Those who draw blood specimens must constantly be aware of the signs and symptoms of an impending loss of consciousness and be prepared to react. Signs can include pallor, perspiration, hyperventilation and/or anxiety. A proper response to such signs is key to protecting the patient from falling and the injuries that can result. However, collectors can prevent an injury before it happens if they take the following precautions:

• make sure that all outpatients are drawn from chairs with arm rests that can stop a fainting patient from falling to the floor;
• inpatients should be drawn while recumbent or sitting in arm chairs. When patients state that they have a tendency to pass out during a blood draw, it is best to draw them while they are in a recumbent position;
• never turn your back on a patient after you have completed the draw. Many patients give no warning before passing out.
• should a patient become dizzy or lose consciousness during a collection, release the tourniquet and remove the needle at once. Presence of mind must be maintained so that you don't sustain an accidental needlestick in the process.
• if the patient loses consciousness, support him/her from falling to the floor and summon assistance. Lower the patient's head below the level of the heart to facilitate blood flow to the brain. This can also be accomplished by carefully, and with assistance, lowering the patient's head between the knees or by lowering the patient to the floor, being careful not to allow the patient to fall and sustain an injury.
• avoid the use of ammonia inhalants. Patients who are asthmatic may develop respiratory distress as a result.

Specimen Collection Safety: Gloves

Do you ever draw blood without wearing gloves? OSHA insists on glove use for phlebotomy. You should, too. Gloves do not prevent needle penetration, but they will protect you from blood exposure to chapped or non-intact skin. Sure they deaden the sensitivity of your fingers, but you can locate the vein prior to gloving. If the vein is palpable but not visible, take note of its location in relation to creases on the skin, freckles, or other skin markers that can serve as guideposts. By so doing, you become less reliant on feeling for the vein after your gloves are on.

This Month in Phlebotomy Today

Need more than Phlebotomy Today-STAT!? Our flagship newsletter, Phlebotomy Today, is currently in its 8^th year of publication. Here's what subscribers are reading about this month:

• Feature Article: Blood Culture Collection, Part I
• Sidebar: Blood Cultures: Protecting the Collector
• Ask the Safety Lady: OSHA consultant addresses these burning questions:
  • Are labs required to designate a sink for handwashing only or can it double for other lab uses?
  • Our jackets for the phlebotomy team are embroidered with the employee's name and look very professional. Our safety officer says they are not compliant. Is this correct?
  • What types of shoes should I wear in the lab?
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in December including these stories:
  • Lab Manager Recognized for High Phlebotomy Standards;
  • Polycythemia Outbreak Investigated;
  • Phlebotomist Perishes in Fire
• According to the Standards: What the CLSI standards say about using cotton versus gauze for post-venipuncture care.
• Tip of the Month: The Last Line of Defense
• CEU Questions for managers and educators to use the January issue as an in-house continuing education tool. (Institutional subscribers only.)
• On a Personal Note: A funny thing happened on the way to naming the new members-only section of phlebotomy.com.

For subscription rates and to subscribe to Phlebotomy Today, visit www.phlebotomy.com/PhlebotomyToday.html. The current month's issue will be emailed to you immediately upon subscribing.

Conference Corner

"Symposium for Clinical Laboratories: An Interactive Experience in Quality Systems" will be conducted May 2-5, 2007 at the Hilton San Diego Resort on Mission Bay in San Diego, California. Features of the symposium jointly sponsored by University of Wisconsin School of Medicine & Public Health and COLA includes:

• General sessions on successfully implementing quality systems in your laboratory using proven tools and techniques;
• Breakout sessions on preparing preparing for laboratory inspections, systemizing regulatory complaince, hiring and retaining laboratory personnel, and using quality tools to maximize revenue and profits;
• CE to meet state requirements for continuing education for clinical laboratory testing personnel;
• CME to meet CLIA regulations to qualify as laboratory director of a moderate complexity laboratory.

Exhibit area with displays of laboratory instruments, supplies, and services Internationally recognized experts giving presentations on implementing quality systems in the laboratory include:

• James O. Westgard, Ph.D
• Dennis Ernst, MT(ASCP)
• Judy Yost, MA, MT(ASCP)
• William Greg Cooper, CLS, MHA
• Lucia M. Berte, MA, MT(ASCP) SBB, DLM; CQA(ASQ) CMQ

For Sympoisum registration or additional information go to www.cola.org. For questions concerning this event, please contact Symposium Operations Director Tricia Hudson at 800-981-9883, ext 427.

Featured FAQ

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 web site. For information on joining Phlebotomy Central, visit www.phlebotomy.com/PhlebotomyCentral.html.

Question: I suspect some of our staff are not very skilled at drawing based on the frequency of their patients who require recollecting and the extent of the bruising they leave behind. Is there anything out there that suggests what the average number of recollects are per phlebotomist?

Response: A Q-Probe published in 1991 examined patient satisfaction and complications among 30,000 patients (80% survey return rate).(1) The survey gathered data on the size (average: 15.1mm) and frequency (16.1%) of bruising and the number of attempts by phlebotomists per patient (1.03). Ninety-three percent of venipunctures were eventually successful. (4.9% not attempted). But it doesn't state how many attempts were made before they were successful.

A CAP Q-Probe conducted in 1992 addressed the level of recollects at 70 hospitals. 95% were collected on first attempt; 2.8% required two attempts; 0.8% required three attempts and 1.1% required four or more sticks. Unfortunately, this data is a bit dated. I haven't seen any more recent studies published.

(References available in Phlebotomy Central)

For information on joining Phlebotomy Central or access to hundreds more FAQs, visit www.phlebotomy.com/PhlebotomyCentral.html.

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