Tubes and their Additives
One of the most common questions we receive here at the Center for Phlebotomy Education is “what tests go in which tubes?” Unfortunately, we can’t answer that question definitively. That’s because every facility is a little different in that regard. In some facilities, electrolytes are tested in heparinized (green-stopper) tubes whereas others test serum from red-stopper tubes. Some measure sedimentation rates on lavender-stopper EDTA tubes while others perform them on blood in a black-stopper tube containing sodium citrate. Because of this variability, there is no universal list of tubes and tests that applies to all facilities. However, some generalities do exist. Here is a list of some of the more common tests specimen collection personnel draw on their patients and the tubes they are most likely to be collected in.
This Month in Phlebotomy Today
Hereís what subscribers to Phlebotomy Today, the Center for Phlebotomy Educationís paid-subscription newsletter currently in its 8th year of publication, are reading about this month:
For subscription rates and to subscribe to Phlebotomy Today, visit www.phlebotomy.com/PhlebotomyToday.html. The current monthís issue will be emailed to you immediately upon subscribing.
Featured FAQ: Face shields and phlebotomy
Question: Iím confused. Someone at a conference recently said face shields are required for phlebotomy. This is new to me and I want to make sure Iím not in violation of the standards. Iím afraid to call my local OSHA office for fear that theyíll show up on my doorstep.
Response: Your fear is unfounded. OSHA actually wants to help you comply with the standards and would look favorably on your willingness to contact them for guidance. The passage in the Bloodborne Pathogens Standard that addresses the issue reads as follows: "Masks in combination with eye protection devices, such as goggles or glasses with solid side shields, or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated." Routine phlebotomy doesn't usually pose that risk, but it's up to the employer to make that determination. So the information you received is not exactly correct. Some companies warn against splatter on the packaging of their safety needles. Make sure you address such warnings with the appropriate precautions.
Each month, PT-STAT! will include one of the hundreds of phlebotomy FAQs in the growing database of questions and answers culled from 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.
Specimen Collection Safety: Syringes
Do you use syringes to draw blood? A study conducted by the National Institute of Occupational Safety and Health (NIOSH) associates syringe use with the highest rate of accidental needlesticks among all healthcare professionals injured during a 4-year period. The Clinical and Laboratory Standards Institute (CLSI), the committee that establishes the standards by which laboratory procedures should be performed, discourages their use for safety reasons. Officials at the International Healthcare Worker Safety Center echo their sentiments.
However, draws outside
of the antecubital area are seldom successful unless syringes are used. In
the antecubital area, they should be employed only when attempting to access
small veins and/or veins that are anticipated to collapse if tube holders are
used. Syringes must have a safety feature or be used with a safety needle and
activated immediately after use.
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 "Accurate Results Begin With Me!® t-shirt. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.
Here's a sampling of what PT-STAT! readers said they'd do. Most of you responded just as Susan from Michigan did:
"You cannot accept the patient's consent to perform a procedure you know may inflict harm upon her. The best plan is to call the physician's office and explain the situation to the patient's doctor to see if he/she will give approval or suggest an alternative course of action. If the physician cannot be reached and you cannot obtain blood from the opposite arm/hand, the patient will have to have her labs drawn at a different time or place after she has been advised to speak with her physician regarding this situation."
For her accurate and well-written response, Susan will be receiving a free "Accurate Results Begin With Me!® t-shirt. Congratulations, Susan.
But we particularly liked the confidence that came from one anonymous submission:
"A good phlebotomist would find a vein on the right arm!"
From the overwhelming number of responses, preliminary indications all suggest the What Would You Do? feature is a phenomenal success. Not only that, but what the vast majority of respondents, a full 86 percent, would do is exactly what the standards require. About 10 percent indicated a willingness to perform a capillary puncture on the affected side, which is just as forbidden by the standards as a venipuncture. The risk is for lymphadenopathy due to infection, which is just as likely to come from a skin puncture as a venipuncture. Therefore, a skin puncture on the affected side requires the same precaution and permission as a venipuncture.
Several submissions entertained thoughts of performing an arterial puncture. However, the standards state that arterial punctures are not to be considered an alternative to a venipuncture in case the draw is difficult. The risk of injury is substantially greater, and therefore unjustified.
The Center for Phlebotomy Education has added a new continuing education (CE) exercise, the sixth this year, to its growing menu of in-house and P.A.C.E.® offerings. Starting this month, every purchase of the Center's Accurate Results Begin With Me! ® poster will be shipped with test questions managers and educators can distribute to students and staff to assure the poster is read and comprehended. The exercise can be implemented into a facility's in-house CE program. There is no additional charge for the exercise. Earlier this year, the Center began shipping a similar exercise with each purchase of the Blood Collection Sites & Precautions wall atlas.
The exercise is the latest addition to the Center's seven different categories of phlebotomy CE opportunities including an online training program, printed material, an e-newsletter, and videos. Other in-house CE exercises include the Applied Phlebotomy textbook with end-of-chapter CE questions, and institutional subscriptions to the Center’s newsletter, Phlebotomy Today, which provides test questions at the end of each issue pertinent to the content.
For formal P.A.C.E.® credits, those who purchase and view any of the Center’s Applied Phlebotomy videos have the option of completing and submitting an exam covering its content, which is now shipped with each video. New this year is the To the PointTM series of booklets, each one qualifying for 3 P.A.C.E.® credits. Finally, PhlebotomyWeb, an online training program, offers up to 9.5 P.A.C.E.® credits.
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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