If a phlebotomist corrected you on order of draw, what would you do? - page 4

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... Read More

  1. by   goodyuvm
    As a nurse if I'm told something different from what I believe to be true I am eager to learn what the truth of the matter may be. I would have gladly accepted the lab manual as it would have been a learning experience. Sounds like this nurse was trying to swing her weight around.
  2. by   yoland
    I almost always draw my own blood. We have no phlebotomy team, so it's the RN or the PCT. Yes, definitely, the blood culture goes 1st, but I would not mind at all if a phlebotomist educated me on the order of the draw. You do blood draws for a living, for Pete's sake! I am not good at the order, like does blue go before purple? But I also like to ask PCT's how they prefer to do things with a patient if they have more experience than I do with either the patient or just more experience in general. Why not? She owes you an apology and she owes it to her patients to educate herself.
  3. by   RNnLTC
    I wouldn't be mad. I mean, a phlebotomist specializes in drawing blood, I don't, I just have to because I get an order for a stat lab. That's not something they teach in nursing school, it's another skill you acquire on the job. I'm always open to listening and learning. I've also learned that I hate using butterfly needles and when I first began drawing blood I loved them...it was because I was blood draw retarded lol.
  4. by   RNnLTC
    lol that explains why I accuse my poor patients of having bad veins when I have no choice but to draw from their hand lol. Thanks for that advice!
  5. by   Nurserton
    As a nurse I defer to the phlebotomist when it comes to that because frankly I still can't remember if the light green or the lavender top comes first. It's what they do all day, every day...why wouldn't they know more than me? Besides that nurse was "special" anyway because everyone knows you draw cultures first to reduce the risk of cross-contamination. DUH.
    If it were me, I would've printed the policy and highlighted it and shoved it in her face to make her look dumb since she was trying to berate.
  6. by   jadelpn
    I would see if your lab manager would send a group email regarding "FYI's". One of which would be that cultures are drawn first--as the site needs to be prepared in an alternate way than a "regular" lab draw, the risk of contamination is high otherwise (and patient safety is priority), and often blood cultures need to be taken from 2 seperate sites (depending on the number of cultures ordered).

    Having differences of opinion in front of a patient is never acceptable. The nurse will realize that you must have done something correctly when your culture doesn't come back contaminated. It strikes fear in the heart of most nurses when you wait 24 hours for a preliminary result of a blood culture and guess what? Contaminated. Doctors don't like to hear that. Especially when then you have started some sort of broad scope antibiotic.....and makes any other cultures pretty much useless.

    See if your dept will do an FYI. If you are questioned again, I would not get defensive, just to say "I am following policy. The risk of contamination is less when cultures are drawn first". Period.
  7. by   jadelpn
    Quote from gonzo1
    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.
    But be careful--blue tops, so I learned, have a "fill to" line. Using a butterfly never do the blue top first. Then the air in the tubing of the butterfly makes it impossible for the blood to fill to the line. And the lab will not do the coags when the blue top is not filled to the line. Learned this the hard way......
  8. by   Nurserton
    Quote from jadelpn
    But be careful--blue tops, so I learned, have a "fill to" line. Using a butterfly never do the blue top first. Then the air in the tubing of the butterfly makes it impossible for the blood to fill to the line. And the lab will not do the coags when the blue top is not filled to the line. Learned this the hard way......
    That's why you should always draw a blue waste before drawing a blue. And it actually SHOULD be first (after cultures). That much I remember. Beyond that, I couldn't tell you.
  9. by   Missy Boquet
    Stick to the guidelines.If you are written up, she ( The nurse) will have the burden of disproving the policies. If this is a chronic issue, then its time to have a chat with her when you both are not busy. I see a lot of conflicts between nurses and Phlebotomist. I think it is important we nurses understand that Phlebotomist are specially trained in what they do.

    Like a nurse, a Phlebotomist must assess several things before proceeding with a draw. Sometimes a Phlebotomist may observe something the nurse or doctor forgot or did not see. A Phlebotmist's objective is to draw blood perfectly every time. They are given very little time and only so many chances.

    They must ensure names, MRNs and all information is precise.They must ensure the tubes are in the precise order to prevent cross contamination of chemicals. Yes, the correct tube order is absolutely necessary. Each tube contains chemicals which can be transferred to successive tubes. Done in the wrong order, the chemicals may give inaccurate or false readings.

    The draw must be perfect to prevent any unnecessary damage to the patient. Then they must ensure everything is documented precisely and process the labs in an expedient manner. Nurses do not intervene when other sub-specialty groups perform their jobs. For example: Xray technicians. Never seen a nurse come in and dictate anything to anyone in radiation, yet they always question the Phlebotomist.

    Maybe they assume a Phlebotomist's job entails grabbing some blood and nothing more. So many times, a Phlebotomist must go behind a nurse and redraw patients and it is really irritating for them. They must double check that everything is labeled correctly and done in correct order or risk being written up for someone's negligence. Be nice to these folks because they also have the patient's' best interest at heart. Like nurses, they must appease the doctor, the laboratory, the patient, the patient's family, and the nurses. In a hospital setting, they must be in several places in a short amount and set time frame.

    If the Phlebotomist is working for a company which is subcontracted by a clinic or hospital, they must also appease their company's policies and guidelines as well as the clients. Many times the client ( Hospital or clinic) and sub contracting lab may have conflicting guidelines regarding timing, processing, preparation etc.. Not an easy task, so I hope folks who read this will be a bit more empathetic and realize the importance of a Phlebotomist's role.

    Thanks! :0)