If a phlebotomist corrected you on order of draw, what would you do? - page 2

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... Read More

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    We are required to do our own morning lab draws (regardless if the patient has a PICC) on my unit. I call down to the lab and phlebotomists all the time with questions because I know they are the experts in that field of medicine and I am grateful for their help. Teamwork people, teamwork.
    jadelpn, DogWmn, sunny3811, and 9 others like this.

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  2. 3
    I still would give her a copy of the lab manual order of draw.
    SopranoKris, nyteshade, and tewdles like this.
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    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.
    Last edit by Indy on Oct 9, '12 : Reason: autocorrect has some stupid ideas
    barbyann likes this.
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    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.
    pyriticsilence likes this.
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    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.
    Sugar Magnolia and SopranoKris like this.
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    Order of the draw is still relevant when drawing from a PICC or CVL. It has to do with the chemicals in the tubes.
    DogWmn, Sugar Magnolia, sunny3811, and 3 others like this.
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    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.
    Last edit by Meriwhen on Oct 9, '12
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    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.
    Nurserton, pyriticsilence, wooh, and 1 other like this.
  9. 0
    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.
  10. 1
    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!
    pyriticsilence likes this.

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