If a phlebotomist corrected you on order of draw, what would you do?

[pyriticsilence]

I currently work as a phlebotomist before entering nursing school. Today, a nurse tried to correct me on my order of draw (she thought I should draw a blood culture last). When I corrected her and tried to explain how she was wrong, she berated me. I told her that I could fetch the lab manual, but she still would not listen.

My question is, would you as a nurse interfere with a phlebotomist's blood draw? If you were wrong and were corrected by the phlebotomist, how would you react?

[Indy, LPN, LVN]

I was a phlebo years before I was ever a nurse. When they correct me I ask why, then do it their way unless there is some overwhelming reason to do it otherwise. We help each other. A couple of years ago I was surprised to learn BNP's switched to hematology tubes, and every few years or so the chemistry tubes may change color so it's good to keep on top of that. Also, nowadays more folks have coag-only draws in the mornings, and some facilities want a waste prior to that, (in a stick or draw, whichever) whereas I am used to coags go with chems so there is no problem. There is always something changing... and you better believe they watch me if I am doing blood cultures. I don't mind because I hate false positives! Nothing like losing a good picc line because you did your culture wrong.

[iluvivt, BSN, RN]

I would venture to say that many nurses do not even know what that means and why it is important. I was helping a nurse a few weeks ago and noted she did not know about this. She of course, listened to me and I even want to the lab and got a chart that is given to the labs from the companies that make the tubes. In your case I would go make a copy of that form using a color printer, They are better with the color copy. I would then send it to her by departmental mail. I have done this a few times in my career and it is very effective when one will not listen.

[8mpg]

tell her she needs to do some reading. You always do cultures first to try and minimize the possibility of contamination of the sample. The tubes that have been rolling around on the bed/counter/pocket/etc can gain bacteria on tops and contaminate the STERILE vacutainer needle you are using. This is why cultures have caps on them and regular blood vials dont.

[blondy2061h, MSN, RN]

Order of the draw is still relevant when drawing from a PICC or CVL. It has to do with the chemicals in the tubes.

[Meriwhen, ASN, BSN, MSN, RN]

If it were me, I'd defer to the one who was more experienced in the matter...in this case, the phlebotomist.

That being said, if I saw something grossly wrong, I would mention it to the phlebotomist only once, and certainly not with "I'm going to go get my lab book and show you!" because to be honest, that comes across as more antagonistic instead of helpful. I magine if the phlebotomist did the same to you about a nursing task, telling you that you were doing it all wrong and they'd get the book to show you...you'd probably be pretty peeved too!

If after mentioning it they disregard your advice, document and let your manager know.

[classicdame, MSN, EdD]

I think your response was fine. Just say I am doing it per policy and let it go. If she continues then she is wrong to do that in front of a patient and I would write her up or tell my supervisor.

[dirtyhippiegirl, BSN, RN]

I've never been a phlebotomist so maybe there's more to it, but I have worked in a lab that processed blood samples. The only cross-contamination that *we* could read from improper tube sequencing was (obviously) from blood cultures and from coags.

[itsnowornever, BSN, RN]

I was always told cultures first, and never questioned it, glad to know why now!

OP---the phlebotomist is the expert, I'd defer to them!

[SGoody]

I used to work in a NICU at a large hospital where we did all of our own blood draws so I know the process of drawing infant labs from heelsticks, arterial, venous or umbilical lines. I now work in a small community hospital in OB and unfortunately I have had to correct a phlebotomist a couple of times when I saw something they were doing wrong. I would never question them about drawing an adult because I sure don't have experience with that (except drawing basic labs when starting an IV).

One girl was doing a heelstick draw for a NBS and was bending the babe's foot back all the way to the shin and squeezing HARD! I showed her the proper way to hold the foot and "milk it". I did it in a nice way though and she didn't feel like I was criticizing her and she actually thanked me for showing her because it was not only safer but also easier :)

I also had to stop someone who was getting ready to draw a serum bili while the bili lights were on. She wasn't aware (nor were some of my RN co-workers) that the lights have to be off for the result to be accurate. Our manager later made this an education topic during one of our skills days.

It would be nice if we could all work together in our different fields and accept advice and tips from fellow workers without being made to feel as if we're stupid. We all have different backgrounds and should share our knowledge with each other. I know, easier said than done, right?

[JBudd, MSN]

I listen to the experts.....

Although I have to admit to teasing the phlebotomist who was doing my annual labs, for doing the CBC first just like I do...

our chart says coags first. It was on the wall next to us, I laughed and told him he was as bad as me, but he didn't know what I was talking about until I pointed it out on the chart.

He was blown away, said he'd never seen it! oh my....

OP is right though, first BCs, then coags. I'd have smiled, answered this is policy, and as long as the offer to get the chart was sincere and not done with an "attack attitude", it was the right thing to do.

[uRNmyway, ASN, RN]

Ive personally always worked places where we did our own blood draws. There is soooo much more delegation of nursing tasks in the US than in Quebec. But yes, if the person who's job consists solely of doing blood draws tells me I am doing it wrong, I will definitely ask for the reason, but if it makes sense, I will go with it. Some people just let their egos in the way instead of just trying to learn from others. Really, it is her loss for being so rigid.

[mariebailey, MSN, RN]

I find it odd that a nurse presumes to know more than a phlebotomist about phlebotomy. I am a nurse who has trained under a phlebotomist when I felt the need to refresh my skills. I have to do blood draws in the field (home visits) periodically, and I have relied on the phlebotomist's expertise to keep me up to speed.