Phlebotomy Today

Study Shows Impact of Hemolysis on Emergency Department

It's no secret more blood samples are hemolyzed when drawn in emergency departments than anywhere else in the hospital. In fact, one study showed eight times as many samples coming from the ED are hemolyzed than from other sources. Unfortunately, many laboratory, phlebotomy and ED managers have come to accept that it will always be that way. A new study, however, shows why such a defeatist attitude should not be acceptable in an industry that otherwise strives to deliver quality patient care.

The study, recently published in the Journal of Applied Laboratory Medicine, details just how detrimental hemolyzed samples are to moving patients through the ED (throughput). After an initiative to reduce ED hemolysis, researchers analyzed their data to quantify the effect hemolysis had on the department's ability to either admit or discharge patients in a timely manner.  Statistical analyses were conducted to compare throughput times for over eleven thousand patients with and without hemolyzed samples.

The length of stay for all patients with hemolyzed samples averaged over an hour longer (62 minutes) than those without hemolysis. For patients who were ultimately admitted, the delay caused by hemolysis was 28 minutes. Patients who were discharged experienced a delay of over an hour-and-a-half (92 minutes).

Given the cost of avoidable delays to the ED and the greater healthcare facility, reducing the percentage of hemolyzed samples is critical to an efficient emergency department. Since hemolysis can be prevented through education and proper equipment choices, all managers have the capability of significantly curtailing the problem and its ripple effect on multiple aspects of patient care, including patient satisfaction. 

Read the abstract.

EDITOR's NOTE: The Center for Phlebotomy Education offers a helpful video to reduce hemolysis in emergency departments and other hospital areas. "Ending Hemolysis in the ED... and Everywhere Else" is available in DVD and streaming options. See the preview.

 

Product Spotlight: Free DVDs with Phlebotomy Central Subscription

For a limited time, new subscribers to Phlebotomy Central will receive the entire set of 6 DVDs in our Lecture Collection series (retail: $599). What's Phlebotomy Central? It's where we park our brain. Just about everything we've ever written, published and produced (except videos) is accessible in this comprehensive online library. In-house continuing education modules, an expansive FAQ section answering just about every question you might have on blood sample collection, training and management, 20+ years of archived issues of Phlebotomy Today, and much more.

Subscribe now and we'll ship you the following titles on DVD:

• Seizing Control of Blood Culture Contamination Rates
• Ending Hemolysis in the ED... and Everywhere Else
• Mastering Pediatric Phlebotomy
• Potassium Results Your Physicians Can Trust
• Delivering World-Class Customer Service
• Successful Strategies for Difficult Draws

These are full-length studio-mastered recordings of Dennis Ernst's most popular lectures, all closed captioned by the National Captioning Institute and current with the latest standards. You'd pay $599 if purchased separately. This offer is for new Phlebotomy Central subscribers only and ends September 1, 2020 and applies only to the DVDs, not their streaming versions.

Simply add both to your shopping cart and the discount will be applied immediately. Subscribe to Phlebotomy Central and for more information.

Preview the Lecture Collection series.

 

Canadian Phlebotomists, Lab Techs Demanding Pandemic Pay

In April, Ontario's Provincial Premier made an announcement that some essential healthcare workers would receive a premium for working during the COVID-19 pandemic. The hazard-pay bonus would be in effect for four months and would amount to an additional $4 per hour plus $250 for those who work more than 100 hours in a month. However, phlebotomists, laboratory technicians and other staff members were not included, according to their union representatives.

The exemption prompted a backlash of protests at Kingston General Hospital and governmental offices. Unions representing Ontario's healthcare workers joined forces to apply pressure to provincial authorities to expand the list of eligible workers. While respiratory therapists and paramedics were later added, phlebotomists and other essential workers remain ineligible. However, not even the eligible workers have yet received their promised bonuses due to funding issues, eligibility requirements, and delays in establishing payment guidelines.

Further east, pandemic bonuses were also announced for healthcare workers in the Province of Nova Scotia. Officials there announced the distribution of up to $2,000 this fall to workers with patient contact. Presumably, that includes those who draw blood samples. Regardless, the announcement was protested by union representatives for not including all healthcare workers.  

Pandemic bonuses are also being paid to healthcare workers with direct patient contact in the Canadian provinces of  British Columbia, and Manitoba, Although in BC, payments are not being provided to front-line employees at privately funded facilities. The province of Saskatchewan is offering a "Temporary Wage Supplement" for low-income employees at essential care facilities like hospitals. In April, the Quebec provincial government gave all health-care workers who come into direct contact with COVID-19 patients an eight percent raise. 

In April, the Alberta provincial government announced it will be funding "health-care aids" at contracted continuing care facilities with an additional $2/hour, but it does not apply to other healthcare worker roles.

In Newfoundland and Labrador, nearly 43,000 employees will be eligible for one-time payments between $600 and $1,500. However, union officials are expressing concern that  most of its members won't see a dollar despite working in high-risk environments. 

 

22 Months of In-house CE exercises

 

YouTube Video of the Month

The Center for Phlebotomy Education's YouTube Channel features high-quality, standards-based educational and inspirational content for anyone who performs, teaches or manages blood collection procedures. This month's featured video discusses why patients should never pump their fist prior to a blood draw, and effective alternatives to finding a suitable vein. 

 

 

Webinar Promotes Safety, Patient Satisfaction During Vascular Access

3M's Health Care Academy will be delivering "Best Practices for Blood Collection and CVC Access to Keep Patients and Staff Safe, Healthy, and Protected." The webinar is scheduled for Wednesday, Aug 19 at 2:00 PM EDT and includes three presenters:

• Joy Selchow, MSN, RN, CRNI, Nurse Director of IV Therapy at Seattle-based Virginia Mason Medical Center
• Pitou Devgon, MD, MBA, Co-founder and Chief Innovation & Strategy Officer of Velano Vascular
• Kris Hunter, BSN, RN, CRNI, VA-BC, Clinical Applications Specialist, Vascular Access

The event explores strategies to help hospitals keep their focus on such foundational practices as blood collection amid the Covid-19 pandemic. Emphasis will be on blood collection practices that increase patient satisfaction scores, reduce healthcare-acquired infections, and increase efficiencies in holistic clinician operations. Ms. Selchow will share how her facility has met these objectives by implementing and standardizing advanced vascular access protocols to enhance clinical quality outcomes while keeping patients and staff safe, healthy and protected in a continuously changing environment. The webinar is co-sponsored by Velano Vascular.

To register and for more information. 

 

From the Editor's Desk

Friends,

As I mentioned last month, I'm spending some extra time off-duty to enjoy the summer. That means I'm digging into the archives of my column and dust another one of my favorites that you probably will enjoy. I'll be back in the present next month. This month's classic editorial goes back to February, 2004 and explains why I didn't send out any Christmas cards two months prior. Enjoy.

 

Take care, my friend, 

Dennis J. Ernst, editor

---

Originally posted December, 2002

Friends,

I trust you had an enjoyable Thanksgiving. Catherine, my wife, and I drove to Michigan to spend it with my side of the family. Dinner was at my sister's house, right across the street from where I grew up in Richmond, just north of Detroit. She acquired it from my grandparents before they passed away. Although my sister and her husband have substantially remodeled and expanded the house, I continue to see it as it was when I was a boy.

It was a two-story house with creaky floors, a coal room and lots of hiding places. Living across the street from Grandma and Grandpa was a great convenience. Grandma would always welcome me with the same greeting when I walked in: "There he is: barefoot boy with cheek of tan." It was a line from a poem she had committed to memory. If I caught her in a particularly good mood, I'd get the whole verse. Regardless, my response was always the same: "Got any cookies, Grandma?" I was never one to conceal my priorities.

My red cookie tin

And of course the answer was always the one I was looking for. She'd open the cupboard, stand on her tip-toes and pull down from the top shelf a round red tin about 10 inches in diameter and four inches deep. Keeping it out of my reach was her way to make sure I went through the proper channels in acquiring what she full-well knew to be the point of my visits.

Grandma & Grandpa

I knew early on that mothers and grandmothers have two completely different philosophies about raising kids. My Mom raised me on such things as asparagus, tuna-noodle casserole, brussel sprouts and creamed tuna on toast; sensible but unfortunate. Unfortunate because I came to hate them all. But Grandma raised me on molasses cookies. They were dark brown, sprinkled with sugar and synonymous with the round red tin. Grandma must have been a sucker for my bare feet and tanned cheek because she never refused to get the tin down for me and I never found it empty.

I could always tell if a fresh batch had been made because with every new lot of molasses cookies, Grandma baked an especially large one just for me. It always lay on top of the others, almost as big around as the tin itself and completely covering the rest. Into it she embedded a smiling face of raisins. If my brothers or sisters happened to beat me to the tin after it had been freshly filled, they were never allowed to have the smiling cookie. Grandma reserved that one for me and me alone. It was the one rule that she strictly enforced.

If my luck was especially kind, I would happen to walk in during the makings of a fresh batch. She'd let me help her add the eggs, molasses, sugar and other ingredients and then hand-mix it into a thick ball. Then she'd roll it out and let me cut them into circles with a round aluminum cutter. During the process, I was entitled to snitch a couple bites of raw dough, but not many. I could tell when I would exceed my limit because Grandma had a very distinctive way of voicing her displeasure. It didn't matter what you did that moved her to scold you, her unique choice of words and tone of voice stopped you cold. If you got caught walking in with muddy boots, fighting with your sister, running in the house, or stealing one too many snippets of molasses-cookie dough, you'd get the same message: a deeply guttoral, rapid-fire "Here! Here! Here! Here! Here!" Always in fives, and always effective. It even worked on Grandpa.

Grandma is long gone now; so is the cupboard at my sister's house where the round red tin used to be. I have the tin, now. My Mom passed it down to me when Grandma passed away. It's a treasure and an icon for me, one that channels me back to Grandma and her kitchen cupboard from time to time. It's forever empty now, resting reverently on my bookcase with a few other relics of my youth. But when I walk into my sister's house, I still visualize it on the top shelf of a cupboard that no longer exists anywhere but in my imagination. In my mind it's still there and still full. Waiting for a barefoot boy with cheek of tan to traipse in and stake his claim.

Take care, my friend,

Dennis

-----------------------------------------------------------

I'll be back with a fresh editorial next month. Happy August, everyone!

Dennis

 

Test Talk: Sed rates

A column that features a different laboratory test each month, what it measures, why physicians order it, and any collection handling restrictions and requirements that must be met.

Sedimentation rates, also known as a sed rate, erythrocyte sedimentation rate (ESR) and Westergren sedimentation rate---is one of the earliest tests developed for clinical diagnosis using blood samples. Although methods have improved dramatically, sed rates are still widely used today to assess inflammation associated with infections, cancers, autoimmune diseases and other conditions. As a non-specific test, it is used as a screen for inflammation that guides physicians in their diagnoses. It reflects an inflammatory response, but does not reveal the cause of inflammation, and can be elevated for reasons other than inflammation.

Conditions that elevate sed rates include rheumatoid arthritis, inflammatory bowel disease, bacteremia, systemic lupus erythematosus, and tumors. However, an elevated sed rate can accompany conditions in which inflammation is not present, such as pregnancy.

When patients have inflammation, increased levels of fibrinogen cause red blood cells to adhere to each other. Because clustered red blood cells are heavier than unbound cells, the cells fall faster in their plasma suspension. The greater the inflammation, the more cells are bound and the faster they fall. A sedimentation rate measures the rate in which red blood cells "settle" over time when the cells are allowed to separate by gravity or with automated methods. Some methods measure the height of the settled red blood cells, i.e., the "sediment," over an hour's time; automated systems provide results in five minutes or less.

Depending on the method used, sed rates are drawn into either EDTA or citrate tubes, and are stable for six hours, although some resources list stability as two hours (WHO).

References

1. LabTestsOnline. American Association for Clinical Chemistry. AACC. Accessed 8/5/2020.
2. CLSI. Procedures for the Handling and Processing of Blood Specimens for Common Laboratory Tests; Approved Guideline—Fourth Edition. H18-A4. Clinical and Laboratory Standards Institute. Document H18-A4 Wayne, Pennsylvania 2010.
3. World Health Organization. Use of Anticoagulants in Diagnostic Laboratory Investigations. WHO. Geneva, Switzerland. 2002.

 

What's Wrong Here?

What's wrong with the picture to the left? We guarantee something isn't as it should be. The answer will be in next month's issue. (Click image to enlarge.)

Last month, our What's Wrong Here? image (right) depicted our pet peeve: scrubs that sweep the floor and deliver pathogens everywhere the "professional" goes. Even home.

If the cuffs of your scrub pants touch the floor, make it a point to hem them up so they aren't a fraction less than an inch-and-a-quarter off the ground (32mm). Your patients don't want someone else's deadly microbes brought into their room, the grocery store doesn't want the bugs you brought from work in their produce department, and your family doesn't want you to bring work home with you. 

 

Product Spotlight: Anatomy Poster Discounted

The Center for Phlebotomy Education's popular Blood Collection Sites and Precautions wall atlas is on sale for nearly 30% off.

Already on display in over a thousand healthcare facilities and academic programs around the world, it's the only poster of its kind that identifies nerves, veins and arteries of the antecubital area. 

This full-color laminated poster depicts the two most common anatomical variations of veins as they pass through the antecubital, i.e., the "H" and the "M" configurations. Approximate locations of nerves, veins, and the brachial artery as they pass through the antecubital area are identified and accompanied by detailed text that discusses the precautions all specimen collection personnel must know when drawing blood for clinical testing to prevent patient injury.

A section on alternative venipuncture sites discusses mastectomy patients, foot/ankle veins, and other alternatives. All text and illustrations reflect the current standards of the Clinical and Laboratory Standards Institute and the Infusion Nurse's Society. This 17" x 22" laminated poster is designed to be posted in classrooms, laboratories, medical offices, healthcare facilities, and other specimen collection environments.

Obtain your copy.