Defusing Fear in Pediatric Patients
Preparing the pediatric patient begins the moment your eyes meet.
Children will be able to detect compassion and tenderness in your face and
body language just as you will be able to read anxiety or complacency in
theirs. How well you interpret and react to the patient's state of mind
determines his/her reaction to this and all subsequent phlebotomies.
For pediatric patients, the fear of the unknown can often be alleviated
in less than 1 minute. Healthcare professionals who read apprehension and
anxiety in their pediatric patients should establish a rapport with the
child by sitting next to the patient or otherwise getting down to the
child's eye level; the affect of a towering, uniformed authority is
intimidating enough. Unless already conducted, an introduction is
necessary. Ask the patient if this is his/her first blood test.
Regardless of the answer, if apprehension is obvious, defuse the child's
fear by talking through the procedure step-by-step, speaking in simple
terms appropriate to the child's age. To do so, demonstrate the application
of the tourniquet by squeezing the child's upper arm where it might be
applied to the degree the tourniquet will be tightened. Ask the child to
make a fist. Point to the antecubital area, explaining that that is where
you will look for a vein. Then explain that you will cleanse the site (for
example, "with something cold and kind of smelly"), and that you
will then ask him/her to look the other way. Explain that, after looking
away, he/she will then feel a little "pinch." To give the child
an approximation of the sensation, gently pinch the antecubital area so
that the child will know exactly what to expect.
Tell the child that, at that point, he/she will be asked to start
counting and that you will probably be done by the time he/she gets to 10.
Explain that you will then put pressure on the site for a few minutes, you'll
bandage it (this is an important selling point: most kids love bandages!),
and you'll be done. Explaining this procedure takes 1 minute or less. When
the child knows what to expect, the fear of the unknown can be put to rest,
and the venipuncture has a much greater chance of proceeding without
From Our Esteemed Readers:
Your article last month,
"Managing Patients Who Lose Consciousness," reminds me of an
instance in the early 1970's when the Kentucky Law Statutes still required that
a VDRL (RPR) be performed on all premarital applicants. While managing a
rural laboratory in central Kentucky, I had the opportunity to draw blood
samples on a soon-to-be-married young couple in their mid-20's. Both were
local law officers.
Things went smooth with the lady, but I detected some early resistance
with the gentleman. With the needle in the arm, the man passed out
"gradually" and proceeded to "wet the floor". While
trying to hold the man in his chair and remove the needle, the puddle caused
my legs to gradually split to keep my shoes from becoming soiled. All was
well after a few minutes, but it was an embarrassing situation for the
"brave" young couple who placed their lives in the way of harm
each day to protect and serve.
lasted about 14 months.
Specimen Collection Safety:
Safety Transfer Devices
When using a syringe to draw blood specimens, do you fill collection tubes with the same needle used to perform the puncture? If so, sooner or later you'll have a needlestick injury. OSHA prefers you activate the safety feature of the needle first, then replace the needle with a safety transfer device prior to filling tubes. Outside of the US, it's still important to use safety needles. Removing a conventional needle is just as risky, if not more, than piercing the stopper with the same needle used to access the vein. Just remember, syringes are the single most common device in use when healthcare professionals sustain accidental needlesticks. Using a safety transfer device to fill tubes is an important device in exposure prevention where safety needles are in use.
Certified Phlebotomist Shunned in NYC
A certified phlebotomist who can't find work in New York City is out of everything except hope. Alham Mastafa emigrated with her husband from Baghdad to NYC in 1981 for a better life, but fears her heritage is why she can't find work. Her husband died of stomach cancer three years ago and left her penniless. Mastafa, who now lives alone with her four sons, one of whom was recently diagnosed with Guillain-Barre Syndrome, has nothing but debt, hope, and a growing sense of desperation.
For the complete story:
Phlebotomy Answers 24/7/365
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This Month in Phlebotomy Today
Need more than Phlebotomy Today-STAT!? Our flagship
newsletter, Phlebotomy Today, is currently in its 8th year
of publication. Here's what subscribers are reading about this month:
- Feature Article:
Blood Culture Collection, Part II
- Sidebar to "Blood
Culture Collection": Five Factors that Lower Contamination Rates
- Ask the Safety
Lady: OSHA consultant addresses these burning questions:
- Do phlebotomists have to wear gloves?
- How often does a safety shower need to be checked?
- When should a sharps container be disposed?
- Phlebotomy in
the News: a round-up of articles on phlebotomy and phlebotomists
who made Internet headlines in January including these stories:
- Phlebotomist has
Hip-Hop in her Blood;
Venipuncture Draws Patient Complaint;
Phlebotomist Shunned in NYC;
- Lab Offers
- 80-Year-Old Phlebotomist Leaves
Legacy of Humor.
- According to
the Standards: What the CLSI standards say about discard tubes.
- Tip of the
Month: Just Say "No!"
- CEU Questions that
enable managers and educators to use Phlebotomy Today as an in-house
continuing education tool. (Institutional subscribers only.)
- On a Personal
Note: The origins of Phlebotomy Today and the life
lessons learned in the process.
For subscription rates and to subscribe to Phlebotomy
Today, visit www.phlebotomy.com/PhlebotomyToday.html.
The current month's issue will be emailed to you immediately upon
"Symposium for Clinical Laboratories: An Interactive Experience in
Quality Systems" will be conducted May 2-5, 2007 at the Hilton San
Diego Resort on Mission Bay in San Diego, California. Features of the
symposium jointly sponsored by University of Wisconsin School of Medicine
& Public Health and COLA includes:
- General sessions on
successfully implementing quality systems in your laboratory using
proven tools and techniques;
- Breakout sessions on
preparing for laboratory inspections, systemizing regulatory
compliance, hiring and retaining laboratory personnel, and using
quality tools to maximize revenue and profits;
- Continuing Education
(CE) that meets state requirements for clinical laboratory testing
- Continuing Medical
Education (CME) that meet CLIA regulations for laboratory directors of
a moderate complexity laboratory.
- Exhibit area with
displays of laboratory instruments, supplies, and services.
Internationally recognized experts giving presentations
on implementing quality systems in the laboratory include:
- James O. Westgard,
- Dennis Ernst,
- Judy Yost, MA,
- William Greg Cooper,
- Lucia M. Berte, MA,
MT(ASCP) SBB, DLM; CQA(ASQ) CMQ
registration or additional information, go to www.cola.org.
For questions concerning this event, please contact Symposium Operations
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Each month, PT-STAT! will
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information on joining Phlebotomy Central, visit www.phlebotomy.com/PhlebotomyCentral.html.
Dennis, Our Ortho rep suggested that I contact
you. Here is my question: Has
OSHA ruled that tourniquets in the outpatient setting must be discarded
after each patient, or only when soiled/end of day? I am looking for the
actual regulation, not opinion. This came up in another hospital's survey,
and they are asking me for help (because I'm a CLS?). Thank you for any
help that you can give us.
This is a common question I receive. OSHA would not make such a mandate.
Discarding tourniquets after one issue is more of a matter of infection
control than an OSHA issue. OSHA is concerned only with employee injury and
illness, not patient issues. In fact, OSHA doesn't even mention tourniquets
in the Bloodborne Pathogens Standard, so they have no position on the
subject unless the equipment is soiled by blood in such a manner and to
such a degree that it is a potential risk to employees.
What OSHA does say is: "All equipment and
environmental and working surfaces shall be cleaned and decontaminated
after contact with blood or other potentially infectious materials."
and "Special care shall be taken to avoid skin contact with other
potentially infectious materials."
So it's really up to you to
establish a policy based on current infection control and this OSHA
passage. It's generally accepted that tourniquets be discarded when visibly
soiled. Your Infection Control Officer should be consulted and a policy
drafted based on his/her recommendations. Establishing a policy to the
effect that visibly soiled tourniquets must be discarded should be the bare
minimum. Facilities vary widely in their policies on tourniquet disposal.
I'm seeing more and more of them adopt a single-use policy to fight
nosocomial infections, and would encourage you to consider one as well.
Keep in mind, over 98,000 patients die every year from nosocomial
infections. I am hard-pressed to think that contaminated tourniquets don't
contribute to the problem. I hope this helps.
Free Phlebotomy Tips cards
Every online order placed at www.phlebotomy.com during the month of February receives 5 free pocket-size Phlebotomy Reminder cards.*
Healthcare professionals with specimen collection responsibilities who carry a Phlebotomy Reminders card from patient to patient have ready access to the recommended Order of Draw as well as 11 tips for successful venipunctures.
The 11 tips remind specimen collection personnel of other critical aspects of blood collection including proper patient identification, vein selection, needle insertion, specimen labeling, the limits to needle manipulation and other important considerations. The Order of Draw and tips reflect the current standards for specimen collection published by the Clinical and Laboratory Standards Institute as well as OSHA guidelines. Specifications: 3.5 x 5.5 inches. 4-color. Glossy cardstock.
To view the products available at www.phlebotomy.com, visit the online catalog.
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