New Technology Leads to Decreased Hemolysis Rates
Laboratories in an increasing number of U. S. hospitals and healthcare systems are seeing significantly lower hemolysis rates in the blood specimens their staff are collecting with new technology designed for drawing blood with a single-use, sterile device that advances into the vein through a peripheral IV (PIV).
The technology, PIVO (Velano Vascular, San Francisco, California), is a needle-free blood collection device that attaches to a PIV and is used as an alternative to venipunctures on patients with peripheral lines. Implementation of the technology, aiming to enable "one-stick hospitalization," is getting the attention of healthcare systems large and small across the U.S. as studies emerge showing significantly and consistently fewer hemolyzed samples in addition to other clinical quality improvements, enhanced patient experience, and reduced infection risks.
The device attaches to a patient's existing PIV through its luer connection; the other end enables the practitioner to attach a tube holder or syringe. A narrower and sturdier length of tubing is then advanced into the existing canula and extended beyond the tip of the indwelling catheter, the point where hemolysis typically occurs. Blood is then withdrawn just as with any line draw and the device is retracted, removed, and discarded. Other advantages include fewer venipunctures, more-satisfied patients, higher quality samples overall, and the potential for fewer accidental needlesticks since the device is needle-free.
Recently, Virginia Mason Medical Center (VMMC) in Seattle, Washington implemented a practice change around drawing blood samples from peripheral IV devices using PIVO rather than from central lines by conventional methods. Researchers then compared data on more than five quality indicators including:
• hemolysis rates
• overall laboratory sample defects (hemolysis, clotted, QNS, and contaminated)
• central line bloodstream infections (CLABSIs)
• patient satisfaction scores
• hospital-onset bloodstream infections (HO-BSIs).
Hemolysis rates in the PIVO samples plummeted 69% while overall sample defects fell 36%. The frequency of CLABSIs dropped by 60% and HO-BSIs fell 64%. Press Ganey scores reflecting patient satisfaction with the level of compassion by the person starting IV and the person collecting blood each improved by at least a full point.The results were presented at the 15th Annual Conference for the Seattle Nursing Research Consortium and awarded "Best Poster in Practice Innovation/Quality Improvement Initiative."
VMMC is not the only facility where hemolysis rates are dropping and sample quality is improving for line draws with the technology. Intermountain Medical Center, a 24-hospital system in Utah, evaluated 285,000 IVs and more than 1.3 million blood draws over a 2-year period pre- and post-PIVO implementation and realized a 38% reduction in hemolysis rates and a 56% relative reduction in sample errors. Centura Health System in Denver, Colorado recently saw its hemolysis rate drop 33% for nurse-drawn samples from IV lines. The system estimates the device prevented over 100,000 venipunctures in 2019 and, according to the Denver Business Journal, expects to use 880,000 fewer needles in 2020 as the technology is fully implemented.
The company reports over 1 million PIVO devices were distributed as of the close of 2019, and the signing of distribution agreements with CardinalHealth and Owens & Minor. "We're particularly honored to be selected as the 2019 recipient of Frost & Sullivan's North America Product Leadership Award for Needle-Free Venous Access Technology," said company representatives.
"I think this industry development is a tremendous opportunity for phlebotomists to become more valuable members of the healthcare team," says Dennis J. Ernst MT(ASCP), NCPT(NCCT), Director of the Center for Phlebotomy Education and a strong advocate for the phlebotomy profession. "With their expertise in reducing preanalytical errors, phlebotomists are well suited to be at the forefront of this practice change that's on its way to becoming a best practice."
For more information visit www.velanovascular.com.
Related article: Phlebotomists Taking the Lead as Change Agents. (MLO)
Editor's note: Ernst recently joined the Advisory Board of Velano Vascular, helping the company, and hospitals nationwide, further realize the benefits of this transformational practice.
Lab Week Giveaways
National Medical Laboratory Professionals Week is April 19-25, 2020. Do those who draw blood samples in your facility feel appreciated? Let us help you celebrate those who collect the samples that keep your lab up and running.
If you're looking for giveaways, consider any of our Order of Draw reminders. Pens, badge tags, and pocket-size Tips On Specimen Collection cards are tasteful graphic reminders of one of the most important aspects of drawing blood samples.
- Our Order of Draw Badge Tags attach to your staff's or students' ID clip or lanyard so the order of draw is always in front of them.
- Put an Order of Draw Pen in every pocket so the correct order in which tubes must be filled is also right at their fingertips.
- The Phlebotomy Tips card is a pocket reminder of key concepts in phlebotomy including the order of draw, and tips on specimen collection. The reverse shows the anatomy of the antecubital area featuring veins, arteries, and nerves.
- The Lab Draw Answer Book is the gift that keeps on giving ANSWERS. Almost 400 to be exact. Put this in the hands of your top performers. If you have an entire staff of top performers, quantity discounts are available.
We've been helping you educate for over 20 years. Now let us help you celebrate.
Rutgers Latest to Design Robotic Venipuncture Device
Over the years, Phlebotomy Today has reported on no fewer than 4 attempts to create robotic devices that automate venipunctures including the Roblood, Veebot, Bloodbot, Phlebot, and the Singapore Project. The latest entry into the arena is a yet unnamed device being developed by Rutgers University in New Jersey as reported by CNET and in Technology.
According to the Technology abstract, Rutgers researchers conducted human trials of an automated robotic venipuncture device using ultrasound imaging and miniaturized robotics to identify suitable vessels. Once identified, a needle is robotically guided toward the center of the vein. After 31 volunteer patients, they report an 87% success rate, 97% on non-difficult veins (n=25). The average duration of the procedure was 93 seconds, plus or minus 30 seconds.
The device seems to be an advanced version of one Phlebotomy Today reported about in 2017, also by Rutgers' engineers, and incorporates sample processing and analysis into its design. Funded by the U.S. National Institute of Health (NIH) and published online, the robotic assembly, once the sample is obtained, a sample handling module transfers it from the venipuncture component to blood collection tubes, and then employs a peristaltic pump to deliver the sample from the tubes to the analyzer.
A related article in CNET reports university officials as claiming studies show health-care professionals are successful only 73% of the time when patients have visible veins and only 60% of the time when veins aren't palpable. Results of a College of American Pathologists (CAP) Q-Probe published in the Archives of Laboratory Medicine, however, surveyed phlebotomy practices at 70 hospitals and found the average first-attempt success rate for venipunctures on all patients (including visible and palpable-only veins) to be 95%.
Read the full CNET article.
Product Spotlight: Anatomy Poster Discounted
The Center for Phlebotomy Education's popular Blood Collection Sites and Precautions wall atlas is on sale for nearly 30% off.
Already on display in over a thousand healthcare facilities and academic programs around the world, it's the only poster of its kind that identifies nerves, veins and arteries of the antecubital area.
This full-color laminated poster depicts depicts the two most common anatomical variations of veins as they pass through the antecubital, i.e., the "H" and the "M" configurations. Approximate locations of nerves, veins, and the brachial artery as they pass through the antecubital area are identified and accompanied by detailed text that discusses the precautions all specimen collection personnel must know when drawing blood for clinical testing to prevent patient injury.
A section on alternative venipuncture sites discusses mastectomy patients, foot/ankle veins, and other alternatives. All text and illustrations reflect the current standards of the Clinical and Laboratory Standards Institute and the Infusion Nurse's Society. This 17" x 22" laminated poster is designed to be posted in classrooms, laboratories, medical offices, healthcare facilities, and other specimen collection environments.
Obtain your copy.
From the Editor's Desk
It never ceases to amaze me how many of my newsletter readers have been loyal subscribers for most, if not all of the 21 years I've been writing this thing. Likewise for customers who have been buying our educational materials for over two decades. That's brand loyalty, and it doesn't come by accident.
When my wife and I first started the company in 1999, we knew in order to make it work we'd have to create the best materials the world has ever known, price them appropriately, and deliver world-class customer service. That's why producing our very first tangible product way back in 1999, the Ten Commandments of Phlebotomy poster, was a really big deal for us. We pored over every word, color and graphic to make sure it was as perfect as humanly possible. Then we went to print and held our breath in hopes that the first product created by our new company was going to be outstanding and well received by our new market. Our first inventoried product cost us $800 to produce and print, the entirety coming from our dwindling savings account.
When we unpacked it we tossed the entire shipment right into the dumpster.
We couldn't possibly offer it to our customers. The colors were terrible and the text impossible to read without squinting. We were crestfallen. We learned an important lesson that day: always check the color proof. We had our graphic artist do some tweaking and the second printing was vastly improved. It's been redesigned twice since and still a best seller.
It wasn't the last time we had to throw inventory away. Our standards are high because yours are. That's probably why you've been with us as long as you have. You know you're going to get the best product, newsletter and customer service that's humanly possible. When we come to you with something new, even if it's just a new issue of this newsletter, we bring our A-game. It's the only game we have, and it's what you expect from us. It's also what you deserve.
It's also what I have come to expect from companies I purchase from. Just like you, there are companies I'm become brand-loyal to as well. Whether it's house paint, shoes, or donuts, there are brands I'll always trust and then there's everyone else. So I thought I'd share with you some companies I've come to respect and trust as much as you trust us, maybe even a little more. These are not paid endorsements, mind you, but sound advice from someone who's learned the hard way that if you buy something right, you'll only have to buy it once.
Chain saws---Husqvarna. This saw is so good the trees around me beg to be cut down with it. I think they realize that if they have to die, it's a lot quicker than the blight. Especially since I had my "huskie" modified to run on aviation fuel (no joke). Even the hardest hardwood gives way like butter does a hot knife.
Power tools---DeWalt. You can't go wrong with "Big Yellow." Every tool I own from this company stands up to any test I put it through, and I'm pretty hard on my power tools. Unlike other brands, DeWalts are not disposable.
Computers---Origin. I just purchased my fourth Origin PC and will never buy anything else. Made primarily for gamers (which I am certainly not), these rigs are the best and most durable on the market. In fact, if Microsoft hadn't sunset their support for Windows 7 recently, I'd still be using the same Origin I bought 13 years ago. It's been crunching out our videos like an insatiable byte-beast since 2007.
Builders/contractors---Amish. You will never go wrong with an Amish craftsman. Their quality and work-ethic is unmatched, and they'll never cheat you. Same for Mennonite artisans. When we gutted and renovated our Indiana home, no fewer than 30 contractors came and went. Only the Amish and Mennonite craftsmen were dependable, honest, and did quality work.
Red wines---Apothic or Dark Horse. Varietals from these California vintners never disappoint. Life is short; drink the good stuff.
Trailers---Big Tex. I've had my 5x10 for over 20 years now and abused it mighty, often, loading it beyond twice its manufacturer's recommended weight limit. It probably has another 20 years left of the same kind of abuse.
Coffeemakers---Cuisinart. I've probably bought 15 coffee makers in my lifetime, mostly cheap-o models from some guy who's first name is "Mister". But my Cuisinart is built to last... and doesn't mind being on a first-name basis with those she serves.
Dog breeds---Great Pyrenees. I'll never own another brand... er, breed. These 100+-pound galoots are as lovable as a dog gets. They're working dogs by nature, but are about the most endearing and protective breed on the planet.
Cameras---Nikon. I've owned many over the years, but nothing compares to Nikon. Before focusing on phlebotomy education, I took thousands of scenic and wildlife photos, placing them in publications, winning juried art shows and framing them for a growing clientele. Nature is beautiful with or without a camera, but my Nikons made me look better than I was. What else do you want from a camera?
Lastly, Phlebotomy educational materials---Phlebotomy.com, of course. Hey, any company that throws $800 of seed money from the owner's savings account into a dumpster because their first product's quality fell short can be trusted to get it right regardless of the cost. Besides, the owner's chain saw runs on aviation fuel. What's not to love about that?
Dennis J. Ernst, editor
What Should We Do?: Blind sticking
Dear Center for Phlebotomy Education:
I have a former student who is being pressured to perform "blind sticks". In my opinion, this is a poor practice that could cause patient injury even in cases where the phlebotomist is well-versed on vascular anatomy. Do you have any references to point me to? What should we do?
Blind sticking is well outside of the standard of care for phlebotomy. Permitting it puts a facility at great risk for liability for patient injury. The Clinical and Laboratory Standards Institute's (CLSI) venipuncture standard (GP41-A7) clearly states that a calculated needle relocation is acceptable (to a limited extent in the area of the basilic vein), but only if the exact location of the vein is known. Not knowing where the vein lies and relocating the needle anyway is considered blind probing, which is not permitted. It can be painful and may produce arterial perforations, resulting in a hematoma and nerve compression or direct nerve injury.
CLSI illustrates two drastically different orientations of the vascular anatomy in its venipuncture standard. In some patients, antecubital veins are arranged in an "H" pattern, while in others it's an "M" pattern. How does the blind-sticker know which anatomy they're dealing with?
Being well-versed in vascular anatomy isn't enough. Does the person who performs blind-sticking know where the nerves are that pass through the antecubital area? If he/she is blind-sticking, probably not. So make sure you articulate to your former student that blind sticking is wrong on many levels, and is without support in reputable textbooks or the standards.
Got a challenging phlebotomy situation or work-related question? Email us your submission at Phlebotomy.Today@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)
Test Talk: Troponin
Troponin, also referred to as cardiac-specific troponin, troponin-I and troponin-T, is a protein found in heart and skeletal muscle.
When the muscle is damaged, troponin is elevated in the bloodstream. Because its concentration in the blood increases rapidly and significantly after a heart attack, cardiac-specific troponin has become a key indicator in the diagnosis of acute myocardial infarction (MI). Typically, a laboratory will test troponin-I or troponin-T, but not both since they have similar diagnostic value.
After a heart attack, troponin increases within 3-5 hours and can stay elevated for up to 14 days. Because a heart attack can cause symptoms for several hours before troponin elevates in the blood stream, a normal result has to be repeated within one or two hours. The concentration of troponin in the blood is also indicative of the severity of the heart attack.
Other heart conditions such as inflammation and congestive heart failure can also cause troponin levels to increase.
Troponin levels are typically tested on serum samples. Point-of-care devices can measure troponin levels from EDTA and heparinized plasma. Results should not be compared with those tested on serum, which may be up to 20 percent higher. Samples not tested within 6 hours should be refrigerated up to 24 hours. Hemolyzed, lipemic, and icteric samples may render inaccurate results.
- LabTestsOnline. American Association for Clinical Chemistry. AACC. https://labtestsonline.org/tests/troponin. Accessed 3/4/2020.
- Wu A. Tietz Clinical Guide to Laboratory Tests---Fourth Edition. Elsevier. St. Louis, Missouri. 2006.
- World Health Organization. Use of Anticoagulants in Diagnostic Laboratory Investigations. WHO. Geneva, Switzerland. 2002.
What's Wrong Here?
What's wrong with this picture? (Click image to enlarge.)We guarantee something isn't as it should be. The answer will be in next month's issue.
Last month's image (right) depicted a floor-model biohazardous waste container with spilled serum on the lid. Not only does this image project a poor impression to patients and others who happen by, it poses a risk of exposure to anyone handles the container.
If you find sloppy biohazardous waste containers like this, you should clean it up according to your facility's policy for handling spills, but don't stop there. Complete a report so those who create such unsightly risks can be properly corrected and/or disciplined.
Tip of the Month: It's About Time
Click here for this month's featured Tip of the Month from our rich library of archived Tips.