Garbage In; Garbage Out: Part III
Over the last few months, Phlebotomy Today-STAT! has been exploring the many ways those who draw and process specimens can unknowingly alter test results. Last month we explored how specimens drawn from vascular access devices become garbage as well as the affect exercise, fist-pumping, posture, and the timing of blood culture collections have on turning specimens—and the results obtained from them—into garbage. (To access this and other archived issues, visit www.phlebotomy.com/PTSTAT.html) This month we will continue with errors committed before the needle is inserted.
Prolonged tourniquet application
Site prep solutions
Blood culture contamination
The following practices will minimize the potential for specimen collection personnel to contaminate blood culture specimens:
Due to the complexity of human blood and physiology, many factors threaten accurate test results before the specimen is even drawn. All of these factors, individually and collectively, work to change a representative blood specimen into a test result that is no better than garbage to the physician. To make sure the specimens you draw don’t earn you the title of “garbage collector”, adhere to sound specimen collection practices based on the CLSI standards, your facility’s procedure manual, and published studies. When you do, you become part of an elite community of healthcare professionals who safeguard sample quality through all aspects of specimen collection.
Next month: Ways to turn the specimen into garbage while withdrawing the specimen.
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 8th year of publication, are reading about this month:
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 Product: Infant Heelstick Model
Featured FAQ: Glucose Stability on Gel
Q: About how long would glucose be stable in a gel barrier tube that was centrifuged and stored for six days? Some here are arguing the gel barrier protects the glucose; I think that the glucose leaches into the gel, causing a falsely low result. Can you provide me with the proper info and a reference?
A: According to CLSI, serum stored on top of gel is stable for 2-5 days.(1) Another source indicates that plasma stored on gel separator barriers show a decrease in glucose concentration from 9% on day 1 to 12% on day 7.(2)
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.
What Would You Do?
Each month, What Would You Do? presents a different case study, then asks readers to contribute their ideas as to how each situation would best be handled. The following month, selected responses will be chosen by the editor and published (sender will be identified by first name and state only). The most accurate, well written response will receive a free "Accurate Results Begin With Me!® t-shirt. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study
Many PT-STAT! subscribers related to this month’s scenario; one admitted it happens at her facility at least once a week. As such, there was no shortage of creative responses. The most common resolution proposed was for the phlebotomist to find a coworker to occupy the children so the draw could go smoothly and without interruption (44%). A typical response for this kind of approach went like this:
“I would go get another Phlebotomist or staff member to watch the children while I draw the patient. I would ask our staff to take them into the outpatient draw room that has a bed, ask them to sit on the bed and engage the children by asking them questions and give them some stickers.”
Twenty-five percent of respondents said they would ask the mother to control her children or request she return after arranging childcare. A typical response in this category went like this:
“I would explain to the patient that the blood drawing area is an area of considerable risk and I would not want anything to happen to any of her beautiful children. I would kindly but firmly tell her that if her children can not be quiet and still, she will have to return at a different time for her blood draw, either without the children or when she is accompanied by someone who can stay with them in the waiting area while the venipuncture is performed.”
We particularly liked the responses from those who would turn the situation into a learning experience for the five inquisitive children. Even though only 12% of respondents were brave enough to think about converting the outpatient drawing area into a classroom, we thought it was a commendable intention. Our favorite response comes from Christine S.:
“The first thing is to address the children before drawing or even attempting to draw the blood. I explain to them what I am about to do for their Mom. I show them the tubes and the unopened needle. I even explain about the tourniquet. They will be told it is something very important for their Mommy and needs to be done perfect. It won't hurt and it isn't scary. But Mommy's chair should not move or be bumped.
“We have coloring books in our lab. I will offer them a choice; you can either color in our coloring book, or you can all stand here quietly by the curtain, and watch what I am doing. Most children want to watch and are quite cooperative. If it turns out the children will not listen to my choices, I will address it with my patient. I will explain very nicely, that I need to be able to concentrate completely on drawing blood, and could she tell her children to go to the waiting area by the curtain. I am the Lab Assistant supervisor in a hospital. On a fully staffed day, I can always ask one of my employees to entertain the children while I draw the blood, or I can do the entertaining part, and they draw the patient. Team work is always most helpful. If that doesn't do the trick, I can suggest the patient come back without her children.”
For her comprehensive and educational approach to this month’s case study, Christine will receive a free "Accurate Results Begin With Me!"® t-shirt.
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