December, 2010

Copyright 2010 Center for Phlebotomy Education, Inc.
 All rights reserved. View our copyright policy.


Latest Preanalytical Variable to Affect Potassiums: 25-gauge needles

Researchers in Verona, Italy have added another preanalytical factor to the long list of collector-induced variables that alter potassium results: 25-gauge needles. In a study published in Clinical Chemistry, renowned preanalytical researcher Salvagno Lippi and his team compared the variability of 23- versus 25-gauge needles on a wide variety of commonly performed chemistry tests in the clinical lab. The team found increased variability for potassium when drawn through a 25-gauge needle compared to the 23-gauge needle. According to the abstract, "Small-bore needles of 25 G or less cannot be universally recommended when collecting venous blood for clinical chemistry testing and should be reserved for selected circumstances."

The size of the needle increases the long list of preanalytical variables that have been reported to alter potassium results. "It's probably the one analyte that is more affected by how the sample is collected, handled, transported, and processed than any other," says Dennis J. Ernst MT(ASCP), Director of the Center for Phlebotomy Education. "No other test result threatens the laboratory's credibility in the eyes of physicians more than their potassiums."

Ernst is referring to the following partial list of preanalytical factors reported to alter potassium levels:

  • Fist pumping;
  • Centrifuging tubes a second time;
  • Centrifuging tubes with their stoppers removed;
  • Inadequate centrifugation of gel tubes;
  • Pneumatic tube transport systems;
  • Hemolyzed samples;
  • Contact of serum/plasma with red blood cells beyond two hours;
  • Refrigeration prior to centrifugation;
  • Tourniquet constriction beyond one minute;
  • Contamination with IV fluids;
  • Contamination with iodine;
  • EDTA contamination from filling tubes in the wrong order.

Earlier this year, Ernst conducted a webinar titled "Potassium Results Your Physicians Can Trust." A recorded version of this presentation will soon be available on the Phlebotomy Channel. (See related article.)

[Editor's note: A potassium troubleshooting checklist containing 43 patient-dependent and preanalytical variables known to affect potassium results is available as part of the Manager's Toolbox.]


Texas Phlebotomist/MLT Needs Kidney

In November of 2008 Stacy Jackson was a 35-year-old phlebotomist working at Grace Clinic in Lubbock, Texas when she was diagnosed with IgA nephropathy. Within months her kidneys stopped working. She now undergoes peritoneal dialysis four times a day, and is praying for a kidney. At the time, she was also pursuing a degree as a medical laboratory technician (MLT) at Amarillo College, and has since completed the program. However, her condition and frequent dialysis only allows her to work 15 hours a week.

Before her diagnosis, Jackson was a phlebotomist dedicated to the education of her peers. She organized conferences that recruited national speakers, wrote continuing education exercises for the American Society for Clinical Pathology's Tech Sample and LabQ programs, and started organizing a statewide membership organization for Texas phlebotomists.

"I lost my kidney function about two years ago," says Jackson. "Since that time I do peritoneal dialysis four times a day. I'm currently not able to work full time, but look forward the day when I'm blessed with a new kidney and can return to my life. I know God will take care of me no matter what my future holds."

Jackson is on several organ donor lists, but has had her hopes dashed eight times so far. While friends and family members with her blood type (B pos) have offered to donate a kidney, all have been systematically disqualified for a variety of reasons. Jackson hopes that those who are aware of her need will consider her should they become aware of the availability of a kidney that matches her blood type. Jackson can be reached at TexasPhlebotomy@yahoo.com.


Featured Product
Phlebotomy Channel

In response to a growing demand for streaming educational videos and presentations, the Center for Phlebotomy Education announces the launch of the Phlebotomy Channel™. Beginning this month, the Center's Applied Phlebotomy Video Series as well as the first of the Phlebotomy Best Practices Lecture Series can be accessed anytime, through any computer with a high-speed Internet connection.

"Our customers have been clamoring for years for the ability to stream our training videos to their staff and students, many of whom are remote to the facility or campus," says Dennis J. Ernst MT(ASCP), the Center's director. "The Phlebotomy Channel delivers the best in preanalytical training videos and lectures to our customers for about two dollars per view. There's no need to involve their IT department and, best of all, no need to entrust their coveted DVDs to other departments, hoping they'll be returned."

Healthcare facilities and academic institutions simply purchase 150—or more—viewings of the titles of their choice based on the nature of their staff or classes. The purchasing facility/institution will receive a login/password combination to login to Phlebotomy Central, and once in Phlebotomy Channel, links to specific videos can be generated for sharing assigned videos and lectures with their staff or students, with an alternate password for sharing. The videos and lectures can be viewed at the user’s convenience from any computer with high-speed Internet access. When the number of views purchased by the facility has been exhausted, additional viewings are available for purchase in increments of 50.

For more information, or to order, call 866.657.9857 or go to PhlebotomyChannel.tv.

Phlebotomy Channel


Feel free to forward this newsletter to a friend!
If this issue was forwarded to you from a friend, subscribe here.


This Month in Phlebotomy Today

Here’s what subscribers to Phlebotomy Today, the Center for Phlebotomy Education’s paid-subscription newsletter currently in its 11th year of publication, are reading about this month:

  • Feature Article: Needlestick Authorities Hold Historic Conference
  • Phlebotomy in the News: a round-up of articles on phlebotomy and phlebotomists who made Internet headlines in November including these stories:
    • Shared Glucometers Suspect in Fatal Hepatitis Outbreak
    • ANA Offers Needle Safety Toolkits, Resources
    • Hospital Institutes Magazine Ban in Waiting Rooms
    • Phlebotomist’s Handiwork Raises £500 for British Legion
    • Skin Cells Transformed into Blood
    • Economic Downturn Impacts California HCWs
    • MRSA Rates Higher in US than UK
  • According to the Standards: Syringe draw safety
  • Tip of the Month: Letter to Santa
  • CE questions (institutional version only).

Buy this issue for only $9.95.

For subscription rates and to subscribe to Phlebotomy Today, click here. The current month’s issue will be emailed to you immediately upon subscribing.


Featured FAQ
Gauze wraps

Q: Our outpatient phlebotomists have begun to use an adhesive gauze wrap as a pressure bandage on our routine outpatients. It seems that our patients are asking for it, thinking that it is better than regular tape, but the question came up that there could be liability if the patient does not remove it in a timely manner. Do you have any information and/or references regarding the use of this type of product?

A: Unless the stretchy gauze wrap is applied so tightly that it restricts circulation, there shouldn’t be any problems associated with a prolonged application. Maybe an in-service would be in order to demonstrate how loosely it should be applied as a way to manage the risk. Another way to limit your liability is to give the patient written post-venipuncture care instructions that tell when to remove the wrap. You might contact the manufacturer for proper use instructions.

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.


Survey Says
Supervisor and staff attributes

Last month’s survey question asked visitors to our website what single attribute they wished their supervisors would improve upon. Since turnabout is fair play, we also asked supervisors to identify one characteristic they would like to see their staff as a whole improve upon.

The number one quality respondents wanted their supervisors to master was to show more recognition and appreciation (28%). Communication was a close second at 20 percent, with trustworthiness and organizational skills tied at 12 percent each. For a complete ranking of responses, refer to Chart 1.
Sample Comments:

  • “I wish management was more responsive to listening to issues that take more time than they should because everyone has their own interpretation of the problem and its solution.”
  • “My supervisor treats me like a child. I would like more consultation within the workgroup. I don’t believe she cares about each of us individually.”
  • “When I send a message to my supervisor, I expect a “yes” or “no” back (via email), but receiving no answer gives me a lack of confidence in how I am approaching the job.”
  • “None of the above. I have a wonderful supervisor who meets all of the above attributes.”

Topping the wish list of what supervisors wanted from their staff was teamwork at 40.9 percent. Professionalism was a distant runner-up at 13.6 percent, followed by a three-way tie between dependability, initiative/time management and interdepartmental cooperation (9.1% each). Supervisor responses are summarized in Chart 2.
Sample Comments:

  • “My staff is wonderful when there are patients to be taken care of. However, they tend to have difficulty keeping themselves productively occupied during downtime.”
  • “As a phlebotomy manager, I spent a large amount of time covering open shifts due to last minute scheduling needs.”
  • “Do your job like you own the business.”
  • “I have a great staff… however, if my staff as a whole would incorporate teamwork more, there would be less “who shot John” and more “Hey, we gotta get these patients drawn”. Also, it’s important to understand that it’s not about “us”, but rather the patients…”
  • “Smile and give our patients a great lab experience.”

So what’s the takeaway message? Regardless of which side of the desk you occupy, for most of us there’s always a little room for improvement.

Chart 1
Supervisor Attributes Chart

Chart 2
Staff Attributes Chart

This month’s survey question:
What is your facility's most important criterion when selecting a sharps safety device for use in blood collection?

Feel free to forward this newsletter to a friend!
If this issue was forwarded to you from a friend, subscribe here

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 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.


Last Month’s Case Study:
A Tight Squeeze

You just returned from a conference where an OSHA spokesperson said the use of auto-release tube holders, the type that releases the needle into the sharps container when one or more side buttons are pressed, violates the Bloodborne Pathogens Standard. Your facility has been using them as long as you can remember. You bring this to the attention of your supervisor who says it's okay as long as the holder is not visibly soiled.
What would you do?


Of the readers who responded to last month’s case study, two-thirds indicated that they would notify OSHA. One respondent commented that she has personally witnessed staff manually removing needles from the tube holders when the device’s auto-release button didn’t work.

One of our readers, Lee, would handle the situation this way: “Forward the information to the facility Infection Control Department, the Employee Health Department, Pathologist, Human Resources, Products Committee, Lab Director, Administrator, [and] Risk Manager. If they refuse to deal with the issue consider finding another job and reporting the problem to OSHA, the Joint Commission or your State Labor board.  Someone there needs to wake up.”

Several studies on tube holder contamination rates have been published. One showed a 9.2 percent visible contamination rate (1), while another study showed that 48 percent of tube holders were contaminated after a single use.(2) A third study found the tube holder blood contamination rate to be 83 percent.(3)

OSHA's Bloodborne Pathogens Standard (29 CFR1910.1030, paragraph (d)(2)(vii)(A)) states: “Contaminated needles and other contaminated sharps shall not be bent, recapped, or removed, unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical or dental procedure.” More specifically, OSHA’s compliance directive, CPL 2-2.69 at XIII.D.5 states, “removing the needle from a used blood-drawing/phlebotomy device is rarely, if ever, required by a medical procedure. Because such devices involve the use of a double-ended needle, such removal clearly exposes employees to additional risk, as does the increased manipulation of a contaminated device.”(4)

In a Standard Interpretations letter dated June 12, 2002 from Richard E. Fairfax, Director of OSHA’s Compliance Programs, Fairfax states the following: “In order to prevent potential worker exposure to the contaminated hollow bore needle at both the front and back ends, blood tube holders, with needles attached, must be immediately discarded into an accessible sharps container after the safety feature has been activated… Removing contaminated needles and subsequently reusing blood tube holders poses multiple potential hazards. The increased manipulation required to remove a contaminated needle from a blood tube holder is unnecessary and may result in a needlestick from either the front or back end of the needle.”(4)

Given the evidence and what’s at stake, there simply isn’t a good reason for reusing tube holders. We echo Lee’s sentiments. Those in authority need to be made aware of the situation and those who condone the practice need to be held accountable. For a concise and articulate response, Lee will receive a free download from our library of articles.

Next month, our What Would You Do? column will be ringing in the New Year with a slightly different format.


  • Howantiz P, Schifman R. Phlebotomists’ safety practices. Arch Pathol Lab Med 1994: 118:957-962.
  • Weinstein S, Hamrahi V, et al. Blood contamination of reusable needle holders. Am J Inf Ctl 1991;19(2).
  • Crawford D. Case Study: Phlebotomy. Adv Admin Lab 2000:9(1);70.       
  • OSHA website. Link. Accessed 12/7/10.


Your most challenging phlebotomy situations and work-related questions. Send your submission to WWYD@phlebotomy.com and you just might see it as a future case study.




Feel free to forward this newsletter to a friend!

If this issue was forwarded to you from a friend, subscribe here to receive your own copy each month so that you never miss a single issue of the only free monthly newsletter on the planet devoted exclusively to blood specimen collection!


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.
Do not respond to this email. Responding to the email address from which this newsletter is sent will result in the deletion of your address from our mailing list. If you would like to send an email to the editor, send it to phlebotomy@phlebotomy.com
For images to appear, you must be logged on to the Internet.
Having a problem with reading or receiving the newsletter? Your satisfaction is important to us. Let us know by sending an email to phlebotomy@phlebotomy.com
Interested in forwarding or reprinting content from PT STAT! ? Read our copyright policy at http://www.phlebotomy.com/Copyright-Policy.cpe

unsubscribe information: This email is sent to you because you have subscribed to PT-STAT! By subscribing, you agreed to receive no more than three emails per month including the monthly newsletter. If you would like to be removed from this list and no longer receive PT-STAT!, click here to unsubscribe. You may also unsubscribe by sending a request via postal mail. Please include your name, e-mail address and a printed copy of your newsletter. Send to:
Unsubscribe PT-STAT!
c/o Center for Phlebotomy Education, Inc.
1304 N. Old Hwy 135, Ste. 103
Corydon, IN 47112

Copyright 2010, 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.