Phlebotomy Handbook
Blood Collection Essentials
Seventh Edition
Diana Garza
Kathleen Becan-McBride
Chapter Six
Safety and First Aid
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
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
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
Laboratory Safety
• Sharps keeper for sharps
and broken glass.
• Biohazard sharpskeeper
for contaminated glass,
needles.
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
Laboratory Safety
• Special encapsulating powders are available which
gel the liquid.
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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
•
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Occur in a vapor–air mixture over flammable
solvents, such as gasoline, oil, paint,
lacquers, grease, and flammable gases.
Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
Laboratory Safety
• Colored biohazard labels must be placed on all
containers used to store, transport or ship blood or
body fluids.
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
Fire Safety
• Components of a fire:
–
–
–
–
Fuel
Oxygen
Heat
Necessary chain reaction
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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
•
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Occur in a vapor–air mixture over flammable
solvents, such as gasoline, oil, paint,
lacquers, grease, and flammable gases.
Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
Fire Safety
Classification of fires
3. Class C fires
•
Occur in or near electrical equipment.
4. Class D fires
•
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Occur with combustible metals, such as
magnesium, sodium, and lithium.
Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
Fire Safety
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Courtesy of Health and Environmental Safety, The University of Texas Health Sciences Center at Houston
Figure 6.2: Proper Use of the Extinguisher
Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
Pearson Education
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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
•
•
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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.
Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
Fire Safety
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Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
Fire Safety
Emergency Response to Possible Fire
•
Things to do in a fire response
1.
2.
3.
4.
5.
6.
7.
8.
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Pull the nearest fire alarm
Call 911 or the hospital’s fire emergency number
Remove patients from danger
Close windows and doors
Use an ABC extinguisher for small fire
Leave the area immediately by stairs
Drop to ground and roll
Crawl to the exit
Phlebotomy Handbook: Blood Collection Essentials, Seventh Edition
Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
Electrical Safety
•
•
Power Outage and Emergency Power
In case of power outrage, emergency power is
delivered to lights by a red switch toggle.
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Diana Garza • Kathleen Becan-McBride
Electrical Safety
• Preventive maintenance on equipment.
• Periodically inspect cords for fraying, if frayed DO
NOT use.
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Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
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
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Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
Electrical Safety
Figure 6.5 Outlet
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Diana Garza • Kathleen Becan-McBride
Radiation Safety
The Three Cardinal Principles of Self-protection
1. Time
2. Shielding
3. Distance
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Diana Garza • Kathleen Becan-McBride
Radiation Safety
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Diana Garza • Kathleen Becan-McBride
Radiation Safety
Figure 6.6 Radiation Hazard Sign
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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.
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Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
Mechanical Safety
Centrifuge use and maintenance.
Figure 6.7 Example of a Centrifuge
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Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
Chemical Safety
• Injury in the laboratory can occur due to
exposure to poisonous, volatile, caustic or
corrosive agents such as strong acids or basis.
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Diana Garza • Kathleen Becan-McBride
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.
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Diana Garza • Kathleen Becan-McBride
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
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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).
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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.
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Chemical Safety
• Each site must have a comprehensive plan to
implement the practice of safety measures
throughout the lab.
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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.
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Diana Garza • Kathleen Becan-McBride
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
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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.
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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.
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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.
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MSDS Sheet
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Chemical Safety
• A hazard identification system was developed
by the National Fire Protection Association.
http://atsdr1.atsdr.cdc.gov/NFPA/nfpa_label.html
http://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
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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.
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Chemical Safety
Figure 6.9 NFPA labeling system for hazardous chemicals
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Chemical Safety
Figure 6.8 Department of Transportation (DOT) Hazardous Materials Warning Signs
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Chemical Safety
Common laboratory chemicals

Require regulatory labels
Figure 6.10 Example of OSHA-mandated labeling
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Diana Garza • Kathleen Becan-McBride
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.
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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.
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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.
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Chemical Spill
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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
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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.
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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.
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Patient Safety Related to Latex
Products
Allergy to latex products
Figure 6.12 Latex-Free Cart
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Patient Safety Related to Latex
Products
Figure 6.13 Latex Safe Environment Sign
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Patient Safety Related to Latex
Products
Table 6.1 Products Containing Latex
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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
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Disaster Emergency Plan
Figure 6.14 Disaster Plans and Phone
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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.
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• 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.
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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.
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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.
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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
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Emergency Procedures
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
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Emergency Procedures
Breathing Aid
6. If no breathing,
maintain the headtilt/chin-lift.
7. Give two full
ventilations.
Figure 6.17 Ventilate with pocket mask
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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.
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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.
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Emergency Procedures
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.
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Emergency Procedures
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.
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