ASCLS Abstracts Highlight Staff Collaboration and Tube Correlation
Want to decrease the number of contaminated specimens your laboratory receives? Ever wondered how BD and Greiner coag tubes compare? If so, two abstracts presented at the 2011 American Society for Clinical Laboratory Science (ASCLS) Annual meeting and Clinical Laboratory Exposition in Atlanta, Georgia last month may hold particular interest for you.
Effectiveness of Educating Nurses as a Means to Decrease the Number of Contaminated Specimens
In an effort to reduce the number of specimens rejected by the laboratory due to IV fluid contamination, researchers collected data for a six-month period, confirming a ward with a high rate of specimen contamination. Case studies detailing the effects various IV fluids have on test results were then prepared and presented to senior nurses within the unit. After the presentation, specimen rejection rates attributed to IV contamination were monitored for an additional six months, with a significant decrease in contaminated specimens realized. Researchers concluded that contamination rates could be effectively reduced through collaborative efforts between laboratory and nursing personnel, including educating nursing staff about the importance of sample quality.
Comparison of Greiner and BD Evacuated Coagulation Blood Collection Tubes
A study comparing Greiner and BD 2.7 mL evacuated sodium citrate blood collection tubes was conducted to determine the equivalence of the following hemostasis assays: PT, INR, APTT, fibrinogen, AT, and vWF. Samples were drawn from 71 volunteers by routine venipuncture, processed according to CLSI guidelines and tested using cap-piercing technology. Correlation between Greiner and BD tubes was demonstrated for all stated assays evaluated. Based on data analysis, it was concluded that the Greiner and BD evacuated blood collection tubes for coagulation testing are substantially equivalent for the testing methodology used.
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 12th year of publication, are reading about this month:
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Last month, we asked visitors to our website and our Facebook page about their use of cell phones and the Internet in the workplace, and if their employers have a policy against their use. Eight percent of those surveyed indicated that they read or send personal text messages while on the clock, while six percent stated that they place or accept personal calls during work time. Sixteen percent reported browsing non-work-related websites while on the job. The majority of those surveyed reserve such activities for break time, with over a third of respondents stating they do not engage in these pursuits in the workplace.
When asked if their facilities have policies against such activities, the results were as follows:
When asked if they agree with their facility’s policies on cell phone and Internet use, 94 percent of survey participants stated that they do.
A self-identified phlebotomist who is also a cancer survivor shared the following perspective: “We are WORKING FOR THEM, not the other way around! I feel it is annoying, distracting and unprofessional to patients as well as other employees. I also think personal phone calls should be limited (regular land-line). …Most people think it's "normal" to have multiple conversations while working (i.e. cell, Internet & tending to patients.) It's just rude. As a Cancer survivor and Phlebotomist, I have been the patient more than I care to count. We need your FULL attention to our Dr. orders for accuracy and care. Many times it's the only contact very ill patients have for days at a time.”
This month’s survey question:
Last Month on Facebook
During the month of July, fans and visitors to our Facebook page shared their thoughts on the following topics:
Phlebotomy Today-STAT! readers looking for a forum to post questions or to simply satisfy their hunger for phlebotomy talk between their newsletter issues should visit and “Like” our page. Don't miss out on another discussion. Your peers need your input, and you need theirs.
Q: I am wondering if you have any articles, studies, or opinions on the practice of collecting blood during IV starts? I am preparing to provide in-depth phlebotomy training to a group of nursing assistants, but anticipate that they may resort to IV-start collections instead.
A: Vascular access devices (VADs) are notorious for hemolyzing blood specimens. The biggest problem occurs in emergency rooms where the staff routinely withdraws specimens during an IV start. Hemolysis is inherent with such devices.
Try to discourage this as best you can. You might run up against the argument that it saves time, but counter with the time lost when specimens have to be recollected due to hemolysis. Explain that when you draw blood through a vascular access device (VAD), you are using the device for a purpose for which it was not designed. They are made for fluids to be infused into the patient, not for blood to be withdrawn. The shear forces and turbulence at the tip of the cannula are too extreme for the fragile red blood cells to tolerate. Hemolysis affects every analyte that could be tested because when a specimen is hemolyzed, what was once solid (RBCs) is now liquid. So there's a dilutional affect to all analytes not to mention the interference of free hemoglobin and cellular materials.
There's not much that can be done to minimize hemolysis during IV starts other than to avoid such draws altogether. However, there are plenty of articles and studies in the existing literature that you might find helpful. Here’s a summary:
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.
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: Warm weather brings with it the temptation for some employees to don footwear that does not provide appropriate protection in the clinical setting.
Other aspects to consider when establishing a footwear policy include the professional appearance of the employee, and the slip/trip hazard a style of shoe may present in the workplace (e.g., flip flops, sandals, etc.) particularly when responding to an emergency situation.
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