Sophia Clavecilla BSMT 1A

Lesson 4 ● Chlorhexidine
- has a wide spectrum of bactericidal
and bacteriostatic activity.
- effective against both Gram-positive
● STERILIZATION - Removal / Killing of all
and Gram-negative bacteria
forms of life
although it is less effective against
● DISINFECTION - Removal / Killing of
some species of Pseudomonas and
pathogenic organisms but not necessarily
Proteus and relatively inactive
bacteria or other spores
against mycobacteria.
● DISINFECTANTS - Applied to inanimate
- It is not active against bacterial
object
spores.
● ANTISEPTICS - Applied to living tissue
● Ethanol
- has a bactericidal activity
- used to disinfect skin prior to
Hand washing injection, venipuncture, or surgical
- Medical professionals use procedures.
antiseptics for hand scrubs and rubs
in hospitals.
Disinfecting mucous membranes. ● Syringe with safety needle
- Antiseptics can be applied to the - Ready for use
urethra, bladder, or vagina to clean - Safety system engaged
the area before inserting a catheter. ● Will see a “flash” of blood in the needle hub
They can also help to treat an when the needle enters the vein.
infection in these areas. PARTS OF SYRINGE
Cleaning skin before an operation
- Antiseptics are applied to the skin
before any kind of surgery to protect
against any harmful microorganisms
that might be on the skin.
Treating skin infections
- You can buy OTC antiseptics to
reduce the risk of infection in minor
cuts, burns, and wounds. Examples
include hydrogen peroxide and
rubbing alcohol.
Treating throat and mouth infections
- Some throat lozenges contain
antiseptics to help with sore throat PARTS OF NEEDLE
due to a bacterial infection.

● Povidone-iodine
- is effective against bacteria, fungi,
viruses, protozoa, cysts and spores.
- significantly reduces surgical wound
infections.
- The solution of povidone-iodine
releases iodine on contact with the
skin.
 - Filling the sharps containers more
quickly

● Splattering of blood
- Care in activating of safety features
● 25-gauge used for intermuscular
- Blood droplet trapped in the safety
injections
device
● 27-gauge needle used for
- Removing the last tube from the
administration of a purified protein
holder before pulling the needle
derivative (PPD) tuberculosis skin test
from the patient
● 18- and 16-gauge needles used for the IV
infusion of fluids or blood products or
removal of blood during donor process
- Tubes are different sizes and contain
different types of anticoagulant
EVACUATED COLLECTION TUBES
- Contain vacuum with rubber stopper
sealing the tube
- 2 – 15 ml.
- Have sterile interiors to prevent
contamination of the sample and the patient
- Glass or plastic
- Length: 65 – 127 mm
- Diameter: 10 mm, 13 mm or 16 mm

● The mechanism of the rubber stopper on

the tube has changed because of the
EVACUATED SYSTEM increase of blood and body fluid
- Uses double- pointed needle precautions.
● The traditional rubber stopper popped on
the top was removed
▪ Creates aerosols that could
be inhaled or ingested

● A tube with a vacuum already in it attaches

to the needle and the tube’s vacuum is
replaced by blood.
● Basic System includes;
- Double pointed needle
- Plastic holder Various additives are introduced to the tubes as
- Series of vacuum tubes with rubber part of manufacturing process to improve the
stoppers quantity of the sample or to accelerate sample
● Angle of insertion: Processing.
15 degrees – 30 degrees ● SILICON COATING
● Reuse of evacuated system holder Internal surface of tubes are
- Contamination microscopically rough, silicon coating fills
- Cost of holders the cracks and crevasses preventing the
cells from adhering to the surface
 - Reduces the chance for hemolysis.
- Makes sides slicker so the cells can
centrifuge to the bottom of the tube faster.
● GLASS TUBES
- Glass surfaces for serum testing will
activate clot formation
- Contains clot activators to speed the
clotting process.
● PLASTIC TUBES
- Unable to activate clot formation
- Silica particles are added on the
sides of the tubes as activators of
the clotting process.
➔ Tubes can contain thixotropic gel to
separate cells from serum or plasma.
➔ Centrifugation of the separator gel tube
causes gel to form Interface between cells
and serum or plasma.
BUTTERFLY COLLECTION SYSTEM - For small,
difficult veins.

Hemostasis - Coagulation process causing

the formation of a blood clot when an injury occurs
and lysing of a blood clot when an injury has
been repaired.

Primary phase
- Damaged blood vessels constrict to
limit blood flow to injury
- Platelets clump to form temporary
plug
- Plug is all that is needed for small
injuries
Secondary phase
- Needed for more serious injuries
Involves formation of fibrin clot
- Coagulation cascade
Designated by Roman numerals
- INTRINSIC PATHWAY
Factor XII measured by aPTT (activated
partial thromboplastin time)
- Used to keep blood from clotting.
- EXTRINSIC PATHWAY
- Whole blood or plasma can be used in
Factor VII measured by PT
testing
(prothrombin time)
- Stop clotting process by removing calcium
or by stopping prothrombin to thrombin
reaction
● Citrate Phosphate Dextrose
Adenine (CPDA -1)
 - For routine blood donor bags

Citrate Phosphate Dextrose

Adenine (CPDA -1)
- Preserves viability of erythrocytes
- Can still transport O2 to tissues even weeks
after blood is drawn from donor
- 1:9
- 63 ml anticoagulant and approximately 450
ml. of blood
Sodium Polyanethol Sulfonate
(SPS)
- Yellow-stoppered tube that does not contain
citrate
- Used for collecting blood culture samples
- Main function of the SPS tube is to allow
bacteria to grow so they can be cultured
- Inhibits phagocytosis
- Inhibits serum complement that destroys
bacteria
- Inhibits certain antibiotics
EDTA – white top Sophia Mae J. Clavecilla BSMT 1A
- Pearl top Lesson 5
- Has gel to separate plasma from cells
- For HIV (+) patients
- For molecular diagnostic tests such as SKILLS IN APPROACHING THE PATIENT
Polymerase Chain Reaction (PCR) or
branched DNA amplification techniques

Royal blue top, Trace elements

tube (Lead, Zinc, Arsenic., Copper)
- Will have a green or lavender label to
designate anticoagulant present
▪ Three varieties:
- No anticoagulant and produces a clot
sample
- Sodium heparin
- Disodium EDTA as an anticoagulant

● All tubes having any type of anticoagulant

must be gently inverted immediately after
collection.
● 5 to 8 gentle inversion of the tube.
● Tubes should never be shaken.
● Vigorous mixing will cause hemolysis of
RBC.
● Anticoagulant tubes that are partially filled
should never be poured together to obtain a
full tube

Tourniquets - constrict flow of blood in the arm to

make veins more prominent

COLLECTION CART / TRAYS

- Phlebotomist needs sample collection tray
or cart to hold all equipment necessary for
proper sample collection
- Will be taken to the patient's room so the GREETING THE PATIENT
phlebotomist is prepared for whatever
procedure is performed.
 - Back of hand
- Wrist vein that is present when the
- hand is positioned so the thumb is
facing up
- Ankle or foot with physician’s
approval

PERFORMING A SAFE VENIPUNCTURE:

SYRINGE METHOD
- Apply the tourniquet, select a vein noting
the location and direction of the vein.
- Clean the venipuncture site with 70 percent
isopropyl alcohol swab
- Proper Hand Position to Hold a Syringe
- Hold syringe in dominant hand
- Draw the patient’s skin taut with your
- nondominant thumb.
- Perform the venipuncture.
- Non-dominant hand pulls on plunger
PERFORMING A SAFE VENIPUNCTURE - Do not change hands once venipuncture is
● POSITIONING THE PATIENT made
- Position of patient is critical for proper Transfer Device
blood collection - Use of transfer device to transfer blood from
- Patient must be in a seated or reclined syringe into tube
position before any attempt is made to draw Alternate Transfer Technique
blood - Used only when transfer device not
-Possibility of syncope Immediately available
● APPROPRIATE VENIPUNCTURE SIGHT PERFORMING A SAFE VENIPUNCTURE:
Appropriate site can vary depending on EVACUATED TUBE SYSTEM
patient - Apply tourniquet
- Primary vein for venipuncture: - Feel for vein
Median cubital vein of antecubital - Clean with alcohol swab in concentric
area of arm circles
- Second choice - Cephalic vein - Hold skin taut with Non-dominant Thumb
- Basilic vein Insert needle at 15- degree angle with bevel
- Least preferred site up
- Use with caution - Remove hand from drawing the skin taut
- Brachial artery and major nerves are along - Insert tubes into holder in correct order of
this vein draw
● Other areas to check for venipuncture - Fill tubes until vacuum is exhausted to
sites in order of preference: - ensure proper blood-to- anticoagulant ratio
 - ▪Warm venipuncture location
- ▪Reseat tube in holder
FAILED VENIPUNCTURE
- Remove the holder Techniques to Enhance the Vein and Recover a
Failed Venipuncture
- Use different tube
- Place your finger below venipuncture site
and stretch vein slightly
- Rotate needle one-quarter to one-half turn
- Pull back or advance needle slightly
PATIENT REACTION TO BLOOD COLLECTION
- Pain
- Nerve damage
- Syncope
- Fainting
- Nausea
- Diabetic shock
- Convulsions
- Cardiac arrest
- Continued bleeding
- Hematoma
- Skin allergies
PATIENT CONDITIONS
Anemia
Order of Draw When Filling Evacuated Tubes Hemolysis
- If not all tubes in order of draw are to be Jaundice
collected, the order is started with first tube Lipemia
needing collection PATIENT BLOOD ABNORMALITIES
BUTTERFLY COLLECTION SYSTEM
- Apply tourniquet
- Feel for a vein
- Clean with alcohol swab in Concentric
circles
- Hold skin taut with non-dominant thumb
- When needle enters vein, should see “flash”
of blood
- Insert evacuated tube into holder
- Release tourniquet Remove butterfly needle
from arm
- Activate safety shield
INTRAVENOUS AND INDWELLING LINES
- Blood collected above IV line will
result in inaccurate results because of IV From left to right
fluid contamination - Normal serum
- To avoid contamination, phlebotomist must - Hemolyzed serum
draw below IV in hand or do fingerstick - Icteric serum
Techniques to Enhance the Vein and Recover a - Lipemic serum
Failed Venipuncture
- ▪Retie tourniquet
- ▪ Use blood pressure cuff as tourniquet
- ▪ Massage the arm. Do not slap the arm.
- ▪ Lower patient’s arm
Sophia Mae J. Clavecilla BSMT 1A
Lesson 6

Micro collection equipments

● Lancets - used to puncture finger or heel
● Microcollection tubes - used to collect small
blood samples

CAPILLARY PUNCTURE: HEEL STICK

- Capillary puncture is method of choice in
children under 1 year of age - Optimal depth of capillary puncture varies
- Done by puncturing the skin and underlying from 0.85 mm for premature infants to 2
capillaries mm for full-term infants
- Foot is puncture site for children under 1 - Excessive crying can result in elevated
year of age WBC counts
- Capillary puncture of earlobe not - Warm heel for three minutes with heel
recommended because blood flow is not warmer
adequate - Clean incision site with alcohol pad
- Puncture site must be warm to increase - Allow to air dry
blood flow - Remove lancet device from package
- Warming puncture site can increase blood - Device should be made for heel sticks
flow sevenfold - Position heel stick lancet on medial or
- Ideal temperature: 42° Celsius - lateral portion of plantar surface
- Site should be cleansed with alcohol - Depress plunger
- Do not use povidone- iodine solutions - Take care not to make direct contact with
- Can cause elevated potassium, collection container
uric acid, and phosphorous MICROCOLLECTION ORDER OF DRAW
- After puncture, first drop of blood - Blood gasses
must be wiped away to avoid contamination - Lavender-stoppered
with interstitial (tissue) Fluid -EDTA(ethylenediaminetetraacetic acid)
- Blood should flow freely into collection - Green-stoppered
device -Sodium heparin
CAPILLARY PUNCTURE: FINGERSTICK - Other additive microcontainers
- Massage lower portion of the finger while - Red-stoppered
avoiding puncture site to stimulate blood - Nonadditive microcontainers
flow CHALLENGES OF PHLEBOTOMY
- Position lancet device to cut across Venipuncture on children
fingerprint lines be aware of two patients:
- Depress plunger with your index finger - Child
- Parent
● Blood should be collected from most - Be calm and confident.
medial or lateral portion of plantar - Get down on the child’s level.
surface of heel - Explain every step of the procedure.
- Role-play with the child by showing with a
stuffed animal or doll what will happen.
- Child is not the only customer the
phlebotomist works with
 - Child will read anxiety of parent/caregiver Dorsal hand vein of newborn or infant less
- If parent is anxious, ask if they would be than 2 years of age is often preferred as
more comfortable leaving the room alternative to heel stick or fingerstick.

HOW A CHILD UNDERSTAND ILLNESS Parent Assistance

The first 2 years: - Parents may hold the child on his or
- Limited understanding her lap while holding the child's arm
- Feel stress due to separation from familiar in a straight position and restraining
caregivers/change in home routine the rest of the child’s body.
Ages 2 to 6 years: - Preferable over all other restraints
- Magical thinking Restraint of the Child
- Medical care may be viewed as punishment - Blanket restraint of a child is less
for bad behavior threatening, but an effective way to restrain
- Internal organs/parts difficult to understand a small child.
6 to 9 years of age: Tips to Effectively Work with Children
- Understand some mechanics of health and Families
- Can understand how procedures will help - Smile and be friendly, natural, and relaxed.
cure illness - Introduce yourself and explain your role.
Age 10 and older: - Be aware of your facial expressions.
- Fairly clear understanding of what illness is - Keep your voice soft and pleasant.
and can explain why they do not feel well - Physically get down to the child’s level.
- Include personal conversation.
REACTION TO PAIN - Talk to the child using simple words and
- Do not tell a child that a fingerstick phrases.
or venipuncture will not hurt. - Use distraction.
- Children react differently to pain depending - Avoid teasing, sarcasm, and euphemisms.
on their age. - Can be difficult for a child to
- Children mature in their ability to locate and understand.
explain pain. - If you cannot answer a question, say, “I do
- Infants rely on caregiver to notice pain not know.”
- Toddlers experience pain but cannot always - Be honest, especially about pain.
pinpoint source or location - Avoid separating parents and children.
- School-age children can locate pain in - Give genuine compliments and
terms of body parts encouragement to children and parents.
MANAGING PAIN - Continue to give the child love when he or
- Topical anesthetic can be used to numb site she is the least lovable.
of venipuncture - Encourage and use play when appropriate.
- Disadvantage: Anticoagulated patient
- Takes approximately 30 minutes to - Patients on anticoagulant therapy will be
fully numb area susceptible to bleeding and hematomas.
- Idea of moving child’s attention from - Contain bleeding after venipuncture with
procedure to something else gauze or cotton and elastic bandage
- Distraction techniques always take several - Instruct patients not to carry purses or other
people. heavy items with venipuncture arm for at
Locating Veins least one hour.
- High-intensity light sources can be used to - Elastic wrap wrapped around the arm
locate veins. provides additional continuous pressure to
- Infrared imaging can be used to display the site.
veins on a monitor.
A Patient Who Is Resistant Capillary and Venous blood
- Patient who is aware does have the right to - One commonly known difference is that the
refuse to have a sample drawn glucose amount in capillary is higher than
- May take more time to convince them that that in venous blood.
collection is necessary. - Total Protein lower in capillary blood.
- Calcium lower in capillary blood.
The Patient With A Psychiatric Disorder - Potassium is lower in capillary blood and
- Often does not understand what is being increased with the presence of hemolysis or
done to him or her in a clinical setting excess of tissue fluid.
- Nurse often accompanies a phlebotomist to
the patient’s room to help explain the Sophia Mae J. Clavecilla BSMT1A
procedure to the patient or to help hold the Lesson 7
patient for optimal care.

The Patient Who Is Obese

- Veins are often difficult to feel through Reason for arterial puncture:
layers of tissue. - Arterial punctures are not intended for the
- Localized tissue globules under their skin beginning phlebotomist.
resemble veins. - Extensive observation and training in the
- Median cubital vein is usually the most technique should be completed before an
prominent vein to feel. arterial puncture is attempted.
- Patients can be seriously injured if a sample
The Patient in Isolation
is improperly collected.
- Phlebotomist must take extra protection
while drawing sample - Used to obtain samples for blood gas
analysis.
Patients with Damaged or Collapsing Veins - Blood gas determines the effectiveness of a
- Veins may be inaccessible due to burns, patients’ ability to use oxygen and carbon
scars, chemotherapy, or surgical dioxide.
procedures. - All living cells in the body must absorb
- Using a syringe is the best way to obtain
oxygen and expel carbon dioxide.
blood from a vein that has a tendency to
collapse. - PO2 (partial pressure of oxygen) reflects
- Evacuated system works to draw blood the amount of oxygen gas dissolved in the
from collapsing veins. blood.
- Only small tubes can be used. - It primarily measures the
effectiveness of the lungs in pulling
Capillary blood
oxygen into the bloodstream from
▪ obtained through capillary puncture
(heelstick/fingerstick) the atmosphere.
▪ Usually done in neonates, infants and children - pCO2 or PCO2, (partial pressure of carbon
dioxide) often used in reference to blood as
Venous blood dissolved carbon dioxide
▪ Obtained through venipuncture by syringe - Body regulates blood pH
method evacuated tube method or butterfly ▪ The measure of acid-base balance
(winged infusion set) collection
▪ 7.35 -7.45, a very narrow range
The source of the blood affects the results. ▪ Not too acidic (acidosis)
▪ Not too alkaline (alkalosis)
▪ Arterial blood is about 5% higher than ▪ 7.40 is a perfect balance
capillary blood and 10% higher than - Blood transports dissolved gasses to and
venous blood. from the cells.
- Arterial blood that has just left the heart and
▪ Not likely to be using arterial blood but
lungs has the highest concentration of
will be comparing capillary blood ( finger
stick sample) to venous blood that is oxygen.
usually taken. - Arterial blood has a uniform composition of
gasses in all parts of the body Sample of
choice for blood gas analysis.
 - Venous blood gas varies depending on cell
location.
- Muscular and metabolic activity of the cells
varies in the amount of gas the blood
contains at different locations of the body.

- Antiseptic
- Gauze squares
- ABG syringe with heparin solution of 1000
IU/ml
- Hypodermic needles, G 22 Syringe
- Ice water solution or bag of crushed ice
ARTERIAL SITES
- Radial artery on adults
- Infant: catheterization of umbilical arteries
Other arterial sites
- Brachial artery
- Deeply located within the muscles and
HEMATOMA
connective tissues, difficult to palpate
- Due to higher pressure in arteries
- May damage major nerves Difficult to
- Arteries contain elastic tissue providing
compress, hematoma is likely.
better closure of the puncture site for young
Femoral Artery
to middle-aged adults.
- Largest artery
- Older patients have an increased possibility
- Palpated and punctured easily
of hematoma.
- Pubic hair cleansing is difficult leading to
- Patients on anticoagulant therapy have a
infection.
greater chance of hematoma.
- Used for cardiac catheterization
ARTERIOSPASM
- Last choice
- A reflex condition in response to pain or
- Reserved for physicians
anxiety
- Goes away rapidly but may make it
impossible to obtain blood
ALLEN TEST
- Used to check for collateral circulation.
- Done when accessing radial artery for blood
gas analysis, an alternate artery is
functional to supply arterial blood to hand.
Lesson 8

- Special considerations must be noted by - Certain samples must be drawn at timed

phlebotomists intervals because of medication or
- Routine venous samples are not the only biological rhythms.
types of samples the phlebotomist will be - Samples should be collected at the precise
required to collect time intervals required.
- Some samples will need to be collected - Tests exhibiting diurnal effect where values
❖ a specific time vary throughout the day
❖ after a special drink ➔ Serum iron
❖ When nothing has been eaten ➔ Corticosteroid
➔ Other hormones
- Phlebotomist needs knowledge of special -Drawn 12 hours apart
procedures in blood collections to obtain Monitoring of patients’ drug therapy requires
the most accurate sample from a patient timed sample
- Other than blood, Phlebotomists often need ➔ Therapeutic drug monitoring (TDM) is the
to collect and assist patients in collecting a most common timed specimen. Drugs such
variety of samples. as aminoglycosides are administered to the
patient via IV.
Drug level in patient must be maintained
within therapeutic range
Usually collected in the morning before breakfast
➔ Concentration of medication that is effective
➔ Before patient has had breakfast
and not toxic in patient management
➔ Before any activities
Pre-sample collected when drug is at the
Sign at the door or at the bed stating “NPO”
lowest level in the patient
➔ Trough level (pre-dose)
➔ Nothing Per Orem
Once drug has been completely administered for a
➔ Nothing by mouth
specific period, peak level (post-dose) is collected
➔ Should not be given anything to eat or drink
➔ Drug level in blood collected 15 to 30
Some tests require diet restrictions
minutes after dosage has been
administered
➔ No alcohol for a number of hours
Tell the nurse as soon as you have drawn pre-dose
➔ Limitation on certain foods and medicines
blood sample
-Some foods or drinks may mask the results
➔ Patients’ IV can be started You will be
that the physician is looking for
informed when to come back for the post
After blood is drawn, patient may be released from
dose collection
restrictions
-Results of these two levels given to pharmacist
➔ Inform nurse
to determine how effective dosage in IV was
➔ Do not give food or tell them they can eat
for the patient.
without first checking with the nurse
➔ Blood drawn is probably one of the several
-If the therapeutic range is not reached, the
tests which the patient must remain fasting
dosage will be adjusted by the pharmacist, and
-May be going to surgery or radiology
new trough and peak specimens will be
Collected.
- Do not Ask if they are FASTING, instead ask if
they have anything to drink or eat.
 Therapeutic phlebotomy
➔ Polycythemia vera and hereditary
hemochromatosis
- Samples that need to be collected
- Diseases that cause the body to produce
immediately due to the critical state of the
too many erythrocytes.
patient.
➔ Draws large amount of blood (500 ml) the
- Stat testing on average takes the laboratory
same manner as making blood donation to
45 minutes to 1 hour to complete after the
the blood bank but blood is discarded and
sample is received.
not used for someone else
Reasons may vary
➔ Removal of blood from the individual is to
➔ Result needed before patient is sent home
relieve the stress on the heart.
➔ Someone forgot to order the test and the
Glucose Testing
result is needed before the next dose of
- Used to determine if patient has diabetes
medicine can be given.
mellitus
Stat test must be handled in such a way as to
➔ Fasting Glucose
obtain it and deliver it to the laboratory as fast as
➔ Glucose Tolerance Test
possible
➔ Gestational Screen
➔ Must be completed with all the proper steps
➔ Postprandial Glucose Test
➔ NEVER take shortcuts to speed the
➔ 2-hour Post Glucose Drink
processing
➔ Home Monitoring of Glucose
STAT vs. ROUTINE TEST
➔ Urine Glucose
As Soon As Possible (ASAP) Samples
➔ Glycosylated Hemoglobin
➔ Typically resulted within two to four hours
Glucose drinks given to patients contain either 50,
from time of collection
75, or 100 grams of glucose.
Routine Tests
➔ Amount given depends on the type of
➔ Collected in a reasonable time after being
tolerance test being administered.
ordered.
➔ For children 12 years of age and under,
➔ No urgency
➔ 1.75 grams per kilogram of body weight is
➔ Collected early morning or the next
given.
scheduled early evening collection
➔ Results indicate whether glucose level is
normal, high, or low

Alcohol Testing
➔ Blood alcohol testing must be collected
Type 1 Deficiency in insulin production
without use of alcohol to clean the arm.
Type 2
➔ Alternative cleaning agents are zephrin
➔ 95% of patients with diabetes have type 2
chloride, soap, or hydrogen peroxide.
➔ Most patients have high glucose values
➔ Results will often be used for legal reasons.
accompanied by high insulin levels
Chain of custody
➔ Some patients have normal insulin
➔ Also known as forensic samples
concentration but lack relative insulin
➔ Form that accompanies the sample dictates
activity
that each person handling the sample must
Prediabetes - Patient’s blood glucose is higher
sign the form.
than normal but not high enough to be
Heavy metals testing
classified as diabetic.
➔ E.g heavy metals testing
Some patients have metabolic syndrome
➔ Special tubes used during testing
➔ Also prediabetic since they are susceptible
● Usually have royal blue top with
to becoming diabetic.
variety of additives
Xylose Tolerance - Test to determine
malabsorption.
Bleeding Time
➔ The time it takes a standardized incision to
stop bleeding.
➔ Blood pressure is maintained with a blood
pressure cuff at 40 mm Hg. Abnormal
results can be from patients on aspirin
therapy, on anticoagulants or
antihistamines, and platelet counts under
100,000 /cubic millimeter.
➔ Due to inconsistencies in the bleeding time
test, platelet function blood test is the
preferred test.

➔ Blood smears used for microscopic

examination of blood
➔ Prepared from venous blood or capillary
Blood
➔ Peripheral smear is the most common
blood smear used for Complete Blood
Count (CBC)
Other smears
➔ Malarial smear - Malaria parasites can be
identified by examining under the
microscope a drop of the patient's blood,
spread out as a “blood smear” on a
microscope slide.
➔ Special hematology Procedures - Used to
diagnose many hematologic disorders.
Helpful in situations where diagnostic cells
can be seen in the bone marrow but not in the
peripheral blood.
 After the site is cleaned, collect blood by one of the
following methods:
● Syringe blood culture collection
● Direct-draw blood culture collection
● Butterfly blood culture collection
● Indirect inoculation blood culture collection
Both aerobic bottle and anaerobic bottle must be
collected
➔ Do not use iodine or Betadine; it may
contaminate the sample.
Blood volume collected is determined by bottle
➔ It takes considerable practice to make good Manufacturer
slides consistently. ➔ Amount of blood needed is 8 to 10 mL per
➔ Slide-making device available in the market blood culture bottle with two bottles taken in
➔ For malaria diagnosis, it is preferred to a set.
make a smear from capillary blood. ➔ Blood must be collected and placed in
● Cells with malarial organisms special blood culture bottles to promote the
concentrate in the capillaries during growth of the bacteria if they are present.
malarial crisis therefore are in a
larger concentration in the
capillaries.
● Thick blood film is often made
-Not a smear at all but a large drop
of blood about the size of a dime

➔ POCT or bedside testing

➔ medical diagnostic testing at or near the
point of care—that is, at the time and place
of patient care.
ADVANTAGES OF POCT
Efficiency
➔ uses an efficient workflow process as the
testing is performed at the bedside or in
close proximity to the location of patient
➔ Collected whenever it is suspected that a care.
patient has septicemia ➔ The testing is performed within the clinical
- Condition in which microorganisms (mainly management setting.
bacteria) circulate and multiply in the ➔ Determination of the need for testing is
patient’s blood made at the bedside with the testing being
Key to accurate and uncontaminated blood culture implemented within a short time frame.
collection: Speed of diagnosis and treatment
● Cleaning skin correctly ➔ Rapid test results with the potential to
● Commercial skin cleaning kits are best used expedite medical decision-making.
for this purpose. ➔ Conducted and medical care can be
promptly implemented.
 ➔ In addition to rapid implementation of
treatment, the process is more efficient for Improved patient outcomes
the physician, as there is not a need to ➔ Immediate availability of test results can be
refamiliarize with the case after test results linked to patient management to facilitate
are returned from a central laboratory. movement of individual patients through the
Expanded testing capabilities system faster.
➔ Provision of laboratory testing in a wide ➔ Allow for handling of more patients in a
variety of sites both within and outside of diminished time frame.
the health care facility. DISADVANTAGES of POCT
➔ Possible non-traditional testing locations or Differences in Methodology
circumstances include, but are not limited ➔ Employs different methodologies.
to, underserved populations, rural areas, ➔ Limitations and interferences can vary from
and locations with limited infrastructure or test methods employed in the central
personnel (eg, disaster, accident, or military laboratory.
sites). ➔ Limitations include test timing and
Specimen stability and ease of handling performing specific steps in the proper
➔ Unprocessed samples, such as whole order. Contamination and improper sample
blood, that do not require centrifugation or collection are method/instrument specific.
processing. ➔ Some POCT test methods must be used for
➔ Reduced potential for sample deterioration, screening only as defined by the
initiated and performed rapidly once the manufacturer. These methods cannot be
sample is obtained. used for diagnoses.
- Potential changes may occur to ➔ A test kit or device should not be used
samples sent to the central outside of its intended use or the written
laboratory due to analyte instability, procedure (eg, HCG testing on serum in a
exposure to the environment, waived testing setting, when the package
cellular metabolism, and insert specifies the waived test is for urine
temperature variation. testing only)
➔ Sample volume influences patient ➔ Monitoring and appropriate storage of
convenience with supplies and reagents
➔ less blood loss and anemia for patients ➔ The reagent/QC storage facilities may be
requiring frequent testing, as well as decentralized and in remote locations.
neonatal and pediatric benefits with a ➔ To prevent deterioration, lack of stock
reduction in specimen volume. rotation, out-dating, and possibly erroneous
Lean Process patient results, a detailed inventory system
➔ Fewer steps are necessary to produce the must be an integral part of the POCT
result, including the elimination of program.
processing and aliquoting, the need to Reliability of results
transport the specimen to the core ➔ Variations in personnel, testing conditions,
laboratory, and the communication of and methods, and perceived simplicity of
results testing methods all contribute to the
back to the clinical staff. potential lack of reliability.
Portable Devices ➔ Personnel: Variations in educational and
➔ Diminished space requirements for experience levels of staff performing the
operation and storage. tests, as well as potential staff turnover, can
➔ Wide menu of analytes. impact the reliability of results.
➔ Allows testing to be performed in a variety ➔ Test result variability: Compared to central
of locations. laboratory testing, POCT may experience
➔ Flexibility to meet the diversity of medical greater test result variability.
needs.
 Pre-Analytic Phase
- Test requisition
➔ Simplicity of waived testing is deceptive: - patient preparation
Incorrect results can be generated when all - Specimen collection
variables are considered. Staff training and - Transport and processing
monitoring with appropriate competency Analytic Phase
assessment will reduce the error level. - Actual testing
➔ Test results may not be comparable to Post analytic phase
central laboratory results - Data transmission/interpretation
➔ Methodologies employed in POCT differ - Release of the result
from those employed in the central
laboratory. PRE-ANALYTIC PHASE
➔ Comparison of results or standardization - Pre-analytic phase occurs prior to specimen
across POCT sites or locations may not be testing and may include variables involving
possible. This variability may impact patient the process of obtaining a specimen.
care. - The most serious error is failure to properly
identify the patient.
Patient outcome - Even if everything else is done
➔ POCT does not guarantee improved patient perfectly, the final result will not apply to the
outcomes. patient incorrectly presumed to be the
➔ POCT provides test results with a faster source.
turnaround time in most instances. - Additional clerical errors include
➔ To effectively expedite clinical management, missing the order and failure to obtain the
the entire clinical pathway must be test, misinterpreting the order.
optimized.
➔ A faster test result can contribute to the - Using the wrong specimen tube (e.g., wrong
improved patient outcome, but does not type and concentration of anticoagulant for
provide the sole factor for this final analysis specimen collection) and the effect of drawing
Lesson 9 blood from an infusion site.
- Hemolysis can occur if the tubes with
anticoagulant additives are not mixed gently
PHASES OF SAMPLE TESTING 5-10 times.
- If blood is drawn from a hematoma.
- Frothing of the sample
- If the venipuncture site is not dry
- Traumatic venipuncture.
- Indwelling lines or catheters are a potential
source of test error because most lines are
flushed with a solution of heparin to reduce
the risk of thrombosis.

Hemoconcentration from an increased

concentration of larger molecules and formed
elements in the blood may be due to several
factors:
● prolonged tourniquet application
● Massaging
● Squeezing
● long-term IV therapy
● sclerosed or occluded veins
 - Prolonged tourniquet application will cause normal ranges, so check reference ranges
hemoconcentration of non-filterable given for the test.
elements POST-ANALYTIC PHASE
- The hydrostatic pressure causes some - Post-analytical phase occur after a test
water and filterable elements to leave the result is generated.
extracellular space. - In general, such post-analytical errors occur
- Significant increases can be found in total with entry, manipulation, and reporting of
protein, aspartate aminotransferase (AST), test data. If results are written by hand or
total lipids, cholesterol, and iron. entered via keyboard, then an entry error
- This also affects packed cell volume and may occur.
other cellular elements in whole blood. - Errors in data transmission include relaying
- Failure to draw the sample into the proper or hearing verbal information incorrectly.
tube can interfere with test results by - Reporting problems include exceeding the
subjecting the sample to improper turnaround time for reporting or not notifying
coagulation or to chemicals that alter the the appropriate health care provider.
compounds to be measured.
- Failure to draw samples in the proper order
of tubes may contaminate samples.
- Example: a specimen for a complete blood
count should be drawn into a purple top
tube, but drawing into a red top tube without
anticoagulant will render the sample
untestable.

QUALITY ASSURANCE
- Phlebotomists must realize that QUALITY is
their responsibility.
- Result of the test sent to the physician
depends on the quality of the sample
phlebotomist obtained.
- Quality Assurance Program guarantee that
all areas of the health care facility are
providing the highest quality and most
appropriate patient care.

ANALYTIC PHASE
- Quality Assurance Program must contain
- Analytic Phase occurs during the actual
the element of Quality Control in order to
testing of the specimen.
function.
- Performance of tests in the laboratory is
- Quality Control comprises the methods of
rigorously controlled, with quality control
monitoring the processes that are providing
procedures in place that markedly reduce
patient care.
errors in the analytic phase of testing.
● Equipment maintenance
- Differences in the methods for performing
● Calibration of equipment
tests in different laboratories may yield
● Following phlebotomy standards
slight differences in reported results or
 - “Secret Shopper”
● Valuable tool in monitoring the
customer service of phlebotomists.
● Person hired by a laboratory to
come to a draw site with an order
from a physician.
● Trained to look for details in
performance.
● Reports findings to supervisor

QUALITY CONTROL
- Monitored by gathering data from several
Sources.
- Threshold for how many patients a
phlebotomist should be able to draw blood
from per hour is usually established for
each facility.
- To determine whether a phlebotomist is
meeting the minimum level or threshold
● Skill
- Patient satisfaction survey
● Good quality indicator
● Checklist to be marked by patients
from excellent to poor.
- Facility cleanliness
- Professionalism and
appearance of staff
- Satisfaction with waiting time
- Time spent waiting to be
served
- Overall experience
- Skill of the Phlebotomist

- Using gathered information from Lesson 1

satisfaction survey will help maintain quality Sophia Mae J. Clavecilla BSMT 1A
standards for the health care facility.
- Comments from clients will alert the
phlebotomists and the supervisors.
- All information should be documented as
proof for the quality assurance program.
- Documentation for corrective action should
be maintained.
 - An adult would use between twenty
and fifty leeches.
- Used in places where phlebotomy
and cupping could not be done,
such as internal membranes.
- They were often also applied inside
the nose, ear, eyes, mouth, anus,
and vagina.

PHLEBOTOMY
- The process of bloodletting
- “Breathing a vein”
Greek word - Phlebos – VEIN
Tome - INCISION

MIDDLE AGES
- Bloodletting was not performed by
physicians but by barber surgeons.
- Barber-surgeons also performed
amputations and pulled teeth.
- The red stripe on a barber pole originated
from the time when barbers performed
blood-letting; the red stripe was symbolic of
the bloodletting portion of their profession.
- At some point in the 16th century, surgery
Ways of bloodletting became more sophisticated and the job of
1. Phlebotomy bloodletting went back to the physicians.
- The direct cutting of a vein to
release blood.
- Done with a knife, later the
spring-loaded knife.
2. Cupping
- Done if the patient is too young, old,
or weak to stand phlebotomy
- The act of applying a cup, in which a
vacuum had been created through
the use of fire, to either intact skin to
cause tumefy or to a place where
small incisions had been made, to
draw out blood.
3. Leeching
- It required little skill.
- Leeches were ready to suck blood
at any time.
 - Some patients who are overweight and
have dee and/or small veins will be
particularly challenging.
- It is imperative that you have total control
over your hands as you perform your task.
- This will help your patients relax, and keep
you from having to restick them over and
over again.
EMPATHY
- There are a lot of people who hate needles,
and you will be dealing with them on a
George Washington - Died: December 14, 1799 regular basis. You will learn to recognize
- Severe throat infection them by their pale faces and the way they
- Cure was heavy bleeding grip the armrest and look away from you
- 9 pints of blood in less than while you prepare your materials.
24 hours Remember that all of your patients deserve
- A failed bloodletting respect, and it is your job to calm themdown
Philosophy of bleeding/bloodletting as the cure to and set them at ease about the procedure.
disease began to change.
- Use a gentle voice and reassure them that
AT PRESENT this will be a quick stick. Don’t force
- Phlebotomy, as we know it today, has a conversation during the procedure, and
different use. never try to trick your patient with a false
- It is not used to simply release blood from countdown. Treat them how you would want
the body but to acquire a sample of blood to be treated.
from a patient for diagnostic tests under a PATIENCE
physician’s orders. - Some patients are difficult to stick, and they
- Moreover, taking a blood sample is a quick, may not respond well when you have to try
- safe, and virtually painless procedure, multiple times or dig around to find a vein.
performed by a certified phlebotomist, in a - If they get frustrated or ask for someone
healthcare environment, using sterile tools. else, you will need to keep your cool and
● Discovery of microorganisms as causative maintain your composure.
agents of the disease started to change - If you are able to ask for someone else to
thinking of how to treat diseases try, honor
- their request. If you are unable to do so, try
THERAPEUTIC to DIAGNOSTIC to be patient with them and suggest other
Role of Phlebotomist tricks that might make them easier to stick
- Collects blood for accurate and reliable test to (tourniquets, trying a different area of the
results as quickly as possible with the least body, hot pack, etc.).
discomfort to the patient. - Will give you a chance to recover and show
TRAITS OF PHLEBOTOMIST that you know what you are doing.
PROFESSIONAL ATTITUDE CONFIDENCE
- Everyone must follow a professional code - You need to know what you are doing, but
of conduct in the treatment of patients you also need to KNOW you know what you
- Includes professional approach to are doing.
all aspects of the job - Having an air of confidence will put your
➔ Attitude is on top as to the importance patients at ease and make it more likely that
STEADY HANDS you will find a vein quickly and accurately.
- Phlebotomists spend a lot of time sticking
needles into people’s arms.
 - In order to build confidence, you need to
practice and learn a lot.
TEAM PLAYER
- A phlebotomist works with other medical
staff to ensure that each patient gets the
right treatment.
- You need to communicate effectively with
lab technicians, doctors, and other medical
professionals.
- When called upon to complete a role, you
have Steps required to follow during ACTIVE
- to be very cooperative since your LISTENING
performance affects the care other 1. Focus on the customer
professionals give the patient. 2. Limit talking to allow the customer to express
DETAIL ORIENTED their feelings
- a phlebotomy technician must follow the 3. Do not interrupt
correct procedures to ensure that the 4. Manage own thoughts
samples get to the lab with no mix-ups. 5. Listen for feelings, not just words
- This involves identifying the patient
correctly, following the right venipuncture GOAL OF COMMUNICATION - to create a
procedures, using the correct labels, and common understanding between two or more
accurate database entry. people.
- A small mix-up in the process can lead to - Common ground of understanding is
misdiagnosis and thus keenness is highly affected by each person's frame of
encouraged. reference.
PROFESSIONAL GROOMING FRAME OF REFERENCE
- Dress code restrictions - Background
- Education
Basic Concepts of Communication - Experience
GOOD COMMUNICATION
- Assurance of being the most important
person
- Shows attitude of caring
PHLEBOTOMY IN HEALTHCARE ❖ Patient has the right to information
Centralized regarding hospital business relationships
- Phlebotomist is part of a laboratory team that might impact his or her care.
and dispatched to hospital units to collect ❖ Patient has the right to consent or decline to
blood samples. participate in proposed research studies.
Decentralized ❖ Patient has the right to expect continuity of
- All members of the health care team share care.
the responsibility to collect blood samples. ❖ Patient has the right to be informed of
AREAS OF NURSING hospital policies and practices that relate to
● Neonatal patient care, treatment, and responsibilities.
● Obstetrics Lesson 2
● Oncology Sophia Mae J. Clavecilla BSMT 1A
● Orthopedics
● Pediatrics
● Intensive care Nosocomial Infection
● Coronary care - Healthcare-associated
● ER - Hospital-acquired
● Nephrology - Develops 48 hours after admission or within
● Geriatrics 30 days after discharge from a hospital or
AREAS OF THE LABORATORY healthcare facility.
● Phlebotomy Community-Acquired Infection
● Clinical Chemistry - Infection picked up prior to admission.
● Hematology
● Histopathology TYPES OF INFECTION
● Microbiology ● Local - Infection restricted to one area of
● Immunology and Serology the body
● Systemic - Infection that affects the entire
● Immunohematology (blood bank) body
● Autogenous - Infection from patient’s own
● Clinical Microscopy flora.
● Molecular Diagnostics COMMUNICABLE diseases
PATIENT’S RIGHTS - are caused by microorganisms such as
❖ Patient has right to considerate and bacteria, viruses, parasites, and fungi that
respectful care can be spread, directly or indirectly, from
❖ Patient has right to receive understandable one person to another.
information.
❖ Patient has the right to make decisions
about the plan of care and refuse treatment
❖ Patient has right to have an advance
directive
❖ Patient has the right to privacy
❖ Patient has the right to the confidentiality of
his or her medical records.
❖ Patient has the right to review records
❖ Patient has right to expect that within its
capacity and policies, a hospital will make
reasonable response to the request of a
patient for appropriate and medically
indicated care and services.
 1. Infectious agent Break: Reservoir
- the pathogen (germ) that - Cleaning
causes diseases. - Disinfection
2. Reservoir - Sterilization
- includes places in the environment - Infection prevention policies
where the pathogen lives. (people, - Pest control
animals and insects, medical Break: Portal of exit
equipment, and soil and water) - Hand hygiene
3. Portal of exit - Personal Protective Equipment
- the way the infectious agent leaves - Control of aerosols and splatters
the reservoir. (through open - Respiratory Etiquette
wounds, aerosols, and splatter of - Waste disposal
body fluids including coughing, Break: Mode of transmission
sneezing, and saliva). - Hand hygiene
4. Mode of transmission - Personal Protective Equipment
- the way the infectious agent can - Food safety
be passed on. - Cleaning
- Disinfection
- Sterilization
- Isolation
Break: Portal of entry
- Hand hygiene
- Personal Protective Equipment
- Personal hygiene
- First aid
- Removal of catheters and tubes
Break: Susceptible host
- Immunization
- Treatment of underlying disease
- Health insurance
- Patient Education

5. Portal of entry Immunization: Get Vaccinated

- the way the infectious agent can - Immune system is designed to have a
enter a new host. (through broken “memory” of previous infections.
skin, the respiratory tract, mucous - When the body encounters a microbe that
membranes, and catheters and has previously caused an infection, it
tubes). enhances its production of white blood cells
6. Susceptible host and antibodies to prevent infection a
- can be any person. (the most second time.
vulnerable of whom are receiving - When you get vaccinated, you “trick” your
healthcare, are body into thinking that it has been infected
immunocompromised, or have by a particular microbe—thus boosting its
invasive medical devices including own defenses against infection.
lines, devices, and airways).
If you don’t finish a course of antibiotics, harmful
Break: Infectious agent superbugs can grow.
- Diagnosis and Treatment
- Antimicrobial Stewardship
Take antibiotics exactly as your prescriber 2. Work practice control
recommends: - Handwashing
- Only take antibiotics prescribed for you—do - Proper disposal of sharps
not share or use leftover antibiotics. - Avoiding eating, drinking, smoking,
- Don’t save antibiotics for the next illness. handling contact lenses, or applying
Antibiotics treat specific types of infections. cosmetics or lip balm in work areas.
Taking the wrong medicine may delay - Storing food and drink separate from
correct treatment and allow bacteria to infectious materials.
multiply. 3. Housekeeping
- Discard leftover medication once the - Clean up spills
prescribed treatment course is completed. - Decontaminate soiled areas
UNIVERSAL PRECAUTION immediately with a disinfectant such
- Assumes that all blood and most body fluids as 10 percent bleach made up fresh
are potentially infectious. daily
Body Fluids - Avoid picking up broken glass with
- Amniotic hands.
- Peritoneal 4. Vaccination
- Pericardial - Many vaccines are primarily
- Synovial intended to prevent disease.
- Pleural - Vaccination has greatly reduced the
- Edematous burden of infectious diseases.
- Seminal 5. Private Rooms
- Cerebrospinal - Reduce the possibility of
Goal of standard precaution: transmission of infection by
- Reduce risk of transmission of separating patients with disease
microorganisms from both recognized and from other patients and health care
unrecognized sources of infection. staff.
- Consider all clinical samples as potentially Isolation Technique
infectious. - Category-specific isolation
STANDARD PRECAUTION - Disease-specific isolation
Five Points of Standard Precautions: - Transmission-based isolation
- Wash hands
- Wear gloves 6. Personal Protective Equipment
- Wear protective covering - Masks
- Wear a mask and eye protection when - Goggles
appropriate - Face shields
- Use designated sharps containers - Gowns
REDUCING EXPOSURE RISK - Gloves
1. Engineering Controls Keeping Hands clean
- Physical and mechanical devices - the number one way to prevent the spread
available to the health care of infection.
associate to reduce or eliminate the - Clean your hands after using the bathroom;
potential to transfer infectious after sneezing, blowing your nose, or
diseases. coughing; before eating; when visiting
● Sharps containers someone who is sick; or whenever your
● Transport bags and hands are dirty.
containers - Make sure that everyone around you,
● Self-sheathing needles and including healthcare providers and your
holders visitors, do too.
Safe Phlebotomy Practices Laboratory Techniques
- Steps that laboratory staff should follow - All procedures involving blood or potentially
when they extract blood. infectious materials are to be performed to
- For example, not using the same needle or minimize splashing, splattering, or
syringe on more than one patient. generation of droplets.
- Remember: One needle, one syringe, only - Health care associates must wear gloves
one time. and protective clothing when working with
Have a clean Environment any potentially infectious material.
- Ask to have your room or equipment Material Safety Data Sheets
cleaned. - Information must be on file to indicate the
- Keeping healthcare facilities clean is hazards of chemicals used in a laboratory.
extremely important. Fire Safety
- speak up and ask to have your room or RACE
equipment cleaned if they appear dirty or - Rescue anyone in danger.
dusty. - Sound the Alarm.
Occupational Safety and Health Administration - Contain the fire by closing doors and/or
- an Agency of the government windows.
- Investigates the possibility of unsafe - Extinguish/Evacuate.
practices in the work environment. Chemical Safety
- Develop and promote standards for all - Chemicals that produce a toxic or irritant
occupations vapor must be used only in an approved
- Develop and issue regulations chemical hood.
- Determine the level of compliance with - A chemical-resistant apron and face shield
health and safety regulations should be worn if there’s a danger of
- Level fines for noncompliance with health splashing.
and safety regulations. - Eye wash station and a safety shower.
- Exposure control plan must be developed Radiation Exposure
- Engineering controls specific to a safer - Phlebotomists must be aware of the
device must be used when feasible. institution’s radiation safety procedures.
- Employee input must be sought when - Phlebotomists may need to be shielded with
choosing safer devices. a special apron or cover gown
- Must do record keeping of any injuries - Monitoring devices for exposure may
Needles and sharps include a badge to detect exposure to
radioactivity.
Electrical Safety
- Equipment must be tested for safety and
proper operation.
Latex allergy
- Growing concern in healthcare
- Allergic reactions to latex
Type IV latex allergy
Biohazard labels must be fluorescent orange or - Irritant contact dermatitis resulting in
orange-red with lettering or symbols in a skin irritation
contrasting color. - Type I latex allergy
- More serious
- Immunologic reaction up to anaphylactic
shock.
Disposal Of Infectious Materials
- Incineration
- Chemical treatment
- Autoclave
Prevention of needlestick injuries
- Eliminate the use of needles when safe and
effective alternatives are available.
- Implement the use of devices with safety
features and evaluate their use.
- Identify hazards and injury trends.
- Set priorities and strategies for prevention.
- Ensure healthcare workers are properly
trained in the safe use and disposal of
needles and sharps.
Response to Accidental Exposure
- Wash exposed area with soap and water
- Report the incident to the supervisor
immediately
- Exposed staff must be tested for HIV and
HBV if consent is given.
- Source individual’s blood is tested for HIV
and HBV if consent is given.
- If the source patient refuses to test, is HIV
or HBV positive, or is in a high-risk
category, staff may elect to receive
prophylactic treatment.

PMSLP 2
Sophia Mae J. Clavecilla BSMT 1A
Lesson 3

- Transportation system for the body to

transfer substances and wastes from one
system to another.

Factory for bone production of blood cells:

- Bone Marrow
- Lymph Nodes
- Thymus
- Spleen
 - 150 lbs. (68 kg) contains approximately 5
liters of blood
- Preterm infant, 1 kg, only have 100 ml of
blood
- Only 2.5% must be drawn in one blood
draw
- No more than 5% must be drawn within the
30-day period.

- Formed elements of the blood make up only

45 percent of the total volume.
- Remaining 55 percent is liquid
- In blood, liquid portion is plasma
- When blood is removed from body, blood
clots and the liquid portion is called serum
Plasma
- Liquid portion of unclotted blood
Serum
- Liquid portion of clotted blood

Formed elements of the blood

● Erythrocytes - Red blood cells (RBCs)
● Leukocytes - White blood cells (WBCs)
● Thrombocytes - Platelets
 Steps in the clotting of blood
- Uncoagulated blood
- Calcium utilized
- Prothrombin converts to thrombin
- Fibrinogen converts to fibrin
- Clot formation with a serum extracted
Separation of plasma or serum from the blood
- Centrifuge
● Spins and separates blood into
layers depending on weight of each
layer.
- Serum removed from a clot
- Plasma removed from RBCs, WBCs, and
platelets
THE HEART
- Organ that keeps blood flowing
- Muscle with four (4) distinct chambers
● Right atrium –blood enters the heart
● Right ventricle – blood leaves the
heart
● Left atrium –blood enters the heart
● Left ventricle – blood leaves the
heart.

Complete Blood count (CBC)

- Differential count is only part of a complete
blood cell count (CBC).
- The rest of the CBC contains the number of
WBCs and RBCs, as well as the patient’s
hemoglobin and hematocrit.
- Used as general screening of patient’s
health.

Blood Oxygenation
- Deoxygenated blood flows through the right
side of the heart.
- From the heart, deoxygenated blood flows
through the pulmonary artery to lungs.
● Where oxygenation occurs
- Oxygenated blood returns to the heart from
the lungs via pulmonary vein to the left side
of heart.
Pulmonary artery Veins
- Only artery in body that carries - Part of the circulatory system that returns to
deoxygenated blood the heart.
Pulmonary vein - Contain valves that keep blood flowing in
- Only vein in body that carries oxygenated one direction.
blood. Arteries and veins
HEART TISSUES - Layers of veins and Arteries giving them
● Endocardium - a membrane layer that Structure And strength.
lines the inner chambers of the heart.
● Myocardium - this is the muscle of the heart
itself.
● Epicardium- the outermost membrane layer
of the heart.
INFECTION OF THE HEART
Endocarditis - Infection of the endocardium of the
heart

Coronary Arteries and Veins

- Coronary arteries supply blood to heart
muscle.
- Coronary veins remove waste products. - Antecubital fossa is usual location where
- When coronary arteries become occluded, phlebotomist chooses to draw blood Median
possibility of myocardial infarction (MI). cubital vein is in center of antecubital fossa
Electrical Stimuli (bend of arm) and used the majority of the
● Sinoatrial node (SA node) - Heart’s time.
pacemaker - Second choice for venipuncture:
● Atrioventricular node (AV node) - Causes ● Cephalic vein
atria to contract - Basilic vein is third choice for venipuncture
● Bundle of His (atrioventricular bundle) - ● More difficult and has a tendency to
Carries electrical impulse to ventricles roll
● Purkinje fibers - Receive impulse and cause ● Approach with caution
ventricles to contract ● Brachial artery and median
Blood pressure cutaneous nerve underlay basic
● Systolic Pressure - Pressure when heart is vein.
contracted Arterial Venipuncture sites
● Diastolic pressure - Pressure when heart is - Superficial veins in the hand
relaxed. - Arteries in the arm
- Blood pressure read as fraction ● Brachial artery in the brachial region
- Systolic pressure on top and diastolic of the arm
pressure on bottom ● Radial and ulnar arteries in the wrist
- Recorded in millimeters of mercury (mmHg) - Veins of the feet
E.g., 120/80 ● Physician’s permission needed
Systolic = 120 before drawing blood from veins of
Diastolic = 80 legs and feet.
Arteries
- Have thicker walls than vein because of
pressure exerted by heart.
- Part of the circulatory system that leaves
heart.
Sophia Mae J. Clavecilla BSMT 1A Timed Samples
Lesson 10 - Certain samples need the timing of
collection.
- Circadian, cyclical, and circannual changes
● Without proper sample preparation and must be considered.
handling, the most accurately collected Evacuated Tubes
blood sample could give invalid results - Filling of evacuated tubes
● Provision for accurate results can be done - Defective tubes
even if there is a delay in testing. - Wrong anticoagulant
● Even the most expensive analytical Syringe Collection
instrument available cannot give an - CLSI discourages the use of syringes.
accurate and precise result if PRE- - Difficult draws are best done with a butterfly
ANALYTICAL ERRORS exist. system.
● Attributed to phlebotomists’ responsibility - Transfer of blood from syringes to tubes
and the physiological factors of the patient. has higher chances of hemolysis.
● 46 – 56% of laboratory errors are PRE- Cleaning TheVenipuncture Site
EXAMINATION ERRORS. - Generally cleansed with alcohol.
- Betadine can increase certain tests.
PRE-EXAMINATION VARIABLES Non-alcohol cleaners must be used for
Patient Identification blood alcohol testing.
- Most serious and potentially most Order of draw
dangerous. - The order of draw for evacuated tubes will
- Misidentification will lead to harmful or even cause a carryover of additive from one tube
fatal treatment. to the next, resulting in compromised test
Tourniquets results.
- Should be no longer than one (1) minute. Chilling Samples
- Increases intervascular blood pressure. - Certain samples require chilling
- Causes hemoconcentration. immediately after collection.
Exercise - Placed in a mixture of ice and water.
- Vigorous exercise can affect the results of Warming Samples
testing. - Certain samples must be kept warm after
- The heart works harder due to increased collection.
metabolic activity. - Cold Agglutinins and Cryoglobulin
Stress specimens often require the specimen to be
- Stress being in the hospital kept warm after collection with a heel
- Stress dealing with the disease. warmer.
- The crying baby will have an effect on the Exposure To light
WBC count. - Light can be detrimental to certain samples.
Posture It is best to place the sample in an amber
- Change in blood volume affects results. tube or wrap the tube in aluminum foil.
- Lying down to standing will increase blood CRITERIA FOR RE-COLLECTION OR
pressure. REJECTION OF SAMPLE
Fasting Samples - When the test result is not consistent with
- Phlebotomists must ensure fasting samples previous test results, always recommended
are indeed drawn. to redraw and run the test again.
- Samples collected may mislead the - There are a variety of reasons for the
physician in treating patients. recollection or rejection of a sample.
- Type of sample acceptable and the volume
required are determined by the procedure
ordered.
 - Recollection is most often done to re-check ● Special containers are available for
results on a patient. transport.
- Transportation of samples from the ● Self-sealing bags have two compartments
phlebotomists’ location to the testing - For the sample
laboratory may use various methods that - For the requisition
will contain a spill or breakage of the ● Transporting of samples long distances by
sample. package service companies requires more
- Primary container is the container in which precautions because there can be leakage
the sample was collected. of the sample outside the packaging.
- Primary container must be placed in a - Companies do not exclusively
secondary container so any leakage or transport samples but all types of
breakage from the primary container will be products.
contained. - Any leakage could spread
SAMPLE TRANSPORTATION blood-borne pathogens to packages
● Increased use of plastic tubes has reduced delivered to someone’s home.
the incidence of breakage, caps should be ● Primary container is wrapped in absorbent
checked. package material and placed in a
- May use sealing film if needed secondary container.
● A plastic self-sealing bag can be used as a - Absorbent material must be
secondary container. sufficient to absorb the entire
- Multiple samples from one patient contents of the primary container.
can be placed in one plastic ● Secondary container is then placed in a
self-sealing bag shipping container.
- Samples from different patients ● Outside of the shipping container must have
should not be placed in the same a biohazard emblem.
plastic self-sealing bag.
● All labels must be attached to the sample INTERNATIONAL AIR TRANSPORT
tubes before they are placed in the bag. ASSOCIATION (IATA)
● Place a large number of samples in a rack Two (2) Categories of Infectious Substances
to avoid spillage or breakage then the entire ● Infectious Substance, Category A
rack be placed into a bag or leakproof box. - in a form that, when exposure to it
- Standard camping cooler is occurs, is capable of causing
excellent for this purpose permanent disability, life-threatening
- Biohazard emblem must be or fatal disease in otherwise healthy
attached. humans or animals.
● Moving samples within a building or to The proper shipping name:
another building a short distance may be - UN 2814 (Infectious substances, affecting
accomplished by a pneumatic tube system. humans).
● Pneumatic tube system are more traumatic - UN 2900 (Infectious substances, affecting
than hand carrying the samples but have animals).
the advantage of faster delivery. ● Infectious Substance, Category B
● To prevent trauma to the sample, a bagged - Infectious substance which do not
sample is placed into a padded container to meet the criteria for inclusion in
maintain the integrity of the sample. Category A
● Some laboratories have local couriers who - UN 3373
pick up samples. - can be human or animal material
● Couriers are trained in how to handle including (but not limited to) blood
blood-borne pathogens. and its components, tissue, tissue
fluids or body parts being
transported for purposes such as
research,
diagnosis, investigational activities, disease
treatment or prevention.
MEDICO-LEGAL TRANSPORT
● Collection of samples from correct
individual
- Blood alcohol testing
- Paternity testing
- Legal toxicology testing
● Chain of custody form be accomplished
- Certifies that the sample was
obtained correctly
- Individuals in possession of the
sample listed
- Technologist who performed the test
is named
- Sample must be secure and must
not be exposed to extremes that
would alter the results.
Sophia Mae J. Clavecilla BSMT 1A - Results of testing are compared
Lesson 11 Timed sample
- Collected at a specific time during a 24-hour
period or after a specific activity such as
eating.
● Samples collected by patients should be
24-hour sample
given more time to discuss the procedures
- Sample is collected over a 24-hour period
● Instructions are given to patients so that
to test for diurnal variation
best possible sample may be obtained.
- Creatinine clearance
● Without the instructions, the result may vary
- Catecholamines
depending on how the patient collected the
- 17-hydroxysteroids
sample.
- Electrolytes
● Patient education is necessary for proper
- First morning sample is discarded, then all
sample collection and non-contaminated
urine is saved including the next first
sample tested.
morning sample.
● Phlebotomist is often responsible for a
- The test starts and ends with an empty
variety of patient samples besides blood.
bladder.
● Patients can collect samples from butter
- All urine is saved, including urine during
tubs to soda bottles or any available
bowel movements.
cotainer at home.
- Patient cooperation is the major drawback.
● Residue from unclean containers can alter
Clean-catch midstream urine (CCMS) collection
results dramatically.
- Most common sample collection
● Phlebotomist does not have control over
- Patient cleans himself / herself with
how patient collects sample.
antiseptic
● Patient cooperation in following instructions
- Patient urinates in the toilet and then stops
is essential.
then continues to urinate in the collection
URINE
container.
● Most common sample the patient needs to
- Urine is submitted for testing
collect
Catheterized urine collection
● Urine collection requires specific
- Only collected when the patient cannot
instructions to patient to obtain accurate
voluntarily produce urine.
sample.
Chain of custody urine
● Laboratory should provide the collection
- Usually used as part of pre-employment
container to ensure cleanliness.
physical
● Sample for culture must be sterile
- Legal sample collections
● Collection requirements is different
- Sample is collected from the patient.
depending on whether collection is from
- Temperature of urine is checked to
male, female, or child.
determine if urine is fresh.
Types of Urine Sample
Urine culture collection
First morning or 8-hour sample
- Sample is collected midstream into a sterile
- Most concentrated sample.
container
- Eight hours refers to samples collected by
- Sample must be cultured within 1 hour of
day-sleeping patients.
collection and refrigerated or a special
Random sample
preservative container is used.
- Can be collected anytime
Problems associated with urine samples
Double – voided sample
Delay in testing can cause:
- Sample is tested at two specific times
- Deterioration of chemical and cellular
- Patient collects urine, then drinks 200 ml, of
components.
water and waits two hours (or a specific
- Multiplication of bacteria.
time) to collect another sample.
 - Decrease or increase in analytes due to - Semen samples are collected to determine
bacterial growth in specimen. the number and activity of sperm contained
Precautions to avoid problems with a delay in in semen.
testing. - Required as a post vasectomy sample to
If testing is delayed more than one hour, determine if vasectomy was successful.
special precautions must be taken: - Must be delivered to the laboratory within 2
- Refrigeration at 5oC hours of collection, no time constraint.
- Special preservatives - Only reports presence or absence of sperm.
- Patient kit provided - Patients must follow specific instructions
- Cleansing towelette and complete a questionnaire as they
-Sterile urine collection cut with screw cap submit sample.
-Preservative tube for urine STOOL
-Fresh urine is best, then refrigerated or Submitted for different types of testing:
iced - Occult blood
Special Preservative Tubes - Culture
- Ova and parasites
- 24-hour chemistry tests
- E.g., urobilinogen, fecal fat
● Feces collection is often embarrassing for
Patients.
● Phlebotomist or laboratory staff must be
sensitive to patients’ feelings when giving
instructions.
● Be sure the patient understood the
instructions by letting them repeat the
- Urine preservative tubes and urine transfer instructions given.
straw ● Placed in sterile leak-proof container
24-Hour Urine container - Liquid stool: 1 teaspoon (5 ml.)
- Formed stool: pea-sized
- Culture: Place in enteric transport
media (Cary & Blair) if transport
exceeds 1 hour
- Can be transported within 24 hours
at RT
- Can be stored at 4°C for 72 hours

- Container may contain hydrochloric acid or

boric acid to preserve sample
- Container is recommended to be amber to
protect the specimen from light.
SEMEN
- Semen samples are collected to determine
the number and activity of sperm contained
- Occult blood samples collected by patient
in semen.
and placed on card.
- Done as part of fertility study
- Must be delivered to the laboratory within
30 minutes.
- Reports and checks for number of sperm,
sperm motility and sperm abnormalities.
 Nasopaharyngeal Swab
- Done with a Dacron or cotton-tipped flexible
wire swab.
- Wire on the swab shaft is made to bend so
that it can be gently pushed into the nose
and pass into the nasopharynx.
- Commercially available swabs and
- Ova, parasite, and stool cultures collected transport media available for use.
in Special Preservative containers.
RESPIRATORY SAMPLES
Sputum
- Mucus and phlegm that a person coughs
out from lungs, bronchi, or trachea.
- Sample needs to be produced through
coughing by patient and then expectorated
into sterile container.
- Patient must rinse mouth prior to
expectoration. Oropharyngeal swab
- Gargle with water to rinse mouth to remove - Use only sterile Dacron or rayon swabs with
excess food particles and bacteria. plastic shafts or if available, flocked swabs.
Throat Swab - DO NOT use calcium alginate swabs or
- For patients with sore throat swabs with wooden sticks, as they may
- Usually for Culture and Sensitivity Test contain substances that inactivate some
- Throat should be swabbed with enough viruses and inhibit some molecular assays.
force to remove organism adhering to the - Insert swab into the posterior pharynx and
throat membrane. tonsillar areas. Rub swab over both tonsillar
- Be especially certain to swab any redness, pillars and posterior oropharynx and avoid
rawness or white patches for optimum touching the tongue, teeth, and gums.
recovery of Streptococcal pathogens.
- Throat cultures or nasopharyngeal cultures
are collected using special swab devices
that have a preservative in the transport
container.
 - Used for COVID-19 Testing

- Nasopharyngeal, Oropharyngeal and throat

culture transport containers.

Drug detection in Meconium or Umbilical Tissue

- Female taking prescription or illegal drugs
during gestation may adversely affect
neonatal development.
- Testing either meconium or a section of
umbilical cord.
- Test for large panel of drugs to determine if
any is present.
- Meconium is a dark, tarry material passed
from neonates rectum in the first days after
birth until milk or formula-based stool
appears.
- Meconium is preferred over urine
- Urine will only test the last 1 – 10 days
Meconium or umbilical cord will document
drug use over an extended period of time
covering at least the last trimester of
pregnancy.
- Meconium takes several days to be
expelled.
- Umbilical cord is available upon delivery.