phlebotomy handbook: blood collection essentials, seventh edition diana garza kathleen becan-mcbride...

Phlebotomy Handbook: Blood Collection Essentials, Seventh EditionDiana Garza • Kathleen Becan-McBride

Pearson EducationCopyright 2005

Phlebotomy HandbookBlood Collection Essentials

Seventh Edition

Diana GarzaKathleen Becan-McBride

Chapter SixSafety and First Aid



Safety in Specimen Collection

• Goal is to recognize and eliminate hazards and provide information on safety education so employees can have a healthy, safe environment.

• OSHA Act of 1991 mandates the provision of a safe working environment.

• Safety in specimen handling is critical to avoid acquisition of infection.



Personal Hygiene at Work

• Put nothing in your mouth.• Wash hands frequently.• Never apply cosmetics.• No eating or drinking.• Tie back long hair.• Button lab coat.• No food in lab fridge.• No loose, dangling clothing or jewelry.• Opened toed shoes usually prohibited



Laboratory Safety

• Correct handling of specimens– Specimens should be covered at all times– Centrifuge specimens using appropriate

precautions.– Dispose of samples in appropriate biohazardous

containers.– Cover needles by properly utilizing the safety

equipment which require a one-handed method of permanently covering the end of the needle.



Laboratory Safety

• Safety advisory has been issued for the use of glass capillary tubes to reduce the risk of injury due to breakage and include the following:– Avoid using capillary tubes made of glass.

– Use capillary tubes wrapped in puncture-resistant film.

– Utilize products which do not require manual filling of end with sealant.

– Utilize products that allow measurement of hematocrit without centrifugation



Laboratory Safety

• Correctly dispose of biohazardous waste.– Double bag

• Causes of infectious airborne transmission– Removing rubber stoppers. – Splashing during transfer of blood or other body

fluids. – Centrifuging without covering with biological hood.– Not wearing a proper face shield when working with

specimens.– Exposure to sharps, such as needles and lancets.



Laboratory Safety

• Sharps keeper for sharps and broken glass.

• Biohazard sharpskeeper for contaminated glass, needles.



Laboratory Safety

– When disposing of specimens in sink, turn water on gently.

– Urine specimens poured down drain.– Blood can be poured down drain if local ordinance

permits, most facilities put in biohazard trash.



Laboratory Safety

• Special encapsulating powders are available which gel the liquid.



Decontaminate Work Area

• Use a 1:10 dilution of bleach, must be prepared daily.

• Blood or body fluid spills must be handled carefully.– Place paper towels over spill.– Flood with bleach solution– Allow to sit for 15-20 minutes before cleaning up.



Fire Safety

Classification of fires

1. Class A fires • Occur with ordinary combustible material,

such as wood, rubbish, paper, cloth, and many plastics.

2. Class B fires • Occur in a vapor–air mixture over flammable

solvents, such as gasoline, oil, paint, lacquers, grease, and flammable gases.



Laboratory Safety

• Colored biohazard labels must be placed on all containers used to store, transport or ship blood or body fluids.



Fire Safety

• Phlebotomist responsibilities– All employees are responsible for safety.– Know the location of fire extinguishers and learn

how to use them correctly.– Know the procedure for reporting a fire.– Know where the fire blanket is.– It is mandatory to attend periodic safety programs

to review.



Fire Safety

• Components of a fire:– Fuel– Oxygen– Heat– Necessary chain reaction



Fire Safety


1. Class A fires • Occur with ordinary combustible material,

such as wood, rubbish, paper, cloth, and many plastics.

2. Class B fires • Occur in a vapor–air mixture over flammable

solvents, such as gasoline, oil, paint, lacquers, grease, and flammable gases.



Fire Safety


3. Class C fires • Occur in or near electrical equipment.

4. Class D fires • Occur with combustible metals, such as

magnesium, sodium, and lithium.



Fire Safety

Figure 6.2: Proper Use of the Extinguisher

Courtesy of H

ealth and Environm

ental Safety, T

he University of T

exas Health S

ciences Center at

Houston



Fire Safety

Fire Extinguishers 1. Type A extinguishers

• Contain soda and acid or water and are used to cool the ordinary fire such as wood, cloth or paper.

2. Type BC extinguishers• Contain foam, dry chemicals, or carbon dioxide (CO2). • Are used to combat fires occurring in vapor–air

mixtures over solvents such as grease, gasoline or oil fires.



Fire Safety

Fire Extinguishers 3. Type ABC extinguishers

• Contain a dry chemical and are used on fires of wood, cloth, paper, oil, grease, and gasoline.

• Multipurpose in combating fires and thus, are located in fire stations throughout health care institutions.

4. Class D fires should be fought by firefighters only.



Fire Safety



Fire Safety - RACE

• Rescue/Remove person(s) from the immediate fire scene/room (RESCUE)

• Immediately pull alarm then call designated number posted on or near phone (ALERT)

• Close all doors/windows. (CONFINE)• If fire is small, use fire extinguisher. (EXTINGUISH)• If evacuation is necessary use stairs.• If clothing on fire, stop, drop, and roll.• If caught in a fire, crawl to exit, get wet towel if possible.• Do not block entrance or try to reenter the building.• Do not panic or run.



Fire Safety

Emergency Response to Possible Fire • Things to do in a fire response

1. Pull the nearest fire alarm

2. Call 911 or the hospital’s fire emergency number

3. Remove patients from danger

4. Close windows and doors

5. Use an ABC extinguisher for small fire

6. Leave the area immediately by stairs

7. Drop to ground and roll

8. Crawl to the exit



Electrical Safety

• Major hazard in any area of a health care institution.

• Potential major hazard is the possibility of electric current passing through a person.

• Location of circuit breaker boxes. – The Healthcare worker should be aware of the

location of the circuit breaker boxes in order to assure a fast response in the event of an electrical fire or an electrical shock.



Electrical Safety

• Power Outage and Emergency Power• In case of power outrage, emergency power is

delivered to lights by a red switch toggle.



Electrical Safety

• Preventive maintenance on equipment.• Periodically inspect cords for fraying, if frayed DO

NOT use.



Electrical Safety

• Control switches and thermostats should be in good working order.

• Unplug equipment when performing preventive maintenance and when cleaning up spills in equipment.



Electrical Safety

• Procedure to follow when coworker has contact with electrical current.– Unplug equipment first or turn off power.– Do not touch the victim.– To remove electrical contact, use asbestos gloves, which cannot

conduct electricity or place hand in glass beaker to push power supply away from the victim



Electrical Safety

• Call for medical assistance and start CPR immediately if needed.

• Do not move the victim• Place fire blanket or

other warm clothing over victim.



Electrical Safety

Using electrical equipment • While collecting blood, avoid contact with any

electrical equipment • Use three-prong “hospital-grade” electrical plugs • Actions to take in an electrical accident.



Electrical Safety

Figure 6.5 Outlet



Radiation Safety

The Three Cardinal Principles of Self-protection 1. Time

2. Shielding

3. Distance



Radiation Safety



Radiation Safety

Figure 6.6 Radiation Hazard Sign



Radiation Safety

Areas Where Radioactive Materials Are in Use and Stored

1. Nuclear medicine. 2. X-ray department. 3. Radioimmunoassay section in research or a

clinical laboratory. 4. Limit time of exposure to patients with

radioactive implants. 5. Health care workers who are pregnant should be

aware of the potential hazard of radiation to the fetus.



Radiation Safety

• In clinic settings, phlebotomist may be asked to assist with proper placement of patient.

• Be knowledgeable about institutions policy pertaining to radiation safety, especially if employee/student is pregnant.



Mechanical Safety

Centrifuge use and maintenance.

Figure 6.7 Example of a Centrifuge



Mechanical Safety

Correct carriers and positions• If the carriers are not in the correct position, they

can swing out of the holding disks into the side of the centrifuge.

• Tubes containing patients’ specimens or spinning chemicals may be propelled onto the side of the centrifuge, and broken, and a dangerous, hazardous problem created.



Chemical Safety

• Injury in the laboratory can occur due to exposure to poisonous, volatile, caustic or corrosive agents such as strong acids or basis.



Chemical Safety

• Different chemicals and reagents can present different types of hazards.– Inhalation of fumes can damage lungs (sulfuric

acid).– Some are corrosive to the skin (phenol).– Some are caustic (acetic acid).– Some are volatile (some solvents).– Some present a combination of hazards.



Chemical Safety

• All chemical and reagents should be stored in original container, tightly closed and in an appropriate, well ventilated storage area, ie, flammable cabinet



Chemical Safety

• Hazard communication manual, mandated by OSHA in 1986 and known as the “Right to Know Act”– requires that employers maintain documentation related to

all hazardous substances and must include the following:

– Written communication program.

– Documented training of employees.

– Sophisticated tracking and documentation of hazardous substances and Material Safety Data Sheets (MSDS).



Chemical Safety

• Occupational Safety and Health Administration (OSHA) hazard communication standard (Right to Know) is designed to ensure that lab orders are fully aware of hazards associated with chemicals in the workplace.



Chemical Safety

• Each site must have a comprehensive plan to implement the practice of safety measures throughout the lab.



Chemical Hygiene Plan

• Outline the specific work practices and procedures necessary to protect worker from any health hazards associated with hazardous chemicals.

• Provide information and training regarding hazardous chemicals to all lab worker.



Chemical Safety

• All hazardous chemical labels must contain the following information:– appropriate warning, ie, corrosive– explain nature of hazard, ie, flammable– special precautions to eliminate risks– explain first-aid treatment for exposure



Chemical Safety

• Information about signs and symptoms associated with exposure to hazardous chemicals used in the lab must be communicates to all.

– Reference materials for this information are included in the material safety data sheets (MSDS) provided by all chemical manufacturers and suppliers.

– This information concerns hazards, safe handling, storage, and disposal of hazardous chemicals used in the lab.



Material Safety Data Sheets (MSDS)

• Information provided by chemical manufacturers about each chemical.

• Each lab must have on file all MSDSs for the hazardous chemicals used in the lab.

• Use of MSDS is a common way that potential product hazard information is made available and OSHA requires this provision by all chemical manufacturers.



Material Safety Data Sheets (MSDS)

• The health care facility is required to provide this information to its workers.

• Each MSDS contains basic information about the specific chemical or product including:– Trade name, chemical name and synonyms.– chemical family– Manufacturer’s name, address and phone number for

further information.– hazardous ingredients.– Physical data, fire and explosion data– Health hazard and protection information.



MSDS Sheet



Chemical Safety

• A hazard identification system was developed by the National Fire Protection Association. http://atsdr1.atsdr.cdc.gov/NFPA/nfpa_label.htmlhttp://www.ee.byu.edu/cleanroom/NFPA.phtml?NFPA-see-all=true

• This system provides at a glance, in words, symbols, and pictures, information on the presence of potential health, flammability, chemical reactivity and special hazards information



Chemical Safety

• The hazard identification system consists of four small, diamond-shaped symbols grouped into a larger diamond.– Top diamond is red and indicates a flammability hazard.– Diamond on right is yellow and indicates a reactivity-stability hazard,

these materials are capable of explosion or violent chemical reactions.– Diamond on the left is blue and indicates a possible health hazard.– Diamond on the bottom is white and indicates special hazard

information such as radioactivity, special biohazard, and other dangerous elements.

– The system indicates the severity of the hazard using numerical designations from 0 to 4, with 0 being no hazard and 4 being extremely hazardous.



Chemical Safety

Figure 6.9 NFPA labeling system for hazardous chemicals



Chemical Safety

Figure 6.8 Department of Transportation (DOT) Hazardous Materials Warning Signs



Chemical Safety

Common laboratory chemicals Require regulatory labels

Figure 6.10 Example of OSHA-mandated labeling



Routine Safety Precautions

• Read labels for potential hazards prior to use.• Use appropriate PPE when handling.• Use special carriers for transport.• Rooms/cabinets used for storage must be labeled with

caution sign at entrance specifying chemicals present.• Never store chemicals above eye level.• Explosives/flammable stored in specially designed

cabinet.• If chemical is transferred from original container, the

new container must be labeled with chemical name and hazard identification diamond.



Chemical Spill or Exposure

• Know the location and proper use of the eye wash station and safety shower.

• If clothing involved go to safety shower, remove clothing, rinse for 15 minute.

• If eyes are splashed go to eye wash station, remove contact lenses, rinse 15 minutes.



Chemical Spills on Surfaces

• Obtain chemical clean up kit from clinical chemistry department.

• Special supplies which absorbs/neutralizes acid, alkali, mercury and other chemicals.

• Type used will depend on type of chemical involve.

• Has indicator system that identifies when spill has been neutralized and can be cleaned up.



Chemical Spill



Chemical Disposal

• Acids/alkalis that are soluble in water can be flushed down sink with lots of cold water.

• Pour alkalis into large amount of water first.

• NEVER add water to acid, may result in explosion, add acid to water



Equipment and Safety in Patients’ Rooms

• Properly dispose of all specimen collection supplies.

• Leave bed rails in position they were in when you entered.

• Report unusual odors• Check for spill on floor• During blood collection, do not touch

electrical instruments, patient may become grounded and receive a shock.



Equipment and Safety in Patients’ Rooms

• If patient has an IV report to the nurse if the site is red and swollen, if blood is backing up, the IV container is empty or the IV alarm is sounding.

• If the patient is in unusual pain or is unresponsive, notify the nursing station immediately.

• Be aware of signs/symptoms of latex allergies in patients: skin rash, hives, respiratory problems, or shock.



Patient Safety Related to Latex Products

Allergy to latex products

Figure 6.12 Latex-Free Cart




Figure 6.13 Latex Safe Environment Sign




Table 6.1 Products Containing Latex



Patient Safety Outside the Room

• Travel with care as trays, carts, ladders may be placed in unusual places.

• Pick up items on the floor to prevent individuals from slipping.

• Avoid running, as others may become alarmed and run also, or you may run into someone



Disaster Emergency Plan

Figure 6.14 Disaster Plans and Phone



Disaster Emergency Plan

• Most institutions have developed procedures to follow in case of: hurricane, flooding, earthquake, bomb threat and local major disasters.

• Must become knowledgeable about your role in disaster plan procedures.

• Many places have annual or semi-annual city wide disaster drills involving all emergency service departments and appropriate health care facilities.



• Detach yourself from the situation to the degree necessary to perform well and deliver best possible care.

• Be prepared to act if an accident occurs in your presence.

• Prevent severe bleeding, maintain airway, prevent shock and further injury.

• Get assistance immediately, but do not leave patient.



Bleeding Aid

• Place a clean cloth over the site and apply pressure.

• If none available use your hand until one is available.

• Elevate the extremity to decrease blood flow, raise above the heart.

• Do not use a tourniquet unless limb is mangled, crushed or amputated to the extent that there is profuse bleeding.



Breathing Aid

• When breathing stops lips, tongue and fingernails become blue.

• This is an indication for immediate mouth to mouth resuscitation.

• Delay in artificial respiration may result in brain damage or death.



Emergency Procedures

Breathing Aid 1. See if the victim is

conscious.

2. Place the victim on his or her back.

3. Open the airway.

4. Head tilt/chin lift.

Figure 6.15 Head-tilt/chin-lift for emergency care




Breathing Aid 5. Listen and feel for return of air from the victim’s

mouth and nose.

Figure 6.16 Listen for return of air from the victim’s mouth and nose




Breathing Aid 6. If no breathing,

maintain the head-tilt/chin-lift.

7. Give two full ventilations.

Figure 6.17 Ventilate with pocket mask



Circulation Aid

• Circulation aid can only be achieved by proper training in a CPR class.

• Most large institutions offer classes and refresher courses periodically.

• TAKE ONE.



Preventing shock

• May be the result of excessive bleeding, extensive burns, lack of oxygen or other traumatic events.

• Signs include: pale, cold, clammy skin, weakness, rapid pulse, increased shallow breathing and frequently nausea and vomiting.

• Main objective is to improve circulation, get sufficient oxygen in the maintain body temperature.




Shock Prevention • Six actions

1. Correct the cause of shock if possible (e.g., control bleeding).

2. Keep the victim lying down. 3. Keep the victim’s airway open. If he or she vomits, turn

head to the side so that the neck is arched. 4. In the absence of broken bones, elevate the victim’s

legs so that the head is lower than the trunk of the body.

5. Keep the victim warm. 6. Call for emergency assistance.




Shock Prevention • Actions that are not recommended

1. Giving fluids to a victim who has an abdominal injury (the person is likely to require surgery or a general anesthetic).

2. Giving fluids to an unconscious or a semiconscious person.

phlebotomy handbook: blood collection essentials, seventh edition diana garza kathleen becan-mcbride...

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