Defusing Fear in Pediatric Patients

Preparing the pediatric patient begins the moment your eyes meet. Children will be able to detect compassion and tenderness in your face and body language just as you will be able to read anxiety or complacency in theirs. How well you interpret and react to the patient's state of mind determines his/her reaction to this and all subsequent phlebotomies.

For pediatric patients, the fear of the unknown can often be alleviated in less than 1 minute. Healthcare professionals who read apprehension and anxiety in their pediatric patients should establish a rapport with the child by sitting next to the patient or otherwise getting down to the child's eye level; the affect of a towering, uniformed authority is intimidating enough. Unless already conducted, an introduction is necessary. Ask the patient if this is his/her first blood test.

Regardless of the answer, if apprehension is obvious, defuse the child's fear by talking through the procedure step-by-step, speaking in simple terms appropriate to the child's age. To do so, demonstrate the application of the tourniquet by squeezing the child's upper arm where it might be applied to the degree the tourniquet will be tightened. Ask the child to make a fist. Point to the antecubital area, explaining that that is where you will look for a vein. Then explain that you will cleanse the site (for example, "with something cold and kind of smelly"), and that you will then ask him/her to look the other way. Explain that, after looking away, he/she will then feel a little "pinch." To give the child an approximation of the sensation, gently pinch the antecubital area so that the child will know exactly what to expect.

Tell the child that, at that point, he/she will be asked to start counting and that you will probably be done by the time he/she gets to 10. Explain that you will then put pressure on the site for a few minutes, you'll bandage it (this is an important selling point: most kids love bandages!), and you'll be done. Explaining this procedure takes 1 minute or less. When the child knows what to expect, the fear of the unknown can be put to rest, and the venipuncture has a much greater chance of proceeding without incident.

From Our Esteemed Readers:

Dennis,

Your article last month, "Managing Patients Who Lose Consciousness," reminds me of an instance in the early 1970's when the Kentucky Law Statutes still required that a VDRL (RPR) be performed on all premarital applicants. While managing a rural laboratory in central Kentucky, I had the opportunity to draw blood samples on a soon-to-be-married young couple in their mid-20's. Both were local law officers.

Things went smooth with the lady, but I detected some early resistance with the gentleman. With the needle in the arm, the man passed out "gradually" and proceeded to "wet the floor". While trying to hold the man in his chair and remove the needle, the puddle caused my legs to gradually split to keep my shoes from becoming soiled. All was well after a few minutes, but it was an embarrassing situation for the "brave" young couple who placed their lives in the way of harm each day to protect and serve.

The marriage lasted about 14 months.

Ken F.
Nashville, Tennessee

Specimen Collection Safety:
Safety Transfer Devices

When using a syringe to draw blood specimens, do you fill collection tubes with the same needle used to perform the puncture? If so, sooner or later you'll have a needlestick injury. OSHA prefers you activate the safety feature of the needle first, then replace the needle with a safety transfer device prior to filling tubes. Outside of the US, it's still important to use safety needles. Removing a conventional needle is just as risky, if not more, than piercing the stopper with the same needle used to access the vein. Just remember, syringes are the single most common device in use when healthcare professionals sustain accidental needlesticks. Using a safety transfer device to fill tubes is an important device in exposure prevention where safety needles are in use.

Certified Phlebotomist Shunned in NYC

A certified phlebotomist who can't find work in New York City is out of everything except hope. Alham Mastafa emigrated with her husband from Baghdad to NYC in 1981 for a better life, but fears her heritage is why she can't find work. Her husband died of stomach cancer three years ago and left her penniless. Mastafa, who now lives alone with her four sons, one of whom was recently diagnosed with Guillain-Barre Syndrome, has nothing but debt, hope, and a growing sense of desperation.

Phlebotomy Answers 24/7/365

Phlebotomy Central is the single most comprehensive source of specimen collection information on the Internet. The goal of the members-only section of the Center for Phlebotomy Education's web site is to provide the global phlebotomy community with accurate information that is accessible 24/7/365. Launched in January, Phlebotomy Central is the most comprehensive compilation of specimen collection information ever available on the Internet. Phlebotomy Central has three sections: articles, FAQs, and all issues of Phlebotomy Today, current and archived.

The FAQ section will feature answers to the most common questions posed to the Center on all aspects of specimen collection and management since its founding in 1998. The Articles section will contain 16 lengthy To The Point™ articles on a wide variety of specimen collection topics, previously available only on a pay-per-download basis. All articles will be free to Phlebotomy Central members. The Newsletter section will include an institutional subscription to Phlebotomy Today as well as access to seven years of back issues, previously unavailable.

For more information, visit www.phlebotomy.com/PhlebotomyCentral.html.

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 II
• Sidebar to "Blood Culture Collection": Five Factors that Lower Contamination Rates
• Ask the Safety Lady: OSHA consultant addresses these burning questions:
  1. Do phlebotomists have to wear gloves?
  2. How often does a safety shower need to be checked?
  3. When should a sharps container be disposed?
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in January including these stories:
• Phlebotomist has Hip-Hop in her Blood;
• Gloveless Venipuncture Draws Patient Complaint;
• Certified Phlebotomist Shunned in NYC;
• Lab Offers Drive-Through Phlebotomy;
• 80-Year-Old Phlebotomist Leaves Legacy of Humor.
• According to the Standards: What the CLSI standards say about discard tubes.
• Tip of the Month: Just Say "No!"
• CEU Questions that enable managers and educators to use Phlebotomy Today as an in-house continuing education tool. (Institutional subscribers only.)
• On a Personal Note: The origins of Phlebotomy Today and the life lessons learned in the process.

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 for laboratory inspections, systemizing regulatory compliance, hiring and retaining laboratory personnel, and using quality tools to maximize revenue and profits;
• Continuing Education (CE) that meets state requirements for clinical laboratory testing personnel;
• Continuing Medical Education (CME) that meet CLIA regulations for laboratory directors 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 Symposium 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:
Discarding Tourniquets

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:

Dennis, Our Ortho rep suggested that I contact you. Here is my question: Has OSHA ruled that tourniquets in the outpatient setting must be discarded after each patient, or only when soiled/end of day? I am looking for the actual regulation, not opinion. This came up in another hospital's survey, and they are asking me for help (because I'm a CLS?). Thank you for any help that you can give us.

Response:

Karen,
This is a common question I receive. OSHA would not make such a mandate. Discarding tourniquets after one issue is more of a matter of infection control than an OSHA issue. OSHA is concerned only with employee injury and illness, not patient issues. In fact, OSHA doesn't even mention tourniquets in the Bloodborne Pathogens Standard, so they have no position on the subject unless the equipment is soiled by blood in such a manner and to such a degree that it is a potential risk to employees.

What OSHA does say is: "All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials." and "Special care shall be taken to avoid skin contact with other potentially infectious materials."

So it's really up to you to establish a policy based on current infection control and this OSHA passage. It's generally accepted that tourniquets be discarded when visibly soiled. Your Infection Control Officer should be consulted and a policy drafted based on his/her recommendations. Establishing a policy to the effect that visibly soiled tourniquets must be discarded should be the bare minimum. Facilities vary widely in their policies on tourniquet disposal. I'm seeing more and more of them adopt a single-use policy to fight nosocomial infections, and would encourage you to consider one as well. Keep in mind, over 98,000 patients die every year from nosocomial infections. I am hard-pressed to think that contaminated tourniquets don't contribute to the problem. I hope this helps.

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