Painless Skin Punctures: Is a Revolution Coming?
Over the years, the Center for Phlebotomy Education has been approached by many inventors trying to wow us with their better mousetrap. We don't impress easily. Recently, however, we were gobsmacked by a skin-puncture device that seems poised to revolutionize the way capillary samples are collected.
We first caught wind of Seventh Sense Biosystem's TAP® back in 2012. Since then, the company has been diligently testing, tweaking and perfecting their technology. Last month we were invited to visit the company's offices in Medford, Massachusetts to meet with its team of innovators, see the technology and, yes, have our blood drawn.
It is truly painless.
The TAP device, which is about the diameter of a stethoscope head, is placed on the surface of the skin, usually the upper arm, after routine cleansing. A layer of hydrogel secures it to the skin. The user pushes a button that deploys a matrix of 30 solid microneedles, each as thick as a human hair, into the upper layers of the skin. Once pushed, the device applies gentle suction pulling blood from the capillaries into an interior reservoir. When filled (in 90 seconds or less), an indicator tells the user collection is complete, and the entire device, containing 100 microliters of heparinized blood, is removed from the skin and sent to the testing facility. Alternatively, the device can be handed to a healthcare professional for testing in a point-of-care device. Testing personnel extract the sample with a pipette inserted on the underside of the TAP device, and transfer the blood to a POCT device or conventional laboratory instrument for testing.
Minute puncture site from TAP's 30 microneedles
Just days before our visit, Seventh Sense received FDA clearance for the TAP for healthcare professionals to collect hemoglobin A1C samples. That would explain the palpable electricity we felt in the air. The company is developing, and intends to commercialize after clearance by the FDA, versions that enable consumers to collect their own blood anywhere and anytime. In the short term, the company is pursuing clearance for other laboratory-based collections, including models that collect larger volumes of blood and modifications that transform samples into dry blood spots. Designs that include EDTA or separates plasma from cells within the device are also in the works.
According to reports, TAP has been tested with Abbott's iSTAT and Abaxis's Piccolo POCT devices. The company suggests compatibility with central laboratory instruments is not far away, as more and more instruments are being introduced that handle microsamples of whole blood.
After eight years of development, TAP is ready for prime time. According to a recent press release, Seventh Sense's CEO Howard Weisman says "TAP has the potential to transform blood collection from an inconvenient, stressful, and painful experience to one people can do themselves anywhere, making health monitoring much easier for both healthcare professionals and patients."
Cops in Washington State Trained to Draw Blood
The state of Washington joined Arizona and Idaho as states with jurisdictions that have trained law enforcement officers to draw blood samples from DUI suspects.
So far, six officers in Lakewood, Washington, south of Tacoma, have undergone training to draw blood samples in an effort to reduce the time required to gather valuable evidence to prosecute drunk drivers. According to an article published online by FOX affiliate Q13, the program's objective is meant to speed up the process for booking DUI suspects.
The officers are all certified by the Washington Department of Health after having completed their phlebotomy course at Bates Technical College. In Washington, those who draw blood samples must be certified medical assistants with a phlebotomy designation (MA-P). The program is funded with a $50,000 grant from the Washington Traffic Safety Commission.
Law enforcement Nampa, Idaho and Tucson, Arizona have been drawing blood samples from DUI suspects since 2015.
National Medical Laboratory Professionals Week: April 23-29
Empowered Healthcare Manager
Every month we run an excerpt from our editor's popular blog, The Empowered Healthcare Manager.
Rehiring Your Staff
Think about every member of your staff and ask yourself this question: If he/she wasn't already working for me, would I hire him/her?
If the answer is yes, you did an excellent job hiring, empowering, and maintaining that person as an asset. If the answer is no, you're maintaining a liability.
If you find you're maintaining liabilities you have three choices. 1) turn the liability into an asset; 2) terminate the liability; 3) let the liability continue to be a drag on your spirit, your department and your team.
The first option should exhaust you, the second should sadden you, and the third should embarrass you.
Subscribe to The Empowered Healthcare Manager.
This Month in Phlebotomy Today
Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's flagship newsletter currently in its 17th year of publication, are reading about this month:
The Patient's Bill of Rights, Phlebotomy Edition
On the Front Lines
Spinning tubes in the home
From the Editor's Desk
Phlebotomy Today is changing
Customer Care Corner
How are your phone manners?
Lactate dehydrogenase (LD)
An update on an article from the inaugural issue of Phlebotomy Today
How we teach about the composition of blood
Subscribe to Phlebotomy Today and get this issue immediately. Sign up for an institutional subscription during the month of February, and get one month free!
What Should We Do?: The two-person draw
Question: Sometimes I need help when performing a difficult draw, so I find someone who can work the syringe while I insert the butterfly needle and keep it in place. My manager is telling me that's not acceptable or appropriate because it doubles the risk of a needlestick. I think it's actually safer since if I'm holding the needle I don't have to be distracted by working the syringe. Most of my coworkers agree and want to continue the practice. Besides, that's the way we were taught in school. What should we do?
Our response: Your manager is correct to ban the practice. Four hands performing a blood draw are two too many. It only takes one hand to work the needle and one to work the syringe. The only time two people are required to draw a blood sample is when one of them is needed to provide physical or emotional support.
If you commonly move the needle while filling a syringe, keep your eyes on the needle, not the syringe. You can also work to reduce your usage of butterfly sets. Limit them to small and fragile veins, such as those encountered in oncology, geriatric and neonatal venipunctures. The fewer butterfly sets you use, the less frequently you'll feel a second person is required to complete the draw.
The school that teaches doubling up should be approached by your manager to discontinue teaching this method since it's creating problems for their students when they enter the field. Using two phlebotomists to perform one venipuncture is not consistent with the policies of any facility we are aware of.
Product Spotlight: Gifts for Lab Week
Merchandise Just for Phlebotomists
Last fall, the Center for Phlebotomy Education launched a new online store offering merchandise just for phlebotomists.
Aptly named, Just For Phlebotomists promotes phlebotomists and their profession, proclaiming the critical role they play in healthcare. The shop offers a variety of shirts, mugs, hoodies, hats, and other merchandise with images and text that lets phlebotomists show pride in their profession. Imprints include caricatures of blood collection tubes including Lolita Lavender, Randy Red, Guy Green, and Bobby Blue. Phrases include Phlebotomy: It's not as simple as I make it look, and I'm a professional, perfectionist, phlebotomist!
"Over the years, we've been almost exclusively an education company," says the Center's Director, Dennis J. Ernst. "But since phlebotomists are the backbone of the laboratory, and so critical to the care of every patient they draw, it's time we help them shout it from the mountaintops."
The Center is partnering with Cafe Press to host the growing collection of custom designs on a wide variety of clothing and accessories. Visit Just For Phlebotomists.
Survey Says: Your most-violated policies
Last month we asked our readers and visitors to our web site what policies where they work are commonly violated. The clear winner: personal texting.
A full 75 percent of those responding said texting personal messages was by far the most common policy infraction in their places of employment. The next four frequent violations included tardiness (50%), duration and frequency of breaks (43%), handwashing (43%) and surfing the Internet for personal reasons (43%). (Multiple selections were permitted.)
Thirty six percent included taking/making personal phone calls as common policy violations, while exceeding allowable sick days and gossiping were violations for 32 percent of those responding. Violations of dress codes were reported as problematic for 29 percent of those responding.
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.
While texting, tardiness, excessive breaks, and web surfing are certainly problems managers must address to improve morale and productivity, each could be considered victim-less crimes. However, failure to follow policies on handwashing is far more consequential to the very people healthcare professionals are employed to serve.
When asked what the single most commonly violated policy was where they worked, exceeding allowable sick days was cited by 21 percent of those responding. Coming in second at eighteen percent was personal texting.
We also wanted to know how consistently policies are enforced where survey respondents worked. Forty-three percent said "my manager is inconsistent with what policies he/she enforces and with whom" (inconsistently inconsistent). Twenty-five percent said "my manager enforces some policies with all employees" (consistently inconsistent).
- Not sterilizing hands between changes of gloves when taking blood from a single patient. Our policy is to change the gloves 3 times per patient for each draw.
- Most women don't respect the Appearance policy. They want to work with their hair down, large earrings, and long fingernails. I can't understand why it is so hard to follow the protocols that are there for their own safety and the patients.
- Allowing cliques and not recognizing problem areas when brought to the attention to supervisor
This month we're asking our readers which of the 28 steps of a basic venipuncture listed are most commonly omitted, or performed incorrectly, where you work?
Take the survey.
Tip of the Month: Specimen Handling: Fact or Fiction?
Click here for this month's featured Tip of the Month from our rich library of archived Tips.