Is the Order of Draw a Tough Sell in Your Facility?
Have you witnessed others with blood specimen collection responsibilities drawing additive tubes in the wrong sequence? Have you been preaching the Order of Draw in your facility and found that winning converts is an uphill battle?
If your message on correct tube filling isn’t sticking with those who perform the task, perhaps we can help. It is well documented that the Order of Draw is necessary. It's a subject the Center for Phlebotomy Education knows a great deal about and has written on extensively.
The Clinical and Laboratory Standards Institute (CLSI) in its venipuncture standard (H3-A6) states that the following order of draw is recommended to avoid possible test result error due to additive carryover:(1)
To help you get this point across, we’ve provided the following links to free articles either authored or co-authored by our Executive Director, Dennis J. Ernst MT (ASCP), on the Order of Draw. One or more of these cites an article that first appeared in the literature in 1977 showing result differences when additive tubes are drawn in a random order:
We also have a video clip on YouTube.com about the Order of Draw for venipunctures that provides some explanation as to why it’s so important. http://www.youtube.com/watch?v=P5pcmqPuSDo
Order of Draw Products™, a California-based online company founded by phlebotomist Pam VandeDrink, is another resource for Order of Draw items including bracelets, watches, badges, t-shirts, and much more.
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 12th year of publication, are reading about this month:
For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.
Last Month on Facebook
During the month of September, fans and visitors to our Facebook page shared their thoughts on the following topics:
Looking for an online community to post questions or to simply satisfy your hunger for phlebotomy talk between newsletter issues? Visit and “Like” our Facebook page and you’ll never miss out on another discussion. Your peers need your input, and you need theirs. www.facebook.com/CPEInc
On a Personal Note...
A few months ago, my "From the Editor's Desk" column in Phlebotomy Today talked about an incident that took place after I conducted a phlebotomy workshop in Austria. But there's more to the story. ….If you have a moment, follow me.
Q: With a triple lumen catheter, there is one port that is used to draw blood. Do all other ports need to be shut off for a certain amount of time before collecting the specimen, and should there be a volume discarded before withdrawing blood to be tested?
A: According to the Infusion Nurses Society's Procedures and Policies for Infusion Nursing, the procedure for withdrawing blood from a triple lumen catheter is the same as what the CLSI venipuncture standard says for drawing from any vascular access device. That is, all other ports need to be shut off for at least 2 minutes. The lumen through which the blood is to be drawn should be flushed with 5 cc of saline, and a discard volume withdrawn prior to collecting the specimen. The discard volume should be twice the dead-space volume of the catheter for all labs except coags, which require 6 times the dead-space volume. Five cc is usually sufficient.
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 website. For information on joining Phlebotomy Central, click here.
Last month’s survey confirmed what we’ve long suspected: those who draw blood wear a lot of hats and have quite a few job titles. We asked visitors to our website and Facebook page if blood specimen collection was their main duty at work. Nearly two-thirds of survey participants responded that it is.
At your place of employment, is blood specimen collection your primary duty?
Of those who indicated blood specimen collection is their primary duty, 57 percent reported performing five or more additional tasks. Just five percent of this group reported that drawing blood is their only responsibility in the workplace. Figure 1 provides a breakdown of survey responses by job title.
To learn more about the additional duties being performed by those who draw blood, we asked survey participants to identify those tasks and indicate if they felt their training was adequate. Responses are summarized in Table 1 below.
In addition to blood specimen collection procedures, what other tasks do you perform as part of your regular duties? Do you feel that you received adequate training to perform these tasks?
With regards to training, the good news is an overwhelming majority of respondents felt it was sufficient for the tasks assigned. Interestingly, the activity with the highest negative response for adequate training was patient coding/billing (27%).
Other work activities mentioned by survey participants not on the list included various clerical duties, patient registration, computer order entry, printing daily reports and pending logs, QA reporting, problem solving, handling physician/patient complaints, urine drug screen collections, N95 fit testing, payroll, health fairs, and therapeutic phlebotomy draws.
Participants in this survey self-identified as phlebotomists (49%); medical or laboratory assistants (22%); phlebotomy managers or supervisors (15%); medical laboratory technicians (5%); laboratory managers (3.5%); clinical laboratory scientists/ medical technologists (3.5%); and other (2%).
What Should We Do?
[Editor’s Note: "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.]
Our response: According to Tietz Clinical Guide to Laboratory Tests, recumbency can account for decreased HCT results. "Hb, HCT and RBCs are slightly lower between 5:00 PM and 7:00 AM and after meals (up to 10% lower); they are up to 5.7% lower if drawn from a recumbent patient."(1)
Diurnal, postural and postprandial variations of hematocrit were documented in the literature as early as 1965. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936443/pdf/canmedaj01137-0011.pdf
Some of these studies are dated, but by sharing this information with your medical director, your facility can make an informed decision. We know of no facility that has posture requirements for HCT testing. Nor do the CLSI standards or guidelines make such a recommendation.
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