Книга_3777_Библиотеки_им_академика_М_И_Перельмана

CHAPTER 2 The Student’s Role in the Clinical Environment

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[ ALERT ]

Material safety data sheets (MSDS) within the department allow the phlebotomist to check for safety precautions concerning hazardous ingredients in supplies. MSDS contain such information about the manufacturer, product identi cation, hazardous ingredients, special protection information, and  rst aid procedures.

Always read container labels before using a product. OSHA requires that hazardous materials be labeled as to the danger of the substance. Substances are labeled as toxic,  ammable, or combustible. In the event of a spill or other exposure, consult the  rst aid measures listed in the laboratory safety manual.

The phlebotomist should know the location of safety showers and eye wash stations and be instructed in their use in order to be prepared for a possible chemical splash or spill. The body part affected should be  ushed with water for a minimum of 15 minutes, and this washing should be followed by a visit to the emergency room.

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ELECTRICAL SAFETY

Many accidents, such as  res and electrical shocks, can result from using electrical equipment in the laboratory environment. Follow these guidelines for ensuring electrical safety:

Avoid using extension cords.• Inspect cords and plugs for fraying and breaks.• Do not overload electrical circuits.• Unplug equipment while servicing it. Also unplug equipment that •

has had liquid spilled on it. Do not plug it in again until the spill is cleaned up and the wiring is dry.

Discontinue using and unplug malfunctioning equipment.• Save electrical repairs for trained professionals.•

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PART 1 Student Success in Phlebotomy

All phlebotomists should know where the  re extinguishers are located in their department and be familiar with their use. They should know how to use  re blankets or heavy toweling to smother  res on clothing. They should also be familiar with the locations of all emergency exits, and know the facility extension to call in case of  re.

RADIATION SAFETY

The phlebotomist may encounter radiation hazards when collecting specimens from patients who have had radioactive treatments, when collecting specimens from patients in the radiology department, and when delivering specimens to departments in the laboratory that use radioactive elements in testing.

Radiation exposure depends on the amount of radiation experienced, how far away one is from the source of radioactivity, how long the exposure lasts, and what protective equipment is worn during the exposure. Radiation effects are cumulative. Phlebotomists generally do not receive enough exposure to cause any problems, but they must always be cautious when entering areas displaying the radiation hazard symbol. Please refer to Figure 2-12.

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Figure 2-12 Radiation hazard symbol. See color insert.

CHAPTER 2 The Student’s Role in the Clinical Environment

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SUMMARY

The phlebotomist must always be vigilant regarding personal and patient safety. The greatest risk to the phlebotomist in the health care environment is exposure to bloodborne pathogens. Hepatitis B is a particular danger, often contracted through needlesticks. Today’s health care environment is made safer by the availability of hepatitis B vaccinations. Contracting bloodborne pathogens such as hepatitis, HIV, malaria, and syphilis can be avoided by following procedures set up to minimize such risks.

There are also chemical, electrical, and radiation hazards in the health care environment. Consistently careful work habits should minimize or eliminate most health risks to both the phlebotomist and the patient.

REVIEW ACTIVITIES

1. OSHA’s concern is for the safety of the .

2.

and are the two most signi cant bloodborne diseases encountered by the health care professional.

3. Pathogens may enter the phlebotomist’s body through:

a. b.

4. The standard precautions system is interaction-driven. “Interaction-

driven” means

5. OSHA has developed  ve major methods to reduce risk of expo-

sure to bloodborne pathogens. They are: a. b. c. d. e.

6.

has been identi ed as the single

most important means of preventing the spread of infection.

7. If needles must be recapped, the appropriate method of recap-

ping is

.

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PART 1 Student Success in Phlebotomy

8. Give  ve examples of personal protective equipment.

a. b. c. d. e.

9. Phlebotomists must wear gloves when

.

10. The hepatitis B vaccination is administered for the purpose

of

.

11. Name one duty that phlebotomists may perform that can cause

a chemical burn.

.

12. Name two electrical safety precautions a phlebotomist can take.

a. b.

13. Name two areas where a phlebotomist may come in contact with

radiation hazards. a. b.

DISCUSSION QUESTIONS

1. You have just completed drawing blood at the patient’s bedside.

You label the collection tubes and are about to bag the tubes for transport. You knock your collection tray to the  oor, spilling all of the contents as well as breaking the glass tubes of blood you just collected. What steps should be taken to rectify the situation?

2. You have accidentally stuck yourself with a contaminated needle.

What steps should you take?

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Blood and Urine Collection

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PART

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“All the veins and arteries

proceed from the heart;

and the reason is that the

maximum thickness that is

found in these veins and

arteries is at the junction

that they make with the

heart; and the farther away

they are from the heart the

thinner they become and

they are divided into more

minute rami cations.”

The Circulatory System

After studying this unit, it is the responsibility of the learner to be able to:

1. Describe the  ow of blood through the heart.

2. Describe the branching of the artery network.

3. Describe the venous system of the arm.

4. Explain the components of plasma.

5. State the primary functions of erythrocytes, leukocytes, and

thrombocytes.

6. State the stages of the blood clotting mechanism.

—Leonardo da Vinci

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aorta the largest artery that carries blood from

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the heart to be distributed by branch arteries through the body

arteriole the small terminal branch of an artery that

ends in capillaries

artery a tubular, muscular, and elastic-walled

vessel that carries blood from the heart through the body

atria the two chambers of the heart that receive

blood from the veins and force it into the ventricles

capillary a small blood vessel connecting arterioles

with venules

circulatory system the system that comprises

blood, blood vessels, lymphatics, and heart, and is concerned with the circulation of the blood and lymph

coagulation cessation of bleeding; formation of

a clot. The clotting process consists of the action of blood vessels, platelets, and coagulation factors.

diastole the resting phase of the heart muscle’s

contraction

erythrocyte red blood cell granulocyte a cell with granule-containing cytoplasm hematopoiesis the formation of blood cells in the

body

hemoglobin an iron-containing protein pigment

present in red blood cells. It functions primarily to transport oxygen from the lungs to the tissues of the body.

hemostasis the process of coagulation, or clot

formation, that repairs vessel damage and stops blood loss

leukocyte white blood cell lymphocyte a leukocyte produced in the lymphoid

tissue

monocyte a large leukocyte formed in bone marrow,

with abundant cytoplasm and a kidney-shaped nucleus; ingests bacteria and debris in tissue

pathogens disease-producing agents peripheral circulation includes both the systemic

circulation and the pulmonary circulation

plasma the yellow  uid component of blood pulmonary circulation the blood  ow to the

lungs

serum liquid portion of blood without clotting

factors

systemic circulation the  ow of blood to the body,

exclusive of the pulmonary circulation

systole the active, or contracting, phase of the heart

muscle’s contraction

thrombocyte platelet tunica adventitia an enclosing tissue that makes up

the outer layer of the artery wall

tunica intima the innermost membrane of the

artery wall

tunica media the middle layer of the artery wall vein a vessel that carries blood back to the heart ventricles the two chambers of the heart that

receive blood from the corresponding atria and force it into the arteries

venule a small vein connecting the capillaries with

the larger systemic veins

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A

PART 2 Blood and Urine Collection

s a member of the clinical laboratory team, the phlebotomist should be familiar with the various tests performed in the laboratory. Tests are designed to assess the functioning status of all of the human body’s systems: the integumentary, skeletal, muscular, nervous, sensory, endocrine, circulatory and lymphatic, respiratory, digestive, urinary, and reproductive systems. A sound knowledge of the structure and function of these systems is essential for phlebotomists to understand better why they are collecting a blood sample from a patient. Because the circulatory system is the primary system with which phlebotomists interact in collecting laboratory specimens, this book will discuss that system. Phlebotomists are encouraged to do further reading and to study supplementary materials to expand their knowledge of the other body systems.

circulatory system, or cardiovascular system, is made

The up of the heart, blood vessels, and blood. The system functions to transport nutrients, waste products, gases, and hormones through the body. In addition, the circulatory system plays an important role in the immune response and the regulation of body temperature.

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THE HEART

The heart is a muscular pump that forces the blood through the blood vessels. Actually, the heart can be seen as a two-pump system. One pump sends blood to the lungs, and the other pushes blood to all other tissues of the body. The blood  owing to the lungs makes up the

circulation. The blood flowing to the rest of the body makes up the

systemic circulation. The heart pumps approximately 5 L of blood per minute in a healthy adult. It contracts an average of 70 to 75 times per minute, without stopping, throughout a person’s lifetime. The heart is about the size of a closed  st and is located in the thoracic cavity, between the lungs.

The heart consists of four chambers: two atria and two ventricles. The

right atrium receives blood returning from the bodily tissues. This blood is depleted of oxygen and is carried by veins. The right ventricle pumps the venous blood received from the right atrium into the lungs. The left atrium receives blood from the lungs that is high in oxygen content. The left ventricle pumps the oxygenated blood back to the bodily tissues. This oxygenated blood travels through arteries. Please refer to Figure 3-1.

pulmonary

CHAPTER 3 The Circulatory System

Cut edge of periocardium at site of reflection from great vessels

Superior vena cava

Right lung

Left lung

Auricle of left atrium

Cut edge of pericardium

Diaphragm

Coronary sulcus

Right ventricle

Left ventricle

Apex

Left pulmonary artery

Pulmonary trunk

Arch of aorta

Trachea

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Figure 3-1 The interior of the heart. See color insert.

The right and left sides of the heart work together. The blood is

pushed through the chambers by the heart muscle’s contractions. Contractions begin in the atria and are followed by contractions in the ventricles. The active—contracting—phase is called systole. It is followed by a resting phase called

diastole. The atria rest while the ventricles contract.

After the ventricles empty, both chambers relax while they  ll again with blood. Then the atria contract and the cycle begins again.

BLOOD VESSELS

The pulmonary circulation and the systemic circulation together make up the peripheral circulation. Please refer to Figure 3-2. The blood vessels and the four heart chambers form a closed system for the flow of

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RV

LV

RA

LA

oxygen-poor blood

Lung

Air sac

Pulmonary arteries

Venae cavae

Capillary beds

Trachea

Pulmonary capillaries

Pulmonary circulation

Pulmonary veins

Aorta (major systemic artery)

Systemic circulation

Smaller arteries branching off to supply various tissues

Tissues

RA RV LA LV

= Right atrium = Right ventricle = Left atrium = Left ventricle

oxygen-rich blood

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PART 2 Blood and Urine Collection

Figure 3-2 Schematic drawing of blood circulation. See color insert.

Delmar/Cengage Learning

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blood. The pulmonary vessels transport blood to and from the lungs. They include the pulmonary artery, capillaries in the lungs, and veins that drain those capillaries. The systemic circulation network consists of the aorta and systemic arteries and veins.

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