Study: Single-drop Test Results Not Reproducible
The Empowered Healthcare Manager:Make these happen where you work
Product Spotlight: training "arms"
From the Editor's Desk: Forced vacations
This Month in Phlebotomy Today
What Should We Do?: Contamination frustration
Tip of the Month: Peace on Earth
Study: Single-Drop Test Results Not Reproducible
A study recently published in the American Journal of Clinical Pathology suggests test results from a single drop of blood may not be as reliable as we think. Researchers at Rice University's department of Bioengineering collected six consecutive drops of blood into separate containers from 11 donors. Each sample on each patient was tested for hemoglobin levels,WBC counts, differentials, and platelet counts. In all draws, the first drop after the puncture was wiped away.
The drop-to-drop variation was up to three times greater for hemoglobin than for samples collected by venipuncture when repeatedly tested on the same instrument. Variability was 5.7 times greater for WBC counts, 3 times greater for lymphocyte counts, 7.7 times greater for granulocyte counts, and 4 times greater for platelets.
In a separate collection, hemoglobins were measured on each of ten successive drops of blood from seven donors using the Hemocue 201+ point-of-care (POC) hemoglobinometer. The average variability was up to 5 times higher than for venous blood.
The author recommends caution when reporting and interpreting hemoglobin and WBC results for clinical decision-making when obtained by devices that use minute quantities of blood.
Read the full study.
[Editor's note: recently, Phlebotomy Today-STAT! ran a story on Theranos, a laboratory facing FDA scrutiny for its proprietary technology that performs multiple tests on a single drop of blood.]
The Empowered Healthcare Manager: Make this happen where you work
Every month, Phlebotomy Today-STAT! reprints one of the prior month's posts to The Empowered Healthcare Manager blog, written by Dennis Ernst.
Empowered healthcare managers make:
- disruptive employees nervous;
- dysfunctional employees temporary;
- engaged employees loyal;
- benign managers uncomfortable;
- physician interactions trusting;
- patient interactions positive;
- routine activities energizing;
- team membership prestigious;
- mundane functions meaningful;
- administrators become calculated risk-takers;
- employment at their facility coveted;
- quality healthcare possible.
Are you making these happen where you work? If not, what---or who---are your obstacles?
Identify them and set out to clear your path. But first, make sure you're not one of them.
Subscribe to The Empowered Healthcare Manager.
Product Spotlight: Newly redesigned training models
If you've ever looked through the Center for Phlebotomy Education's catalog, you'll notice all but two of the products are of our own creation. That's because few products on the market meet our strict quality standards. One of them is the newly redesigned Advanced Venipuncture Training Aid. Completely upgraded, this training aid costs far less than the anatomical-looking arms, and provides a far superior real-patient experience. What we like the most (besides the price) is that needle tracks are not nearly as obvious as they are with anatomically designed trainers.
The latex-free Dermalike™ vein block has four simulated veins in three different sizes, with the fourth vein deeply placed. As the needle enters the vein, a realistic "flashback" of simulated blood confirms proper needle placement, helping students and staff develop hand-eye coordination, confidence, and competence. Durability for this model is rated at 5,400 sticks with a 22-gauge needle.
From the Editor's Desk
I hope you don't mind this month's issue being abbreviated. Not only have I been presenting lectures from North Carolina to California, guiding my volunteer CLSI committee through the final phases of revising the industry's venipuncture standard, and redesigning our web site, but I had the audacity to take a vacation. Yep, a vacation. My wife forced me.
It was only three days, but it's all I'll get this year. I'm not complaining, really. I don't consider what I do "work," so what's is there to vacate from? Insufferable bosses? I don't have one. Alarm clocks? I wake up naturally. Drudgery day in and day out? Haven't had that since I left the bench for good in 2004. So I can't really say I had a vacation since I don't really work. Still, it was nice to wake up three mornings in Napa Valley, California without having to go anywhere or do anything. Just don't ask me to get used to it.
Now that I'm back, it's time to put this year to bed. Let me start the process by wishing you a most excellent Christmas, and by sharing my hopes your next year is outstanding. I won't be travelling as much in 2016 as I have this year, due to the pending release of the revised CLSI venipuncture standard. Once published, I will have to update most of our videos, downloads, online modules, books and other products to keep them current.
I delivered 26 lectures in eight cities this year, but am limiting myself to 12 in three for 2016. They will be Charlotte (Boot Camp), San Francisco (CE Day) and Philadelphia (ASCLS National). Time permitting, I may be able to squeeze out a few webinars for you, but the bulk of my time will be spent updating our materials. The good news for you is I'll be able to take your phone calls and answer your emails on technical questions when they come in and give you the information you need to get on with your day. I love, love, LOVE hearing from my subscribers, so feel free to pick my brain. Unless I'm forced to take another vacation, you will have my undivided attention.
Dennis J. Ernst MT(ASCP) NCPT(NCCT)
This Month in Phlebotomy Today:
Here's what subscribers to Phlebotomy Today, the Center for Phlebotomy Education's flagship newsletter currently in its 15th year of publication, are reading about this month:
The Art (and Magic) of Centrifugation, Part 2
On the Front Lines
Is Vitamin B-12 light sensitive?
Sticks, Staph, and Stuff
Is somebody watching you ignore the hand gel?
Spinning tubes without stoppers?
What's Wrong Here?
A monthly image to test your powers of observations
Subscribe to Phlebotomy Today and get this issue immediately.
What Should We Do?: Contamination frustration
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: During a recent mock inspection, a surveyor watched a blood draw and cited us because the phlebotomist took additional supplies from the tray after touching the patient with gloved hands, and for putting the filled tubes on the tray with gloved hands. According to the inspector, doing so contaminated the entire tray, including the outer wrappings of sterile, packaged supplies, and needed to be cleaned before going into another patient area. Now my infection control managers want us to change our practice. What should we do?
Our response: This concern seems highly unusual for routine, non-isolation patients. If the patient is not in isolation, we wonder what exactly the tray is being contaminated with that is of concern? The phlebotomy tray is far from sterile when it comes into the room. Nor does it need to be. If there is concern over touching the contents of the tray, what about phlebotomists who stock the tray with bare hands? What about the bottom of the tray after it is set down in the patient's room upon entry?
If the items in sterile packaging you are referring to are the needles and syringes, it's the contents of the packaging that are sterile, not the outside of the packaging. Touching the packaging doesn't contaminate the contents
If we draw this logic out further, it starts to get silly. For example, nurses are not required to wear glove to administer an IM medication, which requires touching the patient, So, at your facility, do med carts have to be decontaminated when nurses touch supplies and medications? We think someone's really overthinking this, and don't feel a change is necessary. We hope you can reason this out with them.
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.)
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.
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
Click here for this month's featured Tip of the Month: Peace on Earth