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?

[germsjackson]

Talk to the manager. this needs to be an educational topic for all nurses on the floor.

[ArrowRN, BSN, RN]

If I was a nurse, I would assume I do not know squat compared to a phlebotomist who does like what 50 plus blood draws a day? I think you would be the expert in this field and the RN needs to fall off their "high chair" and onto their butt and then get up and go learn something...I've personally seen experienced RN's who have to run get a phlebotomist because they could not find a "viable vein" to draw from and the phlebotomist comes and does it in less than 30 seconds. One should never be too proud to learn.

[gonzo1, ASN, RN]

Blood culture, blue top, red top, green, lavender, then the last blood culture, or preferably the last blood culture from a different site.

Most nurses don't know the order, but after not doing it right for about 8 years I finally listened to the lab as to why it needs to be in a certain order and I do that now.

[ProgressiveActivist, BSN, RN]

the original poster didn't say what the issue was between her and the lab tec

[PediLove2147, BSN, RN]

the original poster didn't say what the issue was between her and the lab tec

The OP (phlebotomist/lab tech) was fighting with the RN about blood cultures and the proper order of draw.

[SopranoKris, MSN, RN, NP]

I just finished my phlebotomy class and when we did rounds with the phlebotomists in the hospital, I was amazed at how condescending many of the RNs were towards them. It had a very negative vibe in that unit. The RNs mainly rolled their eyeballs at the phlebs, especially when a draw had to be done off a line. Only an RN, PA or doc can draw off a line (per this institution's policy). So, what does the RN expect? The phleb to break the rules? Stick the patient when he/she already has a line? I mean, honestly, there was no need whatsoever for the animosity between these groups. I got a good long look at how the pecking order works in that institution. Now, when I went to a different hospital in the area, there was more synergism between these roles. Bottom line: I know which hospital I'd rather work in!!!

In reference to the OP's post, the RN shouldn't have acted the way she did. The phleb was right...you always do cultures first to avoid sample contamination. If the RN wasn't open to listening to the phleb, then a quick word with the RN's supervisor (politely!) would be in order. Drawing samples incorrectly can lead to inaccurate lab results and the patient might not get the appropriate care due to the RN's carelessness with order of draw. That can definitely have a negative impact on the patient and needs to be addressed.

I would never argue in front of a patient, though. But I would definitely let the lab know the draw was done incorrectly. Let the RN explain why labs have to be re-done!!!! Hospitals don't like wasting time & resoucres! :)

[Salisburysteak, BSN, RN]

I was always taught blood cultures first(from the first site) then red tops(no chemicals in tube), yellow, blue(and it better be the whole tube!), green then purple, and lastly the second set of cultures from a different site preferably from the other arm.

If I am wrong please correct me!

P.S. and to always use a syringe attached to the drawing needle when drawing from the hands. I was taught it was to prevent the vein from blowing and causing a hematoma.

[SopranoKris, MSN, RN, NP]

I was always taught blood cultures first(from the first site) then red tops(no chemicals in tube), yellow, blue(and it better be the whole tube!), green then purple, and lastly the second set of cultures from a different site preferably from the other arm.

If I am wrong please correct me!

P.S. and to always use a syringe attached to the drawing needle when drawing from the hands. I was taught it was to prevent the vein from blowing and causing a hematoma.

That's exactly what we were taught. Never use a Vacutainer on a hand draw or you'll blow the vein. BCs first, then red tubes (if using a vacuatiner), then blue (coags, full tubes), green (hep), then purple (CBCs). If a second set of BCs has to be drawn, use a different arm and do this last. If doing a syringe draw, then blue goes first (after BCs).

However, order of draw varies so much by institution, so you really have to go by the chart the lab provides. I noticed that between the 2 hospitals they sent us to, some use a few different variations in color. Essentially the same order in terms of tests being performed, but the tops were slightly different (e.g. pink instead of purple, black instead of yellow, etc.)

Bottom line: trust your phlebotomist

[mamaxmaria]

this thread brought me back to when I was in school for Medical assisting..... I always knew to draw cultures first, that reason is obvious... but one thing I remember but cannot remember the reason was never to draw a lavender tube first....

so if you have to draw only a CBC you have to use a red stopper tube first, then you can draw the CBC

I THINK the reason was air getting in the tube effecting the result but I'm not sure.... any one know the proper reason??

[chorkle]

However, order of draw varies so much by institution, so you really have to go by the chart the lab provides.

As a student, I've noticed what SopranoKris indicates here: order of draw varies by hospital, and may not follow the order your phlebotomy text indicates as correct.

In some cases, a specific hospital unit may have its own "correct" order of draw, differing from that of Lab.

Therefore, it's difficult to know an absolute "correct" order.

[chevyv, BSN, RN]

I wouldn't have a clue but would just be happy someone came to do the draw. I never have time to even go in with the plebotomist so telling them they arent' doing something correctly isn't even on my radar. I'll be the nurse 3 doors down trying to break up a fight. Who has the time?

[ecerrn]

Seriously, there are more than one way to draw cultures, variables being whether you are using a syringe, butterfly, what other labs need drawn and tubed first or second. The blood culture doesn't matter where in the order of the draw...only if using a syringe, the aerobic container is last, so as not to inject air. It may also be better to make the culture second if using a butterfly as to to include surface cells. We always cultured last in the draw, very last is the aerobic bottle.

Ask the pathologist where you work, they should be happy to tell you how to draw for quality control reasons.