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October, 2016

Theranos Shutting Down

TheranosTheranos, the beleaguered Palo Alto California laboratory that promised technology capable of running 30 tests on a single drop of blood, says it will close all of its labs and release 340 employees.

The announcement, posted on its web site October 3, comes after months of federal investigations and the banning of CEO Elizabeth Holmes from running a laboratory for two years. According to a letter to Theranos' stakeholders, "We have decided to close our clinical labs and Theranos Wellness Centers, which will impact approximately 340 employees in Arizona, California and Pennsylvania." The layoffs constitute 40 percent of its workforce.

The Theranos ship ran aground last year after federal regulators found multiple compliance issues, proficiency testing irregularities, and the use of unapproved medical devices as collection containers. Phlebotomy Today-STAT! reported Theranos' woes in the November issue.

According to the announcement, the company is shifting its focus to their miniLab, an instrument through which it hopes to commercialize miniature, automated laboratories.

Read Theranos' letter to stakeholders.

More information.

New Products Launched at Clinical Lab Expo

ITL BioMedical SampLok Adapter Cap 2

The exhibit hall was buzzing with new displays and product launches at this year's Clinical Lab Expo, part of the American Association for Clinical Chemistry's (AACC) annual conference. The Expo, the industry's largest trade show, drew over 600 exhibitors and 16,000 attendees from around the world. Phlebotomy Today wandered the aisles, as usual, in search of the answer to the age old question: What's new in the preanalytical world? Here's what we found:

ITL BioMedical (Melbourne, Australia)---ITL is introducing two new  tube-holder adapter caps designed to make blood culture sample collection safer and more efficient. The SampLok® Adapter Cap 2 is an all-in-one adapter cap with a safety lid and integrated tube guide. The Universal Adapter Cap is a one-size-fits-all adapter cap that conforms to the shape of the blood culture bottle then returns to its original shape for blood collection tubes. Both adapters are smaller than conventional adapters, taking up less space on phlebotomy trays, storage rooms, and sharps containers. Both are versatile and negate the need for separate inserts when collecting blood collection bottles.  More information.

DASH APEX 12Drucker Diagnostics (Port Matilda, Pennsylvania)---Drucker introduced the new DASH Apex centrifuge line, designed for STAT service and compatible with the new BD BarricorTM tubes. The two companies have validated three-minute spin cycles for BD's Barricor tubes (5 minutes for the Apex 24). More information.

Greiner Bio-One (Monroe, North Carolina)---Lancelino Safety Lancets made their Greiner debut this year at the Expo. The retractable lancets are designed with simple activation, and ergonomically rounded design, a rounded base for pinpoint precision, and precisely defined puncture depths, which range from 1.2 to 2.0 mm. More information.

Greiner Bio-One (Monroe, North Carolina)---Greiner also launched of a new line of small laboratory equipment products including vortex mixers, a mini block heater, centrifuges and the Sapphire Maxipette. Incorporating a selected range of small key devices into its portfolio is seen as a way to help customers source all their preanalytical supplies from fewer vendors. Greiner's new line is coordinated with their Vacuette line of tubes to assure compatibility. A key focus in adding the new line was ensuring the devices are user-friendly. More information.

BD (Franklin Lakes, New Jersey)---Raising eyebrows at this year's Expo was BD's new separator tube, the BarricorTM Tube. Instead of gel, the mechanical separator of Barricor tubes is a proprietary elastomer that positions itself between cells and plasma during centrifugation to preserve sample integrity and assure accurate test results. The separator, which was recently granted FDA approval, elongates upon and throughout centrifugation to allow more time for cellular components to be pulled below the barrier. When centrifugation slows, the separator returns to its original shape and becomes the permanent barrier. According to the company, the shorter centrifugation time required (up to seven minutes less than for gel tubes) and the fact that it does not need blood to clot decreases turnaround times significantly. Because the mechanical separator permits separation to continue throughout centrifugation far longer than gel separators, Barricor tubes can reduce cellular contamination by 50 to 65 percent compared to leading gel tubes. As a result, they have the potential to reduce manual sample remediation and instrument maintenance. Improved laboratory efficiency and lower laboratory costs are also expected. Barricor is currently available only in heparinized tubes. More information and video.

BD (Franklin Lakes, New Jersey)---Also new is the BD Vacutainer® UltraTouch™ Push Button Blood Collection Set. With an innovative wingset design that includes the company's PentaPoint™ Comfort and RightGauge™ Ultra-Thin Wall technology, which increases the inner diameter of the needle without increasing the outer diameter (gauge), the UltraTouch reduces penetration forces by 32% without compromising tube fill-times or sample quality. Lower penetration forces translate to minimizing patient discomfort during blood collection. More information and video.

Center Opens Online Store Just For Phlebotomists

MerchandiseGroupThe Center for Phlebotomy Education is opening a new online store offering merchandise just for phlebotomists. 

Aptly named, Just For Phlebotomists helps phlebotomists promote their profession and proclaim the critical role they play in healthcare. The shop offers a variety of shirts, mugs, hoodies, hats, and other merchandise with images and text that lets phlebotomists show pride in their profession.

"Over the years, we've been almost exclusively an education company," says the Center's Director, Dennis J. Ernst. "But since phlebotomists are the backbone of the laboratory, and so critical to the care of every patient they draw, it's time to shout it from the mountaintops."

The Center is partnering with Cafe Press to host the growing collection of custom designs on a wide variety of clothing and accessories.

Visit Just For Phlebotomists.

What Should We Do?: Adjusting coag tubes for high hematocrits

CitrateTubes_3[Editor's note: the following question was originally posted on The Fritsma Factor, an online coagulation blog. We responded to the question and are grateful to George Fritsma for permission to reproduce the discussion here.]

Question: Do you have any recommendations on how the sample should be collected for coag testing if the patient's hematocrit is above 55 percent? We have the formula in our procedure for adjusting the amount of anticoagulant in the tube to obtain the 9:1 ratio of blood to anticoagulant, but once we break the vacuum seal on the vacutainer tube to adjust the anticoagulant volume it cannot be filled without using a syringe. Since the risk of the sample clotting or hemolyzing is greater when using a syringe to draw the blood, we don't recommend that either. Any suggestions?

Fritsma Factor Response: This is indeed a tricky maneuver. The CLSI coag standard (H21) has a chart that tells you how much sodium citrate is required based on the patient's hematocrit, and states "Place the volume (of anticoagulant) in a collection tube and add blood up to the required total volume." This seems to require knowledge of the patient's hematocrit in advance of the coag collection, and the use of a syringe to transfer the blood to the "doctored" citrate tube. That's not the ideal solution, but I'm afraid there is no ideal solution.

Our follow-up response: On page 20 in the February 2005 issue of MLO, an article titled "Under the Blue Top: Coags, Corrections, and Crits" explains that the cap should be removed and the tube filled 8 mm from the top edge of the tube using a syringe. The tube should then be recapped with a new cap because the overfill will prevent re-fitting the original stopper.  The author suggests hematocrit-based tinkering is not worth the effort and may cause more problems than it solves.

Got a challenging phlebotomy situation or work-related question? 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.)

Product Spotlight: Errors and Impacts poster

Do those who work with you and for you scoff at the many details you know are critical for every venipuncture? Do you need something that reinforces the importance of every step to your students, new hires and other staff? We thought so.

That's why the Center for Phlebotomy Education just released a new poster that connects the dots between preanalytical errors and patient outcomes. Blood Collection Errors and Their Impact on Patients is a 20 x 28-inch laminated chart listing over 40 errors that can be committed during the collection, transport, and handling of blood samples. A corresponding column lists the impact each error can have on the test result and patient. Examples include:

  • ERROR: Delay in transporting/testing coagulation specimens
  • POTENTIAL IMPACT: Stroke, thrombophlebitis, and pulmonary embolism caused by unwarranted modification to blood thinner dosage based on inaccurate aPTT result.

  • BloodCollectionSitesPoster_1000wERROR: improper mixing
  • POTENTIAL IMPACT: Patient mismanagement due to delays when anticoagulated tubes contain clots and must be recollected.

  • ERROR: patient misidentification
  • POTENTIAL IMPACT: Transfusion- or medication-related death. Misdiagnosis, medication error, and general patient mismanagement due to being treated according to the results of another patient.

  • ERROR: filling tubes in the wrong order
  • POTENTIAL IMPACT: Seizure and death from potassium carrying over from EDTA into tube to be tested for K+. Medication errors when additives carry over into coag tubes, falsely lengthening coagulation times and leading to unwarranted and life-threatening medication adjustments. Unnecessary antibiotic administration and prolonged hospitalization due to contaminated blood cultures.

  • ERROR: pouring blood from one tube into another
  • POTENTIAL IMPACT: Patient mismanagement/misdiagnosis & medication errors based on altered results, especially potassium. Stroke/hemorrhage due to unwarranted modification to blood thinner dosage. 

  • ERROR: underfilling heparin tubes
  • POTENTIAL IMPACT: Patient mismanagement and/or /misdiagnosis from altered potassium, sodium, ALT, AST, amylase, and lipase results.

This is a posterized version of one of the Center's SmartChartsTM, a series of desktop reference materials in pdf format available for downloading at www.phlebotomy.com and free to all Phlebotomy Central members. Posting the Errors/Impacts poster in prominent areas provides poignant evidence to the entire staff of the importance of every step of blood collection, handling, and transportation.

 For more information and to purchase.


Survey Says:

Would you recommend your profession to a friend?

Lab coat man friendlyA full 80 percent taking this survey would definitely make the recommendation citing the opportunity to master a specialized procedure that is essential to every patient's health as the most common reason. The rewards of the profession and the interesting nature of the work came in second and third.

Here are some of their comments;

  • I'm a nurse but took phlebotomy separate and loved it!!! A great profession!!!
  • Never a dull moment.
  • I would recommend the MLA or MLT professions to many of my friends and acquaintances...but only through a certification program.
  • I love phlebotomy and it's an excellent entry into the medical field.
  • As a phlebotomist, you get to experience every department of healthcare and really decide where your passion is and where you want to be. I found that I loved drawing in the ER and OB and that inspired me to pursue an education as a paramedic. There is also a lot to be learned about the lab tests you are drawing for, and that is great knowledge to have for your patients. Phlebotomy is a great career to jump into and get lots of experience with before moving on to a more demanding job such as a nurse or paramedic. Learning about needle safety and standard precautions is a necessity in this job, and I have found it very helpful in deciding what my next steps are going to be.
  • Phlebotomy has been an enriching & rewarding career for 44+ years, but there is change in our future.
  • Phlebotomy is a fantastic stepping stone to the medical world and you can use this as the basis for nearly any other line of work in the field. While it can be high risk (needlesticks, combative patients, lawsuits) and high stress (goes without explanation), it's also high reward.
  • Out of everything I have learned throughout my medical technology career (and I'm currently a laboratory director), I am most proud of my phlebotomy skill!
  • A Med Tech. salary is very low. wouldn't be able to support one's self. But as my second career I find it challenging and fun.
  • I love being a phlebotomist but I know it's not for everyone. I would recommend it as a career to those who can handle it .
  • Only if they truly have an interest in it. Nothing worse than a Phleb that only took it because it was a "quick course."
  • It's a great beginning into the lab if you are interested in becoming a lab technician or even further. However don't expect to get paid well and don't expect a hole lot of respect from the rest of the hospital staff or at least from the hospital I work at. I feel it's rewarding knowing you have help with the patients recovery.

The most common reason given by the remaining 20 percent for not recommending a phlebotomy profession was low pay (60 percent). Lack of respect from other healthcare profession (50 percent), lack of respect from other laboratorians (30%), no opportunities for advancement (40 percent) and always being understaffed (30 percent were also high-frequency responses. (Multiple reasons were permitted in the survey.) Some comments:

  • More training is needed before they let students loose to perform such invasive procedures.
  • It truly depends upon the person & their bent. Not everyone should be in (any kind of) healthcare.
  • Pay too low for the work and best-practice knowledge.
  • If you are in it for the patient only...then yes it can be very rewarding. Very little upward mobility available, even with education and the first to be cut budget-wise.
  • Too much stress, too little pay, even less appreciation by lab, nursing & medical staff.
  • Where I work there is never enough staff. Staff are continuously run off their feet. The pay is atrocious.

This month, we're asking staff and management the same question separately: If you had a magic wand that would make one single work-related problem go away, what would that problem be?

Take the survey.

CE Broker to Distribute Center's CEs

CEbrokerThe Center for Phlebotomy Education announces its continuing education (CE) events and exercises are now available through CE Broker.

CE Broker is the CE tracking and management system trusted by innovative regulating entities across the US, including the Florida Department of Health, the DC and Georgia Boards of Nursing. Licensed professionals who require CE can access the Center's programs through CE Broker to simplify the compliance management process. The system currently manages CE requirements for over 1.3 million licensed professionals.

The Center offers a wide variety of CE exercises to maintain credentialing and licensure requirements including live events, downloads, videos and interactive online modules.


The Empowered Healthcare Manager

Your garden: futile or fertile?

A lab tech I'll call Ernie worked alone on second shift at a small county hospital. A hallway separated the lab: the hematology, microbiology, urinalysis, coagulation and blood bank departments on one side, chemistry and the outpatient drawing area on the other. Both sides had a phone, but only one worked. Multiple work orders to the maintenance department filed by the lab manager were ignored. For months, whenever the phone rang, Ernie would have to stop whatever he was testing, regardless of its urgency, and run across the hall to answer it. It delayed test results, impeded patient care, and stressed Ernie out of his mind.

One particularly hectic night Ernie took matters in his own hands. Around the corner from the lab was a bank of five unused phones at a nurse's station that had been closed long ago. He took one and replaced the dysfunctional phone with it. In a matter of minutes, Ernie accomplished what the maintenance department couldn't do in months, doubling his productivity, increasing test-result turnaround times and reducing his stress level dramatically.

The next day his manager slapped him with a written reprimand. She felt it was not his job to fix the phone issue.

Those who bring every element essential for empowered employment into an environment hostile to those elements will never have empowerment bestowed upon them until either their manager moves on or they do. Their gifts remain dormant, unused, and asleep, and they are forced to choose whether or not to remain oppressed, underutilized, and ineffective.

Ernie ultimately left his oppressive employer and landed a management position in fertile ground that produced abundant fruit for many. While it is often said you grow where you're planted, sometimes you have to plant yourself where you'll grow.

Even if you have all the personal attributes required---humility, vision, connect-ability, ethics, patience, integrity, leadership and confidence to name a few---they serve no purpose and bear no fruit in the wrong environment.

Empowerment is bestowed. Empowerment is conditional.  

 Subscribe to the Empowered Healthcare Manager blog.