Nurses vs Phlebotomist

TraumaSurfer · Jan 22, 2014

California and a few other states now require a recognized national certification for phlebotomists if they are not licensed as a nurse or accepted profession. This has upset EMTs and Paramedics who want to be ER Techs.

I have known of one hospital which went beyond probation for violations to losing lab accreditation. Get an outside lab to take over is not easy. Even someting as simple as glucometers can get a lab in big trouble. RNs sometimes forget these devices are still ultiminately the responsibility of lab who must trust they are being operated and maintained according to standards.

**canoehead, BSN, RN** · Jan 31, 2014

Assumptions can do harm to a patient. Careless or inaccurate reporting does no one any good. Don't expect someone else to jeopardize their license because you can not fill out the required data. I would have a bad attitude also if you wanted me to put my license on the job for your lack of proper documentation and attention to detail.
Would you view and treat the results of a VBG differently than an ABG? Line draw vs stick can make a difference by line contamination and acid base results which can skew the ABG results. If it was a stick and the results looked more "venous", that is a clue about the validity of "ABG" reporting. Yeah it is a big deal for treatment.

If the patient is dying, no one cares if it's a stick or line draw, we need the results NOW, and any results are better than none, just do your best. Whether it's a stick or line draw, the numbers in the result remain the same, and THAT's what we need.

I needed uncrossmatched blood once for a pregnant woman who was literally bleeding like a faucet. But the tech had to look up who had to sign what piece of paper. Yes, I understand she has to cover herself...I will sign whatever...but GIVE ME THE BLOOD. Even worse, she'd only give me one unit at a time.

I may be the only person, but if a federal regulation gets in the way of saving a life I will ignore it. I'm ready to be accountable for those decisions. I wish there was a code word that would suspend time and space in a trauma sometimes.

ICULINDA · Jan 31, 2014

If the patient is dying no one cares if it's a stick or line draw, we need the results NOW, and any results are better than none, just do your best. Whether it's a stick or line draw, the numbers in the result remain the same, and THAT's what we need. I needed uncrossmatched blood once for a pregnant woman who was literally bleeding like a faucet. But the tech had to look up who had to sign what piece of paper. Yes, I understand she has to cover herself...I will sign whatever...but GIVE ME THE BLOOD. Even worse, she'd only give me one unit at a time. I may be the only person, but if a federal regulation gets in the way of saving a life I will ignore it. I'm ready to be accountable for those decisions. I wish there was a code word that would suspend time and space in a trauma sometimes.[/quote']
Actually the results are not always the same.

psu_213, BSN, RN · Feb 1, 2014

Actually the results are not always the same.

The normals might be different but is the pH (pCO2, pO2, etc) themselves actually different based on whether it's a line draw or a puncture draw? Are the run on different machines that would give different results? They are both sent down to the lab in the same make of hep syringe.

ICULINDA · Feb 3, 2014

I guess it depends. On our unit the RT does the ABG and runs the results on the unit. For VBGs the RNs draw it and give to RT in a blood tube and they run it. We don't use the syringes for VBGs. Here's a pic of the card that shows differences.

**canoehead, BSN, RN** · Feb 4, 2014

What I mean is that you get the syringe and run the results, and the numbers come out the same. If you send the numbers up to the floor, the caretaker at bedside will know if it's an arterial or venous stick, and how to interpret the numbers. I understand that it's optimal to have each specimen labelled, but if I pass a syringe to a coworker and say "send that for a gas!" they may not know what blood vessel got stuck, the patient's temperature, or the amount of O2 being used...all questions our computer asks. The temperature causes a slight adjustment in the results...but the amount of O2 doesn't. Frankly, if the patient is sick enough, we want a starting point, and then we trend to see if our interventions are making them better or worse.

Another one that is annoying...PT/INR requires the name of the anticoagulant and time of last dose. Who cares? I just need the results, I don't need anyone to interpret them for me.

annie.rn · Feb 4, 2014

I generally LOVE lab/phlebotomy b/c I have worked at places where we had to draw all labs outside of AM round labs and it ate up a lot of my time! So nice to just put the order in and someone comes up. Our lab is great, too... I've never seen them not be able to get blood from someone. However, I did get slightly ticked this AM... had to start an IV on a pt. who could not be stuck in her R arm. I'm waiting for someone to bring me the IV supplies when lab comes in to draw AM labs. She had one really great, straight vein on the top of her hand and not much else. I see the lab tech eyeballing that vein so I say to her... "Can you leave that one for the IV? I can pull your labs off of it if you don't mind waiting a minute." I could tell the 92 year old pt.'s veins were frail. She replies so flatly I almost thought she was joking, "No. You can still use it for the IV" as she proceeds to puncture the vein. Needless to say, the vein blew out so I couldn't use it and the pt. had a big bruise. (Despite waiting awhile to allow it to clot off before applying the tornequet) Luckily I found another vein. A little teamwork would have been nice to save a little old lady's limited veins. Oh, well. Tech must have been having a bad day or maybe has been burned by nurses in the past. Who knows. I was surprised by the lack of teamwork though.

thelema13 · Feb 11, 2014

In every ED I have worked in, everything is ordered STAT, due to the fact that it is an emergency room.

And I too notice that certain days, more samples are hemolyzed. And I guess colour is a perspective, sort of?

I'll draw my labs off my IV start, if I can. I leave all blood cultures to the phleb though. They can have the contamination on their side, I'm too busy to swab each bottle. I stick and move.

z.RN. · Mar 21, 2014

I work in a 30 bed ER and all the labs are nurse draw. We do have medics that can draw blood sometimes if they aren't transporting pts to CT or the floor but I would say its about half and half (nurse and medic) as to who draws the blood. We never get into it with the Phlebs. because the only time they come down is to help us with super hard sticks, so we love them. Lab techs on the other hand can be the reason someone has to wait 8hrs in our ER as opposed to 2hrs. The list of excuses as to why lab results haven't come back never ends and it can be quite frustrating at times. I don't think they are incompetent or lazy necessarily, but the system they use needs to be improved.

MatadobraK · Sep 16, 2015

A lot of the lab techs at my hospital DO have degrees and a lot of loans to pay off. And thank you for appreciating your lab techs! Phlebotomy is a hard-won skill.