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October, 2017


AMT Names Phlebotomist of the Year

American Medical Technologists named Chantal Jordan RMA, RPT, CMAS as 2017's Phlebotomist of the Year at its annual conference in Kansas City, Missouri this summer. 

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Chantal Jordan (right) with her mom (middle) and son Corey (left)

Ms. Jordan is the Clinical Lead at Georgia Urology in Atlanta, Georgia where she's worked for the last 11 years. Phlebotomy Today-STAT! caught up with the rising star to see what makes a world-class phlebotomist tick. 

Phlebotomy Today: What part of your job gives you the greatest satisfaction? 
Chantal Jordan: The greatest satisfaction with my job would be meeting the need of each patient I come in contact with. Out of fear, many patients request a skillful person when performing phlebotomy. I always aim for success on the first stick. 

PT: How did it feel to receive the award?
CJ: Receiving the RPT Award of the year was so exciting. I have always wanted to receive a national award from AMT, and look forward to receiving more in the future. I would like to acknowledge them for honoring me. This is a moment that I will never forget.

PT: Why did you become a phlebotomist?
CJ:  I enjoy obtaining blood specimens; it has a meaning with me. I feel like I am assisting in a diagnosis by obtaining the blood specimen for lab processing. When I was first learning ultrasound and phlebotomy in school, I enjoyed interacting with patients and facing the challenge of obtaining blood specimens properly. The vein may not always be in sight, but you can feel them. I enjoy attending blood draw events in the community because I'm able to come in contact with patients who might not have healthcare insurance, but it gives them the opportunity at little or no cost to find out if they need medical care based on the lab results.

PT: What advice would you give someone who is thinking about becoming a phlebotomist? 
CJ: Be sure to know the order of draw. Be courteous and fearless when encountering a patient. And to remember that just because you can't always see a vein, you can feel the vein. It's not about the look, it's about the bouncing back of the vein. Also, follow your heart and take your time when collecting blood specimens.The phlebotomist plays a major role in the healthcare field for our patients. In general without proper training, the specimen is not likely to be obtained properly, which threatens the proper diagnosis for the patient. Keep the determination and dedication.


Liability Insurance for Phlebotomists

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Standards Update: Blood pressure cuffs as tourniquets

The newly revised venipuncture standard released by the Clinical and Laboratory Standards Institute in April, 2017 is the most comprehensive revision in the document's history. With over 140 new mandates, facilities have a lot of changes to implement. This series discusses one or more substantive changes each month.

GP41_cover_400wSometimes, a tourniquet isn't the right tool for the job. Obesity, for example, often requires a blood pressure cuff so that the patient's circulation in the arm is restricted sufficiently to palpate the available veins of the antecubital area. In prior versions of the industry's venipuncture standard, Blood pressure cuffs, when used in place of a tourniquet in phlebotomy, were recommended to be inflated to 40 mm Hg. When the new standard was revised, the limit was changed. Now, cuffs should be inflated just below the patient's diastolic blood pressure.

"My committee's research found 40 mm may not be sufficient for all patients," says committee chairholder Dennis J. Ernst MT(ASCP) NCPT(NCCT). "Applying one limit for all patients isn't practical and not always effective. For patients with high blood pressure, 40 mm may not be enough; for pediatric, and geriatric patients and patients with low pressure, it may be too much."

To comply with the standard, Ernst says collectors will need to find out patient's diastolic pressure by asking a caregiver or by taking the pressure themselves.

 

Editor's note: Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions as soon as possible. The document, Collection of Diagnostic Venous Blood Specimens (GP41-A7), is the standard to which all facilities will be held if a patient is injured during the procedure or suffers from the consequences of an improperly performed venipuncture.

Read an interview by CLP Magazine with Dennis J. Ernst MT(ASCP), NCPT(NCCT) about the revised standard.


Phlebotomy Q&A Book

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From the Editor's Desk

BlogShot2_bw_400wFriends,

I rarely editorialize in this newsletter, but I'm willing to bet you'd like something off-topic now and then. Until now, you'd have to be a subscriber to our flagship newsletter, Phlebotomy Today, to get this column. It's been a favorite among Phlebotomy Today readers for 17 years.  I'll reveal in a moment why PT-STAT! readers will be see it more frequently.

From where I sit, the world of phlebotomy and the preexamination phase (formerly preanalytical) of laboratory medicine is evolving at an incredible pace. As subscribers to the only free monthly newsletter devoted exclusively to phlebotomy, you see evidence of that in every issue. I scour the planet for new studies, innovations, regulations and developments every month to keep you on the bleeding edge of the industry. That's probably why we're closing in on ten thousand subscribers, and why they forward each issue to thousands of other healthcare professionals around the world. That's just fine with us. We want this newsletter in the hands of everyone who draws blood samples, so feel free to pass it along. Most free newsletters boast a 7-15 percent "open rate." To have an open rate consistently over 100%, as this newsletter enjoys, is unheard of in any industry. Why? Content. We know what you want in a newsletter and we've been nailing it every month since 2000. 

Early next year, we are merging our two newsletters into one. Phlebotomy Today-STAT! will live on in its current format as Phlebotomy Today, and will remain free of charge. No action is required on your part to continue receiving this newsletter. You can expect the same high-quality reporting, informative columns, and accurate information you have come to trust in every issue. In addition, I will be incorporating my column into the merged newsletter. This month, I'm sharing with the rite of passage I recently ushered my 4-year-old grandson through.

If you have a moment, follow me.


Product Spotlight: Training models

VATA2366Dark_2017_WebFew products meet the Center for Phlebotomy Education's high standards. This is one of them. In fact, we like it so well we became a distributor ten years ago for the company that manufactures it, and use it whenever we conduct training sessions. 

The Advanced Venipuncture Training Aid (manufactured by VATA, Canby, Oregon) is now completely upgraded and better than ever. This training aid costs far less than the anatomical-looking arms, and provides a far superior real-patient experience. What we like the most (besides the price) is needle tracks are not nearly as obvious as with anatomically designed trainers.

VATA's proprietary latex-free Dermalike™ tissue block allows trainers to teach venipunctures on a life-like model that includes visible and/or palpable veins of varying size and depth. Within the tissue block are embedded four simulated veins at various depths and in various diameters to provide a real-patient training experience. As the needle enters the vein, a realistic "flashback" of simulated blood confirms proper needle placement, helping students and staff develop hand-eye coordination, confidence, and competence. The bag of simulated blood is easily replenished with colored water trainers can prepare themselves.

Durability for this model is rated at 5,400 sticks with a 22-gauge needle.

View our review of venipuncture training arms.

More information and to order.


Donations Sought for Haitian Phlebotomy Station

Movers&ShakersThe American Society for Clinical Pathology, working in coordination with Partners in Health, is seeking donations of phlebotomy supplies, stands, carts and workstations for the new Regional Reference Lab in Mirebalais – Haiti. 

"We want to upgrade an infusion center for patients with cancer," says Dan Milner, MD, MSc, FASCP, ASCP's Chief Medical Officer. "It will include a small phlebotomy station, which we need help setting up and stocking. Any help from Phlebotomy Today-STAT! readers, including manufacturers, would be outstanding."

The facility will have an ongoing need for blood collection tubes, tube holders, multi-sample needles, but the immediate need is for chairs and stations similar to those marketed by Clinton Industries. Donations of freestanding phlebotomy stations similar to those offered by MarketLab, Inc. are also acceptable.

Anyone interested in donating phlebotomy supplies and equipment can learn more about Partners in Health and the Mirebalais Reference Laboratory for Diagnostic and Research can visit their web site or contact Daniel Orozco at dorozco@pih.org.


Record Attendance Expected at Global Conference

Managers and other healthcare professionals are gathering in record numbers from around the world this month to attend the Global Summit on Best Practices in Preanalytics. Registration is still open, but seating is limited. Interested individuals are urged to secure their place at the event by registering as soon as possible.

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The event will be moderated by Phlebotomy Today editor Dennis J. Ernst MT(ASCP) NCPT(NCCT) and includes a faculty of national and international presenters.


Virtual Reality and Acupressure in Phlebotomy?

Pediatric girl afraidTwo new approaches to managing pediatric pain during venipunctures made the headlines last month. 

Virtual Reality

R&D Magazine published an article detailing the success Children's Hospital Los Angeles is having with distracting children with virtual reality (VR) during their venipuncture. With the patient's/parent's permission, a VR headset is worn during blood draws, and the child plays Bear Blast, a game specifically designed to be used in this context. In the activity, the patient launches foam balls at animated bears just by looking at them, requiring minimal movements, which is ideal for venipuncture distractions. Patients engaging in a VR activity are more relaxed, giggle, smile, and have fun instead of focusing on the procedure. 

Acupressure

The Journal of Acupuncture and Meridian Studies recently published a study comparing the effectiveness of acupressure versus a topical anesthetic in reducing the pain of venipuncture. 

Researchers at the University of Medical Sciences in Rafsanjan and the Kerman University of Medical Sciences, both in Iran, set out to prove which was more effective in reducing the severity of venipuncture pain in 6- to 12-year-old children. EMLA, a topical mixture of lidocaine and prilocaine, was used on children in the topical anesthesia group. Subjects in the acupressure groups received a two-point acupressure technique, employing points in the palm of the hand and between the eyebrows. Children in the control group received no intervention.

Five minutes after a routine venipuncture, a behavioral assessment scale rating face and leg activity, crying, and consolability was recorded. The observed severity of pain based on these indicators were significantly lower in acupressure and EMLA groups than that in the control group. There was no significant difference between the acupressure and EMLA groups.

The authors noted that, although acupressure was as effective as topical anesthesia cream, the nurses involved in the study preferred acupressure due to its greater safety, cost-effectiveness, and applicability.

Read the full study.


Survey Says: Product Wish List

Lady listeningLast month we asked our readers and visitors to our web site what products and concepts they wish would be developed to help them in their role as blood collection personnel. We provided a list of 14 possibilities and asked them to pick their top five. We also gave them an opportunity to propose other products and concepts that were not on our list. For the purpose of this report, we found it interesting that managers, educators and front line healthcare professionals had different preferences.

Three products/concepts were in the top five for all three: a device that eliminates hemolysis, a site prep solution that both cleanses and anesthetizes the site, and gloves that don't feel like you're wearing gloves.

Managers' top five:

  1. a device that eliminates hemolysis---73.7% 
  2. a device that makes it impossible to misidentify a patient or mislabel a tube---68.4% 
  3. a site prep solution that not only cleanses the site, but instantly anesthetizes the skin, making every blood draw painless---63.2% 
  4. gloves that don't feel like I'm wearing gloves when I palpate for veins---57.9% 
  5. a device that eliminates blood culture contamination---36.8% 

Educators' top five:

  1. a device that eliminates hemolysis---88.9% 
  2. a device or method that improves patient comfort and satisfaction---66.7% 
  3. a device or feature that eliminates accidental needlesticks during phlebotomy---66.7% 
  4. gloves that don't feel like I'm wearing gloves when I palpate for veins---66.7% 
  5. a site prep solution that not only cleanses the site, but instantly anesthetizes the skin, making every blood draw painless---44.4% 

Front line healthcare professionals' top five:

  1. a site prep solution that not only cleanses the site, but instantly anesthetizes the skin, making every blood draw painless---69.8% 
  2. a device or method that improves patient comfort and satisfaction---56.6% 
  3. gloves that don't feel like I'm wearing gloves when I palpate for veins---50.9% 
  4. a device that reduces back strain caused by bending over to draw blood---45.3% 
  5. a device that eliminates hemolysis---43.4% 

Here are some interesting suggestions participants offered that were not on our list:

  • A device to help identify the difference between a vein and a tendon
  • A needle system that auto retracts the needle like the butterfly sets
  • A supervisor that listens
  • Something easier that takes the place of blood cultures
  • a device to hold pressure on the draw site for the appropriate length of time
  • there needs to be a chair product for children that will not only help them maintain stillness of their arm but will be effective with distracting them and must be comfortable and not too restrictive for the rest of their body. Some adults may benefit from this as well
  • A good lab computer program that would consolidate a patients lab draws would be great. Often times we are sticking patients 2 or 3 times in 4 hour period due to draws being ordered at different times
  • Anything to improve my patient care
  • A better way to do PKUs
  • Wider tourniquets so they don't end up like a rubber band on extra-large arms
  • a device that comes out of the vein already sheathed whether by accident (patient moves) or by design (end of draw).

Other comments:

  • A lot of these "futuristic" products are already available, we just need to be able to prepare a business case that is likely to be accepted by our CEOs in a limiting economic environment.
  • Contamination rate is higher in the ED. Would be nice if they could follow procedure and get the rate <3%
  • Time management of staff
  • How about prepping something with the tubes you need and then performing the venipuncture and the tubes fill up one after the other in correct order of draw without you removing and replacing tubes minimizing needle movement - and of course done quickly and painlessly :-)

Answers to 400+ questions

LabDrawCOVER_FINAL_Front_1000wThe Center for Phlebotomy Education has just released its highly anticipated Lab Draw Answer Book.

The 440-page full-color reference book answers over 400 commonly asked questions on blood sample collection and handling, and managing phlebotomy services and personnel. It's the second edition of Blood Specimen Collection FAQs, which was released in 2008, with 100 new entries and all original entries updated to fully reflect CLSI's new venipuncture standard. The second edition is co-authored by Dennis J. Ernst MT(ASCP), NCPT(NCCT) and his wife Catherine Ernst, RN, PBT(ASCP)CM.

"Bringing Catherine on board as co-author adds a nursing perspective so necessary for a phlebotomy reference book," says Dennis Ernst. "She's been very instrumental in making sure all passages not only reflect the CLSI standards, which she helped write, but the Standards of Practice of the Infusion Nurses Society.

Chapters in the book include:

  1. Safety and Infection Control
  2. Training, Management and Certification
  3. Skin Punctures, Heelsticks, and Pain Management
  4. Patient Identification, Vein Selection, & Site Prep
  5. Tourniquets & Butterflies
  6. Order of Draw & Discard Tubes
  7. Hemolysis and Potassium Issues
  8. Blood Cultures
  9. Labeling and Post-venipuncture Care
  10. Line Draws & IV Starts
  11. Processing, Storage, & Transportation
  12. Patient Injuries & Complications
  13. Unorthodox Techniques
  14. Miscellaneous

Copies are currently only available from the Center for Phlebotomy Education. More information and preview pages.


 

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