? Phlebotomist: I will try to
find out. Can you tell me the patient identification
number on the test request and the date that the
specimen was sent? Caller: The number is 243576-1.
The date for the specimen was 8/12. Phlebotomist:
Thank you. Can you hold while I check? Caller: Yes.
Phlebotomist: Thank you. Please hold. [Phlebotomist
places call on hold, checks for the results, and returns
to the phone.] Phlebotomist: Dr. Watson? What is your
patient’s name? Caller: The patient is Harry Blum.
Phlebotomist: I’m sorry. The results are not back yet—
we’ve had a slight delay here. May I take your number
and call you when they are ready? It should be about 2
hours. Caller: Yes. I’m at 555-5555. Phlebotomist:
[Writes down number.] I will call you as soon as the
results are ready. Caller: Thank you. Phlebotomist:
Thank you. Good-bye. CLINICAL TIP Always write
down all pertinent information when answering the
phone. PROFESSIONAL ORGANIZATIONS AND
STANDARDS The high standards necessary for the
proper prac tice of modern phlebotomy have led to the
cre ation of several organizations that develop stan
dards and monitor training in the field. There are three
aspects of this type of professional monitor ing:
accreditation, certification, and continuing medical
education. Accreditation is for institu tions that train
phlebotomists, whereas the other two are for
phlebotomists themselves. The pro gram in which you
are training to become a phle botomist should be
accredited. Once you receive your training, you can
become certified. After you become certified, you may
need to participate in continuing medical education to
remain certified.
Some of the organizations and the services they
provide are shown in Table 1-1. Membership in a
professional organization for phlebotomists offers an
additional way to follow changes in the field and to
learn important new information. Some of the
organizations listed in Table 1-1 publish journals with
useful articles or sponsor workshops or seminars.
Accreditation Programs that train phlebotomists
receive ac creditation or approval from a professional
orga nization by meeting and documenting
established requirements, called standards. An
accredited education program exposes students to
both class room and clinical experiences and fully
prepares them to become professional
phlebotomists. As shown in Table 1-1, the
organizations that provide accreditation or approval
are the American Medi cal Technologists (AMT), the
American Society of Phlebotomy Technicians (ASPT),
the National Accrediting Agency for Clinical
Laboratory Sci ences (NAACLS), and the National
Phlebotomy Association (NPA). The program you are
enrolled in may be accredited by one or more of these
or ganizations. As discussed later, California accred
its training programs within that state. Certification
After completing an accredited or approved pro gram,
you are eligible to take a certifying examina tion.
Certification is evidence that an individual has
demonstrated proficiency in a particular area of
practice. As shown in Table 1-1, the organizations and
companies that offer certification are American Allied
Health, the American Certification Agency for
Healthcare Professionals (ACA), the AMT, the
American Society for Clinical Pathology (ASCP), the
ASPT, the National Healthcareer Association (NHA),
and the NPA. Once you pass the examina tion, you
may use the title shown in Table 1-1 as part of your
professional name. State Licensure Several states
require that phlebotomists obtain a li cense directly
from the state to perform phlebotomy within the state.
These states include California, Louisiana, Nevada,
and Washington. The require ments for each state as
of late 2013 are discussed below. California
Phlebotomists in California fall under a set of state
regulations governing their education, training, and
certification. Those who wish to become phleboto
mists must show proof of having met several educa
tional requirements, including the following: • High
school diploma or equivalent • Forty hours of
classroom instruction in phlebot omy (20 hours basic,
20 hours advanced) in a state-accredited program •
Forty hours of practical training in phlebotomy in a
state-accredited program, including at least 50
venipunctures and 10 skin punctures • Certification
from a national phlebotomy organi zation that is
approved by the state to administer examinations and
issue certification Once you have met all these
requirements, you are eligible to apply to the state for
certification to prac tice phlebotomy. (A high school
diploma or equiva lent plus 20 hours of training will
allow you to qualify as a limited phlebotomy
technician and perform skin punctures only; this does
not require certification.) State certification is for 2
years, with renewal based on meeting continuing
education requirements. The initial certification
granted is as a certified phlebotomy technician level I
(CPT-I), which en ables phlebotomists to perform
dermal punctures and venipunctures without
supervision and arterial punctures with the
supervision of a physician, reg istered nurse, medical
laboratory scientist, medical laboratory technician, or
certified respiratory thera pist. After performing 20
successful supervised arterial punctures, the CPT-I
can apply to become a CPT-II, with the ability to
perform unsupervised arterial punctures. Practicing
phlebotomists may need to show proof of classroom
instruction to obtain state certi f ication, even if they
are already certified by a na tional organization.
Regardless of whether you plan to practice in
California, it is wise to get the maximum amount of
training before you start your career as a
phlebotomist. Louisiana The state of Louisiana
requires phlebotomists to ap ply for licensure through
the State Board of Medical Examiners after receiving
certification from one of the private national
organizations. There are multi ple exemptions from
this requirement, however. If you fall into one of the
categories for exemption in the board’s rules, you do
not need a state license to practice phlebotomy.
Those exempted include phlebotomists supervised by
a licensed physician, or a licensed clinic, hospital,
nursing home, or other licensed health care facility
authorized by licensure to perform clinical laboratory
testing.
Nevada In Nevada, you must present a high school
diploma or equivalency degree. You must also be
certified by one of two national certification agencies
(either the ASCP or the AMT) or complete at least 6
months of training under the supervision of a state-
approved practitioner. For the purposes of the
application, phlebotomists are classified as either
Office Lab Assistants (if you work in a physician’s
private practice) or Lab Assistants (if you work in an
independent licensed laboratory, a hospital, or other
facility serving more than a single physician’s
patients). Washington As of July 2013, phlebotomists
in the state of Washington must obtain certification
from the state as a “Medical Assistant–Phlebotomist.”
This is not to be confused with a medical assistant
who has completed a training program specific to
medical assistants. A Medical Assistant–Phlebotomist
is trained specifically in the field of phlebotomy. Re
quirements for licensure as a Medical Assistant
Phlebotomist include a high school diploma or
equivalency degree; the ability to read, write, and
converse in English; 7 hours of acquired immuno
deficiency syndrome (AIDS) education; and proof of
appropriate training in phlebotomy. Acceptable proof
includes one of the following: a transcript in dicating
successful completion of a phlebotomy program
through an accredited postsecondary school, a
statement from a health care practitioner that he or
she supervised your training, or a tran script indicating
you received phlebotomy educa tion and training in
the military. Continuing Education Certification
programs usually require phlebotomists to participate
in continuing education programs and earn a certain
number of continuing education units (CEUs) to
remain certified. These programs provide updates on
new information, regulations, and techniques and
help phlebotomists refresh skills that are used less
frequently. Larger health care insti tutions often
sponsor such programs on site. As shown in Table 1-1,
the organizations that provide continuing education
are the AMT, the American Society for Clinical
Laboratory Science (ASCLS), the ASCP, the ASPT, and
the NPA. LEGAL ISSUES IN PHLEBOTOMY As in every
other profession, phlebotomy is bound by laws and
regulations governing the workplace, relations with
customers (patients), and the privacy of privileged
information, such as medical records. Failure to
observe these laws and regulations may be cause for
dismissal and may lead to a lawsuit against you or
your institution. These issues are covered in more
detail in Chapter 19. Here, we stress the two most
important legal aspects of the phlebotomist’s
profession: informed consent and confidentiality.
Find the Full Original Textbook (PDF) in the link
below:

CLICK HERE