February, 2015
draft: by Dennis Ernst • last updated: December 28, 2021
Journal Roundup, Part 1
The Empowered Healthcare Manager: High-Powered Talent
Product Spotlight: ABG video
Ernst to Conduct Greiner/Drucker Webinar
This month in Phlebotomy Today
Survey Says: Salary survey
Order of Draw Pens: They're Back!
What Should We Do?: breastfeeding during phlebotomy
Tip of the Month: Sir Lance-a-lot
This month, Phlebotomy Today—STAT! has rounded up some recent publications appearing in the literature pertaining to blood specimen collection. To keep you up to date, we’ve corralled several new articles and studies on the CLSI standards, hemolysis in pneumatic tube systems, infectivity of hepatitis C, decentralized phlebotomy, a tube holder that reduces hemolysis and the affect looking away from a venipuncture has on the perception of pain. Next month we'll round up some more.
Compliance with CLSI Venipuncture Standard Abysmal
Researchers affiliated with the European Federation of Clinical Chemistry and Laboratory Medicine's Working Group for the Preanalytical Phase (EFLM WG-PRE) set out to assess the level of compliance with the CLSI venipuncture standard (H3-A6) in 12 European countries. A median of eight out of 29 critical steps observed in the procedure were performed incorrectly (27%). Nearly half the steps were performed incorrectly in some cases.
Heparinized gel tubes more susceptible to pneumatic-tube hemolysis than serum tubes
Scandinavian researchers compared hemolysis rates between heparinized and serum tubes delivered to the lab by a pneumatic tube system (PTS). The median difference in the Hemolysis Index between plasma and serum was 46. They concluded blood samples in lithium heparin tubes may be substantially more susceptible to hemolysis by pneumatic tube transportation than serum samples.
Looking away from the venipuncture makes it more painful
Out of 192 patients, 73 percent spontaneously looked away before the needle was inserted into their arm. For the group that looked, the mean verbal and nonverbal pain responses were significantly less than for the group that looked away.
Tube holder type affects hemolysis during line draws
Sixty emergency department patients had their blood drawn through 20-gauge IV devices using the Greiner Holdex and the BD Vacutainer One Use Holder. Concentrations of potassium, LD and cell-free hemoglobin were higher in samples collected with the One Use Holder than with Holdex. The frequency of samples with cell-free hemoglobin greater than 0.5 g/L was identical for both devices, however, those with concentrations greater than 3.0 g/L was higher using One Use Holder.
Hepatitis C Infectious Longer Than Once Thought
Researchers at Yale found the hepatitis C virus still capable of being infectious for up to six weeks when acquired from inanimate surfaces.
Decentralize Phlebotomy Fails More Often Than it Succeeds
Executive Insights published an article for healthcare CEOs on the dangers of decentralized phlebotomy. The article, written by Center for Phlebotomy Education director Dennis J. Ernst MT(ASCP) details the pros and cons of this troubled staffing strategy, provides a historical perspective, and includes interviews with those who have engineered decentralization in their facilities with disappointing results. This article is worth passing on to any CEO entertaining thoughts of decentralizing.
The Empowered Healthcare Manager: The value of humility
Every month, Phlebotomy Today-STAT! reprints one of the prior month's posts to The Empowered Healthcare Manager blog, written by Dennis Ernst.
High-powered talent...
…abhors gossip.
…is self-directed.
…oozes confidence.
…is easily mentored.
…rejects mediocrity.
…acts professionally.
…dresses professionally.
…embraces opportunity.
…treats customers like royalty.
…communicates professionally.
…considers him/herself a servant.
…doesn’t know the meaning of “can’t”.
…pushes the limits of his/her comfort zone.
…serves, protects, and defends the company.
…seeks ways to make him/herself more valuable.
…welcomes the seemingly impossible challenge.
…implements directives without needing reminders.
…takes pride in, and demonstrates passion for, his/her work.
...can recite the organization’s mission statement in his/her sleep.
…realizes the road to success is paved with failures; takes the road anyway.
…doesn’t think of him/herself as high-powered talent, but is always striving to be.
...always thinks the company is on the verge of explosive growth, and that he/she is lighting the fuse.
Post a PDF of this in your workplace.
Subscribe to The Empowered Healthcare Manager.
ASCP Posts Podcast on Empowered Management
The American Society for Clinical Pathology’s LabMed web site recently posted a podcast about becoming an empowered healthcare manager. In “Empowered Managers" the Center for Phlebotomy Education’s Executive Director Dennis J. Ernst MT(ASCP) was interviewed by LabMed’s web editor Kelly Swails.
Ernst defines the empowered manager as one who has the ability, permission, desire humility and courage to lead the willing and transform the unwilling. In the podcast, Ernst explains why empowered managers don't let their staff recognize them on "Boss' Day, why they are more effective as leaders, and why they get things done in ways and to degrees mere managers cannot.
The podcast can be accessed here.
Product Spotlight: Arterial Blood Gas DVD
For a limited time, the Center for Phlebotomy Education is reducing the price on the industry's most popular DVD on collecting arterial blood gas samples.
Features of the Arterial Blood Gas Collection DVD include:
• Detailed step-by-step instructions for collecting blood gases by arterial puncture, arterial line draw, and capillary puncture;
• Highly researched and consistent with the AARC Clinical Practice Guidelines and the most current Clinical and Laboratory Standards Institute’s arterial blood gas collection standard;
• Written, directed, edited and published by the world’s foremost authority on blood specimen collection procedures;
• Graphic animation detailing the anatomy of the wrist, hematoma formation, nerve injury, and the acceptable sites for arterial punctures;
• access to CE questions for trainers/users to measure comprehension.
The DVD normally sells for $249, but the product is available through February at half price ($125). For a preview or more information.
Ernst to Conduct Drucker/Greiner webinar
Center for Phlebotomy Education director Dennis J. Ernst MT(ASCP) will deliver a free webinar jointly sponsored by Drucker Diagnostics and Greiner Bio-One. "Best Practices in Blood Collection" is a two-part series on sample collection, handling and centrifugation variables that threaten sample quality and test results.
Part 1 takes place Thursday, February 26 where Ernst will discuss proper tube handling before and after filling, the order of draw, storage/transportation practices, gel-barrier dynamics and the challenge of maintaining sample integrity in samples drawn in outreach settings. Part 2 will be conducted in March and will explore the differences between fixed-angle and swing-bucket (horizontal) centrifugation, g-force versus RPM, executing a validation study for alternative g-force centrifugation, and the nuances between serum and plasma samples.
Each webinar is free and qualifies registrants to receive 1 P.A.C.E. continuing education credit.
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s flagship newsletter currently in its 16th year of publication, are reading about this month:
Feature Article
Opening an In-house School: Is it Time?
On the Front Lines
Heelsticks on infants who are walking
Sticks, Staph, and Stuff
A bug's life
From the Editor's Desk
Past, present and future
The Empowered Manager
The hose or the sprinkler
Myth Busted
Lotion/ointment on the skin before heelsticks
For subscription rates and to subscribe to Phlebotomy Today, click here.
Survey Says: Laboratory Salaries
In our first-ever salary survey, we asked about hourly/annual wages and healthcare benefits. While we don't pretend this survey to be scientific or representative of the industry, it provides a general observation of where healthcare professionals stand in the arena of compensation. Here's the tally by position. All numbers are in US dollars, and converted from native currencies where required.
- phlebotomist: $14.80/hour
- phlebotomy supervisor/manager: $19.12/hour
- phlebotomy/laboratory educator in a healthcare facility: 18.74/hour
- Phlebotomy/laboratory educator in an academic program: $34.33/hour
- laboratory testing personnel (e.g., MT, CLS, MLT, MLA, MLS, etc): $26.95/hour
- laboratory manager/director/administrator: $104,500
The range for phlebotomists was $9.81/hour to $25.48. Phlebotomy supervisors/managers ranged between $11.03 to $36.44, while phlebotomy/laboratory educators earn a range of $15.75 to $25.00.
Twelve percent of those who responded indicated they get full healthcare coverage. (Four percent of respondents live in countries where the government provides full coverage to all citizens.) Thirty-eight percent have most of their healthcare expenses covered, while 31% have some coverage provided. Sixty percent of those who are provided with at least some coverage indicated the coverage extends to their families as well.
This month, Phlebotomy Today-STAT! is asking readers about their facility's policies on designating phones, keyboards and touch monitors as "contaminated", requiring staff to wear gloves when using.
Order of Draw Pens: They're Back!
Managers and trainers looking for an inexpensive but uniquely educational gift for their students and staff can keep the recommended order of tube collection right at their fingertips. Just in time for National Medical Laboratory Professionals Week (April 19-25), the Order of Draw pen is comfortable and attractive with the order of draw illustrated in full color on the barrel for easy reference.
Many studies have proven that when blood collection tubes are filled in the wrong order, test results can vary, sometimes wildly, from the patient’s actual condition. Those who follow the prescribed order of draw collect specimens that are less likely to yield misleading test results that impact how the patient is diagnosed, medicated, and managed.
Reinforce the importance of the order of draw with phlebotomists, nursing personnel, medical assistants, the ED staff, and all those who draw blood specimens in your facility by putting this constant reminder in every pocket.
For more information or to order, click here.
What Should We Do?: Breastfeeding during phlebotomy
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.
This month's case study: Our birth center nurses are becoming more insistent that infants breastfeed during their phlebotomy to sooth, distract, and comfort the infant. It is not a practice I support because of my concerns for the choking hazard, impeded access to the infant for positioning, and the visible expressions of concern, protectiveness and worry we see on the mother's face. That said, we have seen a decrease in perceived infant discomfort and crying since we started using oral sucrose products during phlebotomy. It is my goal to arrive at an agreeable solution to our situation that is supported by experts in the field. What should we do?
Our response: A multitude of studies support breastfeeding and oral sucrose/glucose administration as a strategy to reduce pain during infant heelsticks. We authored an article in the July 2007 issue of MLO that summarized the body of knowledge on infant pain reduction strategies. You'll find it worth reading and full of the references you're looking for. Since that article, more studieshave reinforced the practice of breastfeeding during infant phlebotomy. We have found no evidence in the literature that breastfeeding during infant phlebotomy poses a choking risk.
Your concerns on positioning limitations may be overcome with a short inservice in which a cooperative new mother can hold her newborn in a position as if she were breastfeeding, and have the staff experiment with positioning themselves in a way that facilitates a successful and comfortable draw. It may be possible to position the nursing infant as if he/she were in a nursery crib (face up), with the head turned sideways to feed. That way, the infant's legs and feet are downward, in the same relative position the staff is used to for a crib draw.
If the mother holds the infant sideways, stomach-to-stomach, the infant's legs may be awkwardly oriented, requiring the phlebotomist to contort uncomfortably. You'll just have to experiment with the baby and mother, and establish what works best. Then make sure the staff is fully trained.
This will require some effort, but the benefits to the baby and mother in reduced pain and anxiety require a determined collaboration between the laboratory and nursing staff. If you find it difficult to implement, you might consider the use of pacifiers instead of breastfeeding. Studies show such non-nutritive sucking to also reduce the pain responses during heelstick procedures in neonates. That way, the infant can remain in the crib and the mother doesn't have to be involved.
Each month, our “What Should We Do?” panel of experts collaborates on a response to one of the many compelling problems submitted by our readers. Panelists include:
Got a challenging phlebotomy situation or work-related question?
Email us your submission at [email protected] and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)
Tip of the Month: Sir Lance-A-Lot
Click here for this month's featured Tip of the Month from our rich library of archived Tips. ------------------------------------------------------------------------------
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