Safety Considerations in Phlebotomy

Vol. 20 • Issue 12 • Page 34

Part of your responsibility as the laboratory manager is to be in tune with safety concerns and considerations of your staff, including the phlebotomists. To ensure your team of phlebotomists has the interest of the patient and themselves always at heart, review the following checklists and post in a prominent location in your lab.

How phlebotomists put themselves at risk:

Drawing without gloves. Being a better phlebotomist means making no exception to this rule.

Compromising gloves. Gloves by definition have fingers. If you’re tearing the tip of your glove off, you’re no longer wearing a glove. See “drawing without gloves” above.

Not changing gloves between patients. Better phlebotomists don’t need to be lectured about passing deadly bugs from one patient to another, and consider glove changes between patients to be good insurance.

Not adhering to hand hygiene protocols. Better phlebotomists also wash their hands between glove changes or use an alcohol-based cleaner. Sure it slows them down, but the seconds lost is protection gained.

Failure to don additional personal protective equipment, or PPE (e.g., lab coat, face protection), when appropriate. Blood is a liquid, and liquids splatter. You can be a better phlebotomist by gowning up and protecting your face when drawing or processing blood samples.

Anchoring from above and below the puncture site. If you routinely put your index finger above the intended puncture site to anchor the vein, you’re setting yourself up for a needlestick.

Drawing with syringes when tube-holder assemblies will suffice. Better phlebotomists don’t use syringes unless they have to because they know how much more vulnerable they are statistically to an accidental needlestick.

Not having a sharps container at the point of use. Being a better phlebotomist means having a sharps container always within reach at the point of use. They don’t take the risk of having to transport a contaminated needle, even when the point is concealed.

Using conventional (non-safety) devices. Among the better phlebotomists, going retro on safety is inconceivable.

Recapping needles. You can be a better, and safer, phlebotomist if you vow to never recap a clean needle. That’s because if you break this habit for even an unused needle, you’ll never, ever recap a dirty one.

Using butterfly sets without a tube holder or syringe attached. When mediocre phlebotomists use a butterfly set, they pierce the tube stopper with the back-end needle without benefit of a tube holder; better phlebotomists know better, and use a tube holder adapter or syringe.

Failure to immediately activate the needle’s safety feature. Being better means being faster when it comes to clicking the needle’s safety feature or otherwise concealing the contaminated sharp.

Not discarding the needle and tube-holder assembly as a single unit. Removing the contaminated needle from a blood collection device is not the practice of the better phlebotomists out there. They know they must be disposed of as one complete unit.

Allowing sharps containers to overflow. For better phlebotomists, their cup runs over with caution, but their sharps containers never run over with needles.

Not using a safety-transfer device to evacuate a syringe. There’s only one proper way to empty a blood-filled syringe, and healthcare’s better phlebotomists know to remove the contaminated needle after activating the safety feature, discarding it, and attaching a safety transfer device to fill the tubes.

Using non-retractable skin puncture devices. If you’re one of the better phlebotomists, you have a wide variety of devices at your disposal for a variety of blood collection circumstance, but non-retractable skin puncture devices are not among them.

How phlebotomists put their patients at risk:

Failure to properly identify their patients. One thing all of the better phlebotomists have in common is that they make no exception to the proper procedure in identifying their patients. Even when the patient is their best friend, they still ask them to state their name.

Failure to safely position their patient. The better the phlebotomist, the more aware they are of the risk of patients fainting. That’s why they never draw patients who are sitting upright on their bed or an exam table, or in chairs without arm rests.

Inserting the needle at an excessive angle. Good phlebotomist know not to insert the needle at an excessive angle; better phlebotomists know what that maximum angle is and why it shouldn’t be exceeded.

Drawing from the basilic vein when safer veins are available. Being a better phlebotomist means knowing where the nerves are in the antecubital area and avoiding the basilic vein unless there are no other antecubital options.

Drawing from an unacceptable site. If you know the acceptable sites for venipuncture are the antecubital area, lateral (thumb) side of the wrist, the back of the hand and the feet/ankles (with physician’s permission), you’re a better phlebotomist than those who don’t.

Failing to immediately terminate the draw when a nerve has been provoked. Better phlebotomists bear the burden of backing out when blood draws bring bolts of shooting pain or boisterous bursts of unbearable burning.

Providing inadequate pressure to the puncture site. Pressure is something better phlebotomists know well and work to their patients’ advantage by making sure it’s applied firm and long enough so that sites don’t bleed long after they’ve left the patient.

Bandaging the site without performing a two-point check. Better phlebotomists take at least 10 seconds to observe a site after pressure is released to make sure the degree and extent of pressure was adequate.

Not anticipating adverse reactions. Studies say five out of every 200 patients will pass out during or after a blood draw. Better phlebotomists anticipate they all will and are prepared to react. One way they don’t react, though, is by using ammonia inhalants, which may complicate matters for patients who have respiratory conditions.

Prelabeling sample tubes. To be a better phlebotomist, forbid yourself from ever labeling tubes before they’re filled. Sure, you like to be organized, but should the draw fail and you forget to throw away the empty, labeled tubes, you’ve put the next patient at risk. Better phlebotomists know being organized is good, but not when doing so creates the potential for errors.

Not labeling samples at the patient’s side. Better phlebotomists always label the samples they draw in the presence of the patient. When feasible, they also have the patient verify the information on the tube. It’s just an added layer of safety and reassurance for both patient and collector. Better phlebotomists are also brave and courageous, rejecting unlabeled samples that are drawn by others.

Sacrificing safety for expediency. Better phlebotomists don’t cut procedural corners in an effort to increase productivity. So what if you shave a minute off your collection time? If you compromise patient safety in the process, you’re just better and faster at placing more patients at risk. Besides, doing things right is always more efficient than doing things over.

Multitasking. While under their care, better phlebotomists make their patient their primary focus. They know that little gaps in attention lead to gaping holes in safety and strive to keep distractions and disruptions to a minimum.

To ensure patient and collector safety, engineering and work practice controls have their place. The best phlebotomists understand that compliance with safety protocols is not just about engaging the right device at the right time in the right way. It also includes engaging the heart and mind, and knowing the choices you make-even when no one is watching-not only makes you a better phlebotomist, but your facility a better place for patients.

Lisa O. Balance is the director of Online Education for the Center of Phlebotomy Education Inc. in Corydon, IN. Portions of this were reprinted with permission from Phlebotomy Today, ©2011 Center for Phlebotomy Education Inc.

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