CLINICAL LAB SCIENEC

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ESSENTIALS OF CLINICAL LABORATORY SCIENCE
Assessing the Patient’s Mental Status
The phlebotomist or technician should remain calm and professional, regardless
of the patient’s reactions, which might be fostered by fear, loneliness, or anger.
Interacting with patients with cognitive impairments, such as senility, Alzheimer’s
disease, or mental illness or other cognitive impairments, will require different
skills than for those without any of these conditions. The ability to deal well with
this type of patient will come with experience and observation of others who
have developed an approach that the patient will accept. There will be occasions
where the patient speaks by sign language or converses in a language other than
the one the phlebotomist speaks, requiring special arrangements for preparing
the patient for phlebotomy. If help might be needed, procure aid before beginning
the procedure.
Explaining the Procedure to the Patient
Explain to the patient that any detailed questions should be asked of his or her
physician. In most facilities, the phlebotomist is allowed to only tell the patient the
basics of what is being done. Some facilities do allow a description of the tests, such
as routine testing, but the phlebotomist is not to discuss the meaning of the tests
or the patient’s treatment. Most patients understand that blood tests will be performed
to rule out certain conditions and to confirm others. If the patient initially
objects to the tests, remind the patient that his or her physician needs the tests to
provide treatment. Sometimes a nurse who is dealing with the patient can convince
him or her that the tests are absolutely necessary. If the patient is still opposed to
having blood taken, the phlebotomist must write on the laboratory request that the
patient refused to provide a specimen. The nurse responsible for the patient must
be informed of the patient’s refusal, and the physician will then be notified.
Identifying the Patient Correctly
Identify the patient by checking the arm band as well as addressing the patient
by name. Ensure that a patient who should have been fasting has done so. It
is better to ask the patient the last time he or she ate rather than asking if the
patient has eaten since some will deny having eaten to try to comply with the
requirements for fasting. If the patient should be in a fasting state but is not, it is
necessary to consult with the nurse or the physician as to how to proceed.
Assembling the Equipment and Supplies
Depending on the patient’s age, condition of the veins, department policy,
and amount of blood needed, the decision is made as to what system to use
for obtaining the blood. In the example shown in Figure 11-4, the venipuncture
supplies arranged for use are appropriate for procedures where a barrel
(needle holder) and evacuated tubes will be used. Assemble and label the
proper tubes, checking them for expiration date and condition before arranging
them in the order in which they should be drawn (see Table 11-3 for a
sample order of draw). This sequence largely avoids contaminating specimens
from additives in the tubes, which may cause erroneous results. Arrange all of
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