Phlebotomy Today

Product Spotlight: Phlebotomy Answer Book

The  Lab Draw Answer Book, published by the Center for Phlebotomy Education, contains answers to nearly 400 commonly asked questions on blood sample collection and handling, and managing phlebotomy services and personnel.

The 440-page full-color reference book fully reflects CLSI standards, OSHA guidelines, and the Standards of Practice from the Infusion Nurses Society. The second edition is co-authored by Dennis J. Ernst MT(ASCP), NCPT(NCCT) and his wife Catherine Ernst, RN, PBT(ASCP)^CM.

Chapters in the book include:

1. Safety and Infection Control
2. Training, Management and Certification
3. Skin Punctures, Heelsticks, and Pain Management
4. Patient Identification, Vein Selection, & Site Prep
5. Tourniquets & Butterflies
6. Order of Draw & Discard Tubes
7. Hemolysis and Potassium Issues
8. Blood Cultures
9. Labeling and Post-venipuncture Care
10. Line Draws & IV Starts
11. Processing, Storage, & Transportation
12. Patient Injuries & Complications
13. Unorthodox Techniques
14. Miscellaneous

Copies are currently only available from the Center for Phlebotomy Education. More information and preview pages.

 

From the Editor's Desk

Marie Moorhouse & friend

Friends,

Never underestimate the power of a rubber chicken. Seriously.

Marie Moorhouse is one of the most dynamic and delightful people I've ever met, not just in my professional circles, but in life. I first met Marie in 2015 when she came to our Phlebotomy Supervisor's Boot Camp in Charlotte, North Carolina. When she walked into the room, we had no idea how much energy and hilarity she would bring to the 3-day event. Having produced seven Boot Camps across the U.S. by then, they were becoming rather routine. Not that we don't like routine, we do. In fact we vastly prefer it to drama or chaos, both of which we've had plenty at prior Boot Camps. 

It soon became obvious that Marie was a real spitfire, packed with spunk, sparkle and sass. Between sessions, during round tables, and at the Q&A sessions she had everyone busting up, most of all, my wife Catherine and I. Marie brought just the right blend of levity and professional passion to the conference that made her presence a Godsend for all. We know the event would have been smashing success without her, we had gotten pretty good at producing a satisfying event for our attendees, but with her it was so much more. 

Prior to the Charlotte event, Catherine and I decided we were going to start a new Boot Camp Tradition. The Rubber Chicken Award would be presented at closing of the event to the attendee who made it the most fun for us. Marie was without question the first recipient. It would not be the last time she made a difference for me and for the phlebotomy community... including you. 

As you know, I have been trying to revise our popular Preventing Preanalytical Errors video for at least two years. What you don't know is that I've run into nothing but obstacles from the get-go. It's as if I had embarked upon something that refused to happen. In fact, a more fitting title would be The Video That Does Not Want To Be Made. By the time filming finally started in February at Covenant in Saginaw, Michigan it should have already been completed and streaming. But over the years I've learn that everything takes longer than you think it should. If it's a video, plan on it taking even longer.

We filmed in the laboratory at Covenant Healthcare in Saginaw, Michigan (ironically and appropriately the same facility at which I completed my medical technology internship many years ago). It took a full day to capture sample handling closeups and some pretty good footage in outpatient and inpatient environments. But our Applied Phlebotomy videos are complex, requiring multiple days of filming narrations and simulations, and reshooting scenes that didn't meet my standards of perfection from the first day. A second day of filming was planned for March. Then along came Covid-19, locking me and my film crew out of any and every healthcare setting... understandably so. Every month or so I'd check in to see if filming could resume. It couldn't. The delay in returning to the facility seemed indefinite.

Marie & me on filming day

I'm a firm believer that if you keep banging on a door that won't open, you should stop banging and move along to a door that will. That's how I felt in July when nothing was working out. Maybe the video wasn't meant to be revised. Maybe it's time to work on something else. Something easier. I had no location, no narrator, and my film crew had a limited geographic circumference in which they could now work. Then I thought of Marie. 

Like a thunderbolt, it struck me that she worked her magic at the University of Michigan in Ann Arbor, just four hours away. I had nothing to lose, so I reached out. It was a long shot, for sure. Covid still had its grip on the nation, and especially Michigan. What it was going to take to get this video back into production was something I didn't have. It required someone with spitfire, someone with award-winning spunk. someone who can make things happen. It required Marie Moorhouse.

And just like that, the door opened. Marie arranged for us to complete our filming in July, and the 3rd edition of Preventing Preanalytical Errors is now in the final phase of production. It should be available to you and other healthcare professionals and educators around the world sometime in November.

It's no coincidence Marie came to Charlotte in 2015. Our paths were destined to cross, and for good reason. Namely, so that those who draw, handle, process and transport blood samples for diagnostic testing around the world can do so properly, safely, and in a manner that assures all their patients are treated according to accurate laboratory results.

Marie will be the first to tell you her path to becoming the Lead Training Specialist over the phlebotomy services at one of the nation's most prestigious healthcare systems was predestined, but not what she had planned. Nor did she plan on coming home from Charlotte in 2015 with a rubber chicken, the power of which is not to be underestimated.

 

Take care, my friend,

Dennis

 

Blood Culture Collection Device Named Best Product in 2020

An innovative technology solution for reducing blood culture contamination was recently named as a Best Infection Prevention Product of 2020. The device, Steripath® Gen2 Initial Specimen Diversion Device® developed by Magnolia Medical Technologies was selected in partnership with The Leapfrog Group, an independent nonprofit organization that evaluates health care quality.

The device functions by diverting and sequestering the initial 1.5-2.0 mL of blood collected for culture, which is the portion known to most likely contain contaminants. Blood cultures are then collected through a second independent blood flow path, creating a vein-to-bottle closed collection system.

The selection committee evaluated each product using 4 specific criteria: effectiveness, safety (to both patients and health care workers), successful real-world implementation, and the stability of the company. When assessing safety and effectiveness, evaluations from the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) were considered, along with published research studies.

“We are honored to have been selected by Newsweek as one of the Best Infection Products of 2020,” said Greg Bullington, CEO of Magnolia Medical Technologies. “We are impressed with The Leapfrog Group’s fact-based methodology utilizing publicly available clinical data and independent market research to inform their selections.” Bullington concluded, “As a company we are dedicated to providing technology solutions that enable sepsis testing accuracy to reduce unnecessary antibiotic treatment, prevent patient harm and decrease hospital-acquired infections.”

The patented Steripath® Gen2 ISDD® is the only FDA-cleared device indicated to reduce blood culture contamination. This exclusive indication was cleared by the FDA based on peer-reviewed published controlled clinical studies demonstrating Steripath’s ability to reduce blood culture contamination by 83 and 88%.

Recently, the company also announced an initiative to reset the national blood culture benchmark from three percent to below 1.0%. The "Mission to Zero" initiative challenges healthcare professionals in clinical laboratories, emergency departments, critical care units, and infection prevention teams to pledge to work as a unified team to eliminate blood culture contamination.

"Magnolia is committed to diagnostic accuracy and the prevention of patient harm," said Bullington. "Scientific and clinical evidence proves that we can significantly improve diagnostic accuracy for sepsis testing. This data underlies our commitment to raising the bar for performance nationally with the belief that we as an industry should be targeting zero preventable diagnostic errors."

In 2005, the American Society for Clinical Microbiology established a 3% threshold for blood culture contamination. Since then, multiple peer-reviewed published studies established that a rate well below 1% is attainable with the right technology. Additionally, a multi-discipline consensus manuscript was published in Clinical Microbiology Reviews in January with a call-to-action to establish a new blood culture contamination benchmark of less than 1%.

"We are proud to introduce the Mission to ZERO initiative, empowering all healthcare workers to have a direct impact on helping prevent the risk of patients experiencing a misdiagnosis of sepsis while further enabling driving antibiotic stewardship," said Bullington. "We will achieve this mission through a combination of supporting change in national guidelines and benchmarks, Steripath® technology solutions and a strong partnership with our healthcare community – which begins with each individual patient, healthcare worker and hospital uniting as one team. As a team, we can help stop the significant clinical and economic challenges associated with false-positive blood culture results."

Blood culture contamination has been shown to increase a patient's length of stay up to 3.3 days, add up to $8720 per event, and result in an average of three days of unnecessary antibiotic administration.

More information.

 

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 instructs how to properly identify patients before drawing blood and establishes the Golden Rule of Patient Identification. 

 

 

TestTalk: HLA B27

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.

 Human Leukocyte Antigen B27 is a protein that coats white blood cells in patients with autoimmune diseases. It also refers to the gene that codes for this protein. It is found in about 6% of the U.S. population. Those whose leukocytes are coated with HLA-B27 are more likely to develop an autoimmune disease such as ankylosing spondylitis, juvenile rheumatoid arthritis, and reactive arthritis. It's also been linked to inflammatory bowel disease. HLA-B27 does not cause these disorders, but patients with them are more likely to have the protein coating their white blood cells than those who don't (6% in the general population versus up to 90% in those with these conditions).

Previous bacterial infections seem to play a role in HLA-B27's autoimmune response connection. Some researchers speculate similarities between the HLA-B27 antigen and the antigens on the surface of certain microbes signal the immune system to attack both the microbe and the patient's own tissues. After the infection, the autoimmune disorder is triggered.

HLA-B27 is drawn into EDTA tubes and, occasionally, ammonium heparin tubes. Stability at room temperature is one day or less. No patient preparation is required (e.g., fasting, recumbent, timing, etc.)

References

1. LabTestsOnline. American Association for Clinical Chemistry. AACC. Accessed.
2.  World Health Organization. Use of Anticoagulants in Diagnostic Laboratory Investigations. WHO. Geneva, Switzerland. 2002.

 

What's Wrong Here?

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

Last month, the picture we chose for your scrutiny (right) showed a patient being drawn by a healthcare worker with unprotected arms. OSHA does not specifically mandate arms to be fully covered when drawing blood samples unless the employer determines it to pose a risk of exposure. However, in the June 2009 issue of Phlebotomy Today we published the results of a survey that showed the risk is worth considering.  Approximately 134 of the 180 survey participants (74%) reported one or more incidents of blood splatter beyond the wrist when performing venipuncture procedures. Those who reported splatter beyond the hand area averaged 6.9 occurrences per person. For that reason, we consider the right to "bear arms" not to be part of anyone's constitution if phlebotomy is one of their responsibilities.

 

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.

 

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.