Phlebotomy from student to professional 3e 2011

FIGURE 2-11 Universal Delmar/Cengage Learning Delmar/Cengage Learning Biohazard Symbol FIGURE FIGU FI GURE RE 2-12 -12 12 R Radiation ad dia iation a on H Hazard azar az ard d Symbol Cut edge of periocardium at site of reflection from great vessels Trachea Arch of aorta Pulmonary trunk Superior vena cava FIGURE 3-1 Right lung The interior of the heart Left pulmonary artery Auricle of left atrium Left lung Auricle of right atrium Coronary sulcus Right ventricle Cut edge of pericardium Diaphragm Apex Delmar/Cengage Learning Left ventricle Cut edge of pleura Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it Trachea Lung Air sac FIGURE 3-2 Schematic Drawing Pulmonary capillaries of Blood Circulation Pulmonary circulation Pulmonary arteries Pulmonary veins Venae cavae LA Aorta (major systemic artery) RA LV RV Delmar/Cengage Learning Systemic circulation Capillary beds Smaller arteries branching off to supply various tissues Tissues RA = Right atrium RV = Right ventricle LA = Left atrium LV = Left ventricle ARTERIES VERSUS VEINS oxygen-rich blood oxygen-poor blood Arteries Veins Carry blood from the heart, carry oxygenated blood (except pulmonary artery) Carry blood to the heart, carry deoxygenated blood (except pulmonary vein) Normally bright red in color Normally dark red in color Elastic walls that expand with surge of blood Thin walls/less elastic No valves Valves Can feel a pulse No pulse FIGURE 3-3 Blood Flow from Artery to Capillary to Vein Artery Arteriole Capillaries Venule Vein Delmar/Cengage Learning To Heart From Heart Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it Tunica interna, or intima endothelium, areolar, and elastic tissue FIGURE 3-4a The three layers of the walls of a artery and a vein Tunica media smooth muscle Tunica externa, or adventitia connective tissue Delmar/Cengage Learning FIGURE 3-4b Cross section of blood vessels Valve Endothelium Capillary Lumen Artery Vein (A) Types of blood vessels and their general structure Endothelium Internal elastic membrane Tunica media (muscle tissue) External elastic membrane Lumen Tunica adventitia or externa (connective tissue) Artery Vein Capillary (B) Cross section of blood vessels Delmar/Cengage D Delm ar/Cenga ar/C engage gee LLearning earning earn ing Elastic fibers Right internal carotid artery Right external carotid artery Right vertebral artery Right subclavian artery Right left ght and lef ft common carotid arteries Brachiocephalic artery Left subclavian artery Right axillary artery Aortic arch Ascending aorta Descending (thoracic) aorta Right brachial artery Common hepatic artery Left gastric artery Splenic artery Descending (abdominal) aorta Left renal artery Right common iliac artery Left radial artery Right external iliac artery Left ulnar artery Left internal iliac artery FIGURE 3-5 The major arteries of the systemic circulation Right femoral artery Right popliteal artery Right posterior tibial artery Right peroneal artery Right dorsalis pedis artery Delmar/Cengage Learning Right anterior tibial artery Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it FIGURE 3-6 The major veins of Right external jugular vein the body Right internal jugular vein Right and left brachiocephalic veins Right subclavian vein Superior vena cava Delmar/Cengage Learning Left cephalic vein Right axillary vein Left brachial vein Right hepatic vein Splenic vein Inferior vena cava Left renal vein Right common iliac vein Left ulnar vein Right internal iliac vein Right external iliac vein Left radial vein Right femoral vein Right great saphenous vein Plasma (55% of total volume) Right popliteal vein Erythrocytes Thrombocytes (platelets) Neutrophil Monocyte Formed elements (45% of total volume) Right anterior tibial vein Right peroneal vein Leukocytes Test tube containing whole blood Right dorsalis venous arch Blood cell Life span in blood Eosinophil Lymphocyte Function Erythrocyte 120 days O2 and CO2 transport Neutrophil 7–12 hours Immune defenses Eosinophil Unknown Defense against parasites Basophil Unknown Inflammatory response Basophil Delmar/Cengage Learning Right posterior tibial vein FIGURE 3-8 The major components of blood FIGURE 3-9 The function and life days–years B Lymphocyte Unknown Antibody production (precursor of plasma cells) T Lymphocyte Unknown Cellular immune response Platelets 7–8 days Blood clotting Monocyte Delmar/Cengage Learning span of blood cells Immune surveillance (precursor of tissue macrophage) Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it Vessel cut FIGURE 3-10 The stages of bloodclotting Hemorrhage Aggregation of platelets Prothrombin Thromboplastin Red cells Fibrin Thrombin Red cells enmeshed in fibrin Platelets Delmar/Cengage Learning Fibrinogen Delmar/Cengage Learning FIGURE 4-1 Routine Venipuncture Supplies— Part of a Phlebotomy Collection Tray FIGURE 4-7 Blood Delmar/Cengage Learning Transfer Device Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it FIGURE 4-8 Reprinted with permission of Becton, Dickinson and Company Evacuated Tube Collection Guide Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it Delmar/Cengage Learning Delmar/Cengage Delm ar/C Ceng e gagee LLearning earn ning ing FIGURE 4-9 Puncture-proof Sharps Container FIGURE FIGU FI GURE RE 4-10 -10 10 S Spring-loaded prin ngg-load aded ed llan lancet an nce cett FIGURE 4-11 Microcollection Tubes Basilic Cephalic Delmar/Cengage Learning Median Cubital Median Plastic sheath Shaft Delmar/Cengage Learning Lumen Point FIGURE 4-12 Unopette Blood Diluting Unit Point Shaft Lumen Hub Hilt FIGURE FIGU FI GURE RE 5-1 -1 S Superfi Sup upe fici uper cial ial Veins of the Forearm Delmar/Cengage Learning Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it FIGURE 5-3 Collection Tube Order Delmar/Cengage Learning of Draw Inferior vena cava Adrenal gland Renal artery Renal vein Kidney Aorta FIGURE 9-3 Twenty-four Ureter Hour Collection Container Hilum Uterus Urinary bladder Urethra Delmar/Cengage Delm mar/C /Ceng engaage LLearning earning ea Rectum (cut) Delmar/Cengage Learning FIGURE 9-1 Organs of the Urinary System Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it GLOSSARY 226 M median cubital vein—vein in the antecubital area that is most commonly used for venipuncture message—any communication, written or oral, from one person to another monocyte—a large leukocyte formed in bone marrow, with abundant cytoplasm and a kidneyshaped nucleus; ingests bacteria and debris in tissues morning rounds—a batch of laboratory test orders scheduled for early morning collection osteomyelitis—an inflammatory disease of the bone, resulting from infection P Needlestick Safety and Prevention Act—a bill signed November 6, 2000, that contains an amendment to OSHA’s bloodborne pathogen standard to ensure more widespread use of safer medical devices to prevent dangerous needlesticks The legislation requires employers to identify and provide safer equipment for their staffs nephron—structural and functional unit of the kidney neutrophil—leukocyte that engulfs and digests pathogens found in tissues Its granules stain with neither basic nor acid dyes NIOSH (National Institute for Occupational Safety and Health)—a federal agency responsible for conducting research and making recommendations for the prevention of work-related disease and injury It is part of the Centers for Disease Control and Prevention nosocomial—a disorder associated with being treated in a hospital, but unrelated to the patient’s primary condition pathogens—disease-producing agents patient-focused care—an approach to health care in which services are simplified, decentralized, and placed close to the patient Patient’s Bill of Rights—a protection of rights for the health care patient, such as the rights to human dignity, privacy, confidentiality, informed consent, and refusal of treatment peripheral circulation—includes both the systemic circulation and the pulmonary circulation personal protective equipment (PPE)— specialized clothing or equipment worn by a professional for protection against a hazard phenylalanine—amino acid essential for the growth in children and for the metabolism of protein phlebotomist—an individual trained and skilled in obtaining blood samples for clinical testing plantar—relating to the sole of the foot plasma—the yellow fluid component of blood point-of-care testing—collection of a blood sample and immediate testing at the site of client care polycythemia—abnormal increase in the number of erythrocytes in the blood portal vein—a short vein that receives branches from several veins leading from abdominal organs and then enters the liver pulmonary circulation— the flow of blood to the lungs O Q obligationism—an ethical theory that attempts to resolve ethical dilemmas by balancing distributive justice with the promotion of good and the prevention of harm occult—hidden OSHA (Occupational Safety and Health Administration)—a federal agency that develops and promotes occupational safety and health standards, develops and issues regulations, conducts investigations and inspections, and issues citations and proposes penalties for noncompliance with safety and health standards and regulations quality assurance—established policies and procedures to ensure that laboratory testing is carefully monitored from beginning to end, including collection of specimens N R reflective listening—repeating what has been heard back to the speaker reliability—accurate, dependable performance respiratory system—consists of the nose, nasal cavity, pharynx, larynx, trachea, bronchi, and lungs responsiveness—readiness to provide prompt service Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it GLOSSARY risk management—the monitoring of patterns and trends in the health care environment to assure the safety of patients and professionals routine collection—orders collected per individual laboratory policy S saline—a solution containing sodium chloride used as a plasma substitute and a means to correct electrolyte imbalances security—assurance, certainty, safety septicemia—the presence in the bloodstream of infectious microorganisms or their toxins sharp—an object that can penetrate the skin such as a needle, scalpel, broken glass, broken capillary tube, or lancet social contract theory—an ethical theory based on the assumption that the least advantaged are the norm, with income, liberty, opportunity, and selfrespect distributed equally standard precautions—combines many of the basic principles of universal precautions with techniques of body substance isolation stat—at once, immediately From the Latin word statim sterilize—to use a physical or chemical procedure to destroy all microbial life syringe—a device used for drawing out (or injecting) a quantity of fluid systemic circulation—the flow of blood to the body, exclusive of the pulmonary circulation systole—the active, or contracting, phase of the heart muscle’s contraction; the upper number of a blood pressure reading T tangibles—things that are actual and concrete teamwork—the subordination of the individual’s tasks or goals to the common purpose of the group teleology—an ethical theory that determines right or good based on an action’s consequences tetany—a disorder characterized by muscular twitching, cramps, and convulsions 227 thrombocyte—platelet thromboplastin—a lipoprotein that promotes blood clotting; found in platelets thrombosed—occluded, or blocked, by a blood clot thrombus—a clot of blood formed within a blood vessel and remaining attached to its point of origin timed collection—orders collected at a specified collection time tourniquet—a length of rubber or synthetic rubber tied around the arm to arrest blood flow and increase venous filling 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 U understanding—appreciation, sensitivity, comprehension universal body substance precautions— an approach to infection control that considers all human blood and certain body fluids to be infectious and handles them as such infectious urinary system—consists of the kidneys, ureters, urinary bladder, and urethra urine—fluid secreted by the kidneys urobilinogen—compound formed in the intestine from the breakdown of bilirubin V values—strongly held personal and professional beliefs about worth and importance vein—a vessel that carries blood back to the heart venipuncture—a puncture of a vein with the purpose of withdrawing blood 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 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it Index A abdominal aorta, 67 ABO blood typing, 168 access, definition, 205 accommodator as conflict style, 198–199, 201 definition, 197 acid phosphatase (ACP) test, 168–169 activated partial thromboplastin time (APTT) test, 169 aerobic, definition, 129 AIDS (autoimmune immunodeficiency syndrome) as biological hazard, 40 alanine aminotransferase (ALT) test, 169 alcohol (ethyl/legal/medical) test, 169 aldolase test, 169 alkaline phosphatase (ALP) test, 169 American Certification Agency (ACA), 209 American Hospital Association, patient rights and, 19 American Medical Technologists (AMT), 209 American Society of Clinical Pathologists (ASCP) on arterial punctures, as certifying agency, 209–210 ammonia test, 170 amylase test, 170 anaerobic blood cultures and, 133 definition, 129 anion gap, 176 antecubital alternative sites, 149–151 bloodletting and, definition, 3, 97–98 antibody testing, 177, 180 anticoagulant, definition, 79, 88 antinuclear antibody (ANA) test, 170 aorta definition, 59, 62 location, 67 arterial blood gases test, 170 arterial puncture, definition, 3–4 arteries blood flow and, 63 definition, 59, 63 first ligation of, overview of systemic circulation and, 67 arteriole, definition, 59 arterioles blood flow and, 63 definition, 63 arteriotomy, definition, articulation as communication skill, 189–191 definition, 187 ASAP (as soon as possible) definition, 97 prioritizing orders and, 99 aseptic, definition, 97–98 aspartate aminotransferase (AST) test, 171 atherosclerosis cholesterol test and, 172 definition, 167 triglycerides test and, 181 atria, definition, 59, 60 avoider as conflict style, 198–199, 201 definition, 197 axillary vein, 66, 68 B B lymphocytes, function/life span of, 72 Baptist Health South Florida, 25 basilic vein, 66, 68 definition, 3, 97 Harvey and, and site selection for venipuncture, 102 228 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX basophils, definition/function/life span of, 71–73 battery, definition, 3, 21 Becton Dickinson Eclipse Needle, 85 Bellevue Hospital Center (New York), 25 Betadine, definition, 79, 83 bevel, definition, 79, 83–84 bile bilirubin test and, 171 definition, 167 bilirubin bilirubin test and, 171 definition, 167 urinalysis test and, 181–182 bilirubin test, 171 biohazard symbol, 50–51 biological hazards chemical safety and, 52–53 electrical safety and, 53–54 engineering controls and, 42–44 glove removal and, 48–50 hand washing and, 45–46 hepatitis B vaccine and, 50–51 housekeeping and, 50 latex allergies and, 51–52 material safety data sheets (MSDS) and, 53 one-handed recapping method, 47 PPE and, 47–48 radiation safety and, 54 UBSP and, 40–41 work practices and, 44–45 bladder, 161–162 bleeding bowls, 9–10 bleeding, prolonged, 75 bleeding time test, 136–140, 171 blood ABO blood typing, 168 B lymphocytes, 72–73 basophils, 71–72 clotting of, 74–75 complete blood count (CBC) test, 173 composition of skin puncture blood, 119 eosinophils, 71–72 erythrocytes, 71–72 hematopoiesis and, 69–70 leukocytes, 71–73 major components of, 69–70 monocytes, 72–73 neutrophils, 71–72 occult blood in stool test, 178 229 plasma and, 66, 69 Rh typing test, 180 T lymphocytes, 72–73 thrombocytes (platelets), 72–75 transfusions as complicating factors of site selection, 105 blood bank department of pathology laboratory, 27 blood collection See collection procedures (special) blood collection equipment blood collection tubes (venipuncture), 88–90 blood transfer device (venipuncture), 87–88 collection supplies assembly, 105–106 collection tray (capillaries), 80, 92 cotton covering (venipuncture), 80–81 devices (capillaries), 91–93 disinfectant (venipuncture), 83 disposal units (venipuncture), 90–91 gloves (venipuncture), 91 hypodermic needles (venipuncture), 85 lancet (capillaries), 91–92 lancets, 9, 79, 122, 126 multiple-sample needles (venipuncture), 84–85 needle holder (venipuncture), 86 needle types (venipuncture), 83–84 syringe (venipuncture), 86–87 tape (venipuncture), 90 tourniquet (venipuncture), 81–83 wing-tipped (butterfly) needles (venipuncture), 86 blood cultures, 133–135, 172 blood dilution, 91–93 blood transfer device (venipuncture), 87–88 blood urea nitrogen (BUN) test, 172 blood vessels arteries, 63–64, 67 capillaries, 63–65 circulation and, 61–62 cross section, 64 veins, 63–66, 68–69 bloodborne pathogens, definition, 37 bloodletting arteriotomy as procedure, 10 cupping as procedure, 11 instruments for, leeching as procedure, 11–12 major points for, scarification as procedure, 11 venesection as procedure, 9–10 bone marrow, 70, 73 Bowman’s capsule, 160 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it 230 brachial artery, 66–67 brachiocephalic artery, 67 brachiocephalic vein, 68 burns as complicating factors, 105 butterfly needles definition, 79, 86 procedure using syringe/butterfly needle collection system, 112–114 C calcium test, 172 cannula as complicating factor, 105 CAP (College of American Pathologists) definition, 37 general information, 39 capillaries blood flow and, 63 definition, 59, 65 capillary action collection devices and, 121 definition, 117 capillary pipettes, 91–92 capillary puncture See also venipuncture (skin puncture) definition, 3–4 carbon dioxide content, 176 carotid artery, 67 CDC (The Centers for Disease Control and Prevention) definition, 37 general information, 39 Cedar -Sinai Medical Center (California), 25 cell counts, 73 See also leukocytes central venous catheters (CVC) definition, 143 PICC and, 151–153 cephalic vein, 66, 68 definition, 97–98 certification, 209–210 chemical safety, 52–53 chemistry department of pathology laboratory, 26 chloride, 175–176 cholesterol test, 172 chromosome analysis test, 172–173 circulatory system blood and, 66–75 blood vessels and, 61–65 definition, 59 INDEX early beliefs of, 6–7 heart and, 60–61 cirrhosis definition, 167 magnesium test and, 178 clean-catch urine specimen, 163–165 clinical assignment expectations for phlebotomists, 31–32 clinical laboratory departments, 26–27 clot blood cultures and, 134 definition, 3, clot activators, 88 CLSI (Clinical Laboratory Standards Institute) definition, 37 general information, 40 coagulation, definition, 59 coagulation department of pathology laboratory, 27 colitis definition, 167 magnesium test and, 178 collaborator as conflict style, 198–199, 201 definition, 197 collection by routine venipuncture See venipuncture (routine) collection by skin puncture See venipuncture (skin puncture) collection devices routine venipuncture and, 105–106 skin puncture and, 121–122 urine and, 162–164 collection procedures (special) bleeding time test, 136–140 blood cultures, 133–135 children, 146–147 elderly, 147–149 infants, 144–146 newborn screening, 130–132 oral glucose tolerance testing, 135–136 collection requisition/order, 99 collection tray, 92 Columbus, Realdus, communication, definition, 205 communication skills See also conflict management listening, 187, 191–192 speaking, 187–191 telephone techniques and, 192–193 compassion of phlebotomist, 14–15 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX competence, definition, 205 complete blood count (CBC) test, 173 compromiser as conflict style, 198–199, 201 definition, 197 conduct, 14 confidentiality definition, HIPAA and, 20–21 legal issues and, 21 conflict, definition, 197 conflict management conflict styles and, 198–199 problem-solving, 202 situational survey, 200–201 connective tissue, blood as, 66 contaminated definition, 37 and OSHA reduction of bloodborne pathogen exposure, 42 continuous quality improvement (CQI), 21 controller as conflict style, 198–199, 201 definition, 197 cortisol test, 173 costs, patient-focused care and, 155–156 courtesy, definition, 205 creatine kinase (CK) test, 173–174 creatinine clearance test, 174 creatinine test, 174 credibility, definition, 205 culture urine collection, 165 cupping, definition, 3, 11 customer, definition, 205 cyanotic definition, 117 heelsticks and, 120 cytogenetics department of pathology laboratory, 27 cytologic study of urine test, 174–175 cytopathology, definition, cytopathology department of pathology laboratory, 27 D decontaminate, definition, 37 deontology definition, as type of ethical theory, 17 dermatitis due to latex allergy, 52 231 diastole, definition, 59, 61 diet restrictions, 101 digoxin test, 175 disinfectant (venipuncture), 83 disposal of sharps See sharps disposal units (venipuncture), 90–91 dorsal and collection of blood from infants, 145 definition, 143 dorsal hand vein venipuncture, 145–146, 150–151 dorsalis pedis artery, 67 dorsalis venous arch, 68 drug-free workplace, 215 Duke bleeding time test, 137, 171 E earlobes and skin puncture, 119 edema as complicating factor, 105, 120 edematous, definition, 97 education clinical assignment expectations for phlebotomists, 26–27 study/testing skills for phlebotomists, 28–31 efficiency of phlebotomist, 15 egoism definition, as type of ethical theory, 17–18 elderly, blood collection in, 147–149 electrical safety, 53–54 electrolytes (Na/K/chloride/CO2 /content/anion gap) test, 175–176 emergency patients, 100 employment, 210–216 See also phlebotomist engineering controls definition, 37 and OSHA reduction of bloodborne pathogen exposure, 42–44 enzymes acid phosphatase (ACP) test and, 168, 168–169 alanine aminotransferase (ALT) test, 169 aldolase test, 169 alkaline phosphatase (ALP) test, 169 amylase test, 170 aspartate aminotransferase (AST) test, 171 creatine kinase (CK) test, 173–174 definition, 167 lactic acid dehydrogenase (LD) test, 178 renin test, 180 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX 232 eosinophils as component of blood, 70 definition/function/life span of, 71–73 Equal Employment Opportunity (EEO), 214–215 equipment See also blood collection equipment blood cultures and, 134 collection tubes See laboratory tests erythrocyte, definition, 59 erythrocyte sedimentation rate (ESR), 180–181 erythrocytes definition, 66, 69–70 production/function/life span of, 71–72 sedimentation rate (erythrocyte sedimentation rate, or ESR) test, 180–181 ethics definition, theories of, 16–18 ethylenediaminetetracetate (EDTA), 88 etiology blood cultures and, 133 definition, 129 evacuated blood collection system, 13 See also blood collection equipment definition, 79 performing, 106–111 tube guide, 89–90 excretory organs definition, 159 urinary system and, 160 external customer, definition, 205 F fainting, 154 family members, 149 fasting blood sugar (FBS), 176 fasting urine specimen, 162 feel/roll/trace/palpate, 103–104 femoral artery, 67 femoral vein, 68 ferritin test, 176 filter paper collection for newborns, 131–132 filtrate definition, 159 of urinary system, 160 fingerstick procedure for, 122–123 site selection, 119–120 first morning urine specimen, 163 fistula as complicating factor, 105 fleams, 9–10 flexibility, 213–214 Food and Drug Administration (FDA) on glass capillary tubes, 43 G Galen of Roman/Greek medicine, 6–7 gastric artery, 67 gauge, definition, 79, 83–84 gauze, definition, 79 geriatric blood collection, 147–149 glass capillary tubes, 43 glove removal, 48–49 gloves (venipuncture), 91, 106 glucose (2-hr postprandial) test, 176 glucose (random/fasting) test, 176 glucose tolerance testing (GTT), 135–136 gowns, 50 granulocyte, definition, 59 granulocytes definition/function/life span of, 71, 73 Groshong Lines, 151–153 H hand washing procedure, 45–46 Harvey, William, hazards See biological hazards HBV (hepatitis B virus) as biological hazard, 40 definition, 37 and OSHA reduction of bloodborne pathogen exposure, 50–51 HCV (hepatitis C virus) as biological hazard, 40 definition, 37 hearing loss, 148 heart, anatomy/physiology of, 60–61 heelsticks, 124–126 helpfulness of phlebotomist, 14 hematology department of pathology laboratory, 26 hematoma definition, 97–98 as reaction, 154 hematoma as complicating factor, 104–105 hematopoieses, definition, 59 hematopoiesis, definition, 69–70 hemoconcentration definition, 97 and site selection for venipuncture, 102 hemoglobin A1c test, 177 hemoglobin, definition, 59, 71 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX hemostasis bleeding time test and, 136 definition, 59, 129 heparin, definition, 143 heparin lock, definition, 151 hepatic artery, 67 hepatic vein, 68 herpes simplex virus (HSV), 177 Hevea braziliensis, 51 Hickman Line, 151–152 HICPAC (Healthcare Infection Control Practices Advisory Committee), definition, 37 HIPAA (Health Insurance Portability and Accountability Act) definition, provisions of, 20–21 Hippocrates, histopathology, definition, histopathology department of pathology laboratory, 27 historical aspects of phlebotomy bloodletting, 8–13 early beliefs/discoveries, 5–8 HIV (human immunodeficiency virus) as biological hazard, 40 definition, 37 HIV antibody test, 177 housekeeping, 50 and OSHA reduction of bloodborne pathogen exposure, 50 hub, definition, 79, 83–84 Hubbard, Elbert, 212–213 human chorionic gonadotropin (HCG) test, 177 Humoral Theory, humors, definition, 3, Hynson, Wescott, and Dunning, 13 hypodermic needles, 85 hypothyroidism in infants, 131 I IgE antibodies, 51 IgG/IgM test, 177 iliac artery, 67 iliac vein, 68 incident report forms, 23–24 infants collection of blood from, 144–146 heelsticks and, 124–126 hypothyroidism, 131 newborn screening, 130–132 233 phenylketonuria (PKU) screening, 130–131 procedure for filter paper collection for newborns, 131–132 skin puncture and, 120–121 urine collection and, 162 inpatients, 100 insulin, definition, 129 intelligence, 148 internal customer, definition, 205 Internet usage, 210 Interpersonal Conflict (Wilmot and Wilmot), 198 interstitial fluids, definition, 119 interstitital fluid, definition, 117 intravenous therapy as complicating factor, 104 iron test, 177–178 Ivy bleeding time test, 137, 171 J The Joint Commission (formerly JCAHO) definition, 37 general information, 40 jugular vein, 68 K kidneys, 160–161 L LabCorp, 25 laboratory tests ABO blood typing, 168 acid phosphatase (ACP), 168–169 activated partial thromboplastin time (APTT), 169 alanine aminotransferase (ALT), 169 alcohol (ethyl/lega/medical), 169 aldolase, 169 alkaline phosphatase (ALP), 169 ammonia, 170 amylase, 170 antinuclear antibody (ANA), 170 arterial blood gases, 170 aspartate aminotransferase (AST), 171 bilirubin, 171 bleeding time test, 171 blood culture, 172 blood urea nitrogen (BUN), 172 calcium, 172 cholesterol, 172 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX 234 laboratory tests (continued) chromosome analysis, 172–173 complete blood count (CBC), 173 cortisol, 173 creatine kinase (CK), 173–174 creatinine, 174 creatinine clearance, 174 cytologic study of urine, 174–175 digoxin, 175 electrolytes (Na/K/chloride/CO2 /content/anion gap), 175–176 ferritin, 176 glucose (2-hr postprandial), 176 glucose (random/fasting), 176 hemoglobin A1c, 177 HIV antibody, 177 human chorionic gonadotropin (HCG), 177 IgG/IgM, 177 iron, 177–178 lactic acid dehydrogenase (LD), 178 lipase, 178 magnesium, 178 occult blood in stool, 178 osmolality, 179 ova and parasites (O&P), 179 phenylketonuria (PKU), 179 prothrombin time (PT), 179 renin, 180 Rh typing, 180 rubella antibody, 180 sedimentation rate (erythrocyte sedimentation rate, or ESR), 180–181 throat culture, 181 triglycerides, 181 uric acid, 181 urinalysis, 181 vitamin B12, 182 lactic acid dehydrogenase (LD) test, 178 lancets as bloodletting instrument, definition, 79, 91–92 heelsticks and, 126 skin puncture and, 122 lateral definition, 117 heelsticks and, 120 latex allergy definition, 37 general information, 51–52 leech, definition, leeching, 11–12 legal issues confidentiality, 21 procedures for incompetent/illegal actions, 22–24 refusal of treatment, 21 leukocyte, definition, 59 leukocytes definition, 69–70 production/function of, 71, 73 ligate, definition, lipase test, 178 listening definition, 187 professionalism and, 191–192 loop of Henle, 160 loyalty, 212 lymphocyte, definition, 59 lymphocytes definition, 73 function/life span of, 72 lymphostasis and complicating factors of site selection, 104 definition, 97 M magnesium test, 178 masks, 50 mastectomy as complicating factor, 104 median cubital, 66–67 median cubital vein, definition, 97–98 message, definition, 187 microbiology department of pathology laboratory, 27 microtubes, 91–93 midstream urine specimen, 163 Modern Surgery, 11 monocyte, definition, 59 monocytes as component of blood, 70 definition, 73 function/life span of, 72 morning rounds, definition, multiple-sample needles, 84–85 muscle strength/flexibility, 148 N National Credentialing Agency (NCA), 210 NCCLS (National Committee for Clinical Laboratories Standards) See also CLSI (Clinical Laboratory Standards Institute) general information, 39 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX needle holder, 86 needles (venipuncture) collection supplies assembly and, 105 hypodermic needles, 85 multiple-sample needles, 84–85 needle holder, 86 syringes and, 86–87 types/sizes of, 83–84 wing-tipped (butterfly) needles, 86 Needlestick Safety and Prevention Act definition, 37 and OSHA reduction of bloodborne pathogen exposure, 42 nephron definition, 159 of urinary system, 160 neutrophils as component of blood, 70 definition/function/life span of, 71–73 newborn screening See infants NIOSH (The National Institute for Occupational Safety and Health) definition, 37 general information, 39 and OSHA reduction of bloodborne pathogen exposure, 43 nosocomial, definition, 37 nosocomial infections, hand washing and, 45 O obligationism definition, as type of ethical theory, 18 occult definition, 167 occult blood in stool test, 178 occult blood in stool test, 178 one-handed recapping method, 46 oral glucose tolerance testing, 135–136 order of draw skin puncture and, 124 tube guide, 108–109 OSHA (Occupational Safety and Health Administration) definition, 37 engineering controls (bloodborne pathogen reduction) and, 42–44 general information, 38–40 235 hepatitis B vaccine (bloodborne pathogen reduction) and, 50–51 housekeeping (bloodborne pathogen reduction) and, 50 PPE (bloodborne pathogen reduction) and, 47–48 work practices (bloodborne pathogen reduction) and, 44–45 osmolality test, 179 osteomyelitis definition, 117 heelsticks and, 120 outpatients, 100 ova and parasites (O&P) test, 179 P pathogens, definition, 59, 71 patient children, 146–147 communication skills for, 187–193 diet restrictions/time requirements and, 101 elderly, 147–149 and family members, 149 as identified inpatient, 100 as identified outpatient, 100 infants, 120–121, 124–126, 130–132, 144–146, 162 patient-focused care, 143, 155–156 point-of-care testing, 143, 156–157 special considerations, 155 as unidentified emergency patient, 100 patient-focused care, 155–156 definition, 143 patient rights HIPAA and, 20–21 Patients’ Bill of Rights, 18–19 Patients’ Bill of Rights, 19 pediatric blood collection children, 146–147 infants, 144–146 Penrose-St Francis Hospital (Colorado), 25 peripheral circulation, definition, 59, 61–62 peripherally inserted central catheters (PICC), 151 peroneal artery, 67 peroneal vein, 68 personal appearance of phlebotomist, 15–16 personal protective equipment (PPE) definition, 37 and OSHA reduction of bloodborne pathogen exposure, 47–48 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX 236 personnel policies drug-free workplace, 215 Equal Employment Opportunity (EEO), 214–215 on sexual harassment, 215 violence-free workplace, 215–216 worker’s compensation, 216 phenylalanine necessary for metabolizing protein definition, 129 phenylketonuria (PKU) test, 130–131, 179 phlebotomist certification, 209–210 clinical assignment expectations for, 31–32 clinical laboratory departments using, 26–27 communication and, 205, 208 communication skills for, 187–193 competence and, 205, 208 courtesy and, 205, 208 credibility and, 205, 208 customer satisfaction and, 205, 206–207 definition, ethics and, 16–18 external/internal patients and, 206 health care facilities using, 25–26 HIPAA and, 20–21 patient rights and, 18–19 personnel policies for, 214–216 professionalism in, 13–16 qualities for success, 212–214 reliability and, 205, 207 researching potential employment, 210–212 responsiveness, 205, 207–208 security and, 205, 208 study/testing skills for, 28–31 tangibles and, 205, 208 and understanding/knowing customer, 205, 208–209 values and, 18 phlebotomy definition, historical aspects of, 5–8 as pathology laboratory department, 27 physician’s order, 150 plantar, definition, 117 plasma definition, 59, 66, 69 vacuum collection tubes and, 90 volume of blood, 70 platelets See thrombocytes (platelets) point-of-care testing, 156–157 definition, 143 polycythenia bloodletting and, definition, popliteal vein, 68 portal vein definition, Galen and, 6–7 positioning patient, 101 potassium, 175 prefainting, 153–154 pride in work, 214 Principles of Biomedical Ethics, 21 prioritizing orders, 99 privacy, HIPAA and, 3, 20–21 problem-solving See also conflict management professionalism See also phlebotomist importance of, 13–16 listening and, 191–192 speaking and, 188–191 telephone techniques, 192–193 prothrombin time (PT) test, 179 pulmonary circulation definition, 3, 59, 60 discovery of, pus, 71 Q quality assurance definition, versus risk management, 24 Quest Diagnostics, 25 R radial artery, 66–67 radial vein, 68 radiation safety, 54 random/spot urine specimen, 162 reactions fainting, 154 hematoma, 154 prefainting, 153–154 recapping procedure, 46 red bone marrow, 70 reflective listening as communication skill, 191–192 definition, 187 refusal of treatment, 21 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX regulatory agencies (OSHA) See OSHA (Occupational Safety and Health Administration) reliability definition, 205 as quality for success, 213 renal artery, 67 renal vein, 68 renin test, 180 respiratory system definition, 159 as excretory organs, 160 responsiveness, definition, 205 Rh typing test, 180 risk management See also biological hazards definition, 3, 21 procedures for incompetent/illegal actions, 22–24 routine collection definition, 97 prioritizing orders and, 99 routine venipuncture collection supplies assembly for, 105–106 and complicating factors of site selection, 104–105 feel/roll/trace/palpate for, 103–104 procedure using evacuated system, 106–111 procedure using syringe/butterfly needle collection system, 112–114 site selection for, 102–103 rubella antibody test, 180 Rush, Benjamin, 13 S safety See biological hazards saline, definition, 143 saline lock, definition, 151 saphenous vein, 68 scar tissue as complicating factor, 105 scarification, 11 Seattle Children’s Hospital, 25 security, definition, 205 sedimentation rate (erythrocyte sedimentation rate, or ESR) test, 180–181 self-sheathing needles, 42 separating gel, 88 septicemia blood cultures and, 133 definition, 129 237 serum definition, 59, 75 vacuum collection tubes and, 90 sexual harassment, 215 SGPT See activated partial thromboplastin time (APTT) test sharp, definition, 37 sharps, and OSHA reduction of bloodborne pathogen exposure, 42–44 Sims Portex Needle Pro holder, 85 site selection alternative sites, 149–151 point-of-care testing and, 156 for routine puncture, 102–103 for skin puncture, 119–120 skin puncture blood composition and, 119 choosing, 118 collection devices for, 121–122 fingerstick procedure, 122–123 heelstick procedure, 124–126 order of draw, 124 site preparation for, 120 site selection for, 119–120 social contract theory definition, as type of ethical theory, 17 sodium, 175 speaking, 187–191 specimen collection tubes, 42–43 splenic artery, 67 standard precautions, biological hazards and, 40–41 stat definition, 97 prioritizing orders and, 99 Steil, Lyman, 191 sterilize definition, 37 and OSHA reduction of bloodborne pathogen exposure, 42 subclavian artery, 66–67 subclavian vein, 68 surgical pathology department of pathology laboratory, 27 Surgicutt bleeding time test, 137–140 symbols biohazard, 50–51 radiation, 54 syringe, definition, 79 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX 238 syringes, 86–87 systemic circulation definition, 59, 60 upper limbs of, 65–66 systole, definition, 59, 61 systolic, definition, 143 systolic pressure, reactions and, 154 T T lymphocytes, 72 tangibles, definition, 205 tape and bandages (venipuncture), 90 teamwork, 213 teleology definition, as type of ethical theory, 17 telephone techniques, 192–193 Template bleeding time test, 137–140 tests See laboratory tests tetany definition, 143 as reaction, 154 thoracic artery, 67 throat culture test, 181 thrombocyte, definition, 59 thrombocytes (platelets) definition, 69–70 function/life span of, 72 production/function of, 74–75 thrombosed, definition, 97 thrombosed vein as complicating factors of site selection, 105 and site selection for venipuncture, 102 tibial artery, 67 tibial vein, 68 timed collection definition, 97 prioritizing orders and, 99 timed-collection urine specimen, 164 toes and skin puncture, 119 tourniquet blood cultures and, 134 collection supplies assembly and, 105 definition, 79 triglycerides test, 181 tube guide, order of draw, 108–109 tunica adventitia, definition, 59, 64 tunica intima, definition, 59, 63–64 tunica media, definition, 59, 64 U ulnar artery, 66–67 understanding, definition, 205 universal body substance precautions (UBSP) definition, 37 OSHA and, 40–41 University of Texas M.D Anderson Cancer Center, 25 Unopette system, 91–93 ureter, 160–161 urethra, 160–162 uric acid test, 181 urinalysis department of pathology laboratory, 27 urinalysis test, 181 urinary system definition, 159 organs of, 160–162 urine definition, 159 general information, 162 urine tests clean-catch specimen, 163–164 containers, 162–163 culture collection, 165 fasting specimen, 162 first morning specimen, 163 midstream specimen, 163 random/spot specimen, 162 timed-collection specimen, 164 uric acid test, 181 urinalysis test, 181 urinary system, 160–162 urobilinogen definition, 167 urinalysis test and, 182 V vaccinations, hepatitis B vaccine, 50–51 vacuum tube and blood collection, 13, 89–90, 106–111 values, definition, 3, 18 values of tests See laboratory tests vascular access lines, central venous catheters (CVC), 151–153 veins of arm, 69 versus arteries, 63 blood flow and, 63 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it INDEX definition, 59, 60 elderly, 148 of hands/legs, 149–150 overview of systemic circulation and, 68 and site selection for venipuncture, 102–103 vena cava, 68 venesection, 9–10 venipuncture See also infants alternative sites for, 149–151 blood transfer devices and, 87–88 definition, 3–4 disinfectant (venipuncture), 83 disposal units and, 90–91 dorsal hand vein venipuncture, 145–146 gloves and, 91 hypodermic needles, 85 and interacting with patient, 100–102 multiple-sample needles, 84–85 needle holders and, 86 normal values See laboratory tests and organization of workload, 99 physiological reactions, 153–154 syringes and, 86–87 tape and bandages and, 90 types/sizes of needles, 83–84 wing-tipped (butterfly) needles, 86 venipuncture (routine) collection supplies assembly for, 105–106 and complicating factors of site selection, 104–105 feel/roll/trace/palpate for, 103–104 procedure using evacuated system, 106–111 procedure using syringe/butterfly needle collection system, 112–114 selecting site for, 102–103 239 venipuncture (skin puncture) blood composition and, 119 choosing, 118 collection devices for, 121–122 fingerstick procedure, 122–123 heelstick procedure, 124–126 order of draw, 124 site preparation for, 120 site selection for, 119–120 ventricles, definition, 59, 60 venules blood flow and, 63 definition, 59, 65 vertebral artery, 67 Vesalius, Andreas, violence-free workplace, 215–216 vision loss, 148 W Washington, George, 13 white blood cells See leukocytes Wilmot, Joyce, 198 Wilmot, William, 198 wing-tipped (butterfly) needles, 79, 86 work practices and OSHA reduction of bloodborne pathogen exposure, 44–45 work settings clinical laboratory departments using phlebotomists, 25–26 health care facilities using phlebotomists, 25–26 worker’s compensation, 216 Y yellow bone marrow, 70 Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it Copyright 2010 Cengage Learning All Rights Reserved May not be copied, scanned, or duplicated, in whole or in part Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s) Editorial review has deemed that any suppressed content does not materially affect the overall learning experience Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it