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Phlebotomy Today

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February, 2018

Summary of Recent Surveys

Lady listeningThe Center for Phlebotomy Education often posts survey questions inviting readers and visitors to its website and Facebook page to participate, then publishes the results in the following issue of Phlebotomy Today-STAT! This month, we summarize responses from some of the more intriguing surveys conducted over the past 12 months. Topics include patient identification errors, policy violations, certification, reducing anxiety in patients, Lab Week activities and more. Links are provided to the archived issue of Phlebotomy Today-STAT! that discusses the survey results at length. 

Errors and Omissions

 Which of the 28 steps of a basic venipuncture are most commonly omitted, or performed incorrectly, where you work?

  • asking about prior complications/incidents with blood draws---40%
  • releasing the tourniquet within one minute---32%
  • not recleansing the site after repalpating---30 %
  • filling all tubes to the fill line---27.5%
  • observing the site for bleeding for at least five seconds prior to bandaging---27%. 

Read the complete survey results and commentary.


Patient identification

What is your facility's policy on identifying patients prior to a blood draw? Do you always follow the policy?

  • state full name: 77 percent; 14 percent don't always comply;
  • state birth date: 98 percent; 5 percent don't always comply;
  • spell first and last name: 7 percent: 48 percent don't always comply;
  • seek a third-party when patient is unable to provide the required information: 86 percent; 11 percent don't always comply;
  • compare information provided with ID band and test request: 89 percent. 7 percent don't always comply.

Read the complete survey results and commentary.


Pain & anxiety

What are you using to reduce the pain and anxiety of phlebotomy on pediatric and adult patients?


  • Verbal distraction (conversing, small talk, etc,)---85%
  • parental comforting---81%
  • use of a 23-gauge needle or smaller---79%
  • visual distraction---71%. 


  • verbal distraction---91%
  • explaining the procedure in advance---64%
  • visual distraction---51%.

Read the complete survey results and commentary.



 Does your employer require phlebotomists to be certified?

  • Yes---29%
  • No---71%

If you are certified, which agency certified you?

  • American Society for Clinical Pathology (ASCP)--51.3%
  • National Healthcareer Association (NHA)--14.1%
  • National Center for Competency Testing (NCCT)---6.4%
  • National Phlebotomy Association (NPA)---4%
  • American Society of Phlebotomy Technicians (ASPT)---4%
  • American Medical Technologists (AMT)---2.6%
  • New Zealand Institute of Med Lab Science (NZIMLS)---2.5%
  • Australia---2.5%
  • Other---11%

Read the complete survey results and commentary.


Would I recommend my profession?

 Would you recommend your profession to a friend or acquaintance?

  • Yes---80%
  • No---20%

If you would not recommend your profession, why not?

  • low pay---60%
  • lack of respect from other healthcare professions---50%
  • lack of respect from other laboratorians---30%
  • no opportunities for advancement---40%
  • always being understaffed---30%

Read the complete survey results and commentary.


Policy violations

 What policies where you work are commonly violated.

  • texting personal messages---75%
  • tardiness---50%
  • duration and frequency of breaks---43%
  • handwashing---43%
  • surfing the Internet for personal reasons---43%
  • dress code violations---29%
  • taking/making personal phone calls---36%
  • exceeding allowable sick days---32%
  • gossiping---32%

Limits to piercing, policies against vulgarity and offensive speech, policies assuring a safe work environment, and HIPAA policy violations were each reported to be common with 14 percent of respondents. Failure to wear gloves was cited by 4 percent.

Read the complete survey results and commentary.


Tube labeling practices

Do you ever label tubes you didn't draw?

  • Never---60%
  • Only if I witness the collection including the patient identification step---36% 

Of the tubes you draw yourself, do you ever label them away from the patient?

  • Never---81%
  • Sometimes---18%

Do you ever label tubes before they are filled?

  • Never---79%
  • Yes, it's acceptable where I work---7%
  • It is acceptable where I work, but I always label after the draw---14%

Should pre-collection labeling be allowed?

  • Yes---10%
  • No---90%

Read the complete survey results and commentary.


If I could enact a law...

What laws would you like to enacted for those who draw laboratory samples?

  • mandatory certification for those who draw blood---21%
  • mandatory training program---9%
  • mandatory continuing education---9%

Read the complete survey results and commentary.


On my wish list

 What products and concepts do you wish would be developed to help you in your role as blood collection personnel?

Managers' top five:

  1. a device that eliminates hemolysis---73.7%
  2. a device that makes it impossible to misidentify a patient or mislabel a tube---68.4%
  3. a site prep solution that not only cleanses the site, but instantly anesthetizes the skin, making every blood draw painless---63.2%
  4. gloves that don't feel like I'm wearing gloves when I palpate for veins---57.9%
  5. a device that eliminates blood culture contamination---36.8%

Educators' top five:

  1. a device that eliminates hemolysis---88.9%
  2. a device or method that improves patient comfort and satisfaction---66.7%
  3. a device or feature that eliminates accidental needlesticks during phlebotomy---66.7%
  4. gloves that don't feel like I'm wearing gloves when I palpate for veins---66.7%
  5. a site prep solution that not only cleanses the site, but instantly anesthetizes the skin, making every blood draw painless---44.4%

Front line healthcare professionals' top five:

  1. a site prep solution that not only cleanses the site, but instantly anesthetizes the skin, making every blood draw painless---69.8%
  2. a device or method that improves patient comfort and satisfaction---56.6%
  3. gloves that don't feel like I'm wearing gloves when I palpate for veins---50.9%
  4. a device that reduces back strain caused by bending over to draw blood---45.3%
  5. a device that eliminates hemolysis---43.4%

Read the complete survey results and commentary.


Celebrating Lab Week

How did your facility celebrate the last National Medical Laboratory Professionals Week?

  • Our profession was not celebrated---30%

Of those whose facilities did celebrate Lab Week:

  • phlebotomists received special recognition---38%

Among those employed at facilities that celebrated Lab Week:

  • the recognition had no effect on how I feel about my profession---62%
  • the recognition made me feel worse about my profession---6%

 Read the complete survey results and commentary.


Summoning waiting patients

What practices are in place where you work for summoning patients from a waiting room, and confirming their ID once they arrive at the draw station?

  • we announced the intended patient's first name aloud---36%
  • we announced the last name---14%
  • we announced the intended patient's first and last name---31%
  • we announce a unique identifier---11%
  • we displayed a unique identifier for patients to respond to---8%
  • when the outpatient you summoned enters the draw station, how do you confirm his/her identification?
  • we compare the order or labels by requesting the patient to verbally provide specific information---75%
  • we ask the patient who responded to the summoning to affirm specific information the phlebotomist provides---6%
  • no verification takes place in their draw stations---3%
  • other methods---17%

Finally, we wanted to know if and how those who draw blood specimens confirm the tube was properly labeled after the draw, as required by the standards. Surprisingly, 22 percent did not verify the labeled tube. Two respondents said they only confirmed tubes used for transfusion testing. Of those who regularly confirm tubes are labeled properly, 21 percent compare the tube(s) with the patient's ID band, while 39 percent show the labeled tube to the patient for confirmation.

 Read the complete survey results and commentary.


Product Spotlight: Phlebotomy Answer Book

LabDrawCOVER_FINAL_Front_1000wThe  Lab Draw Answer Book, published by the Center for Phlebotomy Education, contains answers to nearly 400 commonly asked questions on blood sample collection and handling, and managing phlebotomy services and personnel.

The 440-page full-color reference book is the second edition of Blood Specimen Collection FAQs and includes 100 new entries. All original entries have been updated to fully reflect CLSI's new venipuncture standard. The second edition is co-authored by Dennis J. Ernst MT(ASCP), NCPT(NCCT) and his wife Catherine Ernst, RN, PBT(ASCP)CM.

"Bringing Catherine on board as co-author adds a nursing perspective so necessary for a phlebotomy reference book," says Dennis Ernst. "She's been very instrumental in making sure all passages not only reflect the CLSI standards, which she helped write, but the Standards of Practice of the Infusion Nurses Society.

Chapters in the book include:

  1. Safety and Infection Control
  2. Training, Management and Certification
  3. Skin Punctures, Heelsticks, and Pain Management
  4. Patient Identification, Vein Selection, & Site Prep
  5. Tourniquets & Butterflies
  6. Order of Draw & Discard Tubes
  7. Hemolysis and Potassium Issues
  8. Blood Cultures
  9. Labeling and Post-venipuncture Care
  10. Line Draws & IV Starts
  11. Processing, Storage, & Transportation
  12. Patient Injuries & Complications
  13. Unorthodox Techniques
  14. Miscellaneous

Copies are currently only available from the Center for Phlebotomy Education. More information and preview pages.

Slapping Veins: Is it necessary? Is it professional? Is it battery?

SlappingA common practice to get veins to become more prevalent is to slap the area where veins are commonly found. However, doing so raises many questions about its affect on test results and the impact it could have on patients, including complaints of battery.

To date, no study has attempted to determine if analytes are altered or not when sites are slapped prior to needle insertion. We can't be sure they are, and we can't be sure they aren't. The evolution of the venipuncture standard (GP41) published by the Clinical and Laboratory Standards Institute (CLSI) provides some indication that the consensus of authorities is to discontinue this practice.

Before the venipuncture standard was revised in 2003, the standards agency's 1998 version suggested sites should be "tapped sharply" when searching for veins. However, the passage was removed when the document was revised in 2003. It has remained vanquished from its pages in two subsequent revisions (2010 and 2017). 

"Having been involved in the 2003 revision, I can tell you that the committee thought the practice was unprofessional, overly aggressive, and had the potential to alter test results," says Dennis J. Ernst MT(ASCP), Executive Director of the Center for Phlebotomy Education.

Ernst is also concerned about the emotional impact of striking the patient. "It's not out of the realm of possibility that any given patient has been abused by a parent or spouse, and that tapping or slapping his/her arm sharply could rip open emotional wounds. Patients might not understand or appreciate this technique. Nor is it out of the realm of possibility they could file a legal claim of battery. You can't be sure patients don't mind. Nor can you assume they haven't been abused. Given other more effective means to find veins exist, it's best to take more conservative, and less risky, measures."

Ernst agrees it is important to locate veins so that the procedure can go as smoothly and quickly as possible, and that the procedure will yield high-quality specimens that reflect the patient's actual physiology. He suggests 1) applying a warm compress to the site for 2-3 minutes to dilate the veins in the area; 2) lowering the patient's arm relative to the heart so blood fills the limb, distending the veins; and 3) asking the patient to squeeze, but not pump, the fist to bring more blood into the muscles and, hence, the veins feeding them. 

Empowered Healthcare Manager

EmpoweredManagerWelcomeScreenShot_500wEvery month we run an excerpt from our editor's popular blog, The Empowered Healthcare Manager. 

Seize the Moment

Today you have the power to:

  • raise the bar;
  • contain expenses;
  • challenge your staff;
  • improve sample quality;
  • hire a promising applicant;
  • turn a bad customer service experience around;
  • take another step toward measurable process improvement;
  • build a bridge between those in your laboratory who draw samples and those who test them;
  • build a bigger bridge between the laboratory and nursing department;
  • recognize an outstanding phlebotomist;
  • encourage a mediocre employee.

Today you have the power to make healthcare a better place for people to work and for patients to get better. With your intense focus day-in and day-out on all of the above, don't lose sight of how incredibly profound it is to be where you are, and to be able to do all that you have been empowered to do.

There was a time when you had none of this. There will be a time when you will have none again. 

Seize the moment.


Subscribe to the Empowered Healthcare Manager.

From the Editor's Desk

DE_grayscale_411wLast week I had the pure delight of directing a film crew for the revision of our Basic Venipuncture training video. This will be the third edition of the video, which made its debut as a VHS tape in 2004. The DVD came out in 2005 and was revised in 2010. Since the first edition, Basic Venipuncture has been used to train tens of thousands of healthcare professionals worldwide.

The taping could not have gone smoother. I employed a talented crew from a local television studio, two good friends to stand in as patients (one of them a lab manager), two top-notch phlebotomists and one of the best on-camera and voiceover talents I have ever met. We spent three full days knocking out about 18 hours of recording for a video that will have a running time of about 35 minutes. Eighteen hours of filming for 35 minutes of video. But that's how it goes. 

When you're filming a training video on a highly detailed invasive procedure like venipuncture, that's actually pretty good. It should have taken twice as long. My phlebotomists were outstanding and easy to direct, even though some of the equipment used in the film they had never seen before. It didn't matter. They've drawn under more stressful conditions than bright lights, hot mics and a camera crew hovering around recording their every move. I guess when you've drawn from screamers, kickers, and spitters before, "lights, camera, action!" means nothing.

If you currently use Basic Venipuncture, you will be delighted to know that this edition will be completely new. I've written an entirely new script, and refilmed every scene. Even though I could have simply carried over a lot of the footage from the second edition, why would I do that to you? You've been watching and listening to the same clips for years. You probably have every passage memorized. If I were you, I'd want an entirely remastered video, too. While some of the graphic animation will look familiar (some things just can't be perfected!), everything else will be 100% new and 100% updated to reflect the massive changes to the industry standard released last April.

20180207_144215What took me so long? That's a fair question. Here's my excuse: I let lots of things get in the way. Things like:

  • writing two newsletters each month;
  • serving on three CLSI committees (the skin puncture standard, a new standard on patient identification and sample labeling, and the Consensus Council);
  • Participating in a CDC Evidence Review Panel to come up with Best Practices to reduce iatrogenic anemia;
  • publishing my 5th book;
  • giving 35 presentations at 12 state and national conferences

Oh yeah, and moving from Indiana to Michigan. Other than that, I've been pretty much a slacker, and have no good excuse for not having Basic Venipuncture revised by now. But I know how forgiving you are and fully intend to make it worth your wait. There's still much to do, but I expect a June release. Not only do we have to go through all the clips and find the best takes, I have to arrange closed-captioning, resize the animation for the new wide-screen format, design the DVD covers, refilm any problem scenes (there's always one), and get the blessings of those who so generously provided educational grants, a necessity for a project of this magnitude. Namely, Greiner Bio-One and Venistat. 

This revision will take many hundreds of hours and many thousands of dollars to produce for a relatively small market. Without their support, I don't know if it would ever see the light of day. These companies know the value of education, though, and wouldn't want the industry to be without this title. Besides, they know it will be impeccably accurate, highly polished, and exquisitely produced. They, like you, know we don't produce anything less.  

Dennis J. Ernst MT(ASCP)

What Should We Do?: Hand veins versus antecubital veins

Dear Center for Phlebotomy Education,

Our Cancer Center made a request that we avoid draws in the antecubital area. They want us to use hand veins exclusively for patients who meet all the following:

  • those who will undergo chemotherapy same day
  • those who have restrictions on one arm such as previous mastectomy/lumpectomy.
  • those who will require venous access for chemo in a median vein.

This is the first time anyone has asked us to completely avoid all draws in the median area. Have you ever heard of this kind of request before? My concern is that if we draw the hand and cause an injury, are we liable because we did not draw from the antecubital? My gut tells me we're not since the request is technically coming from physicians in the cancer center. But still, what should we do?

Our response:  Physicians can't order you to deviate from the standards without putting you at risk of operating beneath the standard of care. Nowhere in the standards does it say "...unless the physician requests otherwise." That said, drawing from a hand vein when an antecubital is available does not go against the standard. But you should know hand veins have been found to be 2.6% less successful, and more likely to be hemolyzed by the same percentage. That said, drawing from hand veins is a low-risk draw. We've never seen a legal case involving a draw from a hand vein. 

Your physicians are not unreasonable in making this request this. Many chemotherapy drugs can cause extravasion, which means if any of the drug leaks out of a prior venipuncture site the patient can experience severe tissue damage. If you have to go this route, make sure your staff doubles their diligence in applying pressure and observing for hematoma. You'll also need to expect that following their request will result in more syringe and butterfly draws, both of which will increase the cost per draw and the risk of needlesticks.

Answers just ahead signGot a challenging phlebotomy situation or work-related question? Email us your submission at WSWDpanel@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)   

Standards Update: Three new questions to ask every patient

The newly revised venipuncture standard released by the Clinical and Laboratory Standards Institute in April, 2017 is the most comprehensive revision in the document's history. With over 140 new mandates, facilities have a lot of changes to implement. This series discusses one or more substantive changes each month.

GP41_cover_400wBefore drawing every patient, there have always been mandatory questions to ask. "Can you tell me your full name?" for example.  "What is your birth date?" is another one. Asking patients "Do you have a latex allergy?" has also been required since 2003.

With the publication of the revised venipuncture standard last year, there are three new questions every patient must be asked. Additional questions now required by the standards include:

Can you spell your first and last name, please?---Requiring patients to spell any part of their name has never been a standards requirement until now, and for good reason. Too many patients have similar sounding names. Only by asking them to spell their first name can Helen Snyder escape being misidentified as Ellen Schneider, and thousands of others who share a phonetically similar names. The answer to this question must be stated by the patient or the patient's caregiver or family member if the patient is unable to provide it him/herself.

Can you state your birth date?---Whereas this question was optional in the past, it is now a mandatory request. 

Have you ever had problems getting your blood drawn?---This has always been a wise question to ask, but now it's required. The intent of this mandate is to encourage patients to reveal complications or special considerations the phlebotomist should be aware of. Complications of past draws that would be helpful to know might include nerve injury or involvement, tendency to bruise excessively and fainting. The standard now requires patients with a history of losing consciousness during a blood draw to be reclined during the procedure.

Special considerations that could come to light when asked this question might include mastectomy, needle phobia, difficult-to-locate veins, and the presence of fistulas or grafts that preclude sites for consideration.

Editor's note: Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions immediately. The document, Collection of Diagnostic Venous Blood Specimens (GP41-A7), is the standard to which all facilities will be held if a patient is injured during the procedure or suffers from the consequences of an improperly performed venipuncture. It can be obtained from CLSI or the Center for Phlebotomy Education, Inc.

Read an interview by CLP Magazine with Dennis J. Ernst MT(ASCP), NCPT(NCCT) about the revised standard.


Tip of the Month: Safety Checkup

Click here for this month's featured Tip of the Month from our rich library of archived Tips.