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August, 2011


Copyright 2011 Center for Phlebotomy Education, Inc.
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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.

Reference
ASCLS Annual Meeting 2011: Official Abstracts of Submitted Papers, Case Studies and Posters. Clin Lab Sci Summer 2011;24(3):153-56.

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Featured Product
Venipuncture Training Models

The Center for Phlebotomy Education offers what we consider to be the best line of venipuncture training aids on the market, allowing educators, trainers and supervisors to teach and assess the venipuncture technique of their students and staff. All models contain visible and/or palpable veins of varying size and depth embedded in latex-free, tissue-like material that is available in light or dark skin tones.

The Advanced Venipuncture Training Aid has a realistic feel and quality construction, providing a life-like experience for those learning how to draw blood for a fraction of the price of anatomical arms, which, under our scrutiny, seem lifelike in appearance only. In addition to the physical “pop” that is felt when the needle enters the vein, this model provides a realistic “flashback” of simulated blood, confirming proper needle placement. The device includes four visible and/or palpable veins of various size and depth, with one deeply placed to simulate the variation in patient anatomy phlebotomists regularly encounter. The back of the device doubles as a cover to protect the tissue block when not in use. An optional carrying case with storage pouch for supplies is also available. (Durability – 22-G needle: 5,400 sticks)

The 4-Vein Venipuncture Training Aid  has three different sized surface veins and one deeply placed vein, similar to the Advanced Venipuncture Training Aid but without the simulated blood, offering a more portable design. (Durability - 22-needle: 2,700 sticks)

Similar in design to the 4-vein model, the 2-Vein Venipuncture Training Aid has two different sized surface veins and is the most compact and portable of the training aids offered. (Durability – 22-G needle: 1,350 sticks)

For more information, click here.




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:

  • Feature Article: How to Become a Better Phlebotomist; Part VIII: Safety Aspects & Considerations
  • Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in July including these stories:
    • Hepatitis Outbreak Leads to Fines for NC Assisted Living Facility
    • Age of Stored Blood Linked to Transfusion Complications
    • Phlebotomist Uses Pageant to Promote HIV/AIDS Platform
    • Handwashing #2 on Infection Control Top Ten List
    • AZ Phlebotomist Signs with Angels
    • WHO Says Hospital Stay Riskier than Flying
  • According to the Standards: Underfilled tubes
  • Tip of the Month: Phlebotomy Road Trip
  • 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.

 

Survey Says
Workplace Connectivity

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.

Sample Comments:

  • “You are here to do your job that you are being paid for, not to be on your cell phone or on the Internet. You do that at home.”
  • “As a Supervisor, I am still able to focus on my work while answering personal texts, if necessary. I generally keep my phone put away unless I know something important is coming.”
  • “Cell phones should not be used while working, only during breaks.”
  • “These things are done but only during down time.”
  • “I keep my personal phone in my locker. Healthcare workers need to stay focused on patient care. It's rude and inconsiderate to be distracted by personal calls.”
  • “This is a big issue at work... I'm always reminding coworkers we aren’t paid to surf and text!”
  • “We are not allowed to carry our personal cell phones when in patient areas and are not allowed to use company computers for access to the Internet EVER.”
  •  “Our lab currently allows us to use our cell phones while we are in the lab area but not on the floor. It only works because no one abuses it.”
  • “Distracts you from your work and patient and looks very unprofessional.”

When asked if their facilities have policies against such activities, the results were as follows:
Texting                        Yes: 84%      No: 16%
Cell phone calls        Yes: 86%      No: 14%
Surfing the Internet   Yes: 88%      No: 12%

Sample Comments:

  • “…because of the bad apples, I think these rules are fine. We should only be focused on our patients at work. I would want it that way if I were a patient.”
  • “Everyone walks around the hospital during work texting; very annoying.”
  • “Despite having rules, they are not enforced. This creates tension between coworkers who comply and the offenders.”
  • “I'm guilty of doing "quick" net surfing, usually on Sunday afternoons when it's slow. I know it's wrong, though.”
  • “It doesn’t stop people!!!”
  • “We have a P&P prohibiting all of the above.”
  • “Our hospital has a strict policy against the above and restricts cell phone (camera) usage when working in any patient care area.”

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.

Sample Comments:

  • “Cell phone use and/or Internet browsing could potentially be two big distractions in the workplace. The patients that come into our facility deserve 100% of our attention.”
  • “Better work done when not distracted.”
  • “News sites should be allowed during downtime.”
  • “When we are working on samples, with our patients, doing paperwork, order entry, etc., our customers deserve our full attention, without “personal” interruption.”
  • “It demonstrates a more professional and safer environment especially to our patients and visitors. From a management perspective, it is more productive.”

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:
What steps does your facility take to reduce the volume of blood drawn from patients susceptible to anemia induced by diagnostic blood sampling, also known as iatrogenic anemia?

 

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Last Month on Facebook

During the month of July, fans and visitors to our Facebook page shared their thoughts on the following topics:

  • What do you think about parents who want to videotape their child having his/her blood drawn?
  • You need to draw a coag tube on your patient. Do you draw a discard tube?
  • Does phlebotomy have a designated work area within the ED?
  • If you were granted three wishes to make your life easier in the workplace, what would they be?

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.

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Featured FAQ
Discouraging draws during IV starts

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:

  • A study found a significant increase in the hemolysis rate in blood drawn during IV starts than by venipuncture, 13.7% versus 3.8% respectively.(1)
  • A study showing hemolysis in ED samples drawn by venipuncture was <1%, while those drawn during IV starts was 20%.(2)
  • The same study compared hemolysis rates when specimens were drawn through IV catheters using a syringe (9%) versus a tube holder/vacuum tube combination (22%).(2)  Another study showed the difference to be 3 versus 19% respectively.(3)
  • A study showed a difference in hemolysis rates between specimens drawn from ED personnel versus laboratory phlebotomists to be 12.4% (ED personnel) versus 1.6% (phlebotomists).(4)
  • A study showing hemolysis of samples drawn during IV starts using 5ml tubes was nearly 50% lower than when samples were collected in the same manner using 10ml tubes (1.1% versus 2% respectively).(5)
  • A study showed blood drawn through 20-24 gauge IV catheters was more than seven times as likely to be hemolyzed  than that drawn through 14-16 gauge cannulas, and 3.6 times as likely as blood drawn through an 18-gauge cannula.(6)

References

  1. Kennedy C, Angermuller S, King R, Noviello S, Walker J, et al. A comparison of hemolysis rates using intravenous catheters versus venipuncture tubes for obtaining blood samples. J Emerg Nurs 1996 22(6):566-569.
  2. Grant M. The effect of blood drawing techniques and equipment on the hemolysis of ED laboratory blood samples. J Emerg Nurs 2003;29(2):116-21.
  3. Stankovic A, Smith S. Elevated serum potassium values: the role of Preanalytic variables. Am J Clin Pathol 2004;121(Suppl1):S105-Sl12 5105.
  4. Burns E, Yoshikawa N. Hemolysis in serum samples drawn by emergency department personnel versus laboratory phlebotomists. Lab Med 2002;5(33):378-80.
  5. Cox S, Dages J, Jarjoura D, Hazelett S. Blood samples drawn from IV catheters have less hemolysis when 5-ml (vs 10-ml) collection tubes are used. J Emerg Nurs 2004;30(6):529-33.
  6. Tenabe P. Letter to the editor. J Emerg Nurs 2004;30(2):106-8.

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.

 

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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.]

 

This Month’s Case Study:
Footwear Dress Code

One reader writes: Is there an OSHA/CLSI or other standard that covers footwear in a healthcare setting? I work in a relatively small university health center where the laboratory staff and medical assistants perform phlebotomy. In addition, the providers perform immunizations and IVs. Yet we have no dress code covering footwear. Therefore, in the summer, many of the staff, including lab staff, wears open-toed shoes and sandals. I feel this is an unsafe practice. Am I correct?

 

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.

OSHA doesn't mandate closed footwear, but applies the same general protection guidelines for all potential exposure situations. Unfortunately, the Bloodborne Pathogens Standard doesn't come right out and say all clinical workers must wear impervious shoes that cover the entire foot. Clinical employees may be allowed to wear open-toed shoes, but only if they are provided impervious shoe covers while performing procedures where they could be exposed. Employers may require employees to wear full shoes if they don't wish to provide booties.

You’ll find more support for establishing a dress code for footwear in CLSI's Clinical Laboratory Safety guideline, (GP17-A2). CLSI states that shoes should be comfortable, rubber-soled, and cover the entire foot. Disposable fluid-resistant shoe covers can be worn during tasks where splashing is expected. Leather or a synthetic, fluid-impermeable material is recommended.(1)

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.

Reference

  1. NCCLS. Clinical Laboratory Safety; Approved Guideline – Second Edition. NCCLS document GP17-A2. Wayne, PA: 2004.
 

Wanted:

Your most challenging phlebotomy situations and work-related questions.

Send your submission to WSWD@phlebotomy.com and you just might see it as a future case study.

 

 

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PT STAT! is a free, monthly educational service provided by the Center for Phlebotomy Education, Inc., the most respected authority in phlebotomy. For a complete company profile and product list for all healthcare professionals who perform, teach or manage specimen collection procedures, visit us on the Internet at: http://www.phlebotomy.com.
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