Case studies of blood draw

Most phlebotomists don’t think that a venipuncture can land them in the witness chair desperately defending their technique; most phlebotomy supervisors don’t realize they can be called as the next witness to defend their hiring and training practices. In today’s litigious society, it would be easy to discount phlebotomy-related lawsuits as the frivolous pursuit of ill-gotten gains. Many patients, however, are suffering and suing with just cause.

Phlebotomy is one of the most underestimated procedures in health care. It’s a heavily detailed invasive procedure requiring the collector to perform a complex sequence of maneuvers to be performed properly and safely.

Labortory Manager Magazine has collected 12 interesting case studies of phlebotomy and related legal issues.


Read more:
Phlebotomy Meets The Law

Source: Laboratory Manager

Blood Tube Tree

Merry Christmas and Happy Holidays to all medical laboratory professionals.

Source: Facebook via Monica Cociasu‎

Blood draw and vacuum tube selection

AACC has created a slide share presentation about phlebotomy and how to select tube type.


Open presentation here::
Pearls of laboratory medicine

Source: AACC

Capillary blood sampling

National recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine

Capillary blood sampling is a medical procedure aimed at assisting in patient diagnosis, management and treatment, and is increasingly used worldwide, in part because of the increasing availability of point-of-care testing. It is also frequently used to obtain small blood volumes for laboratory testing because it minimizes pain. The capillary blood sampling procedure can influence the quality of the sample as well as the accuracy of test results, highlighting the need for immediate, widespread standardization. A recent nationwide survey of policies and practices related to capillary blood sampling in medical laboratories in Croatia has shown that capillary sampling procedures are not standardized and that only a small proportion of Croatian laboratories comply with guidelines from the Clinical Laboratory Standards Institute (CLSI) or the World Health Organization (WHO). The aim of this document is to provide recommendations for capillary blood sampling. This document has been produced by the Working Group for Capillary Blood Sampling within the Croatian Society of Medical Biochemistry and Laboratory Medicine. Our recommendations are based on existing available standards and recommendations (WHO Best Practices in Phlebotomy, CLSI GP42-A6 and CLSI C46-A2), which have been modified based on local logistical, cultural, legal and regulatory requirements.

Read more:
Capillary blood sampling: national recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine

Source: NCBI, Biochemica Medica
Image: Facebook via diagnosci.pl

Blood Drop

Often called a “Digital Age Leonardo da Vinci”, Alexander Tsiaras is a digital innovator, technologist and artist. You might know him from his work that showcases beautiful digital images of the human body, made using cutting edge imaging software along with artsy tweaks. Guided by a passion for the human form and insides, Tsiaras founded the TheVisualMD, an extensive online library that documents human anatomy and illness, as well as Anatomical Travelogue, a company specialized in creating digital works of art that faithfully show the workings of the human body. He also authored a number of well received books like From Conception to Birth: A Life Unfolds, The Architecture and Design of Man and Woman: The Marvel of the Human Body, Revealed, The InVision Guide to a Healthy Heart and The InVision Guide to Sexual Health.

Read more:
Breathtaking digital images probe human anatomy like never before

Source: ZME Science

Blood Sample Spontaneously Unhemolyzes Because Nurse Asks Nicely

PHILADELPHIA, PA – Sources from a local hospital are reporting a miracle, after a sample received by the laboratory spontaneously unhemolyzed following a discussion with the nurse.

The sample was drawn in the PICU, sent to the lab, and accessioned by medical laboratory technician Nancy Stewart. “After processing the specimen, I noticed the serum was pink, indicating gross hemolysis,” says Stewart. That meant having to call the PICU to request a new sample. Stewart says it’s the best part of her job. “I mean, who wouldn’t love getting yelled at for something they can’t control?”

But luckily for Stewart, PICU nurse Linda Nelson was in a good mood. “Normally, I would be pretty annoyed,” says Nelson. “I would berate the lab tech, accuse her of sabotage, and refuse to draw a new sample. But this time, instead of fighting, I just apologized and politely asked if she could recheck the sample. If it was still hemolyzed, I would gladly obtain a new specimen.”

Read more:
Blood Sample Spontaneously Unhemolyzes Because Nurse Asks Nicely

Source: GomerBlog

Phlebotomist sued for injuring nerve during blood draw in USA

According to the claim, Kelly Soileau, was a patient at the defendant's office where she was having some blood drawn on July 30, 2015. The suit states that an employee of the defendant caused the plaintiff injury to her medial antebrachial cutaneous nerve in her left arm.

The defendant is accused of negligence through failing to train its employees, failing to safely draw blood and other negligence.

Read more:
Phlebotomist sued for allegedly injuring nerve in woman's arm while trying to draw blood | Louisiana Record

Source: Louisiana Record

Patient Preparation to Blood Sample Collection

Labquality Days - Nordic Congress on Quality in Laboratory Medicine

Mads Nybo, M.D., Ph.D., Chief Physician, Department of Clinical Biochemistry and Pharmacology, University hospital of Odense, Denmark

The awareness of the importance of preanalytical factors increases exponentially these years as illustrated by this meeting. Many of these factors are difficult to control, among which patient preparation and blood sampling without doubt is crucial for a correct analysis result. However, information about patient preparation often takes place outside the “jurisdiction” of the laboratory, and blood sampling is also often performed by persons outside the laboratory, so these processes seems difficult to control by the laboratory. But the more difficult it seems, the more important it is that the laboratory plays an active role in information regarding these aspects: Knowledge on what influence erroneous patient preparation has on the analysis results and how correct blood sampling is vital for a reliable analysis result is sparse outside the laboratory; an important task is therefore to inform on these issues and to offer tools for quality assessment and quality control outside the lab.

Read more and find full presentation here:
How to guide and prepare the patient and the importance of sampling 

Sourde: Labquality Days
Image credits: Mads Nybo

Standardization of the colors of the blood collection tube caps

Are you in favor of the standardized colors of the blood collection tube caps?

The European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the Standardization of the colors of the blood collection tube closures (TFG-STCC) was established in June 2015, with the aim to initiate and manage a dialog between interested parties in order to achieve the global harmonization of the color coding for blood collection tube closures (caps) and labels.

The TFG-STCC has recently started a close collaboration with the ISO TC76/WG1 on ‘Transfusion, infusion and injection, and blood processing equipment for medical and pharmaceutical use’, which is currently working on the revision of the ISO 6710 standard: 'Single-use containers for venous blood specimen collection’. This revision of ISO 6710 would also replace the current European standard EN 14820.

As we are aware that some barriers and obstacles could put this important project at risk of full implementation, we have decided to set up this short survey in order to gather some feedback from laboratory professionals on the importance and acceptance of such a colour code.

The main aim of the survey is to learn whether EFLM National Societies would be willing to accept an EFLM proposal for the colour coding of the blood tube caps as the European standard. Moreover, if there are institutions, laboratories or individuals which are not in favor of such standardization we would be very interested to understand possible reasons for this.

The results of this survey will provide us an overview of the opportunities and potential barriers for this project.

Open survey here: https://www.surveymonkey.com/r/TFG-STCC

Source: EFLM, Ana-Maria Simundic, chair of the EFLM TFG-STCC

Preanalytical Nightmare 4

A person who collected the sample kept blood sample warm....... in boiling water

Source: Facebook via Abbie Poirier‎

Preanalytical nightmare 3

Have you seen this before?

Source: Facebook via Hillary Dodenbier Parkinson‎

New Microfluidic Blood-draw Device Could Replace Needle Sticks

Tasso is revolutionizing diagnostics by creating technologies for blood sample collection that place the user at the center of process. Our wearable blood collection system, the HemoLinkTM, is being developed to improve the user experience as well as enable both healthcare consumers and providers with convenient access to reliable laboratory test results.

In a process known as “capillary action,” HemoLink leverages microfluidics to create a slight vacuum that pulls blood from capillaries though tiny channels in the skin into a small tube, noted a Gizmag report. The device collects 0.15 cubic centimeters of blood, which is enough to test for cholesterol, infections, cancer cells, blood sugar and other conditions.

Pathologists and clinical laboratory professionals will be watching the eventual launch of HemoLink to learn how its developers have overcome the problems affecting lab test accuracy that can be caused by the interstitial fluid that often accompanies capillary blood when such specimens are collected. How the lab test technology used by Theranos addresses this same problem has been an ongoing point of interest among medical laboratory professionals.

Read more:
New Microfluidic Blood-draw Device Could Replace Needle Sticks and Venipunctures at Medical Laboratories

Source: Dark Daily

Drop-to-Drop Variation in the Cellular Components of Fingerprick Blood

Blood obtained via fingerprick is commonly used in point-of-care assays, but few studies have assessed variability in parameters obtained from successive drops of fingerprick blood, which may cause problems for clinical decision making and for assessing accuracy of point-of-care tests.

A study used a hematology analyzer to analyze the hemoglobin concentration, total WBC count, three-part WBC differential, and platelet count in six successive drops of blood collected from one fingerprick from each of 11 donors, and we used a hemoglobinometer to measure the hemoglobin concentration of 10 drops of fingerprick blood from each of 7 donors.

The average percent coefficient of variation (CV) for successive drops of fingerprick blood was higher by up to 3.4 times for hemoglobin, 5.7 times for WBC count, 3 times for lymphocyte count, 7.7 times for granulocyte count, and 4 times for platelets than in venous controls measured using a hematology analyzer. The average percent CV for fingerprick blood was up to 5 times higher for hemoglobin than venous blood measured using a point-of-care hemoglobinometer. Fluctuations in blood parameters with increasing volume of fingerprick blood are within instrument variability for volumes equal to or greater than 60 to 100 μL.

These data suggest caution when using measurements from a single drop of fingerprick blood.

Read more:
Drop-to-Drop Variation in the Cellular Components of Fingerprick Blood

Source: American Journal of Clinical Pathology

Can falling in love be considered as a preanalytical risk factor for laboratory tests?

What happens when we fall in love? The most common symptoms known to the lovesick are racing heartbeats, nervousness, obsessive focus and loss of appetite. We can say that our body is going through many changes and it is far away from "normal" state.


Read more:
Saint Valentine`s Day - Labquality

Source: Labquality
Image credits: Minna Varhala

Patient guidance for laboratory tests

In Finland, about 70 million laboratory tests are conducted each year. Based on statistics, it is thought that the biggest potential for error in the laboratory process is before the analysis of a specimen is performed. This pre-analytical phase is therefore the riskiest point in the patient’s laboratory process, and it has been estimated that each year up to 1.3 million laboratory tests (1.8%) contain a pre-analytical error. These errors account for 50-70% of all laboratory test errors, and entail significant costs in terms of money and delayed or inappropriate treatment.

The cost to Finnish health care for re-sampling these errors is estimated to be about EUR 10 million per year. In addition, much higher indirect costs are incurred when patients have to make repeated visits to the laboratory or doctor’s surgery. As a result of incorrect results or where results are misattributed, patients may undergo unnecessary further investigation or be subject to incorrect treatment. Patient guidance for laboratory sampling is therefore an important part of the pre-analytical phase of laboratory testing. In helping to ensure that correct procedures are followed, patient guidance can be used to improve patient safety in the laboratory process.

Read more:
Clinical Guideline - Patient guidance for laboratory tests.pdf

Source: Hotus

Five Phlebotomy Tips

Unlike many other types of laboratory professionals, a phlebotomist's job centers on interaction with patients. Obtaining a blood draw from some patients can be quite a challenge. Having to soothe scared patients and getting the blood necessary for tests and screenings is a difficulty all phlebotomists need to prepare for and acknowledge.

There are really only two reasons why patients would be nervous for a blood draw, said Dennis J. Ernst, MT(ASCP), executive director of the Center for Phlebotomy Education. "Either they've never had a venipuncture before, or they did and it wasn't pleasant," he said.

Below are a few ways to help nervous patients through the process of having their blood drawn:

1. Distractions  
2. Reassurance
3. Be Friendly
4. Validation
5. Compassion    

Read more:
5 Phlebotomy Tips

Source: Advanced

Preanalytical Nightmare

Very innovative solution to take a sample for HbA1c

Source Facebook
Image credits:  Emilie Dubé Blaquière‎

All colours of blood plasma

There are a lot of variation in blood plasma colour. Most weird is the green one.

Glucose Preanalytical Challenge

Case: 13 years old girl from Belgium is weak and have been feeling dizzy lately. Family doctor sent her to lab for a blood sugar screening. He requested plasma glucose and instructed patient to fast 12 hours before the blood test. Next morning the phlebotomist welcomed the patien and confirmed the patient identity. Bloot test was taken at 07:30 in the morning. Picture of the blood test is below.

Can you find any preanalytical errors from this case?

Correct answer is below the image


(Click image to enlarge)

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CORRECT ANSWER: Thera are many errors in this case. The most serious errors are: 12h fasting for potential young diabetic girl, the phlebotomist did not ask if the patient were fasting and a wrong sample was taken (capillary blood insted of plasma).

Also the finger prick sample was taken from the wrong finger, from the wrong location (center of the finger) and phlebotomist´s grip of the finger is not optimal. In some countries the use of gloves is requirement as well.

Innovative Blood Draw

Not so closed blood draw system...

Source: Diagnosci.pl