CLINICAL LAB SCIENEC

268
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
programs seek this voluntary accreditation for an institutional phlebotomy
program as most states do not require phlebotomists to be certified or licensed,
unlike medical laboratory workers. Some certifying agencies, such as the American
Society for Clinical Pathologists (ASCP), do require that applicants for
medical laboratory registry examinations be graduates of programs accredited
by agencies such as NAACLS to qualify for a certification examination.
Statistics are compiled in some facilities that gauge the percentage of acceptable
samples and those that require that they be re-collected. Efforts to improve
these figures are often a part of the quality assurance or quality improvement
programs within a facility. Many of the preanalytical errors that affect laboratory
results occur during the phlebotomy procedures for collecting blood
samples and entering them into the Laboratory Information System (LIS).
Some of the areas that are a part of patient safety as well as quality control for
the phlebotomy section would include monitoring of sharps (needles or lancets)
to ensure they are sterile before use. No needle or lancet should be used if the seal
guaranteeing sterility has been broken by other than the person collecting the sample.
Occasionally a needle may be deficient, and it may be possible to detect this
if the needle is visually observed for deformities before use. Used sharps should
be discarded in a specially designed sharps container. Disposal of the entire needle
assembly is most often the practice following venipuncture, whereas reuse of a
syringe and needle were the norm a few decades earlier (Figures 11-2 and 11-3).
Commercial disposal companies are hired to pick up these containers when filled,
along with other biohazardous wastes, for incineration in specially built furnaces.
Evacuated tubes are used for most collections. If they have expired, it is
difficult to collect the proper amount as the amount of vacuum degrades over a
period of time, resulting in obtaining too little blood for testing or for problems
with the amount of anticoagulant in certain tubes.
Steps for Proper Collection of Blood Samples
by Venipuncture
Venous blood is the specimen most often collected by a phlebotomist or medical
laboratory technician or technologist. Other specimens that are routinely but
less frequently collected are capillary blood from a finger, ear, or toe puncture,
or arterial blood for a series of blood tests called blood gases. In most facilities,
respiratory therapists collect arterial blood and are also licensed to perform
the tests for blood gases. Relatively large amounts of venous, or deoxygenated,
blood may be collected for a variety of blood tests by a phlebotomist or a technical
laboratory worker.
The proper steps must be followed to minimize the risk of infection to the
patient and the person collecting the sample, as well as to ensure that adequate
and appropriate samples will be available for testing. There are certain rules that
should never be broken. Experiences of each laboratory worker or phlebotomist
will help in developing individual manners of greeting patients and the setting
up of equipment and supplies. Consistent observation of basic steps will help to
avoid mistakes and problems (Table 11-2). One cardinal rule that most facilities
observe is that a phlebotomist or technician should perform a venipuncture only
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