hey guys welcome to your first online lecture we are going over sorry there you go chapter one um and talk about some phlebotomy basics our objectives are to talk about a little bit about the history of phlebotomy your role as a phlebotomist in some of the various healthcare settings that you may work in including inpatient and outpatient facilities other people that you're going to be working with on a daily basis other people with the healthcare team we're also going to talk about the organization of the laboratory itself so you know your chain of command who all you're working with and what their responsibilities are finally um well i shouldn't say finally actually yet we're going to talk about the regulatory agencies that mandate our jobs as the phlebotomist and finally uh qualities and characteristics of a good phlebotomist okay so phlebotomy means to cut into a vein it's actually making an incision incision into the skin and blood vessel that's venipuncture so you'll see vena puncture and phlebotomy uh used interchangeably sometimes there's also dermal that's capillary it's just puncturing the skin to get blood the nha which is your credentialing organization before you can sit for their exam require that you as a phlebotomy student get 30 successful venipunctures and 10 dermals what you want to understand is that your role as a phlebotomist is super important results of laboratory tests that you as a phlebotomist are performing and drawing and transporting and all of that are crucial to providing quality and accurate care um or quality and appropriate care i should say over 70 percent of medical decisions are based on labs so the history of phlebotomy it actually dates back so drawing blood out of the body dates back to as far as 1400 bc you have hippocrates you've all probably heard of hippocrates he's known as the father of medicine and developed a hippocratic oath and that's still used by physicians today some of the major things that are included in the hippocratic oath include the sick the best of your ability preserve patient privacy and teach the secrets of medicine to the next generation um the process um well there are actually several processes of getting blood out of the body or another way of saying it is bloodletting so bloodletting um also dates back to about 1400 bc and it was believed to rid the bodies of impurity impurities evil spirits and also to return it back to balance or homeostasis um barbers actually were the ones who performed bloodletting a lot and this was back really in the 1800s mostly they had the tools that they needed the sharp tools to do bloodletting i'll show you a video clip here in a minute just because it is so interesting but that is where the barber pole and you can see the picture there the image there originated from so when it first started it was just red and white and in the video you'll see that represents blood and bandages later on the color blue was added and that's more for patriotism here in the united states though if you go over to europe the bar poles do tend to still have just the red and the white let me show you this video and bear with me because i'm gonna have to click out of let's see if i can figure out how to do this real quick before that please bear with me all right [Music] have you ever wondered about the significance and symbolism of the barber pole the meaning behind its design has an interesting start back in the medieval ages a barber was the only person with the sharp instruments needed for a shave and trim which were also used for minor surgeries dentistry and tasks such as bloodletting after the procedures the barber would hang bloody bandages outside these bandages would twist together in the wind forming a familiar spiral pattern as times evolved these bandages were replaced with the pole painted with red and white stripes slightly more sanitary and much less gross eventually a statute passed which required barbers and surgeons to distinguish their services so bumpers use blue and white poles while surgeons use red and white [Music] these days many barber poles are red white and blue particularly in the united states which some cite as a tribute to the american flag while others say the red represents arterial blood the blue represents the non-oxygenated blood in the veins and the white represents the bandages clearly the barbershop as you know it has come a long way but the barber pole still stands or rather spins as an iconic symbol of the trade all right so back at it um another way or another method of bloodletting is using leeches leeches as you can see on this screen are just little worm-like um animals and they actually have two suckers one at each end um they were commonly used for bloodletting the use of leeches was highly popular in the 1800s but it has since made a comeback in modern medicine in modern medicine most often today it's used on newly transplanted tissue sites and sometimes to reduce swelling as well so you will actually see in hospital pharmacies that they keep leeches on hand pretty interesting cupping is another method for bloodletting a lot of us we've seen cupping but not necessarily to the full extent in which it can be used for bloodletting we see the cupping where it just leaves those marks on the skin um but true bloodletting from the cupping is you put the cup the cup on the skin um it's warmed it has a vacuum effect that allows or it pulls all of the blood up to the surface of the skin after that is done then there's a spring kind of spring-loaded box containing a bunch of little tiny neat you know more like a lancet and it just punctures the skin which produces the bleeding um the word you also see the word venisection that in itself just means using a lancet to pierce the skin um and that is also another method of bloodletting an interesting little tidbit as well is that george washington george washington's death our first presence death was believed to be a result of excessive bloodletting he had had a cold and some other things going on had some sort of infection and they did too much bloodletting in an attempt to make him feel better so we're going to talk about the roles of the phlebotomist the duties and responsibilities of the phlebotomist the role of phlebotomist emerged in the 1980s and in the 1990s and is regulated by the clinical and laboratory standards institute or you'll see it abbreviated clsi lobotomists are responsible for the collection of processing and transportation of blood specimens to the laboratory they're also responsible for the well-being of the patient before during and immediately after any kind of venipuncture and also we always want to make sure that we are treating everyone with cultural competence and respect and dignity phlebotomists like i mentioned i think i mentioned you know we primarily think of a phlebotomist in collecting blood but depending on where you work and what you do you may also collect other specimens like urine or feces other members of the healthcare team can be trained as phlebotomists i'm sure you guys can think of some medical assistants rns doctors and just like they can have the role of phlebotomist the phlebotomist can often take on other roles in the healthcare setting as well again depending on where you work you might be a patient advocate patient care technician transport clerical duties as well you're often responsible for doing quality control for your tests and the test that we're performing um and you might also be responsible for point of care testing and we're going to get to that in just a second a little bit more in detail of course documentation is always always always most important and the proper performance of all of the tests that we're doing if a test that we're doing is not done appropriately with quality and accuracy it's not going to serve any purpose for us so we we as phlebotomists might work in inpatient or outpatient facilities and those are the kind of the two two main categories in patients you're typically talking about hospitals nursing homes or rehabilitation centers outpatient doctor's office ambulatory care centers which by the way are the fastest growing outpatient setting that we have now blood collection centers and home health care would be outpatient facilities is where you as a phlebotomist would be more likely taking on some of those other roles uh you know like taking vital signs transporting patients et cetera i mentioned we talked about what point of care testing versus clio wave testing is point of care testing is testing that is performed at the base patient's bedside or at a specific specified work area using portable instruments these tests commonly will include blood glucose monitoring pregnancy tests other ones that you'll commonly see strap or blue test now clia cleo wave test and we have a whole chapter that we're going to talk about clio wave tests um and clea stands for clinical laboratory improvement amendments um these are simple laboratory examinations and procedures that have an insignificant risk of error basically these tests are typically performed on small amounts of blood so like a fingerprint prick or a urine sample for example most point of care testing is clio wave all right so we've got the healthcare team this is you know encompasses everyone uh that you think when you think of the healthcare team ranging from phlebotomists to speech therapists to doctors to nurse aides to nurses et cetera the fla the phlebotomist you should at least be aware of the various health care specialties and professionals in the medical setting some of the most common are going to be listed on pages 8 through 10 and page 14. so you don't necessarily have to memorize every single one of these but you need to have a good understanding of this list and just be able to recognize some of these people okay um and just let me back up a bit here just to spout off a few you know we're talking about anesthesiology emergency department endocrinology geriatrics obstetrics occupational therapy oncology respiratory therapy um surgery pharmacy etc you guys get the idea so the medical laboratory um most hospital hospitals have their own laboratories uh laboratories are organized based on both size and complexity so a lab's gonna look different depending on where you're at hospital laboratories are typically segmented into clinical pathology and anatomical pathology clinical pathology is the analysis of body fluids and tissue so that we can diagnose disease whereas anatomical pathology is the examination of surgical specimens to investigate disease or cause of death so they're within the medical laboratory we have a bunch of specialties okay you do need to be familiar with these as well and that's why they are on these slides but you'll also see these in the book around that same section you want to review these and make sure you can get a good understanding of these individuals especially because this is who you're going to be surrounded by and working with in the lab you've got cytology they investigate human cells for cancer histology the study of body tissues and cells clinical chemistry evaluate the chemicals um evaluate actually let me say i said that better evaluation of the chemical constituents of the human body and an example of that would be glucose lipids how drugs are affecting the body our hormones etc so hematology which is the study of blood in the blood forming tissues this might be a um complete blood count also known as a cbc or coagulation studies immunohe taught him excuse me immunohematology this is blood bank this is the collection and preparation of donor blood for transfusions so these are the people that do the type and cross match medical um oh i'm stupid ahead i'm sorry immunology or serology this is the study of the body's resistance to disease and defenses against foreign substances so this would be strep testing testing for mono antibody testing oh going too fast i apologize medical microbiology this is the study of medically significant microscopic organisms were covered in organisms inside and out so this is medically significant organisms such as bacteria fungi parasites or viruses molecular diagnostics detection and classification of disease states using molecular and dna based testing that was a mouthful but this is testing for things um that are dna based uh hpv gonorrhea for example as well toxicology this is the detection and study of adverse effects of chemicals and this could be toxic substances or drugs your analysis is simply the examination of urine so we also have i mentioned we're going to talk a little bit about regulatory agencies it is important that you have a good grasp on these as well um regulatory agencies are basically independent governmental bodies that are established in order to set standards in a specific field or activity and in our case of course phlebotomy so a few that you'll want to make sure you understand i've already mentioned clea um let's see this is clinical laboratory improvement amendments um 88 this was established established to ensure all laboratories receiving federal funds would meet the same standards they provide guidelines to help phlebotomists provide better patient care and achieve greater accuracy in blood testing they establish the proper order of draw for venipuncture which is very important establish standards for proper levels of additives in vacuum tubes establish proper collection processing and handling of venus blood some laboratories are categorized as waves like we had mentioned before and they're not subject to annual inspections um like some of the other laboratories other laboratories are are classified as moderately complex or highly complex and they do undergo the irregular inspections failure of institutes to comply to the clia amendments results in medicare and medicaid reimbursement loss and privilege uh loss of coverage to perform certain procedures as well the joint commission that's another one to know the credits and certifies thousands of healthcare organizations in the u.s and focuses on continual improvement of patient safety and quality of care here my node centers for disease control and prevention this is uh responsible for organizing and categorizing new laboratory tests as either waived moderately complex or highly complex osha i'm sure you guys have heard of osha this is the um this is the agency that regulates employees employee safety in the workplace the environmental protection agency establishes acceptable practices for the treatment and disposal of medical waste the fda or food and drug administration regulates content labeling requirements for blood banks and also improves medical and diagnostic equipment pharmaceuticals reagents and diagnostic tests before they can actually be marketed to the public the department of health and human services oversees the cms the commission on office laboratory accreditation or cola this is um who accredits physician office laboratories so they're specifically geared at laboratories within physicians offices or something i wanted to go back to bear with me for a second here let me see if it's on the next slide yeah before i jump forward i actually wanted to go back really quick there was one section that didn't have a slide on here and i apologize for that but of course it's in your book um you also want to be we talked about the the specialties within the medical laboratory um but you also want to be familiar with the medical laboratory personnel the other personality you're going to be coming in contact with and working with um you've got just medical office staff you've got medical transcriptionists who prepare the reports so after a pathologist looks at it preparing the reports you've got medical laboratory assistants these are phlebotomists who are trained to perform low complexity testing or assist in laboratory staff you have histologic technicians prepare surgical specimens for examination histologists these perform more complex functions in the histology lab cytologists perform microscopic examination of cells to detect things like cancer or other diseases you have pathologists these are the actual medical doctors who specialize in the study of disease they can be an anatomical pathologist again diagnosing and diagnosing that surgically removed tissue that has been removed to be looked at clinical pathologists they oversee the interpretation of bud blood and body fluid test results you've got medical laboratory technicians mlts they perform low complexity and some moderately complex laboratory testing other than cytology and histology and medical laboratory scientists they perform high complexity testing other than cytology and histology and you may see the mls the medical laboratory scientists functioning as the laboratory administrator or laboratory manager so just to kind of lay that out for you a little bit more clear for the mla is more of an assistant uh the mlt is a tech they have an associate's degree at minimum and the mls has a bachelor's degree at minimum which is why they can act as the administrator or laboratory manager all right let me get over here so qualities of the phlebotomist i know we talked about this a little bit in class on our very first day in person but i'm just going to review over quickly and then we are done with chapter one okay um so of course professionalism professionalism is important um some other things to keep in mind is a neat imp um a neat appearance well groomed you don't want to wear perfumes or colognes that can set someone into respiratory distress excuse me you want to keep your nails clean and short without polish if you don't know the reason behind that because when our nails our fingernails and our hands really aren't aren't um well kept or cracked or dry if you have long nails or chips in your nail polish even if it's clear that is the perfect spot for bacteria and germs to grow and spread and since our hands are the number one way for passing on germs that's why that is so important so no fake nails no nail polish no long nails um you know we talk about public image sometimes when we're talking about professionalism and that's what we mean by that is is first impressions really so first impressions are key um credibility of the individual and the laboratory department that you work at is is what you're representing in that first impression it takes about 15 seconds to make a first impression of somebody um when we have a good first impression of somebody especially if they're coming to poke us with a needle and get our blood we want to have trust in that person and presenting that good first impression establishes trust really quickly or makes people question their trust customer service and communication positive communication is key to customer service and in healthcare we are in a customer service environment the process of communication occurs in a loop involving sender message and receiver and then the feedback okay and we need all parts of that loop to be working and clear in order for our messages to be sent perceived etc some barriers to communication that we might come across especially as a phlebotomist pain right someone's in pain or they're scared of the pain fear other visitors in the room other distractions like television or people coming in to care for them we need to remember that communication is both verbal and non-verbal so our body language is going to say a lot um we want to make good eye contact when it's appropriate we want to have good posture and present ourselves as confident in what we're doing we also want to make sure that we use terms the patient can understand so medical terms are okay but but we have to kind of gauge how we're talking to our patients based on that individual so it's going to change from one person to the other you always want to make sure we're using terms that they understand you have to be um capable of explaining what you're doing in a way that's understandable as well um you're going to be doing this day in and day out and some patients aren't going to be familiar with with process of giving blood or other specimens so you have to be able to walk them through it don't get false assurance so you know if someone's scared about what it might feel like to get their blood drawn don't say oh you're not going to feel a thing that's not true we don't tell them that okay we try and give them reassurance that it's going to be all right that it'll be quick always start by introducing yourself the purpose of your visit and have the patient identify themselves that's super super super important you need to either be using two or three identifiers for every single patient in every single specimen collection that you do name and date of birth are the two most common a vital component of communication is active listening you know one of the things we do often is we listen to respond so as someone's talking to your list and your sort of listening but really you're thinking of what am i going to how am i going to respond to this person or what am i going to say next active listening is just listening taking it all in without having other thoughts going on in your head be empathetic put yourself in their shoes now there are different communication styles uh there's analytical communicators intuitive communicators functional communicators and personal uh person personal communicators whatever kind of communicator you are it's fine there are pros and cons to each kind the analytical people and but it's nice to always know what kind you are right so the analytical tends to prefer to work with real numbers facts and dates and they leave or they put little emphasis on feelings or emotions intuitive communicators prefer to look at the big picture um this can be a very efficient way to communicate but sometimes it tends to leave more questions than answers um when there's because it can be too broad almost at times functional prefer an organized approach with timelines and detailed plans this can be effective as long as you don't overwhelm your patients with way too much information in details and then the personal communicators we use emotional language and connections care about what people think and feel in response to that information and these communicators are often especially good at being active listeners and resolving conflict easily so you all are going to be amazing phlebotomists we're going to get through all of this together and you're going to be successful and have a wonderful career as a phlebotomist it's really exciting and we're really happy to have you here and work towards getting you guys all certified and on your way if you have any questions about chapter one of course as you guys know now we're gonna have our collaborate session this wednesday from six to seven pm and then you also have your in-person skills lab on thursday from 5 30 to 9 30. so for each lecture that we do every week go ahead you know do your reading listen to the lecture and as you're going along in both those write down any questions that you have any clarification that you need and use your collaboration session and your in-person day with michelle ask these questions get clarification and get the help that you need okay thank you