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Hematology is porous and cannot be cleaned

adequately before disinfection


Safety in the clinical hematology laboratory 1:100 (0.05% sodium hypochlorite)is
for hard, smooth surfaces that can be
- Classification of hazards decontaminated adequately,
o Biologic inactivates HBV for 5 mins and HIV
o Chemical for 2 mins, 20 mins for large spills of
o Electrical infectious agents
o Mechanical For metals: iodophores registered
o Thermal as hard-surface disinfectants (not
antisceptic) or phenolic
BIOLOGIC disinfectants.
- Includes all body fluids which are 13. Protective clothing should always be
highly infectious and potentially lethal worn in the laboratory but never
- Materials are referred to as biohazards outside the laboratory
- Extreme caution when processing
- Greatest concern of all hazards CHEMICAL
- All biologic specimens, regardless - Solid, liquid or gaseous chemicals may
of source, should be considered be hazardous if processed
biohazardous inappropriately
- Toxic or corrosive chemicals should
General rules that are strictly followed only be used under a fume hood
in the laboratory - Flammable or explosive chemicals
1. Gloves must be worn when handling should be stored in a safety cabinet
biologic specimens designed for such chemicals
2. Areas or equipment used by personnel - Always wear PPE when performing
who are not gloved should not be special staining of cells because they
touched with contaminated gloves are carcinogenic
3. Wash hands immediately if they - Wear safety glasses when working
become contaminated, with or without with acid or alkaline
gloves on - Mouth pipetting is strictly prohibited
4. Do not remove specimen tube - When carrying bottles or flasks, hold it
stoppers until necessary in the body rather than the neck
5. Mouth pipetting is strictly prohibited - Always add acid to water and never
6. Replace clay slabs for microhematocrit vice versa, perform it in a deep sink to
tube sealing frequently be easily flooded with water
7. Decontaminate sedimentation tube - Reagents should always be labeled
racks regularly with its name and concentration, the
8. Unfixed or unstained slides should be person who prepared it (initials only),
considered infectious and the date on which the reagent was
9. Do not handle needles prepared.
10. Obtain immediate treatment for - Material safety data sheet (MSDS) –
accidental and inappropriate contact information necessary for the safe
with biohazards handling of the material
11. Properly dispose of contaminated - Most noncarcinogenic, diluted may be
laboratory supplies flushed down the sink, otherwise, an
12. Disinfect and clean biohazard spills environmental safety specialist do the
immediately job.
Note: 1:10 dilution (0.5% sodium
hypochlorite) if contaminated surface
ELECTRICAL o Post warning signs
- Caused by inappropriate use or - Good laboratory technique
maintenance of electrical instruments o Careful in transferring
or equipment that may cause electrical chemicals and always add acid
shock, burns, or a fire or explosion to water
- Maintenance is mandatory for safe use o Do not operate new or
of equipment, include replacement of unfamiliar equipment until you
frayed wires or electrical connections. are trained and authorized
- All equipments should be grounded o Read all labels and instructions
by 3 pronged plug according to OSHA carefully
- NEVER OPERATE WITH WET HANDS o Use the personal safety
equipment that is provided
MECHANICAL o Safe handling, use, and
- Improper use, storage, or disposal of disposal of chemicals
glassware, sharp instruments, o Learn emergency procedures
compressed gases or equipments. and become familiar with the
- Avoid breakage place
- Glass and sharp objects that are
contaminated should be disposed in a Specimen collection
puncture proof container
- Dispose needles left uncapped Specimen collection is vital, it is the
laboratory’s first step toward reporting
FIRE accurate and reliable results
- Thermal hazards may be caused by
improper use or storage of either PROFESSIONALISM AND INTERPERSONAL
cryogenic or combustible substances. SKILLS
- Prevention is the easiest way to deal - Phlebotomist is essential to the health
with fire hazard care team and provides the link
- Fire extinguisher should be accessible between the patient and laboratory
in the laboratory (dry chemical is - Good interpersonal skills
popular because of its versatility), fire - Professional attitude
blanket should also be available for - Neat appearance
small fires - Patient consideration and concern
- Patient confidentiality
REMEMBER THE CARDINAL RULES
- Good personal habits SPECIMEN COLLECTION BY VENIPUNCTURE
o Wear proper attire inside the - It is the most common technique to
laboratory and not outside obtain a blood specimen
o Tie back long hair VENIPUNCTURE PROCEDURE
o Do not eat, drink, or smoke in PATIENT INTERACTION
the work area - Identify the patient
o Always wear gloves - Note patient isolation and
o Never do mouth pipetting restrictions
o Do not put objects in the mouth - Note patient dietary restrictions
o Wash hands frequently - Reassure patient
o Keep hands away from any - Verify paperwork
other mucous membranes - Position patient
- Good housekeeping practices ASSEMBLE SUPPLIES AND EQUIPMENT
o Keep work areas clean VENIPUNCTURE
o Store chemicals properly - Select general venipuncture location
o Label reagents and solution - Apply the tourniquet
- Select exact venipuncture site - PPE are placed outside the patient
- Cleanse area room and worn when entering
- Inspect needle (remove all accessories and wash
- Perform venipuncture hands before PPE)
- Release tourniquet
- Position gauze over puncture site NOTE DIETARY RESTRICTIONS
- Remove needle and apply pressure - Make sure the patient has fasted for
SPECIMEN PREPARATION the required period of time (usually
- Fill the right tubes for the right test not required in hematology)
Discard needle
- Label specimens REASSURE PATIENT
- Transport specimens promptly and - The phlebotomist should relieve the
properly patient from stress and anxiety
- Discard needle
- Label specimens POSITION THE PATIENT
- Transport specimens promptly and - Make sure the patient is comfortable
properly - Ask assistance if patient movement is
required
Initial steps - Patient position is noted on the
requisition (variation in blood count
PATIENT IDENTIFICATION values e.g. PCV can decrease an
- The first step average of 8% when a patient is
- The patient’s name, ID number, and lying down because of
any additional information on the test hemodilution, when a patient gets
requisition should initially be out of bed, hemoconcentration
compared with, and found to be occurs)
identical to, the information posted ASSEMBLE SUPPLIES
outside the patient’s room or on the - Organize things and place it in an
chart accessible location before doing
- Greet the patient when entering the venipuncture
room and identify himself/herself - Equipments:
- Explain why it is necessary to collect o Evacuated tubes (normally
blood (to aid in diagnosis and blood clots after removal from
treatment) the body, therefore
- Ask the patient to state his/her full anticoagulants are needed to
name (spell out any unusual name) prevent clotting; anticoagulant
- Never ask a yes or no identity question of choice for CBC: disodium
- Compare the requisition information to or tripotassium salt of EDTA,
the patient’s wristband specific tubes are indicated by
- If patient is unconscious, ask the the color of the rubber
responsible nurse stopper; marked with an
- Age and sex are also identified expiration date, If expired it
(differences in reference range) may either have an ineffective
additive or lose their vacuum;
NOTE ISOLATION RESTRICTIONS certain of amount of blood
- Note any color-coded isolation sign on must be drawn within a certain
the patient’s room or door amount of anticoagulant
- Patients are isolated either to prevent [correct blood-to
spread of disease or to protect them anticoagulant-ratio], too
from employees and visitors much anticoagulant =
changes in cell size and
morphology, too little o Gloves
anticoagulant = clotting; 5 or VERIFY THE PAPERWORK
7ml tubes = adult specimen - Accession numbers on the
collection, 2-3ml = preprinted specimen labels and test
pediatrics; 1.5mg/ml is the requisition must be identical
required final concentration of SELECT GENERAL VENIPUNCTURE
EDTA for complete LOCATION
anticoagulation) - Veins in the arm are commonly used
Routinely used evacuated - 3 major veins
tubes o Median cubital (large, close
Stopper Additive to the skin surface, and well
color anchored by tissue so it will
Red None not roll or move away when
Red and Inert polymer punctured)
Gray barrier o Cephalic (tend to bruise and
material; no roll more easily)
anticoagulant o Basilic (tend to bruise and roll
Lavender EDTA (K3 or more easily)
Na2)
- Alternate sites
Blue Citrate
o Ventral forearm
Green Heparin
o Wrist area
Gray Sodium
fluoride o Back of the hand
o Ankle or foot(consult the nurse
o Tube rack or physician before collecting;
o Syringes cannot be used in circulatory
o Butterfly infusion sets problems in the lower
o Needles (gauge number refers extremity, diabetes in poor
control,
to the diameter or the bore of
the needle; the higher the hemoglobinopathies)
gauge, the smaller the - In selecting the site, avoid areas with
diameter, 19, 20 [most hematomas, burns, scars or
common], 21 [for small and edema(swelling), mastectomy on the
difficult veins, may cause same side, IV infusion side (if both
hemolysis]; most commonly arms are on IV, ask the nurse to stop IV
used needle length: 1-1.5in) infusion for 2 minutes then discard
o Tourniquet (most commonly small amount of blood before
used is a pliable piece of specimen collection, glucose and
phosphorus are not acceptable)
rubber tubing,
seraket[seatbelt like
apparatus, advantageous Blood collection methods
because the phlebotomist can
partially release venous 1. Evacuated tube system
o most commonly used
pressure, thus preventing
hemoconcentration], Velcro o components: vacutainer 2-
and blood pressure cuff can way needle, plastic tube
holder, evacuated glass tube
also be used
o Alcohol pads 2. Syringe method
o Gauze pads o Method of choice in some
o Adhesive bandages or gauze instances
bandage rolls
o Components: barrel and
plunger to which needle is
attached
o Used for small, fragile or
damaged veins because they
may easily collapse under the
vacuum pressure of evacuated
tubes
3. Butterfly infusion set
o Components: stainless steel
beveled needle with attached
plastic wings (for the
phlebotomist to grasp during
the needle insertion), platic
tubing, adapter, syringe,
tube holder
o Commonly used for pediatric
venipuncture, difficult veins,
special collectons requiring
more than one syringe
o Costly

Final steps
APPLY THE TOURNIQUET
SELECT HE VENIPUNCTURE SIITE
CLEANSE THE SITE
INSPECT THE NEEDLE
PERFORM VENIPUNCTURE
EVACUATED
SYRINGE
RELEASE TOURNIQUET
REMOVE NEEDLE AND APPLY
PRESSURE
DISCARD NEEDLE
LABEL SPECIMENS
TRANSPORT SPECIMENS
PROMPTLY AND PROPERLY