New Zealand Phlebotomist Has Zeal for Healthcare
One of the great things about social media is all the fascinating people you get to meet. Having a presence on Facebook has allowed the Center for Phlebotomy Education to reach and connect with an ever-growing number of individuals from around the globe who share a common interest in blood specimen collection. One such person is New Zealand phlebotomist, Tracey Connell. Intrigued by her posts, we asked Tracey if she would agree to be interviewed for Phlebotomy Today STAT! to share her experiences and perspective on becoming a phlebotomist in New Zealand. Her interview is below:
PT-STAT: Tell us about yourself.
PT-STAT: Why did you decide to become a phlebotomist?
PT-STAT: The educational requirements for phlebotomists in New Zealand differ from those in the U.S. Could you describe the process for us?
PT-STAT: How much does it cost New Zealand students to be trained in phlebotomy?
PT-STAT: Is phlebotomy certification and/or licensure required in New Zealand?
PT-STAT: How many hours of continuing education (CE) are required, and who pays for CE? The individual or the employer?
PT-STAT: How are phlebotomists perceived by other healthcare professionals in your country?
PT-STAT: In regards to safety, what steps do you take to prevent occupational exposure and accidental needlesticks?
PT-STAT: What is the average starting salary for a phlebotomist in New Zealand?
PT-STAT: In addition to hospitals and medical centers, where are phlebotomists typically employed?
PT-STAT: What do you think are the most important qualities to become successful in this field?
PT-STAT: What are your short-term and long-term career goals?
PT-STAT: What advice do you have for others who are interested in becoming a phlebotomist?
PT-STAT: Anything else you'd care to add?
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:
For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.
On a Personal Note...
Back before there was a Center for Phlebotomy Education, I worked the bench. After twenty-some years turning out lab results at hospitals small and large, I had lost enthusiasm with my career. I needed to get away and I did, all the way up to Speckled Trout Lake in Ontario, Canada.
If you have a moment, follow me.
Last Month on Facebook
During the month of November, fans and visitors to our Facebook page shared their thoughts on the following topics:
Looking for an online community to post questions or to simply satisfy your desire for phlebotomy talk between newsletter issues? Visit and “Like” our Facebook page and you’ll never miss out on another discussion or one of our special Facebook offers. Your peers need your input, and you need theirs. www.facebook.com/CPEInc
Q: I am the Phlebotomy Coordinator in a large hospital in Australia. We are having a problem with erroneous results from our oncology department where blood is collected from central venous catheters by the nursing staff. On one patient, the haemoglobin rose from 117 g/L to 171 g/L in 24 hours, then came back down two hours later to 109 g/L. There was no transfusion and tourniquet application was not prolonged. This happens a lot. The nursing staff discards 10 mL before collecting samples. Can you explain such a difference?
A: In order to address this variation fairly, we have to question the accuracy of both the normal and abnormal results. In other words, we have to wonder if the normal result is falsely lower or if the higher result is falsely elevated. There are more explanations for a falsely lower hemoglobin drawn from a line than a falsely elevated result. Variables that falsely decrease hemoglobins from line draws include dilution with IV fluids, clotting in the barrel of the syringe prior to filling the tubes, and hemolysis during aspiration. You should investigate if the nurses are turning off the fluids for two minutes prior to collection. If not, there could be a dilutional effect.
Variables that falsely elevate hemoglobin in line draws include hemoconcentration, which most commonly occurs when the tourniquet is left on for a prolonged time. You’ve ruled that out. Physiological conditions like dehydration can also falsely elevate hemoglobin. But if the level came back down two hours later, dehydration is probably not the issue unless it was rapidly corrected by IV infusion between sampling.
Make sure your specimens are well mixed prior to testing. Check the EDTA tubes for clots. Observation of the nurses' technique may reveal other variables. Finally, make sure this is not an analytical (instrumentation) issue instead of a preanalytical issue. You might want to confirm all spurious results by repeat testing.
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.
Last month, we asked visitors to our website and our Facebook page three questions in relation to outpatient draws and fainting. We wanted to know: 1) if every outpatient is asked if he/she has a history or fainting; 2) if ammonia inhalants are being used in outpatient draw stations; and 3) if a reclining phlebotomy chair, cot orgurney is available for those outpatients who feel faint. The results of the survey are below:
Do you ask every outpatient if he/she has a history of fainting?
Are your outpatient draw stations stocked with ammonia inhalants?
In your outpatient drawing area, do you have a reclining phlebotomy chair, cot or gurney for patients who feel faint?
According to the Clinical and Laboratory Standards Institute (CLSI), phlebotomists should anticipate a possible loss of consciousness in their patients, and be prepared to react.(1) Part of that preparation includes drawing samples with the patient seated in an appropriate chair or lying down. The chair should have arms to provide support and prevent falls should the patient pass out.
The use of ammonia inhalants is not recommended.(1) The risk is that the patient who has passed out or is feeling faint may be asthmatic. In such individuals ammonia inhalants may trigger respiratory distress. When we surveyed our readers about the use of ammonia inhalants in early 2009, 24 percent of survey respondents indicated that ammonia inhalants were on their collection trays or in their outpatient drawing areas. In comparison, current survey results indicate the availability of ammonia inhalants in collection areas is significantly higher (34% vs. 24%).
This month’s survey question:
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: You are right about the general affect of underfilling tubes, and you were right to reject the sample. Your patients are lucky to have you around to assure they get treated according to accurate results. I did a lot of research on your question and finally found a passage that supports what you and I already expected. But it doesn't quantify the effect. Nevertheless, I think it should be all the evidence you need. Here's the passage from Tietz Guide to Clinical Laboratory Tests (2006): "Underfilling blood collection tubes can affect red blood cells morphology and lipids in EDTA tubes and binding of electrolytes and troponin to heparin in some plasma tubes." (Emphasis ours.) It doesn't cite a reference, but Tietz is a well-respected laboratory reference book that has been around a long time.
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