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Phlebotomy Today

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October, 2014

Table of Contents:

Did You Know?
The Empowered Healthcare Manager
Product Spotlight
Seattle Company Targets Blood Culture Contamination
This Month in Phlebotomy Today
Survey Says: Change Agent
What Should We Do?: tattooed patients 
Tip of the Month: Anticipation or Precipitation?


Did You Know? 

  • 61% of all accidental needlesticks sustained during phlebotomy procedures occur within seconds of when the needle is removed from the patient's arm? (CDC)

  • laboratorians do not report up to 92% of the accidental needlesticks they sustain. (source)

  • 93.2% of all venipunctures are successful on the first attempt?

  • two out of five nurses surveyed wouldn't recommend their health care facility to a family member?

  • 35% of patients feel more discomfort during a venipuncture than they expected?

  • as many as 10 different healthcare workers are involved in the complex process of transfusing blood. 

  • 55% of patients in one study were without wristbands.

  • an armband attached to the bedrail identifies the bedrail, not the patient.

  • punctures on the fingers should be done across the fingerprint, not parallel to them. (CLSI)

  • potassium, total protein and calcium levels are lower in skin puncture blood than in venous blood? (CLSI)

  • excessive crying can temporarily elevate white blood cell counts in infants? (CLSI)

  • in one study, 24 of 121 surgeries had to be interrupted due to the patient's reaction to a latex exposure with 14 of those requiring transfer to the intensive care unit.

  • bacteremia involving E. coli can exist in the bloodstream in concentrations as low as one organism per ml of blood? 

  • labs that report erroneous laboratory results from blood specimens that are compromised by poor specimen collection practices set themselves up for claims of negligence?

  • underfilled EDTA tubes yield a falsely lower hematocrit because red cells shrink when blood is excessively anticoagulated?

  • the average phlebotomist commits 3.5 procedural errors per draw.

  • the first evidence that collection tube additives carryover and can corrupt the results obtained in the next tube appeared in the literature in 1977?

  • in most states you need a license to cut someone's hair or raise pigs, but not if you want to sink a needle into their vein to draw blood?

  • when citrate tubes for protimes are refrigerated before testing, cold activation of Factor VII can lead to shortened protime results? (CLSI)




The Empowered Healthcare Manager:  Incivility in the workplace

 Today's headlines are full of evidence our world is becoming increasingly uncivil. What about your world, the part of the world you can influence? You may not be able to impact the behaviors of the uncivilized headline-makers, but you can arrest it where you work.

You probably already attempt to, but is your approach passive or active? When you are aware of a harsh exchange, snide remark, stinging retort or passive-aggressive behavior amongst your staff, how do you react? Do you close your door and ears and let the combatants work it out, stepping in only when it lands at your feet, or are you on a perpetual seek-and-destroy mission against workplace hostility?

Empowered managers don't wait for disputes to come to them. They launch out of their chairs at the first hint of incivility, call it what it is, mediate it, and ban even a whisper of it in the future. Before long, they're not launching out of their chairs anymore.

The garden-variety manager doesn't pull weeds, but lets them remain planted in the workforce, choking out anything of value, and is perpetually wanting. The empowered manager is always on the hunt for weeds, pulls them on sight, nourishes what remains, and reaps a bountiful harvest.

Acts of incivility in the workplace are your weeds. Pluck 'em when you see 'em. Otherwise they multiply, and before you know it you're just another garden-variety manager.

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


Product Spotlight:  New Lecture Collection DVDs DVDTrio1_200w

Since 1997, Dennis J. Ernst MT(ASCP) NCPT(NCCT) has delivered hundreds of lectures in nearly every U.S. state and 11 countries. Now his most popular lectures are available on DVD.

The Applied Phlebotomy Lecture Collection will consist of 10 studio-recorded versions of his most-requested lectures. The first three titles are now available.

Seizing Control of Blood Culture Contamination Rates, Ending Hemolysis in the ED… and Everywhere Else, and Mastering Pediatric Phlebotomy contain vital information for anyone who performs, teaches or manages blood collection procedures, and are each galvanized to the standards published by the Clinical and Laboratory Standards Institute (CLSI).

Each video is narrated by Ernst and run between 30- and 60-minutes in length. "We know that not everyone who needs this information can attend a conference presentation," says Ernst. "So we've spent three years creating studio-recorded versions of my lectures that are in the highest demand. We started streaming them in March, and now are releasing them on DVD."

Three new titles of the Lecture Collection will be released on DVD every 2-3 months as they roll off the production schedule. All 10 lectures are already available for streaming online through the Phlebotomy Channel including:

  • Seizing Control of Blood Culture Contamination Rates
  • Ending Hemolysis in the ED... and Everywhere Else
  • Mastering Pediatric Phlebotomy
  • Managing the Risk of Patient Injury
  • Four Pillars of World-Class Phlebotomy
  • Potassium Results Your Physicians Can Trust
  • Successful Strategies for Difficult Draws
  • The Ten Commandments of Phlebotomy
  • Safety Survey: How Vulnerable Are You to a Needlestick?
  • Delivering World-Class Customer Service

For previews, more information, or to order.


Seattle Company Targets Blood Culture Contamination

MagnoliaEveryone knows how expensive a contaminated blood culture is to a healthcare facility. Some estimates put the median additional charges to treat patients for false positives at $8,720 per contamination event. A Seattle-based company has developed a product that prevents skin-flora on the patient's skin that were not eliminated during site cleansing---including those reintroduced by the phlebotomist by repalpating the site---from getting into blood culture bottles.

Here's how it works: after performing the puncture, the collector applies pressure to an "actuator" that diverts the initial 1.5 to 2mL of blood, including any contaminated skin fragments from the trauma of the puncture, into an isolated diversion chamber. The blood culture bottle is then attached and filled with blood via sterile blood flow path devoid of dermal tissue and any bacteria that resided there.

Repalpating cleansed sites, failing to allow antiseptics to remain in contact with the skin prior to the puncture, and not scrubbing the site prior to antiseptic application are the three most common culprits that cause skin flora to contaminate cultures. Eliminating the first 2 mL of blood prior to drawing the blood to be cultured in the broth works for the same reason withdrawing a discard volume from a vascular access device works to eliminate IV-fluid contamination.

Diverting the first 10 mL as waste while collecting a unit of donor blood was shown to contribute significantly to a reduction in the prevalence of superficial skin bacteria in whole-blood units, reducing the risk of sepsis in transfusion recipients.

 The "SteriPath" is available from Magnolia Medical Technologies.


This Month in:

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

Feature Article
Anatomy of a Dysfunctional Team

On the Front Lines
Slapping a site to help find veins

Sticks, Staph, and Stuff
Fingernails in healthcare

The Empowered Manager
The ability to lead and transform

Pouring two tubes together

Hospital Saves Big Money Using Phlebotomy Team and Blood Culture Kits

For subscription rates and to subscribe to Phlebotomy Today, click here.


Survey Says: Change agent

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Last month we asked Phlebotomy Today-STAT! readers how comfortable they feel suggesting changes in the workplace. Seventy-four percent indicated they felt their suggestions were welcome while 26 percent did not.

Of the majority, fifty percent said their suggestions for change are actively solicited, 55 percent suggested their managers bring them into discussions on suggestions other coworkers make, and 80 percent said they feel their suggestions are appreciated even when they're not implemented. Twenty percent said those whose suggestions are implemented get recognized and/or rewarded.

Many provided examples of suggestions they or a coworker made that changed their workplace, process, or patient care for the better. Here are some of them:

  • We asked if we could draft a policy on how to handle difficult draws. We held several meetings to create the policy and then sent it to all the hospital departments for approval. It finally became an administrative policy.
  • Rearranging the lab for better work flow.
  • Information located directly in bathroom on how to obtain a clean catch specimen.
  • Our cancer patients used to have to walk across the hospital to pick up 24 hour urine containers, which was very exhausting. So it was suggested that these be stored in the Oncology collections area. This was a huge win for patient care!!!!
  • We had a huge board for assignments but each department had to get up and go look at it. Now there sheet has the sections and the cell number to call. We use this on all three shifts and has been successful.
  • I suggested the BP cuffs be moved to the other side of the room because blood pressures are more accurate if the patient's feet are on the floor and their backs supported and this was done within a few weeks.

Those whose manager actively solicit suggestions for change shared how new ideas are invited. Eighty-nine percent said they were asked directly in person or during meetings, 22 percent reported suggestions boxes and bulletin boards were positioned for anonymous ideas, and 44 percent said they received emails soliciting their ideas.

The majority of those who did not feel comfortable suggesting changes (75%) said they just didn't feel their suggestions were welcome by management. Thirty-seven percent said they are too new, and don't feel they have enough familiarity with their workplace to suggest changes, and 25 percent said they made a suggestion once with a former employer and regretted it.

This month's survey asks about your practices surrounding the phlebotomy trays or carts you use in your facility.

Where do you set your hand-held tray when drawing from inpatients? What is your facility's policy on disinfecting phlebotomy carts and trays? Is it enforced?

Take the survey


What Should We Do?: tattooed patients

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: Occasionally we have a patient who has both arms completely covered with tattoos.  He has a good feeling vein in the AC area but it is covered with ink and he will not allow the use of his hands.  I was taught in school to never draw through ink, is it okay to draw a discard tube first?  What is the standard?

  Our response: The standards make no mention of avoiding tattooed sites. No studies to our knowledge have attempted to assess the affect of drawing through tattoos on test results. So this is more of a customer service issue than a sample quality concern.  However, if the tattoo is new, there is a high likelihood that the skin is still inflamed and tender, which can make contact with the arm uncomfortable to the patient.

 If the tattoo is not new, we suggest letting the patient decide. However, the patient should not be able to select a vein or location known to be high-risk. For example, if the median cubital vein is readily accessible, but in a part of the tattoo the patient would rather not be punctured, it may not be prudent to draw from the basilic vein, which is in close proximity to the brachial artery and vulnerable nerves.

 The standards are clear on this and make no exception to avoiding median veins because of tattoos.

   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: Anticipation or Precipitation?

Click here for this month's featured Tip of the Month from our rich library of archived Tips.