Phlebotomy Today

Phlebotomy Today in Transition

From the Editor's Desk

Beginning this month, Phlebotomy Today will be transitioning to something more akin to a blog.

Don't let that concern you. You'll still receive the same high-quality articles, impeccably researched information, and standards-based advice you've been enjoying since 2000, including my popular From the Editor's Desk column. You'll just receive them differently. I think you'll like the changes.

You may not realize it, but Phlebotomy Today has always been a blog, technically speaking. Each month, I'd write about nine posts in a blogging web site, then compile them into one email to you, all attractively assembled beneath the Phlebotomy Today masthead as an "issue." It worked for me and I know it's been working for you due to the massive readership Phlebotomy Today has enjoyed over the years. You just never saw the blog site, but now you will.  Beginning this month I'll be making the blog page public and sending each post to you as I write them instead of compiling them all into an "issue."  Here's what it looks like today, but it'll change significantly over the next few months as I massage the archives into being easier on the eyes. For the short term, please forgive some "wonkiness" on fonts as I work back through hundreds of posts. 

Why the change? Three reasons. First, it provides you with instant access to breaking developments in the industry. You will no longer have to wait until the next month to get the scoop on what's newsworthy and relevant to your day-to-day responsibilities. Secondly, it gives me the flexibility I've been needing for some time now. Without a monthly deadline to put out an "issue," I can post new and topical material immediately instead of cramming everything into the first week of every month.
      Thirdly, and probably the biggest reason, is that I want to write in a style that's less technical and more conversational. I'm a creative writer at heart, and I need to let my voice run unharnessed by the constraints and conventions of purely technical (read "stodgy") writing. That's the beauty of blogging. So you can expect my future articles to be more conversational, personable, and light-hearted; yet still packed with solid information to help you do what you do best...and a lot more enjoyable for me to write.

The Phlebotomy Today blog, no longer something we'll call a newsletter, begins now. There is nothing you need to do during this transition. Your experience as a subscriber will not change except for the frequency of articles you'll receive. (If you've been forwarding "issues" along to your staff or students all along, you can still do that for each post you receive. But it may be more convenient for you if you simply have them subscribe for themselves here.) You'll still get no more than two promos of our products each month, just as you have been. I hope that's still okay. That's how I can continue writing good, reliable information for you to implement and enjoy, and I appreciate your accepting the information in exchange. 

Oh, there's one additional change I think you'll like. Each article will have a link taking you to my blog where it also resides, providing you with an opportunity to comment on the article and interact with other subscribers. Building that community is a benefit I really like, and I think you will, too. 

As always, it's an honor to serve you. Send any comments or article ideas to me at editor@phlebotomy.com.

 

Respectfully,

 

Dennis J. Ernst Mt(ASCP), NCPT(NCCT)
Editor

 

Are You Worth Promoting?

If there's a career ladder in place in your facility, do you have what it takes to climb it? If there's not one in place, are you the reason there should be?

Phlebotomists looking to advance should look within to make sure they're appealing to those who offer positions with greater responsibility. Not only that, but it's important to realize today's economic climate is desperate for leadership from the front line workforce. Conduct this self-assessment to see if you have any internal obstacles that could be preventing you from reaching new heights... or from keeping your current position.

Do you make your manager's job easier or harder?

The right answer is obvious, but take a serious look at yourself as your manager sees you. If you quit your job yesterday, would your manager hire you back today? If you think he/she wouldn't, your job's in jeopardy. Think of the reasons you wouldn't be rehired, and fix them. Consider employment at your facility to be a privilege, not a right. Strive to earn that privilege every day by making your supervisor's job easier. It's not "sucking up to the boss" if your motive is sincere and selfless, so forget what your coworkers might think. You don't work for them and they have no authority to invite you up the ladder. Don't like your boss? Then you only have two choices: find something to like about them or find employment elsewhere. If you stop looking at the negatives about that person and focus on the positives, you might start looking more like a long-term employee in his/her eyes and less like someone who needs to be the object of a "staff reduction."

Do you deal with difficult people with poise or poison?

According to author and management speaker Dale Dauten, every tenth person is a jerk. If one of them is your boss, deal with it. That means not focusing on their jerky-ness, but focusing on what your job is. Jerks usually self-destruct. When that happens, make sure you're in a position to step up. You'll never be in that position if you're known for your contempt of authority, however detestable the jerk is. If you focus like a laser beam on your responsibilities and making your jerk-boss's job easier, you've taken the high road, which is usually lined with ladders to even higher roads. If the jerk is a physician or patient, the same rules apply. Remember, everyone has a story, and chances are you have no idea what makes the jerk-of-the-day so difficult. Difficult people are difficult to everyone, so don't take it personally. Deal with jerks with poise, not poison.

Do you present problems, but not solutions?

When a problem comes up in your department and you bring it to you supervisor's attention, pose a solution at the same time. Sure, your manager's job is to solve problems, but make it your job, too. Proving you are a problem-solver is the first step to being considered for a position that involves problem-solving... like Lead Phlebotomist or Phlebotomy Supervisor. Even if you're happy with your current position, helping to solve problems is the hallmark of a team player. Should there come a time when staffing needs to be cut, team players are the last to be considered.

Do you take on extra work?

There's no rule that says you must only perform those tasks within your job description. What do you do when you're not drawing blood? If you're cleaning your department, stocking trays and draw stations, neatening up all those things that make your work area messy, and performing tasks everyone else avoids, then you have a right to be optimistic about your career and your job security. If you sit and chat, surf the Internet, place personal phone calls, or conduct other time-killing activities, you don't. If you can't find anything to tidy up, ask your manager for a menial task, even if that will bore you to tears. If it has to be done, it has to be done. Every moment of your work day can't be filled with joyful activities. That's why they call it "work."

Do you shun gossip?

Nothing erodes morale like hearsay. If you are a party to gossip, you're contributing to a destructive workplace environment. It's not just telling gossip that makes you guilty. In order for gossip to be gossip, there must be ears willing to listen. If those ears are mounted on your head, you're contributing. How do you know if it's gossip? Here's the test: if it's second-hand information of a personal or trivial nature that creates a negative impression of that person in your mind, it's gossip, even if it's true. Get up and walk away. If you're brave enough, comment on the nature of the conversation being inappropriate in the workplace. Prepare to be ostracized by gossipers and held in higher regard by everyone else.

Are you a living example of your facility's mission statement?

If so, you have a tall ladder to climb with slip-proof rungs. If not, the steps of your career ladder with that employer are greased, and you're likely to come crashing down. If your ambition is based on serving others, expect to be well-fed with opportunity. Self-serving ambition, on the other hand, can't be fed for very long before it gives you bad breath.

If you did well on this assessment, chances are you are worth promoting. Even if you're not striving for a higher position, mastering these elements will make you a cherished and valued employee in the eyes of those who pull... and cut... the strings. Should the economic climate force your managers to consider a staff reduction, valued employees keep their jobs. If you want to take this self-appraisal a bit further, take Dale Dauten's "Promotability Index" assessment online.

 

Phlebotomy Reference Book Discounted For Gifting

The Lab Draw Answer Book contains answers to nearly 400 commonly asked questions on blood sample collection and handling, and managing phlebotomy services and personnel. For the Month of December, its price is being reduced 50%, from $39.99 to $19.99.

The 440-page full-color reference book fully reflects CLSI's current venipuncture standard and the Standards of Practice of the Infusion Nurses Society as it pertains to blood sample collection from vascular-access devices.

Chapters in the book include:

• Safety and Infection Control
• Training, Management and Certification
• Skin Punctures, Heelsticks, and Pain Management
• Patient Identification, Vein Selection, & Site Prep
• Tourniquets & Butterflies
• Order of Draw & Discard Tubes
• Hemolysis and Potassium Issues
• Blood Cultures
• Labeling and Post-venipuncture Care
• Line Draws & IV Starts
• Processing, Storage, & Transportation
• Patient Injuries & Complications
• Unorthodox Techniques
• Miscellaneous

Written by Dennis J. Ernst MT(ASCP), NCPT(NCCT) and Catherine Ernst RN, PBT(ASCP), the husband-and-wife team hopes this special price helps put a copy in the hands of everyone who draws blood samples for laboratory testing.

'I've been called the phlebotomy guru many times,' says Dennis. 'Everything I know about performing and managing blood collection procedures is in this book. It's like having my brain on your desk, but without the formaldehyde.'

To order for a Christmas gift, or to preview pages.

 

Study Reinforces Proper Tube Filling

Researchers in Germany have published the results of their study on the impact of underfilling heparin tubes on test results.

In the study, over 74,000 lithium heparin tubes were either filled or 50 percent underfilled, then tested for potassium, sodium, chloride, LD, CK, total cholesterol, and  hemolysis, icterus, and lipemic indices.

Underfilling demonstrated consistently higher LD and K results and showed greater hemolysis. Other analytes remained unchanged. The authors also concluded the practice of underfilling tubes results in a higher velocity of aspiration for a higher proportion of the sample collected than for fully filled tubes where the velocity of aspiration decreases as the tube fills (and the vacuum is exhausted). The higher relative velocity of aspiration likely contributes to the higher hemolysis rates, and the higher LD and potassium levels, since red blood cells have high concentrations of both analytes. Read the abstract.

This study reinforces prior studies with similar results. A study published in 2006 showed lithium heparin tubes filled less than half significantly impact results for ALT, AST, amylase, lipase, and potassium.¹ The excess heparin that results from underfilling was also reported to cause falsely lower sodium levels. Other researchers, including Phlebotomy Today Editor, Dennis J. Ernst,  found ALT, amylase, AST, lipase, potassium, troponin, CK and GGT results significantly changed as compared to completely filled tubes.^2-4

 

References

1. Lippi G, Salvagno G, Montagnana M, Franchini M, Guidi G. Phlebotomy issues and quality improvement in results of laboratory testing. Clin Lab 2006;52(5-6):217-30.
2. Donnelly JG, Soldin SJ, Nealon DA, Hicks JM. Is heparinized plasma suitable for use in routine biochemistry? PediatrPathol Lab Med. 1995 Jul-Aug;15(4):555-9.
3. Tietz Guide to Clinical Laboratory Tests WB Saunders, St. Louis, MO (2006).
4. Lippi G, Avanzini P, Cosmai M, Aloe R, Ernst D. Incomplete filling of lithium heparin tubes affects the activity of creatine kinase and gamma-glutamyltransferase. Br J Biomed Sci 2012;69(2):67-70.

 

Product Spotlight: New Collection of ATMs

One of the Center for Phlebotomy Education's most popular product line is our Abbreviated Teaching Modules. ATMs are short 1-2-page in-house continuing education articles---each with a quiz---covering a wide variety of phlebotomy topics. Series A, B & C include 12 lessons each, one for each month. Series C is our newest set.

Now that we've rounded the series up to 36 exercises and packaged them into three sets, managers and educators can purchase a full year of continuing education at a time for facility-wide distribution (within our Terms of Use), or all 36 months worth of exercises in one download. 

The 36-module set is downloaded immediately after your online purchase as zipped PDFs with answer keys for each exercise. Titles include:

Series A

• The Order of Draw
• Hematoma Prevention
• Tourniquet Time
• Needlestick Prevention
• Hemolysis
• Patient Identification
• Acceptable Sites for Venipuncture
• Blood Cultures Done Right
• Tips for Successful Capillary Collection
• Hemoconcentration: What is it?
• The Aggressive Patient
• Geriatric Phlebotomy
• The Aggressive Patient
  

Series B

• Infants and Toddlers in the Healthcare Environment
• Drawing From Young Children
• Communicating With Elderly Patients
• Give Your Patients Their Personal Space
• Non-verbal Communication: What Message Are You Projecting?
• Bloodborne Pathogens Review
• Are You a Pathogen Parade?
• Phlebotomist’s Guide to PICC Lines, Central Catheters, and Imbedded Ports
• Therapeutic Drug Monitoring
• Customer Service Excellence
• Hand Hygiene in Phlebotomy
• Needle Phobic Patients
  

Series C (All new titles)

• Handling Autistic Patients
• I Stuck Myself! Now What?
• How Your Technique Can Change Lab Results
• Mastectomy Patients: What Are My Options?
• Patient Positioning Do's & Don'ts
• Taking Tubes For a Spin
• Phlebotomists: The Laboratory's Ambassador
• Hand Hygiene & C. diff
• Fist Pumping: Just Say "No"
• Avoiding Nerve Injury
• Your New Mantra for Collecting Newborn Screens
• Phlebotomy and the Obese Patient
  

Priced well under what you've budgeted for continuing education for next year, ATMs are the easiest way to meet requirements for continuing education as mandated by CAP, CLSI, and likely your own facility. Simply distribute one exercise to your staff each month, collect their answers to the accompanying quiz, grade it, file it, and get on with your day. 

Better yet, for the same price as the full set, join Phlebotomy Central and get access to far more articles and educational resources than you could possibly imagine including the full collection of 36 ATMs. 

Stop scouring the Internet for mediocre resources just to meet your monthly staff requirement. All ATMs are highly researched and reflect industry standards and guidelines. 

Sample ATM and more information.

 

From the Editor's Desk

Friends,

All I can say to the year 2020 as it exits our calendar later this month is "don't let the door hit you on the way out." 

With only one month left, it already smells like an old fish. I mean, when I think about the events that transpired this year, 2020 really stunk up the place. Consider the following as evidence:

• In January, hackers in Singapore stole our company's YouTube channel and uploaded over 300 of their own videos before YouTube took the channel down within a week. It took three months of pleading with YouTube to return it to us, its rightful owner. 
• In October, PayPal deactivated our web site's payment portal until we implemented a reCaptcha feature, for which they provided not a scintilla of support. We figured it out without their assistance, but it took the entire month to enable online purchases again.
• Covid. 'Nuff said. 
• Election chaos. 'Nuff said.
• The pandemic's impact on the filming of the revision of our Preventing Preanalytical Errors video, interrupting it for six months all the while not knowing if we'd ever be able to finish it.

But I'm not  a glass-half-empty kind of guy. Let me share the highlights of the Year of the Putrid Fish:

• YouTube eventually returned our channel with all our videos and subscribers intact;
• We figured out how to satisfy our credit card processor without any feedback from them whatsoever;
• Covid has not infected us or anyone in our family;
• We completed filming Preventing Preanalytical Errors and are well on our way to completing production (look for availability in February);
• We created 14 new Abbreviated Teaching Modules (ATMS) for your in-house continuing education, bringing the library up to 36 (that's three years worth of monthly exercises);
• My appointment to the CLSI Board of Directors;
• I did not have to spend any nights away from home or endure the frustrations of air travel because of conference presentations;
• Helping three outstanding and innovative companies bring/expand their products to/in marketplace in an extremely difficult environment;

At the Grand Hotel on Mackinac Island

On a personal note, the year has had more highlights than lowlights. My mother turned 95 and has so far been protected from Covid in an area of our state that's been hardest hit; I've completed the construction of a mighty fine wood shed to keep this winter's fuel dry; updating other areas of our home that have made it more to our liking; we were graced with visits by three out of five of our kids and their families; a granddaughter came to live with us in August (for a duration yet to be determined); finding the perfect place for us to worship and grow spiritually; a visit to Mackinac Island; and plenty of canoe excursions on Lake Huron.

Lastly, and certainly not the least of my highlights, both personally and professionally, is another year in service to you. I must admit the challenges in the first bullet list above have made it very difficult to continue my mission to educate in the industry and for the healthcare professions. But the Year of the Putrid Fish is now all but over, and I look forward to a fresh new scent and a calendar full of promise, opportunity, and enthusiasm to assist you to perform, teach and manage blood collection procedures according to the industry standards. 

Thank you for your constant support and emails, and the opportunities to serve you. If I can make your professional goals easier to accomplish and your problems fewer in number, I know it might just make your life more empowered and fulfilling. And if I can do that, well then I've done what I left the bench 22 years ago to do. That makes me a pretty lucky man, even in years that end up smelling like an old fish.

Merry Christmas, happy holidays, and happy New Year, to all.

Respectfully,

Dennis Ernst

 

Phlebotomy Training During a Pandemic

More and more healthcare educators today are shifting to online learning platforms in response to the pandemic to keep their staff and students at a distance. If you're not currently subscribing to the Phlebotomy Channel, it's time. If you're already a subscriber, it's time to renew.

That's because the cost to deliver high-quality content on a platform as reliable as the Phlebotomy Channel is increasing. Likewise, the cost to access it.

On January 1, 2021 we will implement a modest increase. But here's the good news: educators and supervisors who act by the end of the year can lock in today's current subscription rates, saving hundreds of dollars.

Whether you're a current subscriber or an educator who has been sitting the fence on implementing a distance learning strategy like streaming videos, you can avoid these price increases by acting now:

• a $50/year increase per title when purchased ala cart;
• a $200/year increase for facility-wide access to the entire library (All-access Pass).

Designed for facilities, academic programs and healthcare systems, the Phlebotomy Channel streams 17 of the most current phlebotomy training videos on the market to your staff and students flawlessly wherever there's a high-speed Internet connection. Once you subscribe to the Phlebotomy Channel, you'll not only get more productive, you'll get:

• Seventeen of the most popular phlebotomy training videos on the planet;
• Instant access anytime anywhere;
• The most current versions, even when the industry standards change;
• An insanely affordable cost-per-view.

During a pandemic like the one we're going through, keeping your distance from trainees is just as important as keeping their distance from each other. See why schools and hospitals around the world are rushing to the Phlebotomy Channel to flawlessly deliver high-caliber training videos safely and on demand. Plus, with real-time tracking, you'll get a full report on who watched the videos you assigned and when. You'll also be able to assess their comprehension with the CE quiz accompanying every title.

A pandemic requires innovative training strategies. Subscribe now, and lock in today's rates.

 

 

What Should We Do?: Drug Addict Self-Draws

Dear Center for Phlebotomy Education:

We have a regular patient who is an IV drug addict. Naturally, his veins are extremely hard to find. Those we can find are so scarred they can hardly be used. He keeps asking if he can insert the needle since he knows exactly where his best access sites are. We're at our wit's end with finding veins on him, and wonder what problems there might be in honoring his request. What should we do?

Our Response:

Under no circumstances should the needle be placed in the hands of any patient. Not only can it be used as a weapon if the patient has an ulterior motive, but there's another huge legal liability here. Here's how it could play out. The addict is allowed to stick himself. He injures a nerve or nicks an artery and sues for damages. Remember, your patient is an addict and is always looking for ways to finance his addiction. The addict’s attorney successfully argues that he should not have been allowed to draw his own blood because he has not been trained in the risks of the procedure. The attorney is absolutely right.

To us, it seems permitting this practice is setting your facility up for big problems. We suggest bringing this to the attention of your risk manager and establish a written policy.

 

Safety First: Capri slacks

Question: Our hospital facility has recently approved Capri-type slacks for staff as long as they are neat and professional looking. However, the lab is different. I am concerned with the risk of exposure should a specimen be dropped or should there be a splatter. My staff is enthusiastic about the new policy, but I don't think they realize the risks involved, nor do they know the policy is potentially out of compliance with safety regulations. So I'm about to become very unpopular if I fight this and try to make the lab excluded by the new permissive policy. So first, help me understand if Capri slacks allowable in the lab, and how to I keep myself from being ostracized by my own staff because of my efforts to disallow them.

Our response: We’re with you on this one. Even though the hospital approves of them, let's face it, Capri slacks are neither neat nor professional looking. But the bigger issue is that those who collect, transport and process blood or other bodily fluids are at risk of splatter when tubes and other containers containing samples drop and/or spill. You won't find anything specific to Capri pants in any document or regulation, so it's up to your facility to assess the risk. That means you have the power to establish by your own determination that you feel Capri-type slacks present an exposure risk to your staff. Once you make that determination, you are obligated by OSHA to protect your staff by banning their use in your department.

To win the battle for acceptance among your staff, you'll need to explain that it's your determination based on your experience and professional opinion that Capri slacks put your staff at risk, and because of that, you are bound by federal regulations (OSHA) to prohibit their use. You'll also need to articulate what could happen to any one of them should they be exposed below the cuffs of their Capri slacks. Finally, express that your decision is based on not only the best interests of the facility, but also their own safety. Additionally, we strongly recommend you lobby the administrators to disallow Capri slacks for laboratory staff. That way, your staff sees that there's administrative support behind your decision. Bring your safety office in on the discussion as well.

 

What's Wrong Here?

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

Last month the image we posted (right) was a train-wreck of errors. The most glaring is the way the index finger is positioned above the needle, holding the gauze in place. That's asking for a needlestick. The flow of blood in this image is already in process, so even if the index finger was used to stretch the skin above and below the intended puncture site as the needle was inserted (which it should never be, but that's another discussion), keeping the finger above the needle puts it in harm's way.

Also not the arm is bent. A slight bend is sometimes necessary to locate the vein, but the bend depicted here is far too extreme, making it impossible to effectively anchor the vein and stretch the skin. Also an issue is the manner in which the tube holder is being held. Since no needle should be inserted when held in this manner, switching to this awkward position after the vein is accessed requires significant manipulation, risking needle movement and an unintended relocation that may be injurious, or at least render the draw unsuccessful.

Finally, the device is missing a safety feature and the collector's arms are not protected with sleeves. Other than all that, there's nothing wrong here.