Lecture Notes: Patient Preparation and Phlebotomy Processes

General Information:

• Instructor is out for leadership training.
• Focus on preparation for the national exam.
• Recommended study: 30-60 minutes of book review nightly.
• Instructor available for questions post-training hours.

Patient Preparation:

Importance of Requisition:

• Requisition form is crucial for patient identification and preparation.
• Contains necessary patient details (fasting, medications, age, etc.).
• Requires completion with fasting hours, signature, date, and time of draw.

Patient Interaction:

• Introduce yourself and your role.
• Confirm patient identity using two identifiers (e.g., wristband, verbal confirmation).
• Evaluate patient's understanding during interaction.

Procedure Education and Evaluation:

• Educate patients on procedure expectations and potential complications (e.g., loss of consciousness, nausea).
• Assess patient's condition and choose optimal site and method for draw (antecubital fossa is primary).
• Open-ended questions to confirm fasting compliance.

Complications and Responses:

Common Complications:

• Excessive Bleeding: Caused by anticoagulants; apply pressure, use pressure bandage.
• Severe Pain: Use ice; if unresolved, consult physician.
• Lack of Sensation: Check tourniquet duration; stop draw if nerve is suspected to be nicked.
• Bruising: Apply pressure, particularly if patient is on anticoagulants.
• Infection Signs: Red, swollen areas; consult if infection suspected.

Identifying Patient Condition Issues:

• Unresponsive or confused patients should not be drawn until assessed by a physician.

Consent Types and Patient Identification:

Types of Consent:

• Expressed Consent: Verbal or written.
• Informed Consent: Adequate information provided in native language.
• Implied Consent: Actions imply consent; applied in emergencies.
• Minors Consent: Requires guardian consent unless emancipated.

Patient Identification:

• Must verify inpatient with wristband, outpatient with ID.
• Use two identifiers for unconscious patients.

Venipuncture Techniques:

Site Selection:

• Antecubital Fossa: Primary site; evaluate median cubital, cephalic, and basilic veins.
• Capillary Punctures: Use greater and ring fingers; avoid pinky and index.

Draw Methodologies:

• Use appropriate equipment depending on vein condition (e.g., butterfly for fragile veins).

Special Considerations:

Equipment Quality:

• Ensure sterility, proper labeling, and appropriate expiration.
• Use external liquid controls for new equipment.

Blood Smears and Newborn Screening:

• Blood smears for white cell differentials; prepared from EDTA specimen, 30-degree angle on slide.
• Newborn screening for PKU; proper technique to avoid contamination.

Non-Blood Samples:

Urine Collection:

• Avoid mixing urine with stool; use appropriate containers.
• Methods: Random, clean catch, 24-hour specimen.

Other Samples:

• Semen: Avoid light/extreme temps, deliver quickly.
• Sputum: Rinse mouth before collection; collect mucus from lungs.

Regulatory and Safety Considerations:

Safety Protocols:

• OSHA: Worker safety.
• CDC: Disease control and prevention.
• NIOSH: Sharps safety.

Privacy and Compliance:

• HIPAA: Patient privacy.
• CLIA: Quality assurance for tests.

Conclusion:

• Ensure review of CPR for upcoming practical session.
• Emphasize safety and compliance in practice.

These notes provide a structured overview of the lecture content focused on patient preparation, phlebotomy procedures, and regulatory guidelines. They are designed to support effective study and recall of key concepts for the national exam.