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 patient’s 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 patient’s 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.