February, 2011

Copyright 2011 Center for Phlebotomy Education, Inc.
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Study Evaluates Effect of Sterile Gloving on Blood Culture Contamination Rates

A study conducted by the Seoul National University College of Medicine located in Seoul, Korea concludes that sterile gloving before venipuncture may reduce blood culture contamination. Sixty-four interns in charge of blood culture collections at a single medical center participated in the study, drawing a total of 1,854 patients in the facility’s medical wards and intensive care unit.

The interns were randomly assigned to perform blood culture collections, some donning sterile gloves before every venipuncture, while others were given the option of wearing sterile gloves only when necessary. A total of 10,520 blood cultures were analyzed: 5,265 were collected with mandatory use of sterile gloves and 5,255 were drawn with optional use of sterile gloves. The samples for which sterile gloving was mandatory, the contamination rate was 0.6%, as opposed to a 1.1% contamination rate when sterile gloves were not required.

Kim NH, Kim M, Lee S, et al. Effect of routine sterile gloving on contamination rates in blood culture: a cluster randomized trial. Ann Intern Med 2001 Feb 1; 154(3): 145-51.


Center Seeks Input on Foreign-Language Videos

Through March 15, 2011 the Center for Phlebotomy Education is conducting a survey to determine current demand for Spanish and French versions of our popular phlebotomy training videos. If your facility has a need for translated Applied Phlebotomy videos, now is your opportunity to let us know.

Click here to participate in this important survey.


Ernst Featured in Executive Snapshot

Ever wondered how the Center for Phlebotomy Education came into existence? Dennis J. Ernst, Director, shares his story in the February 2011 issue of Medical Laboratory Observer. Ernst describes life events that led to the creation of his company and how the Center continues to fulfill its mission in MLO’s Executive Snapshot column.



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Featured Product
Order of Draw Packs

New this year, the Order of Draw pack is perfect for distributing to your staff during National Medical Laboratory Professionals Week in April. Not only that, it's an effective way to reinforce the importance of following the order of draw with staff and students alike. Contents of the pack include one each of our popular Order of Draw retractable pen, sticky note pad, and Phlebotomy Tips card, and two Order of Draw bookmarks.

The Order of Draw pen is comfortable and attractive with the order of draw illustrated in full color on the barrel for easy reference. With the Order of Draw sticky note pad, staff and students will take note of the vivid design depicting the recommended order of tube collection every time they write a message. The Phlebotomy Tips card is a durable, laminated pocket-size card that reflects key concepts in the CLSI venipuncture standard including the order of draw, plus nine tips on proper specimen collection. The reverse shows the anatomy of the antecubital area featuring veins, arteries, and nerves.

With the Order of Draw pack, your students and staff will always have the recommended order of draw at their fingertips. Great for Emergency Department and nursing personnel, too. Available for purchase in packages of five.

Click here for more information or to order.


This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 12th year of publication, are reading about this month:

  • Feature Article: How to Become a Better Phlebotomist: Competitive Customer Service
  • Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in January including these stories:
    • Manufacturer Announces Nationwide Recall of Alcohol Prep Products
    • ASCP Calls for Reversal of Physician Signature Requirement
    • Direct-Access Testing a Growing Trend
    • Funding Continues Despite Trade School’s Spotty Record with State
    • LifeScan Stepping Out of Hospital POC Blood Glucose Testing Market
    • Half of Healthcare Workers with H1N1 Infected in Healthcare Setting
    • Taiwanese HCWs Call for Safety Needle Legislation
  • According to the Standards: How long must tubes sit before centrifugation?
  • Tip of the Month: The Right Stuff
  • CE questions (institutional version only).

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.


Featured FAQ
Obese patients and bending the elbow

Q: Do you have specific tips for locating veins in obese patients? One of our employees sticks obese patients with the patient’s elbow bent. I can see bending it slightly while palpating for a vein, but I wouldn't stick a patient with their elbow bent. Would you?

A: Relaxing the joint slightly is acceptable, but only slightly. Bending the elbow can be taught as a possible means of locating vein that can't be found when the elbow is locked, but the technique is not unique to obese patients. Even normal-weight patients can have veins that only appear, visibly or palpably, when the elbow is slightly bent. It’s not necessary for the elbow to be completely locked so that the arm is rigidly straight.

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 website. For information on joining Phlebotomy Central, click here.


Survey Says
Use of Papoose Boards

Last month, visitors to our website were asked about their facility’s use of papoose boards for restraining infants and toddlers during blood collection procedures, and if they give apprehensive parents the option to leave the collection area while their child is being drawn.

Over three-fourths (78.8%) of survey participants indicated that they never use papoose boards, 18.2 percent use the restraint device only when necessary, with 3.0 percent of respondents stating that papoose boards are always used.

Sample Comments:

  • “In general, we try to keep all clients regardless of age in a seated position where the client’s arm may be extended to provide access to the antecubital fossa. Occasionally we will restrain an infant by wrapping them in a blanket and leaving only the required arm out.”         
  • “My personal experience with papoose boards has been positive. I have seen the pediatric patient actually relax when placed in the restraint. Our facility has a couple of employees that have a very negative attitude about using the papoose board. They look at it like it is a torture device. I cannot imagine that having 4-5 people hold you down would be less tortuous.”
  • “We always use a parent and another trained phlebotomist to hold the peds patient while collecting blood specimens...”   
  • “We usually have the parent lie across the toddler’s upper torso restricting movement of the shoulders and holding on to the arm that we are not drawing from. We've found it is best to have a phlebotomist help hold versus a clinical assistant. If you draw blood you know how important it is to hold the toddler still.”          
  • “We lay the child down on the bed and wrap them in a blanket. This is more comfortable for the child.”    
  • “We have one available to us, but I have only seen it used once in the four years I have been there.”
  • “Instructing the parent (or nurse if inpatient) how to assist with holding is much less traumatic for infants and toddlers.”           
  • “We practice pain control and distraction with our pediatric patients.”      

In regard to dismissing apprehensive parents during pediatric collections, 84.8 percent of those surveyed indicated that they give parents the option to leave the collection area, while 15.2 percent said they do not.

Sample Comments:

  • “Apprehensive parents are not the problem; it is the ones that are over-protective or controlling. Our lab director feels that we should have the right to ask the parents to leave during the collection process. So many parents cause stress by observing everything and making negative comments that it can become very intimidating. I do agree somewhat, but as a parent myself I wouldn't want to leave my child.”           
  • “Sometimes you just know ahead of time that the parent is going to have a difficult time watching their child being drawn. If the parent is on the verge of tears, we offer that they can wait in our waiting room.”       
  • “Parents should always have the choice of staying or leaving. We find that when the parent can't handle their child being drawn then this will affect how the child handles the draw.”
  • “Some parents ask if they have to stay in the room. We let them know it is up to them if they would like to stay or not. We do not make them stay if they choose not to.”
  • “We clearly explain the procedure to the parent and if appropriate the child, and give the parent a role in assisting or comforting the child. Having a parent leave is much more stressful for the child.”
  • “We give them the option to leave the draw area. However, we encourage parents to comfort and nurture the child to ease their fears.”

This month’s survey question:
What is the primary reason you choose a winged collection set (butterfly) over a straight needle?

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What Should We Do?

[Editor’s Note: "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:
Chest Vein an Acceptable Draw Site?

One reader asks: “…My phlebotomists informed me that one of the patients they drew blood from today had major edema in all of their extremities. They tried drawing the patient several times and couldn't get anything. The physician said they didn't really want a fingerstick and try to get the blood however they could. They looked to the lower extremities and couldn't find anything. So they actually found a superficial vein on the chest area that they drew blood from. The patient had a pacemaker as well. I have never heard of this being an acceptable site. I wasn't sure if anyone else has ever heard of this and know I need to follow up with the physician. My employees said they just wanted to follow the doctor's orders. Any thoughts or words of wisdom on the use of this alternate site for collection?”


Our response: While well intentioned, drawing from such unorthodox sites is not supported in the CLSI venipuncture standard (H3-A6) and should be prohibited as it may be construed as operating outside the standard of care for phlebotomy. Should the patient suffer an injury or complications from this draw and pursue litigation, your phlebotomist, and by extension your facility, would have to defend a choice that is without support in the literature.

According to CLSI, the preferred venipuncture site is the antecubital fossa. When these veins are inaccessible, veins on the back of the hand are also acceptable. Only with physician's permission do the standards permit drawing from the feet or ankles. When all acceptable sites are exhausted and a capillary collection is not suitable, the requesting physician or attending nurse must be informed of the situation and respond accordingly.(1) Part of what makes a site unorthodox is that phlebotomists are not knowledgeable of the anatomy of areas and underlying structures present beyond the traditional sites, so they cannot accurately assess the associated risks for injury. It is beyond the scope of a phlebotomist to make such decisions. The physician may feel comfortable drawing from unorthodox sites, but we feel it is unfair to expect a trained phlebotomist to operate outside of the prevailing standard.

 If your phlebotomists feel pressured in such situations to obtain a blood sample "however they can", you need to have a conversation with your Laboratory and Medical Directors, and Risk Manager. Perhaps they could provide a specific list of acceptable alternate draw sites and a maximum number of attempts to guide your phlebotomists in the future. To minimize the risk of injury to your patients and limit your facility's legal liability to the lowest degree, the laboratory's blood specimen collection policies and procedures should reflect the current CLSI blood collection standards and facility policy, to which all phlebotomy procedures should be consistently and firmly anchored.

There are various strategies that can be implemented for difficult draws, such as prewarming and massaging the site, lowering the limb below the plane of the heart, etc. But the fact of the matter is there will always be a minority of patients whose veins will elude us and prove to be beyond our skill and capabilities as phlebotomists. At which point, physician intervention is required.

1. CLSI. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard—Sixth Edition. CLSI document H3-A6. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.



Your most challenging phlebotomy situations and work-related questions.

Send your submission to WSWD@phlebotomy.com and you just might see it as a future case study.


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PT STAT! is a free, monthly educational service provided by the Center for Phlebotomy Education, Inc., the most respected authority in phlebotomy. For a complete company profile and product list for all healthcare professionals who perform, teach or manage specimen collection procedures, visit us on the Internet at: http://www.phlebotomy.com.
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Copyright 2011, Center for Phlebotomy Education, Inc. All rights reserved. Newsletters may contain links to sites on the Internet owned and operated by third parties. The Center for Phlebotomy Education, Inc. is not responsible for the availability of, or the content located on or through, any such third-party site. Information in this document is provided "as is," without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability, fitness for a particular purpose and freedom from infringement. The user assumes the entire risk as to the accuracy and the use of this document. We will not be liable for any damages of any kind arising from the use of this information, including, but not limited to direct, indirect, incidental, punitive, and consequential damages.