September, 2007

Copyright 2007 Center for Phlebotomy Education, Inc.
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Preventing Iatrogenic Anemia

How much is too much blood to draw? When a physician’s request for lab work is so extensive that the volume of blood required to perform the tests puts the patient at risk of developing anemia, it’s too much. But what’s the limit? At what level of volume depletion does phlebotomy become risky? Unfortunately, there is no universal threshold.

According to the CLSI skin puncture standard, Document H4-A5, every facility should have a mechanism in place to monitor the amount of blood drawn from pediatric and critically ill patients. Unfortunately, the standards organization makes no recommendation as to what the maximum volume withdrawn should be, or what action should be taken when it’s met. Because there are too many variables for one global recommendation, it’s up to the facility to establish its policy. Consultations between the laboratory, medical staff, nursing staff representative (including a neonatal nursing representative), and risk manager may be necessary.

Once established, one way to implement it might be to require documentation in the patient’s chart every time blood is sampled. When the predetermined level is met, the required intervention would be triggered. The burden of monitoring the volume can be placed on the nurse, physician, or laboratory, but someone must be given the responsibility in order for the policy to be effective.

Three textbooks share a chart that originally appeared in 1982 in the Textbook of Clinical Laboratory Supervision by Kathleen Becan-McBride. The chart contains suggested maximum amounts to be drawn at one time and throughout a hospital admission, each based on the patient’s weight. Adaptations of that chart appear in Applied Phlebotomy by Dennis J. Ernst MT(ASCP) and the 7th edition of Phlebotomy Handbook by Diana Garza and Kathleen Becan-McBride. Because the origin of the chart is dated, it should serve only as a guide and not implemented without thorough consideration.

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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:

Feature Article: How Collection Personnel Alter Test Results, Part I: Hemoconcentration
Ask the Safety Lady:
OSHA consultant addresses these burning questions:

·         Do we need an eyewash station in our patient service centers where all we do is draw blood?

·         How do you test an eyewash station?

Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in August including these stories:

  • UK Physicians Design Tourniquet Alternative
  • Phlebotomist Wrestles Gunman Out of Lab
  • Phlebotomist Wins $5000 Bowling Tournament
  • More Hospitals Investing in Venipuncture Technology
  • FDA Approves New Venipuncture Pain Reduction Product
  • Phlebotomist’s Dog Hangs Ten
  • Phlebotomist Skates His Way into Olympics

According to the Standards: Arterial Puncture for Routine Lab Work
Tip of the Month: What Not to Wear
On a Personal Note: Has the daily grind got you down? Try thinking like a moose.

Buy this issue for only $9.95.

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

Center Looking for Graphic Artist/Web Designer

The Center for Phlebotomy Education is searching for an ambitious full-time graphic artist/web designer to embrace as one of its valued team members. Successful applicants will have a positive work ethic, an appreciation for a professional working environment, experience in graphic artwork and web design, a willingness to relocate to the beautiful, rolling hills of Harrison County, Indiana, and expertise in design programs including Dreamweaver, Adobe Photoshop and Adobe Acrobat. Knowledge of phlebotomy will put your resume on the top of the stack. Send resume and salary requirements to:

Human Resource Manager
Center for Phlebotomy Education
P.O. Box 161
Ramsey, Indiana 47166

Featured FAQ: Discarding Tourniquets

Question: Our Ortho rep suggested that I contact you. Here is my question: Has OSHA ruled that tourniquets in the outpatient setting must be discarded after each patient? Or only when soiled/end of day? I am looking for the actual regulation, not opinion. Thank you.

Response: OSHA would not make such a mandate. Discarding tourniquets after one issue is more of an infection control issue than an OSHA issue. OSHA is concerned only with employee injury and illness, not patient issues. In fact, OSHA doesn't even mention tourniquets in the Bloodborne Pathogens Standard, so they have no position on the issue unless the equipment is soiled by blood in such a manner and to such a degree that it is a potential risk to employees.
What OSHA does say is: "All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials." and "Special care shall be taken to avoid skin contact with other potentially infectious materials."
So it's really up to your facility to establish the policy based on current infection control and this OSHA passage. It's generally accepted that they be discarded when visibly soiled. Your Infection Control Officer should be consulted and a policy should be drafted based on his/her recommendations. Establishing a policy that visibly soiled tourniquets should be discarded should be the bare minimum. Facilities vary widely in their policies on tourniquet disposal. I’m seeing more and more of them adopt a single-use policy to fight nosocomial infections, and would encourage you to consider one as well. Keep in mind, over 98,000 patients die every year from nosocomial infections. I would suspect contaminated tourniquets come into play in many of them. I hope this helps.

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


Specimen Collection Safety: “The Two-Finger Stretch”

Do you use the “two-finger stretch” to anchor veins, i.e., place your index finger above the intended puncture site and your thumb below to keep the vein from rolling? Anchoring the vein both above and below the puncture site helps keep the vein in place; it also puts your finger in position for an accidental needlestick should the patient jump. Anchor the vein from below is sufficient and a appropriate compromise.

Product Spotlight: Online Specimen Collection Training Program


The Center for Phlebotomy Education, Inc. announces the introduction of a dynamic online training program for all managers and educators who train specimen collection personnel, and all healthcare professionals who perform blood specimen collection procedures.

     Subscribers to PhlebotomyWeb have the ability to assign students and staff to navigate through each of nine modules at their own pace. All modules terminate with an exam to measure comprehension. PhlebotomyWeb serves as a comprehensive supplement to a facility or school’s ongoing training program, and gives administrators the opportunity to monitor their students’ or staff’s progress through each module. Additionally, PhlebotomyWeb offers annual competency assessments.

For healthcare professionals who seek self-guided training,
PhlebotomyWeb offers an affordable and up-to-date tutorial in blood specimen collection procedures.

This self-guided program includes nine modules for self-guided study, competency assessment tools, videos, animations and audio narration. As is true of all the Center’s technical material, PhlebotomyWeb is current with OSHA guidelines and consistent with CLSI standards. The program is approved for up to 9.5  P.A.C.E.® CEU credits (recognized in CA and FL).

For more information, visit


Summit Health, Inc. Seeking Medical Professionals for Blood Collection Nationwide


Thanks to a July press release published in PT-STAT!, Summit Health, Inc. (formerly Retail Health, Inc.) has accepted over 150 new per diem phlebotomists to draw specimens at health screening events nationwide.

Over 10,000 health screenings and flu shot programs in all 50 states and Puerto Rico were conducted in 2006. “We expect to double that number by the end of this year” states Richard Penington – President of Summit Health, Inc.  “We can only do this with a team of the most qualified professionals in the field. Our standards are set high with hopes of bringing on board professionals who want compensation commensurate with the valuable skill they bring to healthcare.”

Summit Health, Inc. is the nation’s leading provider of comprehensive wellness, health screening and immunization programs. Based in Southfield, Michigan with regional offices in Denver and San Francisco, Summit Health’s network of over 1,250 offices throughout the US provides health screenings and flu shot programs to Fortune 500 companies and the self-insured clients of Aetna, CIGNA, BlueCross/BlueShield, Humana, Highmark and UnitedHealthcare.

If you are a medical professional who collects blood, competent in blood pressure and skin puncture procedures and interested in becoming part of this High-Quality Health Screening Program please contact Nancy Erickson at or call 248-799-8303 x 213. Summit Health pays $20 an hour to perform a venipuncture or skin puncture, and blood pressure. Most of these positions are per diem, which would allow medical professionals to continue to work their regularly scheduled positions and earn extra money, too. Summit Health is accepting applications from every area in the United States.


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Copyright 2007, 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.