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Phlebotomy Today

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June, 2016

Center Releases Video Tribute to Phlebotomists

TributeThumb_1000w"Phlebotomists are the most under-appreciated professional in healthcare," says Center for Phlebotomy Education's Director Dennis J. Ernst MT(ASCP), NCPT(NCCT). "This video intends to change perceptions."

He's referring to the Center's latest video. "A Video Tribute to Phlebotomists," which defines the profession as one that requires significant technical expertise and a grasp of preanalytical science most patients, and many other healthcare professionals don't appreciate.

"Without phlebotomists, healthcare cannot function," says Ernst, who narrates the seven-minute video." Yet they lack the respect of those whose livelihoods depend on the very thing they provide: blood samples."

Ernst hopes the video will not only be used in phlebotomy training and orientation programs, but viewed by consumers of healthcare. "Most patients don't realize how important the expertise of their phlebotomist is to their medical management, much less other healthcare professionals. We hope this video tribute opens their eyes."

The video can be viewed on the video page of the Center's web site and YouTube channel.

Product Spotlight: A Day With Your Editor

The Center for Phlebotomy Education will be conducting its third annual Phlebotomy CE Day, a one-day conference for phlebotomists and other healthcare professionals to obtain their state-or facility-required continuing education credits.
Empowerment CEday_V2DATE_RGBCE Day will take place on Saturday, August 13, 2016 at the Embassy Suites in Walnut Creek, California. Six P.A.C.E.® credits will be issued to those who attend the full day of lectures. Four lectures will be presented, each 90-minutes in length, by international lecturer and author Dennis J. Ernst MT(ASCP), NCPT(NCCT). Titles include:

  • What's New in Phlebotomy
  • What You MUST Know About the New Venipuncture Standard
  • What Would You Do? (case studies)
  • Phlebotomy C.S.I. 

This will be the Center's 3rd annual CE Day. Prior events have been conducted in northern or southern California to help the state's 30,000+ phlebotomists meet their biannual CE requirements to remain licensed. Prior events have drawn attendees from across the U.S. as well.

Registration is open on the Center's web site


Summary of Phlebotomy Today Surveys

Lady listeningEach month, the Center for Phlebotomy Education posts a survey question inviting readers and visitors to its website and Facebook page to participate, and then publishes the results in the following issue of Phlebotomy Today-STAT! This month, we summarize responses from some of the more intriguing surveys conducted over the past 12 months. Topics include decentralized phlebotomy, butterfly usage, submitting underfilled tubes, following the order of draw, and more. Links are provided to the archived issue of Phlebotomy Today-STAT! that discusses the survey results at length. 

Decentralized phlebotomy

In your facility, is phlebotomy centralized ( i.e., all samples are drawn by laboratory personnel) or decentralized (e.g., majority of samples are drawn by non-laboratory personnel cross-trained to draw blood)?

Centralized: 86%
Decentralized: %15%

Read the complete survey results and commentary.


Policies on ear piercing, body piercing, tattoos, and hair color/styles.

Does your facility have a policy limiting earrings?

Yes: 56%
No: 44%

How many earrings does your facility policy permit?

No earrings are permitted: 2%
No more than one per ear: 29%
No more than two per ear: 46
No more than two for both ears (total): 9%
No more than three per ear: 5%
No more than three for both ears (total)
No more than six for both ears (total): 5%

What types of non-earring piercings are permitted in your facility?

Earrings only: 79
Nostril studs: 17%
Nose rings: 5%
Eyebrows: 6%
Tongue: 11%
Lip: 5%

What limits does your facility policies place on hair color?

Natural hair colors only: 58%
Policy exists, but interpretation is left up to supervisory discretion: 42%

What limits does your facility policies place on hair styles?

Neat, trimmed and groomed: 59%
Policy exists, but interpretation is left up to supervisory discretion: 41%

Does your facility have a policy on the visibility of tattoos?

Yes: 62%
No: 38%

What is your facility's policy on visible tattoos?

All tattoos must be covered: 72%
Minor exposure is permitted: 28%

Read the complete survey results and commentary.


Money-thinking aboutSalary survey

What is your hourly wage or annual salary?

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

Read the complete survey results and commentary.


Contaminated surfaces

Does your facility designate certain phones, keyboards and touch monitors as "contaminated" requiring staff to wear gloves when using

Yes: 41%
No: 59%

What is your facility's policy on decontaminating phones, keyboards, and touchscreen monitors?

We don't have a policy: 21%
Once per shift: 42%
Daily: 29%
Weekly: 8%
When visibly contaminated: 0% 

Read the complete survey results and commentary.


Pet Peeves

What is it about interacting with some patients that irks you the most?

What kinds of things do your coworkers do that make you cringe?

This survey allowed participants to write their own answers rather than select from a list. While statistics were not tallied, responses (including bad breath, and being called a "vampire") are available here.


CertifiedCheckmark_300wThe Value of Certification

Are you certified in phlebotomy?

Yes: 76%
No: 24%

For managers, is your phlebotomy staff certified?

No: 0% 
Yes, all are certified in phlebotomy: 31%
Some are certified in phlebotomy: 69%

Do you feel certified phlebotomists perform better than those who are not certified?

Yes: 39%
No: 61%

Read the complete survey results and commentary.


Underfilled tubes

Do you ever submit underfilled tubes for testing?

Yes: 80%
No: 20%

Have you ever had the laboratory reject an underfilled tube you submitted?

Yes: 59%
No: 41%

When a tube doesn't fill, what do you do? (Multiple responses permitted.)

I try another tube of the same color stopper in case the first one lost its vacuum: 96%
I pour two tubes together as long as the stoppers are the same color: 4%
I pour two tubes together to make one full tube regardless of the stopper color. 0%
I submit the tube to the lab and let them decide if it should be rejected: 58%

Read the complete survey results and commentary.


Arm and phleb supplyGauze or cotton?

What type of compress do you use to apply post-venipuncture pressure, (i.e., gauze or cotton balls)?

Clean gauze: 70%
Sterile gauze: 21%
Clean cotton balls: 8%
Sterile cotton balls: 1%

How you store them prior to use?

They are individually wrapped: 13%
They are in an opened sleeve or container that contains multiple pieces: 64%
They are in a closed sleeve or container that contains multiple pieces:23%

How long do you watch the site for bleeding before you bandage?

I don't lift up the compress in case the puncture is not sealed. I just put the bandage on immediately without looking: 2%
I lift the compress up momentarily. If it doesn't bleed immediately, I put it back and bandage over it: 20%
I lift the compress and watch for at least five seconds before bandaging: 62%

Read the complete survey results and commentary.


Hand hygiene

Do you routinely conduct some form of hand hygiene between patients?

Yes: 97%
No: 3%

Which type of hand hygiene do you perform most frequently?

Soap and water: 29%
Alcohol-based hand gel: 63%
Other: 8%

Read the complete survey results and commentary.


Following the Order of Draw

Tubes4Poster 009Are you aware blood-collection tubes must be filled in a certain order?

Yes: 98%
No: 2%

How confident are you that you know what the proper order of draw is for venipunctures?

Very confident: 88%
Somewhat confident: 12%

Is there a separate order of draw when using a syringe instead of a tube holder?

Yes: 22%
No: 67%
Not sure: 11%

How frequently do you follow the order of draw as you know it?

Always, without fail: 80%
Usually: 11%
Not sure: 9%

Read the complete survey results and commentary.


Butterfly usage

How frequently do you use butterfly sets to draw blood samples?

I never use butterflies: 2%
Fewer than five times per week: 34%
Once per day: 6%
2-5 times a day: 26%
6-10 times a day: 13%
11-20 times a day: 13%
More than 20 times a day: 4%
Other or comment: 12%

How do you respond to patients who request a butterfly be used for their draw?

I honor their request no matter what: 49%
I honor their request only if their veins require one: 50%
If their veins don't require one I will find another phlebotomist who wants to use one: 1%

Read the complete survey results and commentary.


Babies (21)Infant heelsticks

What type of device do you usually use when performing infant heelsticks?

An incision device that slices the tissue: 39%
A puncture device that penetrates the tissue vertically: 49%–
I don't know: 11%

Does your facility have a policy limiting the number of heelsticks that can be performed on an infant?

Yes: 28%
No: 47%
Don't know: 25%

How frequently do you prewarm infant's heels prior to a heelstick?

Always: 74%
Frequently: 11%
Never: 15%

When you perform a heelstick, do you "double-stick" (i.e., make two simultaneous punctures/incisions initially)?

Yes, always: 1%
Sometimes: 11%
Never: 88%

Read the complete survey results and commentary.


Supernatural Phenomenon

Have you ever experienced any incident or event in your work as a healthcare professional that could only be explained as being miraculous or of a supernatural or spiritual nature?

Yes: 8%
No: 92%

Read the commentary here.


Continuing education chalkboardContinuing education

Do you regularly participate in a formal continuing education exercise in phlebotomy (i.e., one that measures comprehension of the exercise material)?

Yes: 76%

How frequently?

Monthly: 48%
Annually: 53%

Who purchases/provides your continuing education?

I do: 54%
My employer: 46%

What is the primary source from which you obtain (or distribute to your staff) formal and informal continuing education (i.e., with and without CE credit)?

Center for Phlebotomy Education (phlebotomy.com): 27%
My certification agency: 18%
MediaLab (Lab CE): 6%
Healthstream: 12%
Product vendors: 6%
Continuing Education Unlimited (CEU inc): 33%
Original material is created and distributed internally: 6%
I don't know: 12%

Read the complete survey results and commentary.



If you could make a law affecting everyone who draws blood from patients, what would it be?

If you could make a law affecting every patient from whom you draw blood, what would it be?

This survey allowed participants to propose their own legislation in a text window. Even though no statistics are tallied by this method, responses are available here.


Links to prior issues of Phlebotomy Today-STAT! that summarized earlier surveys: 2010-20112012 (part 1)2012 (part 2)20132014

Is there a survey you'd like us to conduct? Let us know.

Center Releases "Errors & Impacts" Poster

Do those who work with you and for you scoff at the many details you know are critical for every venipuncture? Do you need something that reinforces the importance of every step to your students and new hires? We thought so.

That's why the Center for Phlebotomy Education just released a new poster that connects the dots between preanalytical errors and patient outcomes. Blood Collection Errors and Their Impact on Patients is a 20 x 28-inch laminated chart listing over 40 errors that can be committed during the collection, transport, and handling of blood samples. A corresponding column lists the impact each error can have on the test result and patient. Examples include:

  • BloodCollectionSitesPoster_1000wERROR: Delay in transporting/testing coagulation specimens
  • POTENTIAL IMPACT: Stroke, thrombophlebitis, and pulmonary embolism caused by unwarranted modification to blood thinner dosage based on inaccurate aPTT result.

  • ERROR: improper mixing
  • POTENTIAL IMPACT: Patient mismanagement due to delays when anticoagulated tubes contain clots and must be recollected.

  • ERROR: patient misidentification
  • POTENTIAL IMPACT: Transfusion- or medication-related death. Misdiagnosis, medication error, and general patient mismanagement due to being treated according to the results of another patient.

  • ERROR: filling tubes in the wrong order
  • POTENTIAL IMPACT: Seizure and death from potassium carrying over from EDTA into tube to be tested for K+. Medication errors when additives carry over into coag tubes, falsely lengthening coagulation times and leading to unwarranted and life-threatening medication adjustments. Unnecessary antibiotic administration and prolonged hospitalization due to contaminated blood cultures.

  • ERROR: pouring blood from one tube into another
  • POTENTIAL IMPACT: Patient mismanagement/misdiagnosis & medication errors based on altered results, especially potassium. Stroke/hemorrhage due to unwarranted modification to blood thinner dosage. 

  • ERROR: underfilling heparin tubes
  • POTENTIAL IMPACT: Patient mismanagement and/or /misdiagnosis from altered potassium, sodium, ALT, AST, amylase, and lipase results.

This is a posterized version of one of the Center's SmartChartsTM, a series desktop reference materials in pdf format available for downloading at www.phlebotomy.com and free to all Phlebotomy Central members. Posting the Errors/Impacts poster in prominent areas provides poignant evidence to the entire staff of the importance of every step of blood collection, handling, and transportation.

 For more information and to purchase.

The Empowered Healthcare Manager

EmpoweredDE_130wWhat winning feels like

Whether you manage or not, here's what winning feels like.

  • You can't remember the last time you had to intervene on a personal dispute among the staff.
  • You make good progress weekly on some major---­­­I mean MAJOR---­­projects.
  • The only time someone quits on your team is when they retire, relocate, or become ill.
  • Those above you keep giving you bigger projects and more important responsibilities.
  • Those below you never come to you with problems unless they also have a solution.
  • Complaints go up the ladder, praise goes down and sideways.
  • Failure is always attributed to a process not a person, even when it's a thought process.

We are all managers. Some manage a staff, others manage themselves. When you're empowered to win, it looks the same either way.

Each month, Phlebotomy Today-STAT! shares one of the gems from the archives of The Empowered Healthcare Manager blog, written by Dennis J. Ernst MT(ASCP). View more of the archives and subscribe here. 

This Month in Phlebotomy Today

PT_logo-2012_400Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's flagship newsletter currently in its 17th year of publication, are reading about this month:

Feature Article
Journal Roundup, Part 2

On the Front Lines
Lactates and tourniquets

From the Editor's Desk
Root canals and web design

Sticks, Staph, and Stuff
The truth about gloves

High-powered Talent
You're in the marketing department

What's Wrong Here?
A monthly image to test your powers of observations

Subscribe to Phlebotomy Today and get this issue immediately.

Fear of Needles Leads to Pancreas Transplant

Hands shape heartBecause of her paralyzing fear of needles, a British patient let her health decline to the point where a pancreas transplant was necessary to save her life.

According to the Medical Daily, a health and science news outlet, Sue York was diagnosed with Type 1 diabetes when she was seven. Now 51, York's ability to manager her condition was seriously compromised due to her aversion to needles. Her condition required two injections per day. Some days, she just had to walk away from the needle. But when the UK enacted legislation in 2012 requiring diabetics like York to test her blood glucose level before driving, and every two hours thereafter, she asked to be put on the transplant list.

York's transplant, conducted in January, makes her the world's first pancreas transplant required because of needle phobia.

Read the full story.

[Editor's note: Phlebotomy Today-STAT! subscribers are urged to exercise an abundance of compassion and understanding towards all patients with an aversion to needles. Because all it takes is one negative needle experience to turn patients like Sue York into transplant patients, phobic-friendly phlebotomists play a pivotal role in preventing aversions from becoming full-blown phobias. Listen to my podcast with needle-phobia expert, Dr. Amy Baxter.]

What Should We Do?

Right way wrong way sign

Question: Every now and then we may have a cognitively functional patient who just can't speak. Is it acceptable to identify them using leading questions? For example, let's say the patient's DOB is April 10, 1999. You could ask him if the month of his birth was January. Then ask if it's in March. Then ask if it's in October and so on, eventually offering April. If he answered no to all except April, would that be considered positive confirmation? Then you could follow the same track for date and for the year. I am only referencing a patient with the wherewithal to follow this line of questioning, i.e., trach patient, laryngeal dystonia, etc. What about reading their lips? I want to be able to properly identify all patients, and it seems like this could be an acceptable form. What should we do?

Our response: This is a fantastic question, and a very interesting approach. We're assuming a caregiver or family member is not able to provide the patient's ID on their behalf, which would be preferable. We've mulled this over a good deal, but can't get comfortable with the kind of multiple choice dialog you're asking about.  It's still having the patient affirm something the collector speaks. We don't think the standards will ever split the hair that way. However, we are in favor of creating three charts: one lists the 12 months of the year, the second displays the days of the month from 1-31, and the third lists years, perhaps in columns that go from 1900 to 2010 or similar. Then have the patient point to the day, month and year of his/her birth. That's not affirmation. 

However, you still have the problem of getting them to provide their name. For that, you could simply provide a fourth chart with the alphabet and have the person spell their full name by pointing at each letter sequentially.