Journals Publishing New Studies on Phlebotomy

Every now and then the staff of Phlebotomy Today—STAT! surveys the literature for new articles and studies pertaining to blood specimen collection to keep our readers up to date. Recently, journals have printed studies on hemolysis, retractable needles, blood culture contamination rates, and patient satisfaction.

Hemolysis and tourniquets
British researchers found that the frequency of hemolyzed samples increases significantly when tourniquets are constricted longer than one minute.
Link to abstract

A splatter matter
The potential for splatter of blood when using retractable devices for venipuncture was increased, according to a study published in the American Journal of Infection Control. For two of the devices included in the study, visible blood was detected on up to 40% of the filters used to measure splatter.
Link to abstract

No stick
An article published in the Joint Commission Journal on Quality and Patient Safety reported a reduction in accidental needlesticks from 3.19 per 100,000 needles to zero per 100,000 needles following a facility’s adoption of a retractable needle.
Link to abstract

Phlebotomists rock
A study conducted at the University of Texas Southwestern Medical Center in Dallas, Texas showed that when phlebotomists collect blood cultures in the ER instead of non-phlebotomy staff, patient charges decreased by approximately $4.1 million per year because of the phlebotomists’ lower false-positive blood culture rates.
Link to abstract

“Hello, my name is…”
A study conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia found that patients were significantly dissatisfied with phlebotomists not introducing themselves (74 percent), and not explaining procedures (57 percent).
Link to abstract

Survey Says: Phlebotomy Career Ladder

Our last survey asked Phlebotomy Today STAT! readers:
“Does your facility have a formal career ladder for phlebotomists who want to progress into positions with increasing responsibilities, authority, and/or pay?”

72% of those who responded indicated there was no career ladder in their facility for phlebotomists. 28% said there was. Here’s a selection of some of the comments:

“At my facility phlebotomy is kind of a dead end job. Their [sic] is no opportunity for growth.”

“THIS PLACE IS THE WORSE PLACE IN THE HISTORY OF JOBS TO WORK AT.”

“Phlebotomist [sic] have no forward movement in their career, unless they become a MLT or MT. A phlebotomist with 10+ years experience won't even be considered for Phlebotomy supervisor position.”

“But we are actively looking to develop one.”

With only 28% of our respondents reporting an established career ladder in the workplace, surely the phlebotomy profession can do better.  At the Center for Phlebotomy Education, we’re committed to see that it does. That commitment is reflected in our mission statement “to be the world's most dependable source of accurate information on blood specimen collection, to share that information in a multitude of ways, and to elevate the status of the phlebotomy profession.”

Without a career ladder, elevating the phlebotomy profession is an uphill climb.  But it’s not an impossible one.  Kudos to every employer that formally supports the professional advancements of its phlebotomists! By doing so, you are blazing a trail that leads to optimal sample quality and patient care.    

Are we there, yet?  As a profession, no.  But we are moving in the right direction, one rung at a time.

This month’s survey question: If you could change one thing to make your job easier, what would it be?
Click here to participate in the survey.

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 9^th year of publication, are reading about this month:

• Feature Article: Decentralized vs. Centralized Phlebotomy
  
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in April including these stories:
• Phlebotomist Accused of Bilking Insurance Company for Bogus Funerals
• California Students Irate Over Tuition to Arizona Phlebotomy School
• According to the Standards: High potassium in lithium heparin tubes
• Tip of the Month: Ten Truths about Syringe Draws
• CEU questions (institutional version only).

Buy this issue for only $9.95.

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 subscribing.

Phlebotomy Today Subscriptions Reorganized

The Center for Phlebotomy Education, publisher of the Phlebotomy Today family of e-newsletters, is adding a third subscriber level to its flagship publication, Phlebotomy Today. The newly dubbed “Premium” subscription level is a new designation for members of Phlebotomy Central, i.e., those who have purchased access to the Center’s online database of specimen collection information, which includes an institutional subscription to Phlebotomy Today.

According to Phlebotomy Today editor, Dennis J. Ernst, the premium subscription level is not so much a new product as it is a more logical bundling of existing digital products. “In the past, Phlebotomy Central was a product that included an institutional subscription to Phlebotomy Today. That proved to be confusing to our customers. So starting in June, we’re changing Phlebotomy Central 'membership' into a premium subscriber level of Phlebotomy Today, which is an institutional subscription to the e-newsletter that includes access to Phlebotomy Central. It’s essentially a name change that keeps the focus on the newsletter."

When launched in 2007, Phlebotomy Central included access to Phlebotomy Today archives, 15  To The Point® articles for download, and a database of nearly 300 commonly asked specimen collection questions and their answers.

Since its launching, the online resource has grown considerably. In addition the expanding e-newsletter archives, a Manager’s Toolbox was added in 2008, which includes:

• a post-venipuncture care card that facilities can customize for distribution to their patients;
• a potassium troubleshooting checklist to research spurious potassium results;
• a summary of journal articles on the frequency of hemolysis during IV starts;
• a competency checklist for specimen collection personnel;
• a chart summarizing analyte stability so your staff knows what can and can’t be added on to previously drawn samples.

New documents have been added to the Manager’s Toolbox this year including procedure templates managers can use to update their written venipuncture and skin puncture procedures so that they reflect the current CLSI standards.

When existing Phlebotomy Central memberships expire, members will renew as Phlebotomy Today Premium subscribers. The change will be in name only. Their institutional subscription to Phlebotomy Today will continue uninterrupted, as will their access to Phlebotomy Central.

The change will not affect your subscription to this, our free newsletter, Phlebotomy Today—STAT!

For more information, or to subscribe, click here.

Featured FAQ: Order of Draw with Syringes

Q: What is your current opinion on the order of draw (transfer) when using a syringe for collections? I still see some discrepant information when looking at different sources, and I'd like to know what you recommend.

A: There's no shortage of discrepancy on the order of draw. CLSI has never recommended a separate draw for syringes. It started to appear in the literature in the 1980s, but in 1998, CLSI put the issue to rest in H3-A4 by saying a separate order of draw is not necessary.
     Some textbook authors were, and still are, of the opinion that clotting in the barrel of the syringe during the draw necessitates an evacuation of the blood into anticoagulated tubes first, with the non-additive red-top tubes last. But such speculation is without merit; no studies support the accelerated clotting theory. In fact, since most syringes are plastic, the coagulation cascade doesn’t proceed as rapidly as it does within glass tubes, glass being a clot activator itself.

Bottom line: tubes filled by syringes should be in the same order as when filled by tube holder.

Each month, PT--STAT! will publish one of the hundreds of phlebotomy FAQs in the growing database of questions and answers available in Phlebotomy Central, the members-only section of the Center for Phlebotomy Education's web site. For information on joining Phlebotomy Central, visit www.phlebotomy.com/PhlebotomyCentral.html.

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What Would You Do?

Each month, What Would You Do? presents a different case study, then asks readers to contribute their ideas as to how each situation would best be handled. The following month, selected responses will be chosen by the editor and published (sender will be identified by first name and state only). The most accurate, well written response will receive a free "To the Point® Article" download. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.

As is typical for this column, many who responded spoke of how they reacted to nearly identical situations in their facilities. Sixty-four percent said they would notify the nursing or housekeeping staff of the blood on the floor, while thirty-six percent said they’d take the initiative to clean it up themselves. Forty-three percent said they’d apologize to the patient, including this comment from Michelle from Massachusetts:

This has happened at my facility and because at the time no protocol had been established…  my actions became protocol. I first covered the drops with a towel to secure area. (Any linen will do, paper is to light.) I then asked the family to wait outside the room as I called for help.
We moved patient to another room and called for a clean up. Although it is not always possible to change rooms the patient must be taken out of the room for clean up.

Michelle was not alone in wanting to move the patient to another room regardless of cleaning up the drops. Twenty-eight percent agreed with her, most indicating they’d wait until the transfer was complete. Our favorite response came from Glenda S.:

In response to the Visitor’s complaint – I would immediately apologize to the patient and their visitors. I would give them the option if they would like to be transferred to another patient room while that room was thoroughly cleansed.  Depending on the Patient’s decision I would then first contact the House Supervisor to arrange another room for the Patient or contact Housekeeping to thoroughly cleanse the room.  Regardless of the decision that was made by the patient, I would stay with that patient until the situation was resolved.

Because of her articulate response, Glenda will receive a free download from the Center for Phlebotomy Education’s To The Point® library of articles. Thanks, Glenda, and all who responded.