Entrepreneurial Phlebotomist Takes Order of Draw to New Heights

One of VandeDrink’s
Order of Draw Charm Bracelets

In 2004, a California phlebotomist saw the need for products that would help her peers remember one of the most important concepts of drawing blood samples for laboratory testing: the order of draw. Today, Order of Draw Products offers a wide assortment of products—from badges to watches to bracelets—that remind the user of the proper order of tube filling during blood sample collection.

In 2007, Pam VandeDrink’s entrepreneurial spirit gained national attention when her story and innovative Order of Draw bracelet were featured in Dark Daily. The editors of Phlebotomy Today-STAT! recently interviewed Pam VandeDrink PBT(ASCP), phlebotomist and founder of the Internet-based business, Order of Draw Products™ located in Santa Rosa, California.

PT-STAT: What prompted you to start developing order of draw products?

PV:  As a phlebotomy student, I tried hard to memorize the order of draw. I knew I needed to create something that at a glance would prompt me to pick up the right tube in the proper sequence. Then one of my classmates brought a pipe cleaner with beads strung on it to class. She said her granddaughter was beading while she was studying. That was exactly what I was looking for. A "seed bead" Order of Draw Bracelet was my first product. I made them for classmates and friends. I started the company in 2004 and created the website (www.orderofdraw.com) two years later. Advertising at that time was mostly by word of mouth.

PT-STAT: Where do you get your inspirations for new products?

PV: I’m a creative person. Ideas flow through my mind all the time. I know there are many websites out there that offer gifts for doctors and nurses, but there’s really not too much for the phlebotomist. Offering products that can help a student succeed is an incredible feeling for me. I’m a visual, hands-on learner and I’ve met many people who are the same. They thank me for providing memory tools that assist them in their new careers. I love helping others.

PT-STAT: Tell us about your work experience, background, etc.

PV: A California native, my husband and I relocated to Idaho where I was an EMT. We’ve also lived in Oregon where I worked in a small town of 600 people at a clinic as a receptionist/assistant. The staff consisted of the doctor on duty and me. It was an hour away from the nearest hospital. I loved what I did. After that, I knew I wanted to go to school to be a phlebotomist and I’ve never looked back. That was over seven years ago. I’ve worked as a phlebotomist in a small hospital and am currently employed by a national reference laboratory in California.

PT-STAT: What are your goals for yourself and your company?

PV: To see a lot more products and interaction from phlebotomy students on my website. I like the community effect of a place to go and find unique items for the phlebotomist. I would like for my website to be known by all schools that teach phlebotomy. My personal goal is to travel to Indiana to have coffee with Dennis Ernst and shake his hand. He’s been a great mentor!

PT-STAT: What advice do you have for others who are interested in starting a business?

PV: Just do it! Don’t be afraid to fail. I’ve owned several businesses and have either sold them or folded them. I have learned something from every one of them. BUT… don’t quit your day job! At least not until the profit margin exceeds your current salary.

Greiner Bio-One Demonstrates Automatic Safety Device

Featured Product
Applied Phlebotomy Video Series

Phlebotomy Channel Seeking Your Input

Earlier this year, the Center for Phlebotomy Education launched the web's only video portal dedicated to streaming videos and lectures on phlebotomy exclusively. The Phlebotomy Channel™ now seeks input from Phlebotomy Today-STAT! subscribers on how it can be even more useful.

"I love our readers because they are so frank with us and anxious to help us help them," says the Center's Director of Online Education, Lisa O. Ballance, BSMT(ASCP), CLC(AMT). "They know we'll listen. Maybe that's why we have such an interactive readership."

Ballance hopes Phlebotomy Today-STAT! readers will take a few moments to provide the kind of information they are famous for—constructive, instrumental, and insightful—and respond to the online survey on how they feel about being able to watch training videos online.

"We'd like to know if they want to purchase one-time access to their choice or choices of videos and lectures" says Ballance. "Right now they have to purchase at least 15 viewings at a time. We have a hunch they'd like to pay as they go, but it sure would be great to hear it from them."

The survey takes less than five minutes, and is accessible at https://www.surveymonkey.com/s/M8THMV9.

This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 12^th year of publication, are reading about this month:

• Feature Article: How to Become a Better Phlebotomist; Part VII: Conquering the Difficult Draw (drug addicts)
  
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in June including these stories:
• A Third of Needlesticks Not Reported by New Zealand HCPs
  
• Cow’s Blood Used in Life-saving Transfusion
  
• Patients Receive World’s First Lab-Grown Blood Vessels
  
• HCWs Feel Risk of BBP Infection Greater as Patient
  
• Aspiring Phlebotomist Earns GED 20 Years Later
  
• Contaminated Soap Dispensers; Contaminated Hands
  
• Hospital Event Showcases Laboratory Services
  
• Resident Fatigue a Factor in Needlesticks
  
• According to the Standards: Underfilled citrate tubes
• Tip of the Month: Sharps Safety Checkup
• CE questions (institutional version only).

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.

Featured FAQ
Analytes affected when drawing above an IV

Q: Many reference books indicate that the some analytes remain elevated for up to 24 to 48 hours post infusion. I checked the latest CLSI standard and it doesn't indicate what those analytes are. Can you point me to the article/study that supports this?

A: It’s a little puzzling why standards and textbooks aren't definitive enough for those who are challenging you. Nevertheless, the support in the literature you are looking for is one by Read, Viera and Arkin and a second one by Savage.^1,2 According to Savage, drug levels, coag studies and glucose were shown to be elevated above an IV. According to Read, et al, "substances present at relatively high levels in the infused solution may still be detected."

The bottom line: avoid drawing above an IV for any analytes being infused.

References

1. Read D, Viera H, Arkin C. Effect of drawing blood specimens proximal to an in-place but discontinued intravenous solution. Am J Clin Pathol. 1988;90(6)702-706.
2. Savage R, ed. Q&A column. CAP Today. 2002:16(4):102-103.

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 website. For information on joining Phlebotomy Central, click here.

Survey Says
Discard Tube

Last month, visitors to our website had a lot to say about the circumstances under which they draw a discard tube prior to collecting a sodium citrate (coag) tube on their patients.

We asked: You need to draw one blue top (sodium citrate) tube on your patient. Under what circumstances is it your routine practice to draw a discard tube?

Nearly half of survey participants (46%) responded that they only draw a discard tube prior to collecting a coag tube when using a butterfly with a tube holder. Two percent of those surveyed indicated that they only draw a discard tube for special factor assays, while 21 percent reported that they draw a discard tube for special factors assays and also when using a butterfly with a tube holder.

For 15 percent of survey respondents, always drawing a discard tube prior to filling a coag tube is just standard practice. At the other end of the spectrum, 13 percent stated that they do not draw discard tubes for coag samples under any conditions. Survey responses are summarized in the following chart.

Sample Comments:

• “The blue top tube would not fill completely because of the air in the butterfly tubing.”
• “Priming the butterfly tubing is necessary when drawing a blue top tube because you have to get the amount of blood to the line of the tube in order for the test results to be correct and have the correct ratio of blood to additive.”
• “This is the way I've been taught and I adhere to the rule. I've seen too many rejected blue tops because of them being underfilled. Because of short-cuts taken, the patient will may be subjected to an unnecessary stick.”
• “According to CLSI, we no longer need a discard tube.”
• “I always draw a discard tube. Better safe than sorry when it comes to accurate results.”
• “At our facility it is in our policy that we use a discard tube before the sodium citrate tube. I am at this time looking into changing this policy.”
• “I always draw a discard tube -- standard practice.”
• “I always draw a discard tube. To eliminate contamination from skin bacteria.”
• “Only when using a butterfly with a tube holder. Hospital policy.”
• “None. Discard tubes are no longer required. Our hospital did a study and does not require us to do this.”
• “Only for special factor assays. First blood could be contaminated.”

In its coag guideline H21-A5, CLSI states that PT and APTT results are not adversely affected if tested on first tube drawn.¹ The guideline goes on to say proof is only circumstantial that a discard tube for other coagulation testing is necessary, with no published data showing this practice is necessary or unnecessary when using a standard evacuated tube system.¹

However, when using a winged (butterfly) blood collection set and the coag tube is the first tube drawn, CLSI states in both its venipuncture standard (H3-A6) and coag guideline that a discard tube should be drawn first.^1,2 This primes the blood collection tubing dead space to avoid underfilling, assuring a proper anticoagulant/blood ratio in the tube. According to CLSI, the discard tube should be a nonadditive or another coag tube, and need not be completely filled.

Comments for Drawing a Discard Tube for Special Factor Assays and Butterfly/Tube Holder Draws:

• “It is the practice consistent with facility procedure and CLSI standards.”
• “Clears the butterfly tube, to ensure the required tube is filled to capacity. Also when drawing special labs, will less likely have contamination and the outcome will be most accurate.”
• “I need to remove the dead space in the tubing when using a butterfly and tube holder. Also, to remove any potentially static blood after releasing the tourniquet for special factor assays in order to avoid hemoconcentration.”
• “I feel in these circumstances the discard helps to ensure the best specimen is collected.”
• “It was how I was taught!”

References

1. CLSI. Collection, Transport, and Processing of Blood Specimens for Testing Plasma-Based Coagulation Assays and Molecular Hemostasis Assays; Approved Guideline—Fifth Edition. CLSI document H21-A5. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.
2. CLSI. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard—Sixth Edition. CLSI document H3-A6. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.

This month’s survey question:
What do you think about cell phone and Internet use in the workplace?

What Should We Do?

[Editor’s Note: "What Should We Do?" gives you the opportunity to ask our team of technical experts for advice on your most pressing phlebotomy challenges. Whether technical or management in nature, we'll carefully consider solutions and suggestions based on the industry's best practices so that you and those in other facilities with the same problem can benefit, all the while maintaining your facility's anonymity. What Should We Do? is your opportunity to ask us for suggestions on the best way to handle your real-life dilemmas.]

Our response: According to The Safety Lady, Terry Jo Gile, when specimens are transported within a facility (phlebotomy tray, pneumatic tube, etc.) they do not have to be in bags that have the biohazard symbol on them. However, if a specimen is carried or transported by any means across a public street or highway (courier service, etc.) they must be in bags bearing the biohazard symbol. That being said, phlebotomists who transport tubes on their trays from the units to the Laboratory usually have the biohazard sticker on the tray.