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Phlebotomy Today

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September, 2015

What is a Phlebotomist?
CE Day
The Empowered Healthcare Manager: dormant potential
Two Charged in Fraudulent Safety Syringe Scheme
Product Spotlight: Successful Strategies for Difficult Draws DVD
This month in Phlebotomy Today
Survey Says: Hand hygiene
What Should We Do?
Tip of the Month
: Defend your "Ear-space"


What is a Phlebotomist?

Shutterstock_26945005First and foremost, I am a professional. I've been around ever since it was discovered that our blood holds deeply complex secrets about human health. Today, thousands of tests are performed on the blood I carefully extract from dozens of patients every day. I perform venipunctures and capillary punctures, two very specialized and highly detailed procedures that are not as simple as I make them look. It took years to perfect my technique, but I make it look like there's nothing to it. I own phlebotomy. I live it, I breathe it, and I have built my professional life around perfecting it as an art form. 

My art is phlebotomy, the most commonly performed invasive procedure in healthcare. It's conducted on every newborn within the first hours, and performed throughout life until the final breath is drawn. Because of the procedure I have mastered physicians are able to assess wellness and disease, monitor and adjust medications, treat life-threatening infections and conditions, and orchestrate the activities of nearly every other healthcare professional involved with every patient I draw.

Although many attempt diminish my expertise by calling me "just a phlebotomist" or referring to me as simply "lab," the truth of the matter is without me healthcare cannot function. Physicians can't diagnose, nurses can't medicate, surgeons can't operate, hospitalists can't consult, and laboratory scientists have nothing to test. I am indispensable. Despite my importance to every patient, practitioner, and laboratory scientist, my earnings are among the lowest of all healthcare professions. Adding insult to injury, I lack respect from those whose livelihoods depend on what my expertise provides.

I provide it regardless. That's because my rewards come from within. Every patient I encounter gets my A-game, the only game I have. At the core of my being is the stark realization that if I don't sweat the details every time I draw blood, I can change how my patients are managed, even in ways that can end their lives.

Shutterstock_72865402No lack of recognition will diminish the satisfaction I receive by knowing my contribution to every patient's care is incalculable. Realizing my patients' diagnosis, medication, and management depends heavily on my grasp of the procedure, and that most medical decisions are based on the quality of the samples I draw and submit for laboratory testing affirms for myself I'm doing meaningful work. Others may minimize my importance, but I never will. I am a professional.

I am a perfectionist. Phlebotomy looks deceptively simple. But beneath the surface are hundreds of details that, if not learned, retained and practiced, can wreak havoc on the patient, the sample and the results the lab reports. Details like preventing nerve injury, mixing tubes slowly and deliberately, not letting the patient pump his fist, reclining patients who have a history of fainting, filling each tube fully and in the proper order, assuring test requirements are met, taking plenty of time to assure bleeding from the vein has stopped before bandaging, and preventing the myriad ways a sample gets hemolyzed, contaminated or otherwise corrupted. If you don't have perfectionists drawing blood samples, you don't have accurate laboratory results and patients get hurt. Some die.

Because I'm a perfectionist, I can quote the standards and our facility's procedure manual by chapter and verse. I don't make exceptions to the rules. If my next patient is my sister, I make her tell me her name. If she wants me to look up her baby's last bilirubin result, I tell her to ask her physician. If she wants to leave before I bandage her, I make her stay until I know the bleeding has stopped. And if she's not my sister, I treat her as if she were anyway because everyone is someone's loved one.

I realize the standards are not merely suggestions, but a well-established process based on the body of scientific knowledge and input from reputable authorities. I don't add my own flair. My flair is the standard of care. I'm a perfectionist.

Shutterstock_265889693I am a phlebotomist. I've worked under many titles over the years. Although the term "phlebotomist" did not emerge until the mid-1900s, every physician, nurse, medical assistant and healthcare professional who ever took blood from a vein has been a phlebotomist, at least for the duration of the procedure. Attempts to eradicate me by giving my procedure to other professions rarely succeed because the complexity of what I do is so vastly underestimated. I've been shuffled around to other departments, had my name changed to "patient-care assistant," and given a multitude of other tasks. Change my title if you like, but I will always be a phlebotomist because I specialize in the procedure my profession was born to perform.

Because phlebotomy is a gateway profession, the doors to many other healthcare professions are wide open to me. The option I prefer, though, is to stay right where I am. I know my work is critical to every patient. I also know not everyone who goes by the title is as dedicated to patients and sample quality as I am. I love my patients too much to let just anyone else draw their blood.

I am uniquely qualified to do my job. I make dozens of decisions in the course of every draw. I call on my vast understanding of the standards, the nature of laboratory medicine, and my impact on the quality of care every patient receives. Most of all, I call on the burning desire to help people get well and stay well. My work is noble. My work is important. My work directs the healthcare decisions of every patient I serve. I am proud of what I do; even more so, I am humbled by what I get to do.

I'm a professional. I'm a perfectionist. I'm a phlebotomist.

This article was adapted from "Characteristics of a Valued Phlebotomist" written by Dennis J. Ernst and published in the June/July 2015 issue of Advance for Medical Laboratory Professionals. 


Center Announces Phlebotomy CE Day 2015

  • CEday_DEwelcome
    Dennis J. Ernst invites you to sunny Southern California for the 2015 Phlebotomy CE Day.
    Do you wish you could complete all your annual CE requirements in one day?
  • Do you wish it could be a live event where you can interact with the presenter instead of reading pages and pages of material? 
  • Do you wish you could attend a full day of lectures given by Phlebotomy Today STAT! editor, Dennis J. Ernst? 
  • Do you wish you could have all of this for less than $100?

If you answered "yes," your wish has just come true. 

IMG_20141112_144126857Join industry expert Dennis J. Ernst MT(ASCP) as he presents the Center for Phlebotomy Education's second annual Phlebotomy CE 
Day on December 5, 2015 in San Diego. With the interactive dynamics only a live event can provide, Mr. Ernst will deliver four lively  presentations worth six P.A.C.E. continuing education credits total.* Half-day registrations worth 3 CE credits are also available. Here's what attendees at last year's CE day in San Francisco had to say about the event:
  • "We were in the same room all day and I was NEVER bored!"
  • "Wonderful! Loved the conference. Worth the travel and money."
  • "I've never enjoyed a class like I enjoyed this one... seriously!"

List of presentations, to register or for more information

* This event meets California's Department of Health Services' requirements for maintaining phlebotomy licensure and for maintaining certification by most certifying agencies. The Center for Phlebotomy Education is approved as a provider of continuing education programs in the clinical laboratory sciences through the ASCLS P.A.C.E. program. Accepted by all nationally recognized phlebotomy certification agencies. All other healthcare professions, check with your credentialing agency. Provider #491. California #0001.


Two Charged in Fraudulent Safety Syringe Scheme

Two Californians have been charged with defrauding medical product investors out of more than $4 million to produce a new safety syringe. According to an article in the Times of San Diego, the two are accused of making false statements about the sales of "SafeSnap" syringes, a product produced by U.S. Medical Instruments Inc.

Prosecutors allege the two showed potential investors a prototype of a syringe featuring a needle that folds up safely into a container for disposal in regular waste rather than as hazardous medical waste.

They allege the syringes were never made in significant quantity and that most of the investors' money went to the defendants, not the company.

Full Story.


The Empowered Healthcare Manager:  Dormant Potential 

Every month, Phlebotomy Today-STAT! reprints one of the prior month's posts to The Empowered Healthcare Manager blog, written by Dennis Ernst. 

Managers manage people. Empowered managers manage potential.

Look past the quirks and nuances of the individuals who answer to you. You'll find elements both savory and unsavory, but forget about those elements for now. They're cosmetic. Look beyond the facade. Look for potential. That's what you or your predecessor hired (or should have). The skin and frame is just what carries it around.

In each individual, identify their most dormant potential. The potential that you know exists, but hasn't been teased out yet. If you can't find any, look deeper. It's there. If you still come up empty, one of two possibilities exist. 1) nothing's dormant, they're already functioning at full potential; 2) it's so deeply suppressed not even you can't see it.

Those in whom potential is fully expressed, the empowered manager celebrates. Those in whom dormant potential is identified, the empowered manager invests. Those in whom potential is deeply suppressed, the empowered manager deeply invests.

Those who respond to your investments pay handsome dividends. Those who don't will either grow weary of your dogged, unrelenting investment and eliminate themselves from your workplace or eventually bankrupt your spirit and your staff.

There's one exception: some fully expressed potential can still be inadequate for the position it occupies. The empowered manager moves that person into one more suited to their potential if possible. If none exists, and all efforts to tease out dormant potential have been exhausted, a decision has to be made. It will be a tough decision for the manager; it will be a necessary one for the empowered manager.

Managers manage people. Empowered managers manage potential.  

 Subscribe to The Empowered Healthcare Manager.


This Month in Phlebotomy Today:  

Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's flagship newsletter currently in its 15th year of publication, are reading about this month:

Feature Article
Newborn Screening Collections: Mistakes Cost Lives

On the Front Lines
Phlebotomists drawing from arterial lines

Sticks, Staph, and Stuff
Being "in the moment"

From the Editor's Desk
It's fire pit season

The Empowered Manager
Being firm

Drawing above an IV, but from a different vein

What's Wrong Here?

Subscribe to Phlebotomy Today and get this issue immediately.


Survey Says: Hand hygiene revisited

Lady listeningFive years ago, we conducted a survey on hand hygiene. To see if practices have changed, we asked the same questions again. We're delighted to see improvement. When asked in 2010 about the frequency in which survey participants performed some sort of hand hygiene between patients, 91 percent said they did. This time, a full 97 percent were in compliance with the CDC requirement. my mind" were among the reasons.

Here are some comments: 

  • Not as consistently on outpatients but very diligent with inpatients and patients in long term facilities.
  • I hand wash with soap and water to start day and after every third patient. I use hand sanitizer between every patient (unless using soap).
  • I cleanse before touching their arm, before and after gloving and sometimes in between. I'm obsessive about clean hands!
  • I try to as much as possible in between patients, but I sometimes forget.
  • Every patient sees me wash my hands and put on new gloves.
  • We have a policy that every tech has to use hand sanitizer  in front of the patient before wearing their gloves.
  • If gloves are worn & changed for all patients PROPERLY, what is the point of continually washing one's hands? It's too much already!!
  • Hand sanitization is required before AND after donning gloves. This is a definite no-brainer.
  • Always, for my safety and theirs.
  • Our facility monitors hand hygiene & we face disciplinary action is we do not adhere to strict hand hygiene protocols
  • I use the sanitizer but soap and water every 3-4 patients because of the feel of build-up after a while.
  • I use soap/water preferably, but have come to terms with the gel.

Hands10_SSSeveral admitted to changing gloves instead of performing hand hygiene, however, the CDC doesn't consider changing gloves to be a substitute, but required it in addition to hand hygiene. 

While only three percent admitted inconsistency in hand hygiene this time, down from seven percent, celebrating doesn't seem to be the proper reaction. Of those who admitted to not cleansing hands routinely between patients, their reasons varied. "I don't have the time," "handwashing facilities/gels are not available where I have patient contact," and "it slips my mind" were among the reasons.

We also asked survey participants which type of hand hygiene they perform most frequently.

The soap and water constituted 29 percent while the alcohol-based gel crowd dominated at 63 percent. Of the eight percent who reported they use "other methods," they fell into two categories. Some used both methods every time while others considered new gloves to be their alternative.

This month we're curious to know how frequently the order of draw is actually followed.

Take the survey.


What Should We Do?: Taking a blood pressure after venipuncture

Right way wrong way sign 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: In our clinic all patients get their blood taken first. Reversing the order of things is not an option for us. Severe bruising and bleeding have occurred in some patients after having their blood pressure taken on the same arm. Is there a standard amount of time that must be allowed before taking a blood pressure reading in the same arm as the blood draw? 

Our response: There is no standard that addresses this, but it is a serious problem that must be managed in your facility. We suspect there's no established time frame between the two procedures because there are so many patient-dependent variables that prevent any specified delay to be universally sufficient. The quality and quantity of platelets and coagulation factors vary too significantly among all patient populations for a standard time frame to work. That puts the burden on your facility to manage the risk appropriately.

Any arm from which a venipuncture has been recently performed is susceptible to bleeding or hematoma formation should circulation above the site be restricted, as is the case when a blood pressure cuff is applied. The risk here is not just of an unsightly bruise, but of potential nerve injury should the subcutaneous hemorrhage impinge on the nerves that pass through the same area. It is not unprecedented for hematomas to lead to permanent nerve injury. 

There needs to be better communication between those who draw specimens and those who perform blood pressure checks. The mere presence of a bandage cannot be counted on. Some patients may remove their bandage moments after the venipuncture. We disagree that reversing the venipuncture and blood pressure order is not an option. It's an option, but one that's not being permitted for whatever reason in your facility. Because of the potential for injury and litigation, not to mention the customer service aspect of minimizing bruising, no options should be off the table. 

We recommend a thorough review of how patients are processed in your clinic. Your goal should be to change the process in one of two ways: 1) to perform all blood pressure checks ahead of venipunctures in every patient's visit or 2) to place the maximum amount of time between a venipuncture and the subsequent blood pressure assessment.

We also recommend all who perform blood pressures be acutely aware of the risk and ask every patient if his/her visit involved a blood draw. If so, there must be a protocol in place to assess the site and avoid applying a cuff whenever possible. When not possible to avoid on the same side as the venipuncture, the site should be carefully monitored for bleeding and hematoma formation as a result of the blood pressure cuff's constriction. All who perform blood pressure checks must know how to react should bleeding or hematoma formation become evident.

 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? Answers just ahead sign

Email us your submission at WSWDpanel@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)

Tip of the Month

Click here for this month's featured Tip of the Month: "Defend Your 'Ear-space'."