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SCHOOL OF PARAMEDICAL STUDIES TEL (876)858-1156, (876)845-4862 & (876)620-9505

PHLEBOTOMY TECHNICIAN

Programme Description

The profession of phlebotomy is taught through didactic, student laboratory, and clinical experiences. The student will be trained to perform a variety of blood collection methods using proper techniques and precautions including: vacuum collection devices, syringes, capillary skin puncture, butterfly needles and blood culture specimen collection on adults, children and infants. Emphasis will be placed on infection prevention, proper patient identification, proper labeling of specimens, and quality assurance. Students will be taught specimen handling, processing and accessioning. Students will learn the theory and principles of CLIA waived laboratory tests and perform the tests in the student laboratory. The testing performed will include: manual hematocrits, Urinalysis dipsticks, fecal occult blood, and pregnancy testing.

Purpose The Phlebotomist is a valuable member of the health care team responsible for the collection, processing, and transport of blood specimens to the laboratory. Phlebotomy is the collection of blood in treatment and prevention of disease. The purpose of this programme is to prepare students for employment as phlebotomists or to provide supplemental training for persons previously or currently employed in this occupation. The content includes, but is not limited to, communication, leadership, human relations, and employability skills; performance of safe and efficient work practices in obtaining adequate and correct blood specimens by capillary or venipuncture on adults, children and neonates; maintaining the integrity of the specimen in relation to the test to be performed; preparing blood smears; labeling specimens accurately and completely; collecting timed specimens; promoting the comfort and well-being of the patient while performing blood collecting duties; observing safety policies and procedures; medical terminology; emergency procedures including CPR; delivering a variety of clinical specimens to the clinical laboratory; sorting and recording specimens received in the laboratory; centrifuging specimens and preparing aliquots of samples according to the designated protocol; distributing samples to appropriate laboratory sections; and preparing collection trays for specimen procurement. Reinforcement of basic skills in English, mathematics, and science appropriate for the job occurs through classroom instruction and applied laboratory procedures or practice. This programme meets the needs of students with no prior knowledge or experience in phlebotomy. It also provides training consisting of hands-on lab and Clinical experiences. Course unit Format The Course units training system allows for the continuous adaptation of a programme. Each Course unit is designed to be self-contained so that the successful completion of training in a unit will ensure the acquisition of the minimum skills levels for performing the activity under employment conditions. The Course Units are divisions of work which indicate the start and finish of a training activity; they cover major areas of

competencies and are an organized group of ‘learning experiences assembled to achieve a specific group of related objectives’. Independent units can be combined to suit the needs of individual candidates, and to reflect changes in the occupation.

Units Objective The objective of the Unit serves to highlight the main focus of the Unit and specifies that which the candidate must be able to do to demonstrate competence in the Unit.

Knowledge Requirement This component focuses on areas that the candidate must know, that is, principles of operation, theories, related knowledge, among other things, and which must be applied in the performance of the application of the practical activities.

Re-enforcement and practice This describes student-centered learning and activities that will reinforce knowledge provided by the instructor.

Programme Objectives

The Phlebotomy Technician Course is designed to provide students with:

The technical skills needed to competently and safely collect and handle blood specimens from a variety of patients.

The interpersonal skills needed to interact with others. The knowledge base needed to pass national certification exams. An introduction to health care professions with emphasis on clinical laboratory science.

Programme Goals

Upon completion of this program the student will successfully:

1. Demonstrate knowledge of the health care delivery system and medical terminology. 2. Demonstrate knowledge of infection control and safety. 3. Demonstrate basic understanding of the anatomy and physiology of body systems. 4. Associate the major areas / departments of the clinical laboratory with the laboratory tests ordered to

evaluate a patient’s pathologic condition / illness. 5. Demonstrate understanding of the importance of specimen collection in the overall patient care

system. 6. Demonstrate knowledge and use of collection equipment, various types of additives used, special

precautions necessary substances and pre-analytical variables that can adversely affect the blood sample and/or interfere in clinical analysis of blood constituents.

7. Demonstrate proper techniques to perform venipuncture and capillary puncture. 8. Demonstrate knowledge of pre-analytical errors that can significantly alter results. 9. Demonstrate understanding of requisitioning, specimen transport and specimen processing. 10. Demonstrate understanding of quality assurance in phlebotomy. 11. Demonstrate understanding of the basic concepts of communications, personal and patient

interaction, stress management, professional behavior and legal implications of the work environment.

Common Career Technical Core – Career Ready Practices Career Ready Practices describe the career-ready skills that educators should seek to develop in their students. These practices are not exclusive to a Career Pathway, programme of study, discipline or level of education. Career Ready Practices should be taught and reinforced in all career exploration and preparation programmes with increasingly higher levels of complexity and expectation as a student advances through a programme of study.

1. Act as a responsible and contributing citizen and employee. 2. Apply appropriate academic and technical skills. 3. Attend to personal health and financial well-being. 4. Communicate clearly, effectively and with reason. 5. Consider the environmental, social and economic impacts of decisions. 6. Demonstrate creativity and innovation. 7. Employ valid and reliable research strategies. 8. Utilize critical thinking to make sense of problems and persevere in solving them.

9. Model integrity, ethical leadership and effective management. 10. Plan education and career path aligned to personal goals. 11. Use technology to enhance productivity. 12. Work productively in teams while using cultural/global competence.

Course Materials 1. Handout Phlebotomy Essentials 5th Edition 2. Medtex Medical Corporation Fundamentals Of Phlebotomy 2nd edition 3. American Red Cross First Aids/CPR/AED Manual 4. E-Book on Vital Sign 5. permanent marking pen 6. Ink pen 7. Digital timer capable of counting seconds 8. Scrubs/Lab Coat – appropriately fitting and professional in appearance 9. Gloves

PLEDGE TO THE PROFESSION As an allied health care laboratory professional, I strive to:

• Maintain and promote standards of excellence in performing and advancing the art and science of my profession

• Preserve the dignity and privacy of others • Uphold and maintain the dignity and respect of our profession • Seek to establish cooperative and respectful working relationships with other health professionals • Contribute to the general wellbeing of the community

I will actively demonstrate my commitment to these responsibilities throughout my professional life.

Phlebotomy Technician Programme Structure This program is a planned sequence of instruction consisting of 2 learning completion courses, with a total of 15units in 495hours for 19 Credits

15 lectures hours is equivalent to 1 credit, while 45 practical/laboratory hours is equivalent to 1 credit

No’s Course Title Lecture Hrs Practical Hrs Total Hrs Course Credits

A Basic Healthcare Core 90 135 225 9

B Phlebotomy 1 & 2 90 180 270 10

After completing this programme, graduates take the following exams:

SPACS final Examination 1 & 2

Registered Phlebotomy Technician (RPT), American Medical Technologists (AMT)-USA or

Certified Phlebotomy Technician (RPT), American Allied Health (AAH)-USA or

Registered Phlebotomy Technician (RPT), American Medical Certification Association (AMCA)-USA Instructional Methods and Activities:

Lecture(Multimedia Power Points)

Individualized Study

Small Group Discussions/Projects

Skills Demonstration

Competency Check-off

Role Play

Independent Research

Homework Assignments

PHLEOTOMY TECHNCIAN CHEDULES

Programme title -Phlebotomy Technician Lecture Hrs

Programme -No A

Course -Basic Health Science Core

1. Introduction to health care 5

2. Safety standards, procedures and OSHA Regulations/Regulatory Guideline for Phlebotomy Practice

5

3. Legal, Ethical, Confidential and Professional Consideration/HIPAA and Patients’ Bill of Right 5

4. Communication and interpersonal relations, Clerical Skill and Duties 5

5. Medical terminologies, Anatomy and Physiology 15

6. Introduction to Phlebotomy and Quality Assurance/Quality Control in Phlebotomy 10

7. Blood circulatory system 10

8. Phlebotomy Equipment and Supplies 15

9. Performing Venipuncture and Dermal Puncture Procedures 20

Total Lectures hours 90

Programme title -Medical Lab Assistant/Technician Lecture Hrs

Programme -No B

Course -Phlebotomy 1 & 2

1. Clinical Laboratory Procedures 15

2. Special handling and processing Procedures 20

3. Special phlebotomy Techniques 20

4. Trouble shooting 15

5. Waste disposal and Decontamination Techniques 10

6. Practicing Phlebotomy 10

Total Lectures hours 90

A. BASIC HEALTH SCIENCE CORE COURSE DESCRIPTION: An introduction to the health care environment, this course focuses on the health care team and Health Care Services Delivery systems. Students will learn about legal responsibilities, ethical issues, safety, medical terminologies infection control, communication, interpersonal behaviors, wellness, and disease and anatomy and physiology

UNIT 1 – INTRODUCTION TO HEALTH CARE Description/Aim: This unit provides students with an exploratory introduction to several healthcare careers and the safety procedures and interpersonal communication skills required for them. The unit will enable students to receive initial exposure to healthcare science skills; attitudes applicable to healthcare including the concepts of health, wellness, and preventative care; and responsibilities of today’s healthcare provider METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, role paly exercises, handouts, demonstrations, role play exercises, assignments, project research and case studies where applicable.

Learning Outcomes: Upon successful completion of this this, students are able to do the following:

Discuss the roles of various health care professionals in the current health care delivery system.

Identifying common methods of payment for healthcare services.

Describing the various types of health care providers (facilities) and the range of services available including resources to victims of domestic violence.

Describing the composition and functions of a health care team.

Recall the educational background methods of credentialing and licensing requirements of health care professions on a state and national level.

Describe the current health care systems and their trends.

Define professionalism.

Identify the rights and responsibilities of being a health care professional.

Identify problem solving skills in a health care situation.

Describe problem solving skills to various health care situations. 1. Prerequisites: (Critical Reading & Thinking) or satisfactory basic assessment skills. 2. Suggested General Guidelines for Evaluation: Comprehension of course material is evaluated

through final examination, research paper, text assignments, and a presentation Logic and critical thinking

3. Attendance: is mandatory and will be taken at every class. If you will be unable to attend a class, you will need to leave early, or you will arrive late please advise your instructor at your earliest opportunity not less than 24hours.

4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in introduction to health care is 70%.

UNIT 2: SAFETY STANDARDS, PROCEDURES AND OSHA REGULATIONS Description/Aim:

This unit covers OSHA policies, procedures, and standards, as well as general industry safety and health principles. Topics include scope and application of the OSHA general health industry standards. Special emphasis is placed on those areas that are the most hazardous, using OSHA standards as a guide METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, lab exercises, assignments, project research and case studies.

Learning Outcomes: Upon successful completion of this unit, students are able to do the following:

Describing personal and jobsite safety rules and regulations that maintain safe and healthy work environments.

Identifying and practicing security procedures for medical supplies and equipment.

Demonstrating personal safety procedures based on Occupations Safety and Health Administration (OSHA) and Centers for Disease Control (CDC) regulations (including standard precautions).

Recognizing Materials Data Safety Sheets (MSDS) and complying with safety signs, symbols and labels.

Demonstrating proper body mechanics and ergonomics.

Demonstrating the proper procedure for identifying patients.

Describing fire safety, disaster and evacuation procedures.

Defining the elements used in a disaster and/or emergency response plan.

Discussing The Joint Commission patient safety goals. (www.jointcommission.org)

Explaining emergency procedures to follow in response to workplace accidents

Defining principles of infection control including standard and transmission based precautions.

Demonstrating knowledge of medical asepsis and practicing procedures such as hand washing and isolation and describing surgical asepsis.

Describing how to correctly dispose of bio hazardous materials, according to appropriate government guidelines such as OSHA

1. Prerequisites: (Critical Reading & Thinking) or satisfactory basic assessment skills. 2. Suggested General Guidelines for Evaluation: Comprehension of course material is evaluated

through final examination, research paper, text assignments, and a presentation Logic and critical thinking.


4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in safety standards, procedures and OSHA regulations is 70%.

UNIT 3: LEGAL, ETHICAL, CONFIDENTIAL AND PROFESSIONAL CONSIDERATION/HIPAA AND PATIENTS’ BILL OF RIGHT

Description/Aim: This unit reviews general healthcare ethics and professional boundaries. It focuses on making sure that healthcare workers understand how to make ethical decisions and why professional boundaries are integral in healthcare. This unit should be tailored to better prepare students for situations they may face in their specific occupations and work environments METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by

lectures, role paly exercises, handouts, demonstrations, role play exercises, assignments, project research and case studies.


Identify a framework for ethical decision making

Be familiar with and know the purpose of the patient’s bill of rights Understand personal and professional boundaries and why they are important

Describe the role personal and professional boundaries have in creating positive relationships with patients and teammates

Understand appropriate boundaries with social media while working with patients

Understand risky behaviors that lead to boundary violations

Discussing the legal framework of the healthcare occupations including scope of practice legislation.

Identifying procedures for accurate documentation and record keeping.

Interpreting healthcare facility policy and procedures.

Recognizing the legal responsibility of consent and confidentiality – oral, written and electronic.

Explaining “The Patient Care Partner" describing patients’ rights and responsibilities

Identifying the standards of the Health Insurance Portability and Accountability Act (HIPAA).

Describing advance directives.

Distinguishing between express, implied and informed consent.

Explaining the laws governing harassment, labor and employment.

Differentiating between legal and ethical issues in healthcare.

Describing a Code of Ethics consistent with the health care occupation.

Recognizing the limits of authority and responsibility of health care workers including legislated scope of practice.

Recognizing and reporting abuse including domestic violence and neglect.

Interpreting and explaining written organizational policies and procedures 1. Prerequisites: (Critical Reading & Thinking) or satisfactory basic assessment skills. 2. Suggested General Guidelines for Evaluation: Comprehension of course material is evaluated



4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in legal, ethical, confidential and professional consideration/HIPAA and patients’

bill of right is 70%.

UNIT 4: COMMUNICATION AND INTERPERSONAL RELATIONS, CLERICAL SKILL AND DUTIES Description/Aim: This unit is an introductory course that is especially relevant for students interested in careers that involve interacting with people. It is also valuable for all students as a life foundation and academic enrichment. This unit addresses knowledge and skills needed for positive and productive relationships in career, community, and family settings. Major course topics include communication skills; leadership, teamwork, and collaboration; conflict prevention, resolution, and management; building and maintaining relationships; and individual needs and characteristics and their impacts on relationships. This unit provides a foundation for

continuing education for all career areas that involve interacting with people both inside and outside of a business/organization, including team members, clients, patients, customers, and the general public METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, role play exercises, assignments, project research and case studies.


Explaining basic speaking and active listening skills including reflection, restatement, and clarification techniques.

Explaining basic observational skills and related documentation strategies in written and oral form.

Identifying characteristics of successful and unsuccessful communication including communication styles and barriers.

Composing written communication using correct spelling, grammar and formatting.

Applying appropriate medical terminology and abbreviations.

Recognizing the importance of courtesy and respect for patients and other healthcare workers and maintaining good interpersonal relationships.

Recognizing the importance of patient/client education regarding health care.

Identifying communication skills to varied levels of understanding and cultural orientation including diverse age, cultural, economic, ethnic and religious groups.

Analyzing elements of communication using a sender-receiver model.

Distinguishing between and report subjective and objective information.

Selecting and employing appropriate communication concepts and strategies to enhance oral and written communication in the workplace.

Locating, organizing and referencing written information from various sources.

Describing verbal and nonverbal cues/behaviors that enhance communication.

Explaining the meaning of active listening skills to obtain and clarify information. 1. Prerequisites: (Critical Reading & Thinking) or satisfactory basic assessment skills. 2. Suggested General Guidelines for Evaluation: Comprehension of course material is evaluated



4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in communication and interpersonal relations, clerical skill and duties is 70%.

UNIT 5: MEDICAL TERMINOLOGY/ ANATOMY AND PHYSIOLOGY Description/Aim: Medical terminology is the study of the principles of medical word building to help the student develop the extensive medical vocabulary used in health care occupations. Students receive a thorough grounding in basic medical terminology through a study of root words, prefixes and suffixes. The study focuses on correct pronunciation, spelling and use of medical terms. Anatomy, physiology, and pathology of disease are discussed yet no previous knowledge of these topics is necessary. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, chart image, assignments, project research and case studies.


• Describe the component parts of medical terms • Analyze the component parts of a medical term • Use basic prefixes, suffixes, and combining forms to build medical terms • Explain the common rules for proper medical term formation, pronunciation, and spelling • Relate the terminology to the names, locations, and functions of the major organs of the body systems • Describe the terms utilized for the major disease processes including symptoms, diagnosis, diagnostic testing, surgeries, and therapies • Define basic terms and abbreviations used in documenting health records • Use common terms and abbreviations in documenting medical records related to the major systems of the body • Identify medical terminology and health issues as they apply to a culturally diverse populations • Utilize appropriate sources of information, including the internet, in learning about medical terminology • Use a word processor to do a properly cited research paper.


through final examination, research paper, text assignments, and a presentation Logic and critical thinking are reflected in the process of dissecting medical terms and defining them in terms of roots, suffixes and prefixes


4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in medical terminology/ anatomy and physiology is 70%.

UNIT 6 INTRODUCTION TO PHLEBOTOMY Description/Aim: the unit introduces student to the history and origin of phlebotomy and also enumerate on the general responsibilities of phlebotomy and emphasized on the regulatory role to the practice of phlebotomy METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, lab exercises, assignments, project research and case studies. Unit 1 Outline

Introduction History of Phlebotomy Roles and Responsibilities of the Phlebotomist Where Do Phlebotomists Work? Regulatory Agencies Safety and Infection Control HIPAA, Ethics, and Law

Learning Outcomes: Upon successful completion of this course, students are able to do the following:

1. Describe the evolution of phlebotomy. 2. Describe the roles and responsibilities of the phlebotomist. 3. Discuss professionalism, public image, and customer service as they relate to the phlebotomist. 4. Identify the various settings where phlebotomists are employed. 5. List the regulating agencies for phlebotomy.

6. Identify safety and infection control practices related to phlebotomy. 7. Describe HIPAA, law, and ethics related to phlebotomy.

1. Prerequisites: (Critical Reading & Thinking) or satisfactory basic assessment skills. 2. Suggested General Guidelines for Evaluation: Comprehension of course material is evaluated through

final examination, research paper, text assignments, and a presentation Logic and critical thinking are reflected in the process of dissecting medical terms and defining them in terms of roots, suffixes and prefixes


4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in introduction to phlebotomy is 70%.

UNIT 7. BLOOD CIRCULATORY SYSTEM Description/Aim: this unit brings an understanding of the student to the circulation of blood and its composition and functions. In addition to the cellular and liquid composition of blood, the student must know how the closed circuit of blood vessels transports blood. Knowing the location of blood vessels, especially the most commonly used arm veins, and the composition of blood is essential to performing venipuncture. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, lab exercises, assignments, project research and case studies.

Unit Outline • Introduction • Circulation and the Vascular System • Blood Vessels • Blood and Blood Components • Hemostasis and Blood Coagulation • ABO and Rh Blood Types


1. Describe circulation and the purpose of the vascular system. 2. Discuss three types of circulation. 3. List and describe the three layers of blood vessels. 4. Identify and describe the structures and functions of the different types of blood vessels. 5. Locate and name the veins most commonly used for phlebotomy procedures. 6. List the functions of blood. 7. Identify the major components of blood. 8. Describe the major function of red blood cells, white blood cells, and platelets. 9. List the different types of white blood cells and give the function of each. 10. Differentiate between serum and plasma. 11. Define hemostasis and describe the basic coagulation process. 12. Describe how ABO and Rh blood types are determined.




4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in blood circulatory system is 70%.

UNIT 8 EQUIPMENT USE IN PHLEBOTOMY Description/Aim: this unit familiarizes the student with the process and all the tools that are involved in venipuncture and dermal puncture procedures. This includes the various pieces of equipment used for the different methods of blood collection. In addition, the student will learn the ordering process, including paper or computer work that must be completed prior to blood collection. A proper blood collection procedure starts with the order, documents, and appropriate equipment. The actual collection of blood must be done in the correct order. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, role paly exercises handouts, demonstrations, lab exercises, assignments, project research and case studies.

Unit Outline • Introduction • Laboratory Requisitions • Specimen Collection Equipment • Dermal Puncture


1. List the information required on a requisition form. 2. Describe computer use in phlebotomy. 3. Describe the supplies and general equipment required for phlebotomy. 4. Describe the components of the evacuated tube system. 5. Explain the proper method for needle disposal. 6. Identify the type, explain the mechanism of action, and identify the evacuated tube color

associated with each additive. 7. Explain the order of draw for evacuated tubes. 8. List the components of the butterfly infusion and syringe systems. 9. Identify the equipment needed to perform dermal puncture.




4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in equipment use in phlebotomy is 70%.

UNIT 9. PERFORMING VENIPUNCTURE AND DERMAL PUNCTURE PROCEDURES Description/Aim: this unit equips the student with the knowledge of the routine venipuncture and dermal puncture procedures include a series of detailed steps that must be performed safely and accurately. How to follow aseptic

technique and standard precautions and also enumerate on how to obtain the specimen in the correct container. The also learn how to accurately identify patient in in-patient and out-patient settings and proper mandatory patient preparation. For the student to be a phlebotomist they must be able to perform venipuncture and dermal puncture proficiently. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, laboratory exercises, assignments, project research and case studies.

Unit Outline • Introduction • Laboratory Requisitions • Specimen Collection Equipment • Dermal Puncture


1. Describe the proper procedure to follow for patient identification. 2. Explain how to prepare a patient for blood collection. 3. Identify the correct steps to follow when a patient refuses collection. 4. Describe the process and time limits for applying a tourniquet to a patient's arm. 5. Discuss factors that must be considered when selecting a site for venipuncture or dermal

puncture. 6. Describe the venipuncture and dermal puncture site cleansing procedure. 7. List the items required on a specimen label and explain the importance of each. 8. State the maximum number of times that the phlebotomist should stick a patient. 9. List the steps to follow when unable to obtain a blood specimen. 10. Describe how to use a butterfly or wing-tipped collection device. 11. Explain the collection procedure for dermal puncture




4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in performing venipuncture and dermal puncture procedure is 70%.

Second semester UNIT 1. CLINICAL LABORATORY PROCEDURES Description/Aim: Candidates will have an understanding of and be able to carry out various categories of clinical procedures while observing universal precautions METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, laboratory exercises, assignments, project research and case studies.

Unit Outline • Universal precautions applicable to Phlebotomy Lab procedures • Sub department/section in medical laboratory department • Components of categories of Lab procedures • Components of panel for laboratory test


1. Describe the safety procedures required in handling blood and blood products. 2. Identify the various compounds used in categorizing laboratory procedures. 3. Discuss various sub department included in medical laboratory (Hematology, Blood banking,

Microbiology, Chemical pathology/Clinical chemistry etc.) 4. Describe the diagnostic tests required for each component identified 5. Describe the components of panels for laboratory procedures




4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in clinical laboratory procedures is 70%.

UNIT 2. SPECIAL HANDLING AND PROCESSING PROCEDURES Description/Aim: In this unit student will learn the process of venipuncture and dermal puncture which involves more than just the collection of a sample of blood. Equally learn the important of how the sample is obtained and how the sample is handled after the collection. Some samples require special handling and/or processing before and after the collection. In some cases other types of specimens may need to be collected. In addition, certain tests are done immediately at the point of care right after the collection of the specimen. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, laboratory exercises, assignments, project research and case studies.

Unit Outline Introduction

• Special Specimen Handling Procedures • Unopette® Procedure • Measuring Microhematocrit • Peripheral Blood Smears

• Point-of-Care Testing (POCT) • Urine Specimens • Centrifuge Operation


1. List requirements for special specimen handling procedures. 2. Describe the technique required for collecting blood cultures. 3. List the steps for Unopette® collection. 4. Describe the procedure for performing a microhematocrit. 5. Explain the collection process and procedure for making a peripheral blood smear. 6. Discuss common point-of-care and CLIA waived tests. 7. Explain the procedure for urine specimen collection and reagent testing. 8. Identify safety requirements for operating a centrifuge.




4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in special handling and processing procedures is 70%.

UNIT 3. SPECIAL PHLEBOTOMY TECHNIQUES Description/Aim: In this unit student will learn and be equipped with knowledge of special laboratory tests. Special tests include timed specimens, glucose tolerance testing, therapeutic phlebotomy collections, bleeding time, blood alcohol, toxicology, chain-of-custody specimens, and therapeutic monitoring of drug levels. Some of these tests require additional preparation and some tests require extra skills. Licensed practitioners depend on the phlebotomist to know the special requirements and adhere to them. Following these special procedures will directly impact the quality of patient care. Patients can affect laboratory results by exercising, eating, fasting, lying down, standing up, being stressed, smoking, or drinking alcohol. The students are made to understand certain or some of laboratory tests that can be affected by different patient behaviors or condition. The students are also given the opportunity to learn how to educate patients about the laboratory and the importance of following the physician's directions in this unit as well. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, laboratory exercises, assignments, project research and case studies.

Unit Outline • Introduction • Timed Specimens • Glucose Testing • Bleeding Time and Platelet Function • Therapeutic Collection and Blood Donation • Blood Alcohol, Toxicology, and Forensic Specimens • Therapeutic Drug Monitoring • Alternative Collection Sites

Learning Outcomes:

Upon successful completion of this course, students are able to do the following: 1. Discuss why specimen collections should be drawn at specified times. 2. Name two tests that require fasting. 3. Describe various types of glucose tests. 4. Explain the purpose of bleeding time. 5. Identify standard protocol and procedure for blood donation. 6. Compare and contrast blood donations, therapeutic phlebotomy, and autologous donation. 7. Discuss the precautions associated with blood alcohol testing. 8. Differentiate between forensic and toxicology specimens. 9. Explain the reasons for therapeutic drug monitoring. 10. List other sites for blood specimen collection.




4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in special phlebotomy technique is 70%.

UNIT 4. WASTE DISPOSAL AND DECONTAMINATION PROCEDURES Description/Aim: Candidates will have an understanding of and be able to apply waste disposal and decontamination techniques in the Phlebotomy practice. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, laboratory exercises, assignments, project research and case studies.

Unit Outline • Requirements and regulations for decontamination and waste disposal • Decontamination, waste disposal techniques and safety precautions


1. Identify the requirements and regulations which control decontamination and waste disposal 2. Describe decontamination and waste disposal techniques utilized for health and safety

practice. 1. Prerequisites: (Critical Reading & Thinking) or satisfactory basic assessment skills. 2. Suggested General Guidelines for Evaluation: Comprehension of course material is evaluated



4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in waste disposal and decontamination procedures is 70%.

UNIT 5. TROUBLESHOOTING /COMPLICATION IN PHLEBOTOMY PROCEDURES Description/Aim: This unit will cover complications and special circumstances that may be encountered during venipuncture and the importance and proper use of standard precautions. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, laboratory exercises, assignments, project research and case studies.

Unit Outline • Introduction • Stages of error/complication • Pre-analytical error/complication • Analytical error/ complication • Post-analytical error/complication


1. Explain the reasons for failure to obtain a sample, and identify the steps to take to correct.

2. List complications associated with blood collection and describe how they may affect the client or the integrity of the specimen.

3. Describe how to prevent each of the complications identified, as well as how to handle those that occur.

4. State reasons for avoiding blood draws from the following areas, and the situations, if appropriate, where blood collection is allowed:

hematoma

IV sites

burned or scarred area

foot collections

arm adjacent to a mastectomy

arm containing a fistula or shunt

sclerosed veins 5. Identify causes of hematoma. 6. Identify factors associated with hemolysis. 7. Identify reasons for specimen rejection. 8. Describe the first aid procedures that may be necessary for health care workers with

direct client 1. Prerequisites: (Critical Reading & Thinking) or satisfactory basic assessment skills. 2. Suggested General Guidelines for Evaluation: Comprehension of course material is evaluated



4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in troubleshooting/complication in phlebotomy procedures is 70%.

UNIT 6. PRACTICING PHLEBOTOMY Description/Aim: This unit exposes student to the working world and steps to employment after completion of the program at SPACS, once they have completed their education as a phlebotomist they will need to practice in a professional manner. This includes completion of certification and continuing education. As a practicing phlebotomist one is required to provide quality assurance and quality control within one daily duty. Following policies of the institution where one is employed and providing quality specimens are necessary. Most importantly they will have an understanding of risk management including liabilities and safety issues relative to phlebotomy practice. METHOD OF INSTRUCTION: course will delivered face to face and the instruction will be provided by lectures, handouts, demonstrations, lab exercises, assignments, project research and case studies.

Unit Outline • Introduction • Certification and Continuing Education • Quality Assurance in Phlebotomy • Quality Control in Phlebotomy • Risk Management


1. Describe certification for phlebotomists. 2. Identify the need for phlebotomy continuing education. 3. Define quality assurance (QA) as it pertains to phlebotomy. 4. Define quality control (QC) as it pertains to phlebotomy. 5. List at least three factors that affect laboratory values. 6. Identify reasons for specimen rejection. 7. Define risk management. 8. Describe risk management issues of liability and safety as they relate to phlebotomy.




4. Final Grade Calculation will be the aggregate of grades achieved in all the unit activities = 100%. 5. A passing grade in practicing phlebotomy is 70%.

Phlebotomy Technician Course Outline (EXPANDED)

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 one hundred and twenty hours of practical work in a lab/clinical environment as specified by the instructor and work experience in outside posting

Session One

Introduction to Phlebotomy Communication skills and interpersonal relationships; Community

Stress management, ethics and 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. to 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, and 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

Bio-safety. Biological hazards: Biohazard exposure routes, Blood borne pathogen.

OSHA regulation: Needle sticks 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.

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: Multi sample 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/cross-match. 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

Bio-safety. Biological hazards: Biohazard exposure routes, Blood borne pathogen. OSHA regulation: Needle stick 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. Assemble equipment and supplies; Wash hands and put on gloves; Position patient;

Apply/Release tourniquet; Venipuncture site (select, clean);

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. Pediatric venipuncture.

Geriatric venipuncture.

Dialysis patients. Long-term care patients. Home care patients. Hospice patients.

Composition of skin puncture blood. Indications for performing skin puncture (adult and children/ infant). Skin puncture site selection criteria

Skin Puncture procedure.

Special skin punctures procedures.

Routine blood smears preparation. Capillary blood gases. Newborn screening. Neonatal bilirubin collection.

Practical demonstration. Session Seven Post Puncture Care

General Guidelines

Post procedure patient’s examination include patients:

With allergic reaction, syncope, hematomas.

How to prevent the complications such as hematoma formation, inadvertent arterial puncture, infection, nerve damage, pain, vein 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 (include: median, cubital and cephalic veins)

Preparing the patient for testing include: 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

Bio-safety. Biological hazards: Biohazard exposure routes, Blood borne pathogen. OSHA regulation: Needle stick 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 Pre analytical Sources of Error

Troubleshooting guidelines and Evacuated blood collection system problem solving

Physiologic and site selection variables that influence specimen composition

Possible Sources of Pre analytical Errors.

Session Nine Knowledge of Pre analytical 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 Pre analytical 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, mislabeled 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, Respondent Superior, Vicarious

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

AMT Registered Phlebotomy Technician (RPT) Certification Examination Construction Parameters

________ _________ _____________________________________________ I. Obtaining Blood Samples (41.5% of test)

A. Identify correct patient properly B. Select appropriate containers for specimens and know requirements for container identification C. Know physiological aspects of blood collection D. Prepare patient for various tests E. Select proper venipuncture site F. Perform venipuncture G. Collect specimen in proper tube-draw sequence H. Perform skin punctures I. Perform heel punctures on infants J. Provide proper post care of venous, arterial & skin puncture sites K. Handle blood samples to maintain specimen integrity L. Label transfusion services (blood bank) specimens according to proper protocol

II. Specimen Collection and Processing (15.5% of test) A. Properly handle non-blood specimens to maintain their integrity B. Properly collect and handle specimens with time/temperature requirements C. Properly collect and handle specimens for blood cultures D. Select proper station for specimen delivery E. Process specimens for shipping F. Instruct patient in the collection of urine specimens G. Instruct patient in the collection of other specimens H. Collect and process point-of-care testing (POCT) specimens

III. Time Management and Assignment Organization (8.0% of test) A. Read physician orders and requisitions B. Set priorities for specimen collection C. Schedule time intervals for tolerance tests D. Schedule time intervals for drug-dependent tests E. Refer problems to supervisor appropriately F. Cooperate with co-workers in the completion of assignments

IV. Professional Communications (4.5% of test) A. Develop and use proper and professional communication skills with staff, patients, and families B. Use proper technique and etiquette for answering the telephone C. Inform patients of special test requirements

V. Clerical Skills and Duties (5.5% of test) A. Chart or file laboratory-generated reports properly B. Enter, retrieve, and verify patient collection data and special notations using appropriate sources C. Maintain inventory levels order and restock supplies D. Employ computer skills

VI. Safety Standards and Procedures (10.0% of test) A. Identify appropriate regulatory and standard-setting agencies B. Know the use of material safety data sheets C. Employ Universal/Standard precautions D. Employ infection control and isolation techniques E. Recognize patient problems related to syncope, nausea, and other complications

VII. Legal, Ethical, and Professional Considerations (6.0% of test) A. Know principles of liability regarding the practice of phlebotomy B. Perform duties professionally, ethically, and legally, adhering to criminal justice and civil rights acts C. Employ professional conduct and appearance in the performance of duties

VIII. Terminology, Anatomy, and Physiology (9.0% of test) A. Employ basic terminology including suffixes, prefixes, and root words B. Know basic anatomy C. Know basic physiological systems

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