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Chapter Summary
Learning Outcome Key Concepts/Examples Related NAACLS Competency
. Summarize the definition and history of
phlebotomy.
. Explain the role of the phlebotomist in
the various healthcare facilities where he
or she may be employed.
. Describe inpatient and outpatient
healthcare facilities and their relationship
to the practice of phlebotomy.
. Identify the healthcare providers and
other members of the healthcare team
with which the phlebotomist will interact in
inpatient and outpatient facilities.
. Summarize the organization of the
medical laboratory.
. Recognize the agencies that regulate
hospitals and medical laboratories.
. List the qualities and characteristics of
a phlebotomist.
Phlebotomy means cutting into a vein.
It is an invasive procedure performed
by phlebotomists; it has evolved
from the use of leeches for blood
collection to modern-day certified
phlebotomists.
Phlebotomists are responsible for
the collection, processing, and
transportation of blood specimens, as
well as other duties required by their
place of employment.
Phlebotomists can be employed
at hospitals, rehabilitation centers,
nursing homes, clinics, physician
offices, ambulatory care centers,
blood banks, reference laboratories,
and insurance companies.
Phlebotomists interact with
healthcare professionals from many
medical specialties including nurses,
physicians, radiologic technologists,
respiratory therapists, physical
therapists, and surgical technicians.
Medical laboratories are organized
based on the needs of the facility
in which they serve. Phlebotomists
interact with medical laboratory
personnel from many laboratory
specialties, including clinical
chemistry, cytology, hematology,
histology, immunohematology,
immunology, medical microbiology,
molecular diagnostics, and urinalysis.
The regulating agencies for the
practice of phlebotomy include CLSI,
TJC, CMS, HHS, CDC, and OSHA.
Proper professionalism, public image,
communication, and customer service
are necessary traits of a phlebotomist.
1.00
1.1
1.2
1.1
1.3, 1.4, 1.5
1.00
9.00, 9.3, 9.6
Chapter Phlebotomy and Healthcare
Copyright © 2019 by McGraw-Hill Education
Chapter Review
A: Labeling
Label the elements of this communication cycle.
Write the name of each element on the lines provided.
1. [LO 1.7]
2. [LO 1.7]
3. [LO 1.7]
4. [LO 1.7]
B: Matching
Match each organization with its role in regulating medical laboratories.
1. Communication
Begins
m
a
r
t
i
o
o
f
n
n
I
.
2
n
o
i
3. Decodes
t
a
4
.
C
l
a
r
i
fi
c
a
t
i
o
m
r
Communication
fi
n
o
C
r
o
n
5. [LO 1.6] sets standards for laboratory testing
a. AABB
b. CAP
6. [LO 1.6] is responsible for minimizing work-related injuries
7. [LO 1.6] regulates content labeling of blood products
c. CDC
d. CLSI
e. EPA
8. [LO 1.6] regulates the internal handling of medical waste
9. [LO 1.6] monitors and reports diseases
f. FDA
g. NAACLS
h. OSHA
10. [LO 1.6] sets standards for phlebotomy training programs
C: Fill in the Blank
Write in the word(s) to complete the statement.
11. [LO 1.2] The healthcare professional who has the greatest control over pre-examination variables during
blood collection is the .
12. [LO 1.5] The medical doctor who works in the laboratory is the .
13. [LO 1.7] Becoming or licensed as a phlebotomist sends a positive
message to patients.
14. [LO 1.3] The term used to describe tests that are performed at a patient’s bedside is
.
List two negative verbal and two negative nonverbal types of communication that should be avoided.
Verbal Nonverbal
15. [LO 1.7]
16. [LO 1.7]
Copyright © 2019 by McGraw-Hill Education
17. [LO 1.7]
18. [LO 1.7]
Chapter Phlebotomy and Healthcare
D: Sequencing
Place the laboratory personnel in the order of hierarchy in a laboratory’s organizational chart (from 1
[highest management function] to 5 [lowest management function]).
19. [LO 1.5] administrator
20. [LO 1.5] technician
21. [LO 1.5] scientist
22. [LO 1.5] phlebotomist
23. [LO 1.5] section supervisor
E: Case Studies/Critical Thinking
24. [LO 1.7] A patient is having blood work done during her lunch hour. She has waited 25 minutes
before being called back for her blood to be drawn. How can you implement customer service in this
situation?
25. [LO 1.7] A phlebotomist has been asked to obtain a blood specimen from a hospitalized patient. The
phlebotomist enters the patient’s room and gives the appropriate greeting but discovers that the patient
speaks only Spanish, a language the phlebotomist is unfamiliar with. Should the phlebotomist proceed
with the blood collection? What are the phlebotomist’s next steps? Explain your answer.
26. [LO 1.7] The phlebotomist is scheduled to obtain a blood specimen from a patient in a patient’s home.
The phlebotomist enters the home and makes the appropriate greetings. The patient is very agitated
and states, “I’m just sick and tired of you people drawing my blood. It’s not helping me to get any better,
so get out! I refuse to be a pincushion for you medical jerks!” What would be a good response for the
phlebotomist to make? How should the phlebotomist handle this situation?
F: Exam Prep
Choose the best answer for each question.
27. [LO 1.1] The term phlebotomy comes from Greek
words that mean
a. “draw blood.”
b. “cut vein.”
c. “drain blood.”
d. “der ma l c ut.”
28. [LO 1.2] The minimum requirements for entry
into a phlebotomy training program generally
include a
a. nursing degree or CNA certification.
b. medical laboratory MLT certification.
c. high school diploma or equivalent.
d. medical assisting certification.
29. [LO 1.2] The main duty of a phlebotomist
is to
a. interpret laboratory values.
b. evaluate blood specimens.
c. process blood specimens.
d. collect blood specimens.
30. [LO 1.2] The phlebotomist is mainly responsible
for which phase of laboratory testing?
a. Examination
b. Pre-examination
c. Post-examination
d. Reporting
Chapter Phlebotomy and Healthcare
Copyright © 2019 by McGraw-Hill Education
31. [LO 1.2] Which of the following is not a
phlebotomist’s duty?
a. Aseptic procedures
b. Dermal/Capillary puncture
c. Surgery assistance
d. Venipuncture
32. [LO 1.3] Which of the following is the fastest-
growing type of facility that provides job
opportunities for phlebotomists?
37. [LO 1.4] Which specialty recommends treatment
plans based on therapeutic drug monitoring
results from the laboratory?
a. Nuclear medicine
b. Pharmacy
c. Radiology
d. Surgery
38. [LO 1.5] Surgically removed body tissues are
prepared and stained by
a. Physician offices
b. Home healthcare
c. Insurance companies
d. Ambulatory care centers
33. [LO 1.4] The diagnosis and treatment of
conditions pertaining to the heart and
circulatory system are the functions of which
medical specialty?
a. Anesthesiology
b. Cardiology
c. Respiratory therapy
d. Electroencephalography
34. [LO 1.4] The assessment and treatment of
breathing disorders are the functions of which
medical specialty?
a. Diagnostic imaging
b. Endocrinology
c. Physical therapy
d. Respiratory care
35. [LO 1.4] Restoration of maximum movement and
functional ability is the purpose of
a. occupational therapy.
b. orthopedics.
c. physical therapy.
d. respiratory therapy.
36. [LO 1.7] Which specialty uses ionizing radiation
to produce diagnostic images?
a. Nuclear medicine
b. Orthopedics
c. Pathology
d. Surgery
a. cytologists.
b. hematologists.
c. histologists.
d. tissuologists.
39. [LO 1.5] Prepared body tissues are examined
and a diagnosis is made by
a. cytologists.
b. histologists.
c. pathologists.
d. tissuologists.
40. [LO 1.5] Cross-matching of donated blood with a
recipient is the function of
a. cytolog y.
b. histology.
c. immunohematology.
d. immunology.
41. [LO 1.5] The study of the body’s resistance to
disease is the function of
a. clinical chemistry.
b. histology.
c. immunology.
d. microbiology.
42. [LO 1.6] CLIA classifies laboratories based on
a. number of employees.
b. size of the laboratory.
c. number of tests performed.
d. complexity of tests performed.
Copyright © 2019 by McGraw-Hill Education
Chapter Phlebotomy and Healthcare
43. [LO 1.6] A college dean who wants to offer
a phlebotomy training program would seek
approval from which organization that sets
standards for phlebotomy training programs?
a. CAP
b. CLSI
c. NAACLS
d. OSHA
44. [LO 1.7] Barriers that can interfere with clear
communication include all of these except
a. eye contact.
b. fear and anxiety.
c. pain or discomfort.
d. television viewing.
45. [LO 1.7] Customer service would least likely include
a. common courtesy.
b. complexity.
c. flexibility.
d. professionalism.
46. [LO 1.7] Evaluate which of the following
scenarios would best contribute to customer
satisfaction.
a. A medical office receptionist tells a patient to
“have a seat” without making eye contact.
b. A phlebotomist fumbles with equipment
assembly prior to the blood collection
procedure.
c. A healthcare worker encounters a lost visitor
and assists this person to his destination.
d. A medical assistant is always dressed in the
latest fashions and jewelry.
Enhance your learning by completing these exercises and more at
connect.mheducation.com.
References
American Association of Blood Banks. (2013). About AABB. Retrieved July 23, 2013, from www.aabb.org/about/Pages/default.aspx
American Association for Respiratory Care. (2011). American Association for Respiratory Care home page. Retrieved February 5,
2011, from www.aarc.org
American Dietetic Association. (2010). Food and nutrition information you can trust. Retrieved February 5, 2011, from www.eatright.org
American Occupational Therapy Association. (2011). About occupational therapy. Retrieved February 5, 2011, from www.aota.org
American Pharmacists’ Association. (2011). About APhA. Retrieved February 5, 2011, from www.pharmacist.com
American Physical Therapy Association. (2011). About us. Retrieved February 5, 2011, from www.apta.org
American Society for Clinical Laboratory Science. (2011). ASCLS history. Retrieved February 5, 2011, from www.ascls.org/
about-us/history
American Society for Clinical Pathology. (2011). ASCP history. Retrieved February 5, 2011, from www.ascp.org/About-the-ASCP
Clinical and Laboratory Standards Institute. (2010). CLSI organizational policy on harmonization. Retrieved February 2, 2017, from
http://clsi.org/wp-content/uploads/sites/14/2016/01/CLSI_Standards_Development_Policies_and_Processes.pdf
National Accrediting Agency for Clinical Laboratory Sciences. (2016). NAACLS entry-level phlebotomist competencies. Retrieved
February 2, 2017, from www.naacls.org/getattachment/d5a69a7a-7323-439e-9db8-1f0ea000b718/2012-Standards-Edited.aspx
Pashazadeh, A. M., Aghajani, M., Nabipour, I., & Assadi, M. (2013). An update on mobile phones interference with medical
devices. Radiation Protection Dosimetry, 156(4), 401–406. Retrieved February 15, 2014, from www.academia.edu/3435639/
MOBILE_PHONES_INTERFERENCE_WITH_MEDICAL_DEVICES
Stedman’s medical dictionary for the health professions and nursing (6th ed.). (2008). Baltimore, MD: Wolters Kluwer Health/
Lippincott Williams & Wilkins.
Taber’s cyclopedic medical dictionary (21st ed.). (2009). Philadelphia, PA: F.A. Davis.
The Joint Commission. (2013). Joint Commission history. Retrieved February 2, 2017, from www.jointcommission.org/about_us/
history.aspx
Thierer, N., & Breitbard, L. (2007). Medical terminology essentials. New York, NY: McGraw-Hill.
Wilson, D. D. (2008). McGraw-Hill manual of laboratory and diagnostic tests. New York, NY: McGraw-Hill.
Design Elements: Communicate & Connect icon (patient and doctor) ©Rocketclips, Inc./Shutterstock.com RF; Think It Through icon (staircase)
©Lightspring/Shutterstock.com RF.
Chapter Phlebotomy and Healthcare
Copyright © 2019 by McGraw-Hill Education
2
Safety and Preparedness
biohazards
Bloodborne Pathogens
Standard
chemical hazards
chemical hygiene plan
electrical hazards
emergency preparedness
ergonomics
exposure control plan
fire and explosive hazards
Globally Harmonized
essential terms
System (GHS)
hazardous materials
(HAZMATS)
hazard statement
needlestick injury
Needlestick Safety and
Prevention Act
other potentially infectious
materials (OPIM)
Occupational Safety and
Health Administration
(OSHA)
physical hazards
pictogram
precautionary statement
radioactive hazard
safety data sheets
(SDS)
signal word
©McGraw-Hill Education/David Moyer, photographer
Learning Outcomes
. Discuss practices to ensure safety and
reduce the risk of infection from medical
biohazards in compliance with state and
federal standards and regulations.
. Recognize symbols and systems and apply
techniques to ensure the physical safety of
healthcare workers and patients.
Related NAACLS Competencies
. Demonstrate knowledge of infection control
and safety.
. Identify policies and procedures for
maintaining laboratory safety.
. Comply with federal, state, and locally
mandated regulations regarding safety practices.
. Describe measures used to ensure patient
safety in various patient settings, e.g., Inpatient,
outpatient, pediatrics, etc.
Introduction
All healthcare personnel must provide for their own safety, as well as the safety
of patients and co-workers. This chapter discusses the various hazards that
may be present in the clinical setting, including methods to maintain safety
and preparedness for these hazards.
.
Medical Biohazards
Biological substances that can threaten human health are called biohazards.
Medical biohazards include any materials that may be contaminated with
infectious agents. They include blood and body fluids, medical waste, and
laboratory specimens and cultures. The handling and disposal of biohazardous wastes are regulated both by individual state regulatory committees and
by OSHA and the CDC at the federal level. As state regulations often exceed
federal requirements, be sure you know the applicable laws in your state.
Always wear gloves when handling biohazardous waste and place them
only in bags or containers that are red and are clearly labeled as biohazards.
Biohazardous waste containers should be placed close to locations where biohazardous waste is generated, such as next to a phlebotomy station.
Bloodborne Pathogens Standard
To help reduce the risk of injury and infection from biohazardous wastes, in
1991 OSHA developed the Bloodborne Pathogens Standard. This standard
requires that healthcare facilities provide annual employee training on preventing exposure to bloodborne pathogens as well as using the necessary personal protective equipment (PPE). The use of PPE according to the standard
applies to all blood products, body fluids, human tissues and cultures, vaccines, and any supplies, instruments, or equipment that have been in contact
with any of these biohazards. Also according to the standard, all potentially
biohazardous waste must be discarded in an appropriate manner or processed
according to strict guidelines.
To comply with the Bloodborne Pathogens Standard, employers must provide documented training to all employees. Training covers general information about infectious diseases caused by bloodborne pathogens, the use of
PPE, universal precautions, and devices engineered to prevent exposure. It
also includes procedures employees should follow when exposure occurs.
The Bloodborne Pathogens Standard also mandates other requirements.
Employers must offer the hepatitis B vaccine (HBV) at no charge to all employees who are reasonably expected to come in contact with blood or other
potentially infectious materials (OPIM). In addition, each healthcare facility is required to have an occupational exposure control plan, which is a
protocol to be followed in the event an employee is exposed to bloodborne
pathogens.
Needlestick Safety and Prevention Act
One of the most common biohazards in the healthcare setting is the risk
of injury or infection from needles. A needlestick injury is a percutaneous
(through the skin) piercing wound that is caused by the point of a needle.
Injuries caused by other sharp instruments or objects, such as lancets, blades,
or glass slides, are also included in this category.
ment, and the elimination of needles whenever possible. Through the
Chapter Safety and Preparedness
Needlestick injuries are preventable with proper education, safety equip-
Copyright © 2019 by McGraw-Hill Education
recommendation of the National Institute for
Occupational Safety and Health (NIOSH) and the
Occupational Safety and Health Administration
(OSHA), the Needlestick Safety and Prevention Act
was passed in 2001.
The Needlestick Safety and Prevention Act
mandates the use of safety devices that reduce
needlestick injuries in the clinical setting. The introduction of needleless equipment and protected needles has significantly reduced the risk of needlestick
injuries. All devices selected for phlebotomy should
be equipped with needlestick prevention features,
such as one-handed needle covering devices or
retractable needles. These devices, called engineering
controls, will be discussed in more detail in the chapter Blood Collection Equipment. To reduce the chance
of a needlestick injury, never break off, recap, or
reuse needles.
In addition, a sharps container must be used for
Figure - A sharps disposal container provides a place to
safely dispose of used needles in order to prevent a needlestick injury.
©Leesa Whicker
the proper disposal of needles and other sharps.
Immediately after using a needle or other sharp device, engage the safety feature and place it in the sharps container (see Figure 2-1). Sharps containers
should be discarded into a designated biohazardous waste container when
they become two-thirds to three-quarters full.
The ultimate objective of the Needlestick Safety and Prevention Act is to
protect both employees and patients from coming in contact with potentially
harmful materials, such as contaminated needles and other sharps. Proper disposal of venipuncture equipment greatly decreases the incidence of accidental
needlestick injuries and exposure.
Exposure to Hazardous Drugs
Research has shown that long-term exposure to hazardous drugs, such as antiviral and cancer drugs, can cause both acute and chronic illnesses in healthcare
workers. In 2004, the National Institute for Occupational Safety and Health
(NIOSH) published the NIOSH Alert: Preventing Occupational Exposures to
Antineoplastic and Other Hazardous Drugs in Health
Care Settings. This Alert is frequently updated and
includes a list of hazardous drugs and recommendations for safe handling. Phlebotomists should be aware
of the existence of these hazardous drugs, especially
when repeatedly drawing blood from patients using
them, such as oncology (cancer) patients.
Cleaning Up Biohazardous Spills
No matter how careful healthcare personnel may be,
biohazardous spills do occasionally occur. Such spills
must be handled carefully and according to federal
guidelines. Depending on the type of spill, a biohazard spill cleanup kit may be needed. These kits contain special hazardous waste control products such
as disposable dustpans and brushes for cleaning up
broken glass that has contained blood or other bio-
Copyright © 2019 by McGraw-Hill Education
hazardous material (see Figure 2-2).
Figure - A biohazard cleanup kit.
©McGraw-Hill Education/Sandra Mesrine, photographer
Chapter Safety and Preparedness
Clean up all biohazardous spills or splatters immediately. Always use appropriate PPE; never allow hazardous substances to come in contact with your
skin. If the spill involves broken glass, use the disposable equipment in the spill
kit to collect the contaminated glass and to dispose of it in a sharps container.
Checkpoint
Questions .
1. Explain the rules and regulations instituted by the federal government to
protect healthcare workers from biohazards.
2. What is the ultimate objective of disposing of sharps in a specially made
container?
.
Personal Safety and Preparedness
Complying with regulations and guidelines not only helps protect patients,
personnel, and visitors from potentially contracting infections, but it also
keeps everyone safe in other ways. Everyone involved in delivering quality
healthcare must be aware of and comply with safety regulations and mandates
from all levels of governmental and employer-developed policies.
In hospital laboratories, a designated safety officer is responsible for implementing a laboratory safety program. Injury and illness can occur because of
improper handling of equipment during procedures or modification of the
steps of the procedures. Each member of the healthcare team is responsible
for his or her own safety as well as the safety of patients and other people in
the immediate area. As part of preparation for working safely in a laboratory,
use the competency checklist Safety Equipment in the Clinical Setting at the end
of this chapter to review and practice identifying all the safety equipment in
your laboratory.
Physical hazards in the healthcare setting are any nonbiological objects
that may cause injury or illness to healthcare employees, patients, or visitors.
Physical hazards include allergen exposure, chemical hazards, compressed gas
cylinders, electrical systems, fire hazards, radiation hazards, temperature hazards, and vacuum systems. In addition, physical hazards can result from using
improper ergonomics in the workplace or lack of commonsense practices.
Common Sense and Ergonomics
Commonsense precautions should be applied in almost every environment,
but especially in the healthcare setting. Avoid running or rushing, be aware of
wet floors, avoid wearing dangling jewelry, and tie back long hair. Dangling
jewelry and long hair may be obstacles in performing phlebotomy. More
importantly, they can become contaminated and increase the risk of infection
transfer, including healthcare-associated infections (HAIs). HAIs are discussed
further in the Infection Control chapter.
ment as recommended by the manufacturer. Again, wearing dangling jewelry
and long hair untied may create a hazard when using equipment such as centrifuges. Keeping the workplace clean and organized also helps create a safe
work environment.
example, some specimens must be frozen at –112°F (–80°C) or even stored
in liquid nitrogen. Other specimens may need to be placed in a heated water
bath. Care must be taken to use appropriate protective equipment, such as
Chapter Safety and Preparedness
While processing specimens in the laboratory, operate laboratory equip-
Phlebotomists may need to process specimens of various temperatures. For
Copyright © 2019 by McGraw-Hill Education
Figure - Specimen processing may require (A) cooling or (B) warming samples.
A
B
©McGraw-Hill Education/Sandra Mesrine, photographer
thermal gloves and hot mitts, when handling heated or cooled specimens.
Ordinary gloves may be used when handling cooled or warmed specimens
that are not stored at extreme temperatures (see Figure 2-3).
Safety awareness is also important when using the vacuum systems that
are found in most hospitals. These systems are used to transport pneumatic
tubes to and from the laboratory. The suction in these systems is strong and
can cause injury if used inappropriately. Caution must be used when opening
these tubes, as the specimen container may have broken on its way to the lab,
creating a biohazard (see Figure 2-4). The use of the
pneumatic tube system must be validated for every
analyte intended to be tested on specimens transported to the laboratory by this method. The facility’s
SOPs (standard operating procedures) should contain
the types of specimens approved for pneumatic tube
transport, along with how they are to be wrapped or
cushioned in the transport tubes.
Ergonomics is the practice of adapting a job task
or equipment so that you can perform the task safely
and productively. In phlebotomy, this includes sitting
rather than standing and bending to perform a blood
collection, lowering a bedrail to provide full access
to the patient’s arm (remember to replace the bedrail to its original position when you are finished),
and placing equipment close to the procedure area
to avoid reaching. Most healthcare employees use a
computer to record and/or process patient information. Adjusting the height of the chair, the angle of
the computer screen, and the position of your wrist
when using a mouse will help you avoid the longterm physical effects of computer use.
Ergonomic principles should also be used when
lifting objects. Bend your knees and use your leg
muscles when lifting awkward or heavy objects to
help prevent back strain. If you are in doubt about
whether an object is too heavy to lift by yourself, ask
Copyright © 2019 by McGraw-Hill Education
a co-worker to help you.
Figure - Vacuum system pneumatic tube station.
©McGraw-Hill Education/Sandra Mesrine, photographer
Chapter Safety and Preparedness