Dear Center for Phlebotomy Education:

We have new residents entering orders and it’s wreaking havoc on us and our patients. In the morning, a CBC is ordered then a few hours later chemistries are ordered. Is it ok to draw an extra gold when we draw the lavender?

Our Response:

Technically, that might be acceptable. Economically, though, it's definitely a bad idea.

From a technical standpoint, drawing an extra tube isn't going to put the patient at risk unless, of course, he/she is already anemic. It's forward-thinking, and may save the patient a stick. By so doing, the availability of test results for anything added on to the original order is greatly reduced. Sounds like a win-win, right? But it isn't.

From an economic standpoint, drawing extra tubes on every patient adds up in a hurry and can be a huge drain on the lab's resources. According to an article in MLO magazine, one facility found only four percent of the extra tubes were ever used for testing. They also discovered the staff was spending more time drawing and processing extra tubes than they were saving by not having to perform a second venipuncture. After calculating the additional costs to draw and manage tubes without orders, the cost of the extra tubes, and their disposal, the facility estimated a cost savings of $200,200 per year by discontinuing the practice.

Of course, performing a venipuncture when no tests have even been ordered would most certainly be against the standard of care. 

A better approach would be every time a new batch of residents show up, they should be versed on lab utilization practices that prevent wasted resources and frustration. This requires constant communication, and strong support from laboratory management, including pathologists.

Program Coordinator

Agree with your response but in mist of a pandemic and nation wide shortage of supplies and supply chain services, we need to be prudent on how we use our supplies without jeopardizing patient care

Howard , 01/27/2022 09:06:23

Poor patient

I think this question is more about the poor patients than anything else. This can also become a morale issue on the side of the phlebotomist if not handled correctly. As phlebotomists in hospital settings, we must deal with the crying, upset patients who have been stuck so many times already. Then we leave their room after calming them down enough to get their blood, just to get another request to go back to that same patient. All that phlebotomist sees, is another test has been ordered they didn’t draw a tube for earlier. Our first thought is an angry one. If the doctors and management had some way of understanding this and empathizing with the patient and the phlebotomist. But this will never happen, and hospitals are really just training facilities, where new phlebotomist gain knowledge and experience in the art of phlebotomy. We also gain our compassion from these kinds of experiences. Then we move on in our careers to somewhere we can become the good guys and the super hero because we can get blood on the first stick with no pain. These experiences are what makes us who we are, and we are “Phlebotomist”.

Jonathan Dobler, 01/27/2022 09:37:05

Drawing extra tubes

Also prudent to mention that with the nationwide shortages of blood collection tube... it is even more important to stop collecting these "extra/just in case" specimens.

David P. Gingrich, 01/27/2022 10:30:44

pronouns

When referring to people/patients, 'he/she' could be replaced by 'they/them' to be more inclusive.

Dawna White, 01/27/2022 11:44:17

Hospital Phlebotomist/AACMA

On weekends I always draw extra because they will 99.9% will add on.

Kristina J Reuter, 01/27/2022 16:46:00

Poor patient

I think this question is more about the poor patients than anything else. This can also become a morale issue on the side of the phlebotomist if not handled correctly. As phlebotomists in hospital settings, we must deal with the crying, upset patients who have been stuck so many times already. Then we leave their room after calming them down enough to get their blood, just to get another request to go back to that same patient. All that phlebotomist sees, is another test has been ordered they didn’t draw a tube for earlier. Our first thought is an angry one. If the doctors and management had some way of understanding this and empathizing with the patient and the phlebotomist. But this will never happen, and hospitals are really just training facilities, where new phlebotomist gain knowledge and experience in the art of phlebotomy. We also gain our compassion from these kinds of experiences. Then we move on in our careers to somewhere we can become the good guys and the super hero because we can get blood on the first stick with no pain. These experiences are what makes us who we are, and we are “Phlebotomist”.

Jonathan Dobler, 01/29/2022 14:05:28

MT ASCP, Supervisor

One should never draw blood/tubes without an order. Are you asking the patient for permission to draw more than what is ordered? This is not a good practice

Karen Nelson, 02/02/2022 08:27:03

When to and when not to

At the hospital I work at as a phlebotomist and lab assistant, we only draw extra tubes in certain situations. Say the MD only ordered a CBC for morning draw, we will almost always draw a PST (lt green) as an extra and possibly a blue coag depending on why the patient is there.

If the patient is a direct admit, we always draw a full rainbow (sometimes including a blood bank depending on why they are there.)

If it is a L&D patient and it is their first draw after being admitted, we draw a full rainbow ALWAYS including a blood bank in case there are complications during birth.

And right now, with having so many covid patients, we draw extras almost anytime we draw them (usually just an extra pst or lav depending on what was originally ordered) so that we can avoid being exposed more than necessary.

We also draw full rainbows during any emergency situation (codes, traumas, rapids, etc…)

And finally, if the patient is a hard stick, we try to get extras if the blood is flowing well.

But for the most part, during routine draws we only draw what is ordered. We may grab an extra lactic if blood cultures are ordered, or if we hear mention of the patient possibly being septic, we’ll grab a set of blood cultures (this very rarely happens, but usually ends up working in our and the patients favor)

Also, if we’re doing a syringe draw, and there happens to be some extra, we’ll throw it in a tube we think they may need later. No point in wasting blood that was already drawn.

I think this should always be something that is looked at on a case by case basis. Sometimes it’s appropriate, sometimes it’s not.

Dianna Yost, 02/07/2022 02:45:46