Literature Review of Newly Published Studies
The Center for Phlebotomy Education has its nose in the news every day. Countless hours are spent researching publications for articles and new studies on all aspects of blood sample collection in order to keep ourselves, our products, and our readers up-to-date in the world of phlebotomy. Rest assured, if it's new and pertinent, you'll find out about it here first.
Here are the summaries of some published studies we've recently encountered that we thought our readers might find useful and informative:
Errors in a blood donation center
Residents admit to inadequate phlebotomy training
Sample-labeling errors studied at 147 clinical laboratories
Researchers study blood bank sample mislabeling
ED Hemolysis costs facilities $556 per day
This Month in Phlebotomy Today
Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 10th year of publication, are reading about this month:
For subscription rates and to subscribe to Phlebotomy Today, visit www.phlebotomy.com/category/eNewsletters.cpe.
Featured FAQ: Hemolysis and 25-gauge needles
Q: I have always been taught that a 25-gauge needle will hemolyze a specimen and affect patient results adversely. But my staff argues that if this is true, why do manufacturers make them? I don’t have an answer for that. I hate being the mean old phlebotomy supervisor and tell my staff they can't use them just because I said so. How do I answer their challenge?
A: Your staff's argument that the availability of 25-gauge needles justifies their use is irrational. Just because 18-gauge needles are available, does that mean that they can use them, too? Of course not. You are exactly right about 25-gauge needles causing hemolysis. Tell your staff 25-gauge butterflies are available, but they have limitations, they often compromise specimens, and should only be used when it clear that no other needle will work. For example, venipuncture on infants or geriatrics where veins are so small or fragile, that a 23-gauge needle will blow the vein. By no means should they be considered for routine draws. Take a stand and stick to it. It’s up to you to define the boundaries; expect for them to be challenged.
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/category/Phlebotomy-Central.cpe.
Survey Says: Outpatient identification practices
Our latest survey asked Phlebotomy Today STAT! readers: Does your facility provide outpatients with an identification band prior to a blood draw? Forty-one percent of respondents indicated their facility tags their outpatients with identification bracelets. Fifty-nine percent worked in facilities that did not provide outpatients with an ID band. Responses include the following:
Identifying outpatients with identification bracelets is up to the facility. Even when identification bracelets are used for outpatients, steps must be implemented that guarantee the band is correct and was applied to the right patient. Asking patients to confirm their identity is one method for discovering banding errors that might have occurred during registration.
This month’s survey asks two questions: Do you routinely ask inpatients to state their name as verification of their identification bracelet? Have you ever found an identification bracelet attached to the wrong patient?
Featured Product: To the Point® Articles
Center Launches Redesigned Web Site
The Center for Phlebotomy Education launched its newly redesigned web site (www.phlebotomy.com) on October 30 with global enhancements designed to improve its visitors' searching, browsing, and purchasing experience. The redesign is the first major upgrade to the site in four years, and is the work of Joseph Sims, the Center's graphic/web designer acquired in 2007. Features of the new site include:
"The primary goal of this redesign was to create a new architecture for our site that helps visitors find what they're looking for quickly, and with the least amount of frustration." says Sims. "We also wanted the re-architecture to permit the kind of content delivery our customers and visitors want and need."
Each month nearly 20,000 visitors roam www.phlebotomy.com's web pages seeking products, services, and information to help them teach, manage, and perform blood collection procedures. The re-architecture has been over a year in the making, and paves the way for more educational and interactive content scheduled for phlebotomy.com in 2010. Future features being developed for phlebotomy.com include more robust CEU options, blogs from the Center's director, the establishment of an online phlebotomy community, and streaming videos.
What Would You Do?
Each month, What Would You Do? presents a different case study, then asks readers to contribute their ideas 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 most accurate, well written response will receive a free download from the Center for Phlebotomy Education’s To the Point® library of articles. The exercise will conclude with a review of the selected submissions and a discussion of the standards pertinent to the case study.
Every reader who responded to this month's case study indicated they know better than to let a patient draw his/her own blood. Many underscored the liability it brings to the facility should an injury occur; others recognized the risk to themselves when giving a sharp to any patient, much less a habitual drug user. Handling the request tactfully requires a polite rejection of their request, and most of those who responded indicated they would be diplomatic.
Sixty-one percent said they would ask the patient for their suggestions on where to obtain blood while 46 percent said they'd seek the assistance of another caregiver with phlebotomy expertise. Some of those would do both.
One respondent indicated he would ask the physician for direction while another indicated she'd find a warm blanket for the patient as a means to increase circulation and, hopefully, distend veins for easier location.
Jan C. said "As a new phlebotomist over 30 years ago, I meet a man with abscesses and dark lines running up both arms from abusing drugs. After just one failed attempt and causing him pain, he offered to draw his own blood. I assumed this was against hospital policy and there was no way I was going to put a sharp object in this man's hands. So I asked him to teach me where and how to get his blood as painless as possible. He showed me, I was successful and we both parted feeling good.
According to Mary M., "I smiled to myself after reading this one. My ex-husband had this exact scenario as a medical student almost 30 years ago, except that the addict was a prisoner and was wearing a leg cuff. He did give the syringe to the prisoner and was able to obtain a sufficient amount of blood for sampling from a foot vein. Needless to say, my ex- was very fortunate that any number of adverse things that might have happened, didn't. In any case, if I remember correctly, at no time are lower extremities to be used by non-MDs for draws and I would politely decline the addict's kind offer but ask for his/her suggestion of a site."
Dean S. was very articulate and professional in his response as well. "Listening attentively to patients goes a long way in providing great customer service, and may also give valuable insight into finding a viable site to draw blood. However, competently drawing blood from a patient goes much further than any skill or knowledge gained from being a intravenous drug user. Not only do I have a responsibility towards safety, but the physician is counting on me to provide a quality specimen—one that yields an accurate result. This includes ensuring proper fill levels, and the correct order of draw at a minimum. I would say to the patient, 'I appreciate your desire to help, but your safety is paramount and, because of that, I will be calling for assistance from a coworker. I will be sending so-and-so who is very competent—someone I would trust drawing blood from myself.'"
Each of these entries are excellent responses, and deserve to be recognized. However, we particularly liked Dustin H.'s response, which includes an experience in which safety needles saved him from an exposure:
"Similar situations came up for me when I was an ED tech at a suburban trauma center. Knowing the drug abuse history ahead of time, this is a case where I would ask the patient where he has had the greatest success and give careful evaluation of his recommended site for quality of veins, scar tissue, and recent damage or use to the area.
Under NO circumstances should the needle be placed in the hands of ANY patient, as it can become a weapon if the patient stops being cooperative. I have been in physical struggles with psychiatric patients, including one who grabbed the needle out of my hands—and her arm!—during collection and tried to threaten me with it, thankfully engaging its safety device in the process. I've never had issues with safety devices, but, after that situation, I'll never complain about the minor inconvenience they occasionally impose.
Because of Dustin's well-articulated response, he'll receive a free download from the Center for Phlebotomy Education’sTo the Point® library of articles.
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