October, 2007

Copyright 2007 Center for Phlebotomy Education, Inc.
†All rights reserved. View our copyright policy.

Needle Know-How

In August, the Center for Phlebotomy Education launched another free service to healthcare professionals and educators worldwide. Each month, a new article in specimen collection is available for viewing and printing from the Center's home page (www.phlebotomy.com).

The series, titled Needle Know-How, is a collection of 2-3 articles focusing on a specific topic in phlebotomy. This month's offering, titled How to Sabotage Potassium Results, discusses how collectors can alter potassium results during specimen collection and processing. An exerpt from the article appears in this issue of PT-STAT!.

The Center is proud to be able to make educational materials available at no cost to the phlebotomy community. Our mission is to "be the world's most dependable source of accurate information on blood specimen collection, to share that information in a multitude of ways, and to elevate the status of the phlebotomy profession." One of the "multitude of ways" we want to deliver such quality information is free.

To access this month's Needle Know-How, visit the Center's home page at www.phlebotomy.com. Sorry, previously posted Needle Know-How articles are not available.


Needle Know-How: How to Sabotage Potassium Results

[Editor's Note: this is an exerpt of a larger article available for viewing and printing from the Center for Phlebotomy Education's web site (www.phlebotomy.com). A link is provided at the end of the exerpt to access the entire article. Printing a single copy is permitted within our terms of use.]

 Of all the tests a laboratory performs on a patient, potassium is one of the most critical. Physicians use potassium results to clear patients for surgery, diagnose dehydration, restore electrolyte balance, maintain proper heart rhythm, regulate neuromuscular activity and manage osmotic pressure and acid-base balance. Potassium is also one of the easiest analytes to change through poor specimen collection and processing practices. When altered during the collection process, the lab report no longer reflects what's really going on inside the patient.

This month in Needle Know-How, we will discuss collection and processing errors that can significantly alter your patient's potassium result before the specimen is even tested. Neglect these well-known influences and you may contribute to medical decisions that lead to serious complications, even death.

     Hemoconcentration. The following specimen collection errors can lead to hemoconcentration and, subsequently, misleading potassium results: having the patient pump the fist prior to collection, leaving the tourniquet on longer than one minute prior to accessing the vein and posture changes.

     Pumping the Fist. If the patient automatically pumps his fist or is instructed to do so, the activity releases potassium into the bloodstream, elevating it temporarily. Instead, have your patients clench and hold the fist if necessary. Alternatively, veins can be made more obvious by warming the site with a warm compress or by lowering the patient's arm.

For the rest of this article, click here.

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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 II, Time-of-Collection Errors
  • Ask the Safety Lady: An OSHA consultant addresses these burning questions:
    • Can the biohazard bags we use to transport specimens be reused if they are not visibly contaminated or torn?
    • Our phlebotomy collection area is small and it gets very hot and humid all year round.  Can we use fans to help cool the area?
  • Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in September including these stories:
  • Lab Tech Bites Pediatric Patient During Blood Draw
  • Phlebotomist Charged with Murder
  • Patient Complains about Gloveless Phlebotomist
  • Phlebotomist is Top Female Blood Donor in Jamaica
  • Phlebotomist Who Drew DUI Suspect Facing Incarceration
  • According to the Standards: Proper Patient Positioning
  • Tip of the Month: It Only Takes a Moment
  • On a Personal Note: Now accessible to non-subscribers from our home page! Visit www.phlebotomy.com.

Buy this issue for only $9.95.

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.


What Would You Do?

This month PT-STAT! announces a new feature. What Would You Do? will present different case studies each month, and then ask readers to contribute their idea 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 exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.

So sharpen up your wit and wisdom. Submit all responses by the 20th of the month and send them to this address and this address only: WWYD@phlebotomy.com. Submissions sent to any other address will not be considered. Keep your suggested solutions less than 100 words. Although you don’t have to be an English scholar to be considered for inclusion, submission with proper grammar and punctuation will be given priority. If you’re not sure of the appropriate solution, check your facility’s procedure manual or ask your manager. Who knows, you might be presented with the very same dilemma tomorrow. Ready? Let’s do it.


A Mastectomy Mystery

Helen Sampson walks in to your outpatient lab with a requisition for lab work. You seat her comfortably in the drawing chair and she immediately tells you that she has had a mastectomy on her left side. Knowing it’s not acceptable to draw from that side, you tighten up the tourniquet around her right arm and survey the antecubital for a vein. There’s none. You look at the hand and the side of the wrist. Nothing. Sensing your frustration, she gives you permission to draw from her left arm. She offers to put her approval in writing. What would you do?


Send your submissions to WWYD@phlebotomy.com.

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Featured FAQ:Blood culture reflux

Question: I have a question that hopefully you can answer. Is there any danger when drawing blood cultures that the bottle contents can reflux back into the patient? I had heard about this in a course a few years back, but have not found anything in literature. We are concerned about nurses using tube holders on central lines to draw blood cultures. Any help would be appreciated.

Response: Reflux is always a concern. That's why the manufacturers of all but one blood culture system (Trek) do not recommend filling bottles directly from a tube holder/needle assembly. Instead, the recommendation is to draw the blood through a butterfly attached to a tube holder or syringe, or directly into a syringe.

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.


Specimen Collection Safety: Inappropriate syringe use

Do you ever force blood into a tube by applying pressure to the plunger of the syringe? Specimen tubes should fill on their own.†If they donít, the vacuum may be lost; try another tube. If this fails, there may be a clot in the needle. Forcing blood into a tube could expose you to blood splattering; it also risks hemolyzing the specimen. Removing the needle is risky. There is no easy way to resolve this predicament.†Consult with your facilityís policies on the acceptable means of handling this problem before it occurs.


Featured Product: Preanalytical Trilogy

Three of the most popular documents downloaded by healthcare professionals from the Center for Phlebotomy Education's web site are its trilogy on preanalytical errors. This month, the Center is offering them for a substantial discount.

The preanalytical trilogy---part of the Center’s To The Point™ library of 15 articles covering a wide variety of specimen collection topics---includes the following articles:

  • Preanalytical Errors That Occur Before Specimen Collection
  • Preanalytical Errors That Occur During Specimen Collection
  • Preanalytical Errors That Occur After Specimen Collection

Regularly priced at $59.85 when purchased separately, the 25-page Trilogy is reduced for the month of October to $39.95, a discount of more than 30%. The articles, immediately downloadable as pdf documents, contain the most current information available on preanalytical errors, and are consistent with CLSI standards. Available since 2004, managers, educators, and healthcare professionals worldwide have used To The Point™ articles to keep current with the CLSI standards and the growing body of knowledge on specimen collection.

The body of knowledge reflected in the To The Point™ library can be used to supplement a facility’s educational material and enhance continuing education programs.  Authoritative articles in the library cover difficult draws, pediatric phlebotomy, phlebotomy-related lawsuits, professionalism, needlestick safety, pediatric techniques, needle phobia, collection, specimen processing errors that alter potassium, and more. For detailed descriptions of articles including word counts and pricing, visit the To the Point™ Lesson Library.

To purchase the Preanalytical Trilogy, click here.


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Newsletter Information:

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 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.