Tips on Fingersticks

Performing bedside glucose testing on fingerstick blood from diabetic patients can be tricky. You may find over time that their fingers become increasingly difficult from which to obtain adequate specimens. Several techniques can be applied, however, to yield adequate specimens from even the most frequently pierced capillary beds.

One method is to pre-warm the finger. This dilates the vessels and increases capillary volume up to seven times their normal levels. Pre-warming with a warm cloth for 3-5 minutes prior to the puncture substantially increases the supply of blood to the intended puncture site. Limit the prewarming temperature to 42 degrees Celsius.

In conjunction with the pre-warming technique, try letting gravity working for you instead of against you. A hand elevated above the level of the heart quickly drains the blood from the extremity. Therefore, lower your patient's hand fully downward to keep the capillary beds full after performing the puncture.

A couple procedural reminders are in order whenever discussing fingerstick collections. Phlebotomists should make sure they wipe off the first drop of blood coming from a finger puncture as it contains tissue fluids from the trauma of the puncture. Remember, testing equipment is designed to measure blood glucose, not tissue glucose, and failure to wipe off the first drop results in an admixture of the two and probably won't yield accurate results.

According to the Clinical and Laboratory Standards Institute, the organization that establishes and maintains the procedures for specimen collection, fingersticks should be performed on the fleshy pads of the fingers, not the sides. (2) This is because punctures to the sides of the fingers bring the sharp closer to the bone, the penetration of which can bring serious consequences, including gangrene. Perform the puncture against the “grain” of the fingerprint instead of parallel with it so that the emerging drop(s) of blood bead up better instead of channeling away from the puncture site.

Haitian Ministry in Need of Surplus EDTA Tubes

Tim R. Randolph is looking for a few good EDTA tubes. Quite a few, in fact. Each year, the assistant professor of clinical laboratory science at Saint Louis University travels to Haiti to help Haitian laboratorians set up and operate labs that would otherwise not exist. One of the most insatiable needs his laboratories have is for EDTA tubes. Since many labs are without tubes for CBCs and lack the funds to procure them, many Haitians go untested and improperly managed for otherwise treatable diseases like HIV, sickle cell anemia, and hepatitis.

If your laboratory, school or manufacturing company has expired or surplus evacuated EDTA tubes and would like to donate them to the struggling laboratories in Haiti, contact Randolph World Ministries, Inc. (www.randolphworldministries.org) or send an email to randoltr@slu.edu.

Other urgently needed laboratory supplies include microscope coverslips, heparinized microhematocrit tubes, microhematocrit centrifuges, large latex gloves, WBC Thoma pipettes, and plastic transfer pipettes.

Waterloo Healthcare Offers Short Phlebotomy/Specimen Collection Cart

Waterloo Healthcare (Phoenix, AX) offers a short phlebotomy/specimen collection cart that brings new convenience to healthcare professionals with specimen collection responsibilities. Features of the cart include:

• 12 clear plastic tilt bins;
• Unique lockable area to hold sharps container;
• Built-in drawer dividers for easy removal and cleaning;
• Tilt out waste bin;
• Includes paper holder and glove box holder;
• ABS white molded top;
• Roller-bearing slides with quick release;
• Central key locking system;
• Height adjustable ergonomic push handle;
• High impact stabilizer system;
• premium casters (2 brake, 1 tracking, 1 swivel);
• Also available in tall version (adds a full-size 6" deep drawer at bottom of cart);
• Fits the Kendall 85221R sharps container.

The cart is all white, has four half-sized drawers (3", 4", 6" and 9") for a total of 22" of drawer space, and has dimensions of 26"W x 18"D x 37"H.
For more information, visit www.WaterlooHealthcare.com or call (800) 833-4419.

This Month in Phlebotomy Today

Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's paid-subscription newsletter currently in its 8^th year of publication, are reading about this month:

• Feature Article: If Tubes Could Talk, Part II: Interview with a Red Top
• Ask the Safety Lady: OSHA consultant, Terry Jo Gile, addresses these burning questions:
  • I have long artificial nails and my supervisor says I have to remove them. Why?
  • Our phlebotomy drawing site is adjacent to the lab. The handwashing sink is across the hall in the lab. Are labs required to designate a sink for handwashing only or can it double for other lab uses?
• Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in April including these stories:
  • Phlebotomists Reject Union
  • Phlebotomist/Nurse Named Professional of the Year
  • Patients Select Phlebotomist as Employee of the Year
• According to the Standards: The Angle of Insertion
• Tip of the Month: Never-Never Land
• On a Personal Note: There's more to the redesign of the Ten Commandments of Phlebotomy poster than just the want for a fresher look.
• NEW feature! Activity: Word search puzzle.
• CEU questions (institutional version only).

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.

Featured FAQ: Certification, Grandfathering-in by experience

Question: I recently finished my phlebotomy externship at an accredited school and I am now ready to sit to be certified in the field. I was hired by a local hospital right out of school. To my surprise not one co-worker has certification. Most have never even attended classes. I was amazed at this information. When I suggested to my boss that one day everyone would need to be certified, he laughed and said that would never happen and that if it did, everyone would just be grandfathered in. That is my question. Would they be grandfathered in? Also, wouldn't they have to sit for the certification based on experience?

Response: One of the sadder truths about phlebotomy is that only three states have any regulations whatsoever mandating certification or minimum training (CA, LA, NV). Other states are considering it and I am personally involved in some states, but legislation takes a long time and passionate commitments from people like you.

If legislation ever becomes enacted in your state, it's no guarantee there will be a grandfathering clause, or to what extent current phlebotomists would be grandfathered. In California's recent legislation, all phlebotomists had to take a 20-hour program and a certification exam. Those who didn't have experience have to take an 80-hour program and pass an exam.

I commend you on finding value in certification and hope your passion and pride in the profession spreads throughout your staff. Good luck.

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.

Specimen Collection Safety: conventional needle assemblies

Do you use conventional needle assemblies, i.e., those without engineered sharps injury protection features? The Needlestick Safety and Prevention Act modifie the OSHA Bloodborne Pathogens Standard in 2001 to mandate the use of sharps engineered for needlestick prevention.The Centers for Disease Control and Prevention (CDC) has shown that safety devices can reduce accidental needlesticks by up to 76 percent. There is no effective argument against converting to safer needles.

Featured Product: Ten Commandments of Phlebotomy Poster

Newly redesigned for 2007, the Center for Phlebotomy Education's popular Ten Commandments of Phlebotomy poster is now available. This 16x20 four-color poster, introduced as the Center's first product in 1998, serves as an eye-catching reminder to those collecting blood specimens to practice techniques that protect patients from injury, safeguard themselves from accidental needlesticks, produce specimens of uncompromising quality and demonstrate compassion for the patient. Some proposed "commandments" include: The First Commandment: Thou Shalt Protect Thyself From Injury. The Fifth Commandment: Thou Shalt Invert Tubes With Additives Immediately After Collection. The Seventh Commandment: Thou Shalt Label Specimens at the Bedside. The Tenth Commandment: Thou Shalt Treat All Patients as if They Were Family. Displayed in outpatient drawing areas, this poster also serves as visible evidence of the facility's ongoing commitment to quality patient care. For more information, visit www.phlebotomy.com/Poster.html.