More on tube system and hemolysis

May 24, 2012

Volume 9, Issue 8

August, 2008

This Month:

Effects of Pneumatic Transportation on Blood Specimens

From the Editor's Desk

According to the Standards: Drawing from Triple-Lumen

Catheters

Phlebotomy in the News

Product Spotlight: Infant Heelstick Model

Tip of the Month: How Cultured Are You?

A monthly newsletter for those who

perform, teach and supervise blood

collection procedures.

Effects of Pneumatic Transportation on Blood Specimens

A laboratory manager begins to notice a high rate of hemolysis on specimens from all areas of the hospital.

She and the phlebotomy supervisor investigate the most common reasons for hemolysis, but find no

common thread. They check their centrifuges and find them all properly calibrated to spin the tubes to the

tube manufacturer's specifications. They monitor those who process the specimens to make sure tubes are

not spun prematurely or that the staff is not rimming the clots. They remind all specimen collection

personnel to allow the alcohol used to prep the puncture site to dry, and that tubes need to be gently

inverted, not vigorously mixed. They have the staff make a notation on all specimens that were drawn with

difficulty. They are assured that nobody is drawing with a 25-gauge needle. They find that hemolysis was

occurring regardless of whether the collector used a tube holder or syringe. Nothing made sense.

Having exhausted all possibilities, they complained to the tube manufacturer that the tubes themselves were

hemolyzing their specimens. Certain that it was not the tubes but how they were being used, the

manufacturer dispatched a team to investigate the problem. They observed the frequency of hemolysis first

hand, and launched a comprehensive analysis to rule out every possible known contributor to hemolysis,

much like the laboratory personnel had, with the same results. Then they turned their attention to the

pneumatic tube system. Bingo.

Tubes hand-carried to the laboratory were found to be rarely hemolyzed, whereas tubes that were

transported by the facility's pneumatic tube system showed a high rate of hemolysis. The facility ordered

padded inserts for the pneumatic transport carriers, and the problem was solved.

Too often hemolysis is blamed on the collector or the tube manufacturer without consideration for the

effects of the mode of transportation. Studies have shown that the agitation some pneumatic tube systems

exert on collection tubes is severe enough to rupture red blood cells en route to their destination.(1) In

addition, transport trauma can lyse white blood cells, forcing a release of potassium into the serum or

plasma that contributes to a falsely elevated potassium level (pseudohyperkalemia).(2) Changes to PO2

levels and antibody reactivity also make such systems unacceptable for blood bank specimens and arterial

blood gases.(3,4)

Specimens transported in pneumatic tube systems can achieve high speeds and be subjected to many

stops, starts, and turns on the way to the laboratory.(4) But according to Bill Powder, national sales

manager of Pevco (Baltimore, land), it's not the speed, turns, and stops that cause hemolysis in

today's modern systems, it's how systems are used. Pevco manufactures hospital pneumatic tube delivery

systems in use at over 600 healthcare facilities (www.pevco.com).

"Since the speed in today's systems is limited to 25 feet per second, lengthy runs, multiple turns, and long

drops are not issues anymore," says Powder. "Even on a vertical drop, the speed is maintained. The more

Page 1 of 7

common threats to pneumatically transported specimens are misuse, improper maintenance, and poorly

designed stations.

"The biggest issue we see is improper packaging. Generally, specimen tubes are placed in sealed, leakproof

bags along with foam padding. Foam should provide for very little movement within the carrier; the

snugger the better. When users take the foam padding out or use a carrier without padding, it can cause

problems. When sending blood along the system, foam- or bubble-wrap inserts really minimize the impact."

"The lack of preventative maintenance also threatens specimens," says Powder. "For example, if the

pressure-relief valves are not maintained, they can be compromised, causing carriers to come into a station

faster than they should. Additionally, if a station is not maintained, foam on receiving end can deteriorate,

reducing the cushioning effect as the carriers arrive.

What should a manager do if he/she suspects the pneumatic tube is contributing to hemolysis? "Look at the

system's maintenance records," says Powder. "Make sure the padded inserts are being used, and make

sure the system is up to date. They should also check to make sure the system isn't designed with any

upward-received or side-received carrier stations. 'Down-receive; up-send' should be the mantra. There's

really no good way to slow down a carrier when they're coming in from the bottom or the side."

Powder also suggests managers investigating hemolysis make sure that if their system releases carriers

into a free-standing basket, they aren't accumulating in the basket and being impacted by other carriers as

they arrive. He also cautions against retrofitting older systems that weren't originally designed to deliver

blood specimens.

"Today's systems are engineered with soft landing capabilities so that every carrier comes in gently, but

systems originally designed to deliver paper and other communiqués probably aren't going to work well for

blood specimen transport. In older systems, carriers bounced around within the tunnel. Today's carriers ride

snugly within a `riding band' of air. That means they no longer bang against the walls of the system on their

way. They're also bidirectional, meaning there's no front or back to a carrier.

Are you pneumatically transporting non-gel tubes and finding them hemolyzed? If so, it may not be the

transport system. One researcher concluded gel tubes provide an unknown mechanism that minimizes

hemolysis when transported through pneumatic tube systems.(1)

Since there are so many preanalytical contributors to hemolysis, troubleshooting it in your facility can be

complicated. More than likely, if your pneumatic tube system is modern, properly maintained, and used

according to the manufacturer's recommendations, it's not the problem. But if you've eliminated other

preanalytical contributors, ruling out your pneumatic tube system can be as simple as establishing a

comparative analysis of visual hemolysis as the tube manufacturer did in the opening of this article.

Alternatively, comparing the potassium or LDH levels of paired specimens transported by different means

has also been suggested in the literature.(5)

References:

1. Sodi R, Darn S, Stott A. Pneumatic tube system induced haemolysis assessing sample type

susceptibility to haemolysis. Ann Clin Biochem. 2004;41:237-240.

2. Kellerman P, Thornberry J. Pseudohyperkalemia due to pneumatic tube transport in a leukemic

patient. Am J Kidney Dis. 2005;46:746-748.

3. Bruner K, Kissling C. Evaluation of a pneumatic-tube system for delivery of blood specimens to the

blood bank. Am J Clin Pathol 1980;73(4):593-6.

4. Kratz, A. Effects of a Pneumatic Tube System on Routine and Novel Hematology and Coagulation

Parameters in Healthy Volunteers. Arch Pathol Lab Med. 2007;131:293-296.

5. Savage R. (ed) Q & A Cap Today. 2007;21(2):87.

This subscription was purchased for single-use only. If you are not the subscriber, please forward this

email to the Center for Phlebotomy Education, Inc. at support@... or contact us toll free at

866-657-9857. The identity of those who report unauthorized distribution will be kept strictly confidential.

Page 2 of 7

Notice: Do not respond to this e-newsletter. 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@....

From the Editor's Desk

When it comes to hemolysis, there's always someone to blame. Whether it's the patient, whose red blood

cells are fragile from disease or medication, or the ER who is drawing during an IV start, or a phlebotomist

who forces blood from the syringe to the tube, there's plenty of blame to go around. Of the multitude of

contributing factors, there is only one that is not a result of human error, and that is the subject of this

month's feature story. Often overlooked as a source of hemolysis, pneumatic transport systems may be your

culprit. Improperly designed, maintained or used systems, or old systems retrofitted for blood specimen

transport can render a perfectly collected specimen to be perfectly useless for clinical testing.

No doubt you will miss Sheila Dunn's OSHA column this month. Dr. Dunn sold her company, Quality

America, and is no longer able to contribute. That's good news for Sheila, who has worked hard for years

building her company to be a reputable and reliable source of information for us all and deserves a rest, but

bad news for us since we are no longer able to benefit from her wit and wisdom. Enter Tim Dumas. Known

as "The Lab Guy" in many clinical circles, Tim brings his own expertise and wit to Phlebotomy Today with a

column on customer service. I met Tim for the first time at the AACC/ASCLS conference in Washington, DC

last month. Our meeting confirmed my suspicions: Tim is a perfect fit for Phlebotomy Today. I think you'll

agree.

On my way home from DC, I picked up a copy of USA Today and found an article about, of all things, fist

pumping during venipuncture. It's no news to you and I that fist pumping causes a falsely elevated

potassium level, but what's interesting here is that the editors at USA Today found it newsworthy, and

thought their 2 million plus readers needed to know. Here at the Center for Phlebotomy Education are

thrilled that the mainstream media is finally realizing how important proper blood specimen collection is to

accurate test results. Now that we know they're interested, we'll raise our voices in their direction.

Respectfully,

Dennis J. Ernst MT(ASCP), Editor

phlebotomy@...

Notice: Do not respond to this e-newsletter. 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@....

According to the Standards

Drawing from Triple-Lumen Catheters

Question: With a triple lumen catheter, do all ports need to be shut off for a certain amount of time before

collecting the specimen? Should there be a volume discarded before withdrawing blood to be tested?

Answer: According to the Infusion Nurses Society's Procedures and Policies for Infusion Nursing, the

procedure for withdrawing blood from a triple lumen catheter is the same as what the CLSI venipuncture

standard says for drawing from any vascular access device. That is, discontinue the infusion into the site for

Page 3 of 7

at least 2 minutes. The lumen through which the blood is to be drawn should be flushed with 5 cc of saline,

and a discard volume withdrawn prior to collecting the specimen. The discard volume should be twice the

dead-space volume of the catheter for all labs except coags, which require 6 times the dead-space volume.

Five cc is usually sufficient. Confirm this with your facility's policy and make sure the policy squares with the

standards.

[Editor's note: For a copy of the CLSI venipuncture standard, H3-A6, "Procedures for the Collection of

Diagnostic Blood Specimens by Venipuncture," visit the "Downloads" section of the Center for Phlebotomy

Education's web site at www.phlebotomy.com/Downloads.html.]

Phlebotomy in the News

Phlebotomist Honored for Saving Patient's Life

A phlebotomist in Terre Haute, Indiana is credited for helping save the life of a patient by assisting in

emergency CPR when he collapsed from a heart attack. Harry Husa, 67, had just finished playing table

tennis when he went into cardiac arrest. The phlebotomist and a nurse immediately started and maintained

CPR until the ambulance arrived.

Full story: http://www.jconline.com/apps/pbcs.dll/article?AID=/20080708/NEWS/807080304

Hospitals Using Color-Coded Bracelets to Warn Phlebotomists

Patients wearing a pink wrist bracelet in three Illinois hospitals have a message for their phlebotomists: "I

have restrictions on where you can draw." The innovative approach is designed to identify mastectomy

patients or patients with conditions that preclude the use of specific draw sites.

Full story: http://www.pantagraph.com/articles/2008/07/14/news/doc487bfcbfe55de838414715.txt

Alleged Killer Confesses to Phlebotomist

A Kentucky phlebotomist testified last month that while she was drawing blood from an intoxicated

emergency room patient, the patient admitted to killing the Clay City police chief, who was found shot to

death earlier that day.

Full story: http://bluegrassbeat.wordpress.com/2008/07/11/witnesses-man-admitted-shooting-police-chief/

Lancets Reused on over 180,000 Patients

A recent survey conducted in Japan found that over 180,000 patients were subjected to fingersticks

involving used lancets.

Full story: http://www.chicagotribune.com/news/nationworld/chi-web-0625-bloodjun26,0,4867149.story

Notice: Do not respond to this e-newsletter. 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@....

This subscription was purchased for single-use only. If you are not the subscriber, please forward this email

to the Center for Phlebotomy Education, Inc. at support@... or contact us toll free at 866-657-

9857. The identity of those who report unauthorized distribution will be kept strictly confidential.

Page 4 of 7

Ask the Lab Guy

By Tim Dumas MT(ASCP)

Tim Dumas, aka "The Lab Guy," is a clinical laboratory scientist,

manager, and consultant with almost 30 years of knowledge and

experience in the field. He consults with laboratory managers,

physicians, equipment distributors and laboratory information system

manufacturers, and is a highly recruited professional speaker and

author. Each month, Tim will be working his magic for you by pulling

solutions to your customer service problems out of thin air while

telepathically tickling your funny bone.

Phlebotomy Today welcomes Tim Dumas, aka "The Lab Guy," as our latest columnist. For over 30 years

Tim has worked as a clinical laboratory scientist, manager, and consultant. Besides consulting for physician

office laboratories, equipment distributors, and laboratory information system manufacturers, Tim is an

author and highly recruited speaker with NSA credentials (National Speakers Association). He attended

laboratory training at MidWestern State University and earned his laboratory degree through the United

States Air Force.

In addition to his day job, Tim practices and studies his true love; making people laugh. Professional

magician, humorist, and a graduate of Artistic New Directions in New York City, Tim combines his business

background and performing talent to present educational AND entertaining interactive workshops across the

US. Tim helps clients enhance employee morale and improve their quality of care, and provides strategies

for maximizing lab revenue. At the core of everything Tim does is his dedication to helping people imagine

the impossible and find a way to do it.

Question: Patients want to tell me where to stick them and that I have to use a butterfly. I don't like to use

butterflies unless the situation requires it, and I don't think the patient should be picking the site for me.

How do I respond to patient requests that I'm not comfortable with?

Answer: Empathy is the key to quality patient service. Try to understand that when a patient attempts to

"assist" you with your job, they have probably had a bad experience in the past. They truly believe that their

recommendation will help you (and them of course!).

When I have encountered this situation (and who hasn't), I found it best to check my ego and accept their

suggestion in the spirit it was given. So the first option should be to assess that site. If it is acceptable, draw

from that site using which ever needle you prefer. If the site is unacceptable, explain why you do not want

to use it and kindly ask their permission to try a different location. Remember: "Please", "Thank You", and a

smile go a long way.

Most patients have the misperception that a butterfly needle is the most painless method of obtaining blood.

Try explaining that a tube holder assembly is easier to handle, and will provide better blood flow. Tell them

that you are so proficient and the difference in size (gauge) is so negligible that they will not experience any

increased discomfort.

When you successfully obtain a blood sample you will win a client/patient for life and a great reputation as a

knowledgeable, friendly phlebotomist.

Have a phlebotomy-related question for "The Lab Guy"? Send Tim an email at tim@....

Product Spotlight

Page 5 of 7

Infant Heelstick Model

New this month from the Center for Phlebotomy Education, Inc. are

simulated infant feet for heelstick training. The feet are made of

compressed foam and are perfect for training staff or students to

perform infant heelsticks properly and learn appropriate squeezing

techniques. The recommended sites for heel punctures according to

CLSI are indicated by green ovals. (Punctures do not produce

simulated blood.) The Infant Heelstick Model is available in packs of

three at: www.phlebotomy.com/TrainingAids.html

Tip of the Month

How Cultured Are You?

There's an old saying, find a job you love and you will never work a day in your life. But as a phlebotomist,

how do you find a job that's right for you? The dividing line between delight and drudgery in the workplace

often comes down to the corporate culture and how compatible it is with your own core beliefs, goals and

work ethic. Corporate culture can be defined as the combination of attitudes, values and expectations held

by an organization.

So, how cultured are you? To find out, evaluate your employer's corporate culture in the following areas:

A Culture of Safety. Does your employer provide and promote a safe work environment? Are employees

properly trained, supplied with appropriate personal protective equipment, expected to comply with safety

protocols, and encouraged to report safety hazards, observed violations or occupational exposures?

Employers that embrace a culture of safety not only respond to such reporting, they value it. In terms of

patient safety, does your facility have and consistently adhere to a written patient identification policy?

When risk management isn't management's priority, sooner or later somebody's going to get hurt. It could

be you, a coworker or a patient. Bottom line—If safety in the workplace doesn't come first, you won't last.

A Culture of Quality. A culture of quality evaluates processes and looks at how all the parts and people

work together. It continually strives to reduce errors and streamline workflow. Does your employer aim for

excellence by removing obstacles to doing the right thing, the right way, the first time? Quality also comes

from the inside out. Just ask any oyster. The pearl exemplifies one of nature's greatest workarounds.

Irritated by sand, the oyster doesn't look for someone to blame, it simply starts the work it knows to do that

ends in a quality product. When the corporate culture is one that "cuts corners" or believes "the end justifies

the means" confidence in the leadership is lost. Likewise, a culture of blame is one that focuses on

problems and misses out on opportunities for long-term improvement.

A Culture of Professionalism. Astute institutions recognize the critical role phlebotomists play in providing

good customer service and obtaining favorable patient satisfaction surveys. As frontline employees who are

often considered the facility's "public face", the appearance, conduct and abilities exhibited by the

phlebotomist shape the patient's experience. Does your employer hold its employees to a high standard of

professionalism? Is pride in the profession and continuing education supported by management? ish

historian, Carlyle describes culture as the process by which a person becomes all that they were

created capable of being. A culture of professionalism embraces that philosophy, with management

promoting professional development of its employees.

So, how cultured are you?

You'll know you've found the right job when the corporate culture inspires, engages, and motivates you.

Undoubtedly, there will be a few irritating grains of sand along the way. But a work environment that is

compatible with your own professional goals and beliefs is worth a few workarounds. The end product will

be amazing. Just ask any oyster.

Page 6 of 7

Post this Tip!

To print an attractive display of this Tip for posting in collection areas, bulletin boards, break rooms, etc.,

click here for a PDF version.

This subscription was purchased for single-use only. If you are not the subscriber, please forward this

email to the Center for Phlebotomy Education, Inc. at support@... or contact us toll free at

866-657-9857. The identity of those who report unauthorized distribution will be kept strictly confidential.

Notice: Do not respond to this e-newsletter. 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@....

Newsletter Help

*Phlebotomy Today is a 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@....

*For images to appear, you must be logged on to the Internet. If you have an idea for an article or Tip of the Month, send me an email at phlebotomy@....

*Having a problem with reading or receiving the newsletter? Your satisfaction is important to us. Let us know by sending an email to phlebotomy@...

*Interested in forwarding or reprinting content from Phlebotomy Today? Read our copyright policy at http://www.phlebotomy.com/CopyrightPolicy.html

Unsubscribe Information: This email is sent to you because you have completed our online subscription form. If you would like to be removed from this list and

no longer receive Phlebotomy Today, 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 Phlebotomy Today issue. Send to:

Unsubscribe Phlebotomy Today

c/o Center for Phlebotomy Education, Inc.

P.O. Box 161

Ramsey, IN 47166

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.

Page 7 of 7

May 24, 2012

Been some time since our VA has undergone renovations so not likely to have

updated tube system. I should add that about 2006 they started an addition of a

third floor to the Primary Care Outpatient building. At this time it is on hold

and it may be years before it is done. Reason is that the contractor took the

money and ran.

>

> www.phlebotomy.com. August, 2008. Single-User

>

> Volume 9, Issue 8

>

> August, 2008

>

> This Month:

>

> Effects of Pneumatic Transportation on Blood Specimens

>

> From the Editor's Desk

>

> According to the Standards: Drawing from Triple-Lumen

>

> Catheters

>

> Phlebotomy in the News

>

> Product Spotlight: Infant Heelstick Model

>

> Tip of the Month: How Cultured Are You?

>

> A monthly newsletter for those who

>

> perform, teach and supervise blood

>

> collection procedures.

>

> Click here to view our copyright policy.

>

> Effects of Pneumatic Transportation on Blood Specimens

>

> A laboratory manager begins to notice a high rate of hemolysis on

> specimens from all areas of the hospital.

>

> She and the phlebotomy supervisor investigate the most common reasons

> for hemolysis, but find no

>

> common thread. They check their centrifuges and find them all properly

> calibrated to spin the tubes to the

>

> tube manufacturer's specifications. They monitor those who process

> the specimens to make sure tubes are

>

> not spun prematurely or that the staff is not rimming the clots. They

> remind all specimen collection

>

> personnel to allow the alcohol used to prep the puncture site to dry,

> and that tubes need to be gently

>

> inverted, not vigorously mixed. They have the staff make a notation on

> all specimens that were drawn with

>

> difficulty. They are assured that nobody is drawing with a 25-gauge

> needle. They find that hemolysis was

>

> occurring regardless of whether the collector used a tube holder or

> syringe. Nothing made sense.

>

> Having exhausted all possibilities, they complained to the tube

> manufacturer that the tubes themselves were

>

> hemolyzing their specimens. Certain that it was not the tubes but how

> they were being used, the

>

> manufacturer dispatched a team to investigate the problem. They observed

> the frequency of hemolysis first

>

> hand, and launched a comprehensive analysis to rule out every possible

> known contributor to hemolysis,

>

> much like the laboratory personnel had, with the same results. Then they

> turned their attention to the

>

> pneumatic tube system. Bingo.

>

> Tubes hand-carried to the laboratory were found to be rarely hemolyzed,

> whereas tubes that were

>

> transported by the facility's pneumatic tube system showed a high

> rate of hemolysis. The facility ordered

>

> padded inserts for the pneumatic transport carriers, and the problem was

> solved.

>

> Too often hemolysis is blamed on the collector or the tube manufacturer

> without consideration for the

>

> effects of the mode of transportation. Studies have shown that the

> agitation some pneumatic tube systems

>

> exert on collection tubes is severe enough to rupture red blood cells en

> route to their destination.(1) In

>

> addition, transport trauma can lyse white blood cells, forcing a release

> of potassium into the serum or

>

> plasma that contributes to a falsely elevated potassium level

> (pseudohyperkalemia).(2) Changes to PO2

>

> levels and antibody reactivity also make such systems unacceptable for

> blood bank specimens and arterial

>

> blood gases.(3,4)

>

> Specimens transported in pneumatic tube systems can achieve high speeds

> and be subjected to many

>

> stops, starts, and turns on the way to the laboratory.(4) But according

> to Bill Powder, national sales

>

> manager of Pevco (Baltimore, land), it's not the speed, turns,

> and stops that cause hemolysis in

>

> today's modern systems, it's how systems are used. Pevco

> manufactures hospital pneumatic tube delivery

>

> systems in use at over 600 healthcare facilities (www.pevco.com).

>

> " Since the speed in today's systems is limited to 25 feet per

> second, lengthy runs, multiple turns, and long

>

> drops are not issues anymore, " says Powder. " Even on a vertical

> drop, the speed is maintained. The more

>

> Page 1 of 7

>

> www.phlebotomy.com. August, 2008. Single-User

>

> common threats to pneumatically transported specimens are misuse,

> improper maintenance, and poorly

>

> designed stations.

>

> " The biggest issue we see is improper packaging. Generally, specimen

> tubes are placed in sealed, leakproof

>

> bags along with foam padding. Foam should provide for very little

> movement within the carrier; the

>

> snugger the better. When users take the foam padding out or use a

> carrier without padding, it can cause

>

> problems. When sending blood along the system, foam- or bubble-wrap

> inserts really minimize the impact. "

>

> " The lack of preventative maintenance also threatens specimens, "

> says Powder. " For example, if the

>

> pressure-relief valves are not maintained, they can be compromised,

> causing carriers to come into a station

>

> faster than they should. Additionally, if a station is not maintained,

> foam on receiving end can deteriorate,

>

> reducing the cushioning effect as the carriers arrive.

>

> What should a manager do if he/she suspects the pneumatic tube is

> contributing to hemolysis? " Look at the

>

> system's maintenance records, " says Powder. " Make sure the

> padded inserts are being used, and make

>

> sure the system is up to date. They should also check to make sure the

> system isn't designed with any

>

> upward-received or side-received carrier stations. 'Down-receive;

> up-send' should be the mantra. There's

>

> really no good way to slow down a carrier when they're coming in

> from the bottom or the side. "

>

> Powder also suggests managers investigating hemolysis make sure that if

> their system releases carriers

>

> into a free-standing basket, they aren't accumulating in the basket

> and being impacted by other carriers as

>

> they arrive. He also cautions against retrofitting older systems that

> weren't originally designed to deliver

>

> blood specimens.

>

> " Today's systems are engineered with soft landing capabilities

> so that every carrier comes in gently, but

>

> systems originally designed to deliver paper and other communiqués

> probably aren't going to work well for

>

> blood specimen transport. In older systems, carriers bounced around

> within the tunnel. Today's carriers ride

>

> snugly within a `riding band' of air. That means they no longer

> bang against the walls of the system on their

>

> way. They're also bidirectional, meaning there's no front or

> back to a carrier.

>

> Are you pneumatically transporting non-gel tubes and finding them

> hemolyzed? If so, it may not be the

>

> transport system. One researcher concluded gel tubes provide an unknown

> mechanism that minimizes

>

> hemolysis when transported through pneumatic tube systems.(1)

>

> Since there are so many preanalytical contributors to hemolysis,

> troubleshooting it in your facility can be

>

> complicated. More than likely, if your pneumatic tube system is modern,

> properly maintained, and used

>

> according to the manufacturer's recommendations, it's not the

> problem. But if you've eliminated other

>

> preanalytical contributors, ruling out your pneumatic tube system can be

> as simple as establishing a

>

> comparative analysis of visual hemolysis as the tube manufacturer did in

> the opening of this article.

>

> Alternatively, comparing the potassium or LDH levels of paired specimens

> transported by different means

>

> has also been suggested in the literature.(5)

>

> References:

>

> 1. Sodi R, Darn S, Stott A. Pneumatic tube system induced haemolysis

> assessing sample type

>

> susceptibility to haemolysis. Ann Clin Biochem. 2004;41:237-240.

>

> 2. Kellerman P, Thornberry J. Pseudohyperkalemia due to pneumatic tube

> transport in a leukemic

>

> patient. Am J Kidney Dis. 2005;46:746-748.

>

> 3. Bruner K, Kissling C. Evaluation of a pneumatic-tube system for

> delivery of blood specimens to the

>

> blood bank. Am J Clin Pathol 1980;73(4):593-6.

>

> 4. Kratz, A. Effects of a Pneumatic Tube System on Routine and Novel

> Hematology and Coagulation

>

> Parameters in Healthy Volunteers. Arch Pathol Lab Med. 2007;131:293-296.

>

> 5. Savage R. (ed) Q & A Cap Today. 2007;21(2):87.

>

> This subscription was purchased for single-use only. If you are not the

> subscriber, please forward this

>

> email to the Center for Phlebotomy Education, Inc. at

> support@... or contact us toll free at

>

> 866-657-9857. The identity of those who report unauthorized distribution

> will be kept strictly confidential.

>

> Page 2 of 7

>

> www.phlebotomy.com. August, 2008. Single-User

>

> Notice: Do not respond to this e-newsletter. 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@...

>

> From the Editor's Desk

>

> When it comes to hemolysis, there's always someone to blame. Whether

> it's the patient, whose red blood

>

> cells are fragile from disease or medication, or the ER who is drawing

> during an IV start, or a phlebotomist

>

> who forces blood from the syringe to the tube, there's plenty of

> blame to go around. Of the multitude of

>

> contributing factors, there is only one that is not a result of human

> error, and that is the subject of this

>

> month's feature story. Often overlooked as a source of hemolysis,

> pneumatic transport systems may be your

>

> culprit. Improperly designed, maintained or used systems, or old systems

> retrofitted for blood specimen

>

> transport can render a perfectly collected specimen to be perfectly

> useless for clinical testing.

>

> No doubt you will miss Sheila Dunn's OSHA column this month. Dr.

> Dunn sold her company, Quality

>

> America, and is no longer able to contribute. That's good news for

> Sheila, who has worked hard for years

>

> building her company to be a reputable and reliable source of

> information for us all and deserves a rest, but

>

> bad news for us since we are no longer able to benefit from her wit and

> wisdom. Enter Tim Dumas. Known

>

> as " The Lab Guy " in many clinical circles, Tim brings his own

> expertise and wit to Phlebotomy Today with a

>

> column on customer service. I met Tim for the first time at the

> AACC/ASCLS conference in Washington, DC

>

> last month. Our meeting confirmed my suspicions: Tim is a perfect fit

> for Phlebotomy Today. I think you'll

>

> agree.

>

> On my way home from DC, I picked up a copy of USA Today and found an

> article about, of all things, fist

>

> pumping during venipuncture. It's no news to you and I that fist

> pumping causes a falsely elevated

>

> potassium level, but what's interesting here is that the editors at

> USA Today found it newsworthy, and

>

> thought their 2 million plus readers needed to know. Here at the Center

> for Phlebotomy Education are

>

> thrilled that the mainstream media is finally realizing how important

> proper blood specimen collection is to

>

> accurate test results. Now that we know they're interested,

> we'll raise our voices in their direction.

>

> Respectfully,

>

> Dennis J. Ernst MT(ASCP), Editor

>

> phlebotomy@...

>

> Notice: Do not respond to this e-newsletter. 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@...

>

> According to the Standards

>

> Drawing from Triple-Lumen Catheters

>

> Question: With a triple lumen catheter, do all ports need to be shut off

> for a certain amount of time before

>

> collecting the specimen? Should there be a volume discarded before

> withdrawing blood to be tested?

>

> Answer: According to the Infusion Nurses Society's Procedures and

> Policies for Infusion Nursing, the

>

> procedure for withdrawing blood from a triple lumen catheter is the same

> as what the CLSI venipuncture

>

> standard says for drawing from any vascular access device. That is,

> discontinue the infusion into the site for

>

> Page 3 of 7

>

> www.phlebotomy.com. August, 2008. Single-User

>

> at least 2 minutes. The lumen through which the blood is to be drawn

> should be flushed with 5 cc of saline,

>

> and a discard volume withdrawn prior to collecting the specimen. The

> discard volume should be twice the

>

> dead-space volume of the catheter for all labs except coags, which

> require 6 times the dead-space volume.

>

> Five cc is usually sufficient. Confirm this with your facility's policy

> and make sure the policy squares with the

>

> standards.

>

> [Editor's note: For a copy of the CLSI venipuncture standard, H3-A6,

> " Procedures for the Collection of

>

> Diagnostic Blood Specimens by Venipuncture, " visit the " Downloads "

> section of the Center for Phlebotomy

>

> Education's web site at www.phlebotomy.com/Downloads.html.]

>

> Phlebotomy in the News

>

> Phlebotomist Honored for Saving Patient's Life

>

> A phlebotomist in Terre Haute, Indiana is credited for helping save the

> life of a patient by assisting in

>

> emergency CPR when he collapsed from a heart attack. Harry Husa, 67, had

> just finished playing table

>

> tennis when he went into cardiac arrest. The phlebotomist and a nurse

> immediately started and maintained

>

> CPR until the ambulance arrived.

>

> Full story:

> http://www.jconline.com/apps/pbcs.dll/article?AID=/20080708/NEWS/8070803\

> 04

>

> Hospitals Using Color-Coded Bracelets to Warn Phlebotomists

>

> Patients wearing a pink wrist bracelet in three Illinois hospitals have

> a message for their phlebotomists: " I

>

> have restrictions on where you can draw. " The innovative approach is

> designed to identify mastectomy

>

> patients or patients with conditions that preclude the use of specific

> draw sites.

>

> Full story:

> http://www.pantagraph.com/articles/2008/07/14/news/doc487bfcbfe55de83841\

> 4715.txt

>

> Alleged Killer Confesses to Phlebotomist

>

> A Kentucky phlebotomist testified last month that while she was drawing

> blood from an intoxicated

>

> emergency room patient, the patient admitted to killing the Clay City

> police chief, who was found shot to

>

> death earlier that day.

>

> Full story:

> http://bluegrassbeat.wordpress.com/2008/07/11/witnesses-man-admitted-sho\

> oting-police-chief/

>

> Lancets Reused on over 180,000 Patients

>

> A recent survey conducted in Japan found that over 180,000 patients were

> subjected to fingersticks

>

> involving used lancets.

>

> Full story:

> http://www.chicagotribune.com/news/nationworld/chi-web-0625-bloodjun26,0\

> ,4867149.story

>

> Notice: Do not respond to this e-newsletter. 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@...

>

> This subscription was purchased for single-use only. If you are not the

> subscriber, please forward this email

>

> to the Center for Phlebotomy Education, Inc. at support@...

> or contact us toll free at 866-657-

>

> 9857. The identity of those who report unauthorized distribution will be

> kept strictly confidential.

>

> Page 4 of 7

>

> www.phlebotomy.com. August, 2008. Single-User

>

> Ask the Lab Guy

>

> By Tim Dumas MT(ASCP)

>

> Tim Dumas, aka " The Lab Guy, " is a clinical laboratory

> scientist,

>

> manager, and consultant with almost 30 years of knowledge and

>

> experience in the field. He consults with laboratory managers,

>

> physicians, equipment distributors and laboratory information system

>

> manufacturers, and is a highly recruited professional speaker and

>

> author. Each month, Tim will be working his magic for you by pulling

>

> solutions to your customer service problems out of thin air while

>

> telepathically tickling your funny bone.

>

> Phlebotomy Today welcomes Tim Dumas, aka " The Lab Guy, " as our

> latest columnist. For over 30 years

>

> Tim has worked as a clinical laboratory scientist, manager, and

> consultant. Besides consulting for physician

>

> office laboratories, equipment distributors, and laboratory information

> system manufacturers, Tim is an

>

> author and highly recruited speaker with NSA credentials (National

> Speakers Association). He attended

>

> laboratory training at MidWestern State University and earned his

> laboratory degree through the United

>

> States Air Force.

>

> In addition to his day job, Tim practices and studies his true love;

> making people laugh. Professional

>

> magician, humorist, and a graduate of Artistic New Directions in New

> York City, Tim combines his business

>

> background and performing talent to present educational AND entertaining

> interactive workshops across the

>

> US. Tim helps clients enhance employee morale and improve their quality

> of care, and provides strategies

>

> for maximizing lab revenue. At the core of everything Tim does is his

> dedication to helping people imagine

>

> the impossible and find a way to do it.

>

> Question: Patients want to tell me where to stick them and that I have

> to use a butterfly. I don't like to use

>

> butterflies unless the situation requires it, and I don't think the

> patient should be picking the site for me.

>

> How do I respond to patient requests that I'm not comfortable with?

>

> Answer: Empathy is the key to quality patient service. Try to understand

> that when a patient attempts to

>

> " assist " you with your job, they have probably had a bad

> experience in the past. They truly believe that their

>

> recommendation will help you (and them of course!).

>

> When I have encountered this situation (and who hasn't), I found it

> best to check my ego and accept their

>

> suggestion in the spirit it was given. So the first option should be to

> assess that site. If it is acceptable, draw

>

> from that site using which ever needle you prefer. If the site is

> unacceptable, explain why you do not want

>

> to use it and kindly ask their permission to try a different location.

> Remember: " Please " , " Thank You " , and a

>

> smile go a long way.

>

> Most patients have the misperception that a butterfly needle is the most

> painless method of obtaining blood.

>

> Try explaining that a tube holder assembly is easier to handle, and will

> provide better blood flow. Tell them

>

> that you are so proficient and the difference in size (gauge) is so

> negligible that they will not experience any

>

> increased discomfort.

>

> When you successfully obtain a blood sample you will win a

> client/patient for life and a great reputation as a

>

> knowledgeable, friendly phlebotomist.

>

> Have a phlebotomy-related question for " The Lab Guy " ? Send Tim

> an email at tim@...

>

> Product Spotlight

>

> Page 5 of 7

>

> www.phlebotomy.com. August, 2008. Single-User

>

> Infant Heelstick Model

>

> New this month from the Center for Phlebotomy Education, Inc. are

>

> simulated infant feet for heelstick training. The feet are made of

>

> compressed foam and are perfect for training staff or students to

>

> perform infant heelsticks properly and learn appropriate squeezing

>

> techniques. The recommended sites for heel punctures according to

>

> CLSI are indicated by green ovals. (Punctures do not produce

>

> simulated blood.) The Infant Heelstick Model is available in packs of

>

> three at: www.phlebotomy.com/TrainingAids.html

>

> Tip of the Month

>

> How Cultured Are You?

>

> There's an old saying, find a job you love and you will never work a

> day in your life. But as a phlebotomist,

>

> how do you find a job that's right for you? The dividing line

> between delight and drudgery in the workplace

>

> often comes down to the corporate culture and how compatible it is with

> your own core beliefs, goals and

>

> work ethic. Corporate culture can be defined as the combination of

> attitudes, values and expectations held

>

> by an organization.

>

> So, how cultured are you? To find out, evaluate your employer's

> corporate culture in the following areas:

>

> A Culture of Safety. Does your employer provide and promote a safe work

> environment? Are employees

>

> properly trained, supplied with appropriate personal protective

> equipment, expected to comply with safety

>

> protocols, and encouraged to report safety hazards, observed violations

> or occupational exposures?

>

> Employers that embrace a culture of safety not only respond to such

> reporting, they value it. In terms of

>

> patient safety, does your facility have and consistently adhere to a

> written patient identification policy?

>

> When risk management isn't management's priority, sooner or

> later somebody's going to get hurt. It could

>

> be you, a coworker or a patient. Bottom line—If safety in the

> workplace doesn't come first, you won't last.

>

> A Culture of Quality. A culture of quality evaluates processes and looks

> at how all the parts and people

>

> work together. It continually strives to reduce errors and streamline

> workflow. Does your employer aim for

>

> excellence by removing obstacles to doing the right thing, the right

> way, the first time? Quality also comes

>

> from the inside out. Just ask any oyster. The pearl exemplifies one of

> nature's greatest workarounds.

>

> Irritated by sand, the oyster doesn't look for someone to blame, it

> simply starts the work it knows to do that

>

> ends in a quality product. When the corporate culture is one that

> " cuts corners " or believes " the end justifies

>

> the means " confidence in the leadership is lost. Likewise, a culture

> of blame is one that focuses on

>

> problems and misses out on opportunities for long-term improvement.

>

> A Culture of Professionalism. Astute institutions recognize the critical

> role phlebotomists play in providing

>

> good customer service and obtaining favorable patient satisfaction

> surveys. As frontline employees who are

>

> often considered the facility's " public face " , the

> appearance, conduct and abilities exhibited by the

>

> phlebotomist shape the patient's experience. Does your employer hold

> its employees to a high standard of

>

> professionalism? Is pride in the profession and continuing education

> supported by management? ish

>

> historian, Carlyle describes culture as the process by which a

> person becomes all that they were

>

> created capable of being. A culture of professionalism embraces that

> philosophy, with management

>

> promoting professional development of its employees.

>

> So, how cultured are you?

>

> You'll know you've found the right job when the corporate

> culture inspires, engages, and motivates you.

>

> Undoubtedly, there will be a few irritating grains of sand along the

> way. But a work environment that is

>

> compatible with your own professional goals and beliefs is worth a few

> workarounds. The end product will

>

> be amazing. Just ask any oyster.

>

> Page 6 of 7

>

> www.phlebotomy.com. August, 2008. Single-User

>

> Post this Tip!

>

> To print an attractive display of this Tip for posting in collection

> areas, bulletin boards, break rooms, etc.,

>

> click here for a PDF version.

>

> This subscription was purchased for single-use only. If you are not the

> subscriber, please forward this

>

> email to the Center for Phlebotomy Education, Inc. at

> support@... or contact us toll free at

>

> 866-657-9857. The identity of those who report unauthorized distribution

> will be kept strictly confidential.

>

> Notice: Do not respond to this e-newsletter. 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@...

>

> Newsletter Help

>

> *Phlebotomy Today is a 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@...

>

> *For images to appear, you must be logged on to the Internet. If you

> have an idea for an article or Tip of the Month, send me an email at

> phlebotomy@...

>

> *Having a problem with reading or receiving the newsletter? Your

> satisfaction is important to us. Let us know by sending an email to

> phlebotomy@...

>

> *Interested in forwarding or reprinting content from Phlebotomy Today?

> Read our copyright policy at

> http://www.phlebotomy.com/CopyrightPolicy.html

>

> Unsubscribe Information: This email is sent to you because you have

> completed our online subscription form. If you would like to be removed

> from this list and

>

> no longer receive Phlebotomy Today, 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 Phlebotomy

> Today issue. Send to:

>

> Unsubscribe Phlebotomy Today

>

> c/o Center for Phlebotomy Education, Inc.

>

> P.O. Box 161

>

> Ramsey, IN 47166

>

> 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.

>

> Page 7 of 7

>

Sign In

More on tube system and hemolysis

Recommended Posts

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Join the conversation

Activity