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Phlebotomy Technician Course Outline

Each lecture session is four hours in length. The requirements for the completion of the course include attendance of all lectures Sessions as well as the completion of forty hours of practical work in a lab/clinical environment as specified by the instructor

Session One
Introduction to Phlebotomy Communication skills and interpersonal relationships; Community
Stress management, ethics, legal issues Personal wellness Ways to control stress Ethical and legal issue in healthcare Public relation and client interaction: Recognizing diversity, Professionalism, Ethical behavior, Patient rights. Communication skills and interpersonal relationships: Effective communication in healthcare. Healthcare delivery: Health care facilities, Ambulatory care and homebound services, Public health care service. Health care financing: Third-Party payers, Diagnosis and billing codes Medicare and Medicaid programs The Changing healthcare system: Managed care, Medical specialties. Departments within the hospital setting

Quality Assurance in Healthcare


Quality assurance and control for accurate and reliable results Areas of Phlebotomy Subject to Quality assurance and Quality control inc specimen collection, delta checks. Clinical Laboratory Improvement Act (CLIA) National Standard and Regulatory agencies. Quality Improvement. Quality Assurance in Phlebotomy: Definition, QA indicators, Threshold and data, Process and outcomes. Areas of phlebotomy subject to quality assessment: Patient preparation procedures, Specimen collection procedures. Documentation: Medical record; Collection manuals; The procedure manual; The safety manual; The infection control procedure manual; QA forms.

Session Two
Human anatomy and physiology review.
Introduction. Anatomic position. Body planes. Body directional terms. Body cavities. Body Functions: Homeostasis, Metabolism. Body organization. Body systems (Functions, Structures, Disorders, Diagnostic tests): Skeletal, Muscular.

Body systems (Functions, Structures, Disorders, Diagnostic tests): Reproductive, Digestive, Endocrine, Nervous. Body systems (Functions, Structures, Disorders, Diagnostic tests): Urinary, Integumentary, Respiratory The Circulatory system The Heart: Structure, Function, Disorders, Diagnostic tests. The Vascular system: Functions, Structures, The flow of blood. Phlebotomy-Related vascular anatomy. Vascular system disorders. Diagnostic tests Hemostasis: Primary and Secondary hemostasis. Hemostatic disorders and Diagnostic tests. The Lymphatic system: Function, Structure, Lymph flow, Lymphatic system disorders, Diagnostic tests.

Session Three
Infection Control
Infection: Communicable Infections, Nosocomial Infections. The chain of infection: Infectious agent, Reservoir, Exit pathway, Means of transmission, Entry pathway, Susceptible host. Breaking the chain of infection. Advanced infectious diseases Infection control programs: Employee screening and immunization, Evaluation and treatment, Surveillance. Infection control methods: Hand hygiene, Personal protective equipment. Isolation procedures

Safety
Biosafety. Biological hazards: Biohazard exposure routes, Bloodborn pathogen. OSHA regulation: Needlestick Safety and Prevention Act, Exposure Control Plan. BBP exposure routes, Exposure incident procedure, Surface decontamination, Body fluid spill cleanup, Biohazard waste exposure Electrical safety. Fire safety: Classes of fire. Radiation safety. Chemical safety. First Aid procedures: External hemorrhage, Shock. Personal wellness: Personal hygiene, Proper nutrition, Rest and exercise, Stress management.

Session Four
Medical terminology
Introduction. Word roots. Prefixes/Suffixes. Combining vowels/forms. 1 hour Word element classification discrepancies. Unique plural endings Pronunciation. Abbreviations and symbols. Joint commission Do Not Use list

Blood Collection Equipment Introduction. General blood collection equipment : Blood-drawing station, Chairs, Carts
and Trays, Gloves, Antiseptics, Disinfectants, Gauze pads, Bandages, Needle and sharps Disposal containers, Slides. Venipuncture Equipment Vein locating devices. Tourniquets. Needles: Types, Gauge, length, Safety features. Evacuated tube system: Multysample needles, Tube holders, Evacuated tubes. Syringe system. Winged Infusion Set (butterfly). Combination systems. Demonstration of equipment Skin Puncture equipment.Lancets; Collection devices; Plastic/Clay sealant; Capillary blood gas collection equipment; Warming devices

Session Five
Venipuncture Procedures
Venipuncture steps The test request: initiation of test request; Receipt of test request by the lab, Review of test requisition, Accessioning the test request. Initiating patient contact; Looking for signs; Identifying yourself; Handling special situations. Patient Identification: Verifying name and date of birth, Checking identification bracelets, 3-way ID, Id discrepancies, Missing ID, Sleeping patients, unconscious patients, Emergency room ID procedures. Identification of infants, young, mentally incompetent, non-English speaking patients. Identification of outpatients. Preparing the patient for testing: Explaining the procedure; Addressing patient inquires; Handling patient objections; Handling difficult patients; Addressing needle phobia; Addressing objects in the patients mouth. Bedside manners. Verifying diet restrictions. Blood Collection Additives. The Blood: Blood composition. Blood type: ABO blood group system, RH blood group system, Compatibility testing/crossmatch. Types of blood specimens: Serum, Plasma, Whole Blood. Blood disorders. Diagnostic tests

Anticoagulation theory
Hemostasis: Primary- vasoconstriction, platelet plug formation Secondary- fibrin clot formation, fibrinolysis Anticoagulants: EDTA, Citrates, Heparin, Oxalates. Special-Use anticoagulants. Antiglycolytic agents. Clot activators, Thixotropic gel separator, Trace-element free tubes.

Waste disposal
Biosafety. Biological hazards: Biohazard exposure routes, Bloodborn pathogen. OSHA regulation: Needlestick Safety and Prevention Act, Exposure Control Plan. BBP exposure

routes, Exposure incident procedure, Surface decontamination, Body fluid spill cleanup, Biohazard waste exposure.

Session Six
Venipuncture Procedures
Venipuncture steps The test request: initiation of test request; Receipt of test request by the lab, Review of test requisition, Accessioning the test request. Initiating patient contact; Looking for signs; Identifying yourself; Handling special situations. Routine (Evacuated Tube System) venipuncture. o Assemble equipment and supplies; Wash hands and put on gloves; Position patient; Apply/Release tourniquet; Venipuncture site (select, clean); o Needle insertion (position, angle); Fill the tubes (remove, mix), Withdraw the needle (activate safety features); Post puncture care (apply pressure, check puncture site, apply bandage); Labels; Specimen transportation. Butterfly procedures (hand). Syringe procedure. o Pediatric venipuncture. o Geriatric venipuncture. o Dialysis patients. Long-term care patients. Home care patients. Hospice patients. o Composition of skin puncture blood. Indications for performing skin puncture (adult and children/ infant). Skin puncture site selection criteria

Skin Puncture procedure.


Special skin puncture procedures. Routine blood smear preparation. Capillary blood gases. Newborn screening. Neonatal bilirubin collection. Practical demonstration.

Session Seven
Post Puncture Care
General Guidelines Post procedure patients examination inc. patients With allergic reaction, syncope, hematomas. How to prevent the complications such as hematoma formation, inadvertent arterial puncture, infection, nerve damage, pain, vien damage. Blood collection variables and complications. Introduction. Basal state. Physiologic variables. Site selection variables ( problem sites ). Vascular access devices and venipuncture sites Complications and procedural errors associated with blood collection. Complications related to patient conditions: Allergies to equipment and supplies; Excessive bleeding; Fainting; Nausea and vomiting; Pain; Petechiae;

Seizures/Convulsion. Complications and procedural errors that adversely affect the patient: Hematoma formation; Iatrogenic anemia; Inadvertent arterial puncture; Infection; Nerve injury; Reflux of anticoagulant; Vein damage. Procedural errors that affect specimen quality: Hemoconcentration from venous stasis; Hemolysis; Partially filled tubes; Specimen contamination. Procedural errors that lead to failure to draw blood (tube and needle position). Collapsed vein.

Advanced anatomical site selection and Patient preparation


Procedure for vein selection (incl median cubital and cephalic veins) Preparing the patient for testing inc. bedside manner, handling difficult patient, explaining the procedure, handling patient objections to testing. Blood cultures (collection procedure, antimicrobial neutralization products) Therapeutic Drug Monitoring (peak level, though level, trace element) Practical demonstration.

Session Eight
Advanced anatomical site selection and Patient preparation (Cont)
Procedure for vein selection (incl median cubital and cephalic veins) Preparing the patient for testing inc. bedside manner, handling difficult patient, explaining the procedure, handling patient objections to testing. Blood cultures (collection procedure, antimicrobial neutralization products) Therapeutic Drug Monitoring (peak level, though level, trace element)

Advanced Infection Control


Infection control programs: Employee screening and immunization, Evaluation and treatment, Surveillance. Infection control methods: Hand hygiene, Personal protective equipment. Isolation procedures. Safety Biosafety. Biological hazards: Biohazard exposure routes, Bloodborn pathogen. OSHA regulation: Needlestick Safety and Prevention Act, Exposure Control Plan. BBP exposure routes, Exposure incident procedure, Surface decontamination, Body fluid spill cleanup, Biohazard waste exposure. Electrical safety. Fire safety: Classes of fire. Radiation safety. Chemical safety. First Aid procedures: External hemorrhage, Shock. Personal wellness: Personal hygiene, Proper nutrition, Rest and exercise, Stress management.

Knowledge of Preanalytical Sources of Error


Troubleshooting guidelines and Evacuated blood collection system problem solving Physiologic and site selection variables that influence specimen composition Possible Sources of Preanalytical Errors.

Session Nine
Knowledge of Preanalytical Sources of Error (cont)
Troubleshooting guidelines and Evacuated blood collection system problem solving Physiologic and site selection variables that influence specimen composition Possible Sources of Preanalytical Errors. Before Collection: Related to patient (age, altitude, inadequate fast, dehydration, exercises, gender, medications, stress, pregnancy, smoking, treatments); Problems with requisitions (incomplete requisition, duplicate test orders, wrong test ordered). Corrective actions At time of collection : misidentified patient, patient position, improper vein selection, nonsterile site preparation, antiseptic not dry, prolonged tourniquet application, incorrect needle size and position, improper tube selection and use, wrong collection time. Corrective actions. During specimen transportation: agitation-induced hemolysis, delay in transporting, exposure to light, failure to follow temperature requirements, transport method. Corrective actions. During Specimen Processing: contamination, delay in processing or testing, delay in fluid separation from cells, evaporation,failure to centrifuge specimen according to test requirements, incomplete centrifugation, mislabled aliquot, multiple centrifugations, rimming of clots. Corrective actions. During specimen storage: Exposure to light, temperature changes. Corrective actions.

Risk factors and appropriate response


Complications and procedural errors associated with blood collection. Complications related to patient conditions: Allergies to equipment and supplies; Excessive bleeding; Fainting; Nausea and vomiting; Pain; Petechiae; Seizures/Convulsion. Complications and procedural errors that adversely affect the patient: Hematoma formation; Iatrogenic anemia; Inadvertent arterial puncture; Infection; Nerve injury; Reflux of anticoagulant; Vein damage. Procedural errors that affect specimen quality: Hemoconcentration from venous stasis; Hemolysis; Partially filled tubes; Specimen contamination. Procedural errors that lead to failure to draw blood (tube and needle position). Collapsed vein Practical demonstration.

Session Ten
Recognition of and corrective action
Recognition of and corrective action to take, for problems with requisitions, specimen transport and processing General Guidelines Handling and Transporting of Routine Specimens Specimens requiring special handling Specimen Processing

Requisitions (manual, computer). Review of requisition

Legal issues related to blood collection


Divisions of Law Standard of care, Respondeat Superior, Vacarious Liability, Malpractice insurance. Patient Consent. Patient Bill of Rights. OSHA Regulations. The Litigation Process Legal Cases involving Phlebotomy procedures. Tort: Assault, Battery, Fraud, Invasion of privacy, Breach of confidentiality, Malpractice, Negligence, Standard of care, Statute of limitations, Vicarious liability. Malpractice insurance. Patient consent: Informed consent, Expressed consent, Implied consent, HIV consent, Consent for minors, Refusal of consent. The litigation process. Legal cases involving phlebotomy procedures. Risk management.