2006 ASPT Newsletter

From the Desk of Helen Maxwell

Dear Member,

Another year has passed and there have been many ups and downs for some of our members. Some members are serving on active duty and we salute and honor them for helping keep the peace here and hostilities over there. Some members have lost everything in storms and our prayers are with you. If you are in service; or, a victim of one of the destructive storms contact the ASPT office and let us know how we may assist you in your renewal for 2006.

ASPT would like to highlight some of the changes instituted by NCCLS. The first is a name change; they are now CLSI, the "Clinical and Laboratory Standards Institute." It is nice to note that in many cases CLSI has after 25 years finally begun to recommend the ASPT method of phlebotomy. Some changes to note are:

• Tube holders should be discarded along with the needle in a sharps container (do not remove the needle from the holder)
  
• Chlorhexidine is an alternative site cleanser to iodine.
  
• CLSI believes that gloving just before site preparation allows for the selection and palpation to occur without gloves. This may be a true statement; however, to what end? Gloving just after patient identification limits the direct skin to skin contact between the patient and phlebotomist. The greater the exposure to skin to skin contact the greater the chances to spread disease between worker and patient. Gloves lessen this exposure.
  
• CLSI recognizes what ASPT has preached for years and that is phlebotomist should not rely on any other identification other than arm bands and verbal communications, not door tags, not bed tags, and not solely on verbal identification. Arm band information must be verified by the phlebotomist, before the venipuncture.
  
• "Sleeping patients should be awakened before drawing blood." A phlebotomist cannot verify the patients armband information on a sleeping patient.
  
• Arterial punctures are not alternatives to venipunctures. This is consistent with the 25-year teaching of the ASPT.
  
• Wrist veins should not be used for venipunctures.
  
• Median cubital, cephalic, and basilic veins (in this order of priority) should be the primary site of venipunctures.
  
• Tourniquets are no longer optional to use for vein selection. "A tourniquet must be used to aid in the selection of a vein..." ...unless... it interferes with test results (i.e.lactate)
  
• Tapping (slapping) of the veins no longer recommended." For decades vein tapping has been considered assault and battery.
  
• Let the patient know the venipuncture is imminent to avoid a surprise which may bring about a loss of consciousness and be prepared to cope with such reactions.
  
• Needle insertions should be 30 degrees or less; however, ASPT recommends between 15 and 30 degrees. An angle too shallow can also create problems as well as an angle too steep.
  
• As soon as possible after the blood begins to flow, release the tourniquet; however, ASPT believes a tourniquet should be left on only one to two minutes maximum. Even if the blood does not flow, one does not leave the tourniquet beyond a certain time element.
  
• Revised Order of Draw: First: blood culture tubes or vials; Second: sodium citrate tubes (blue top); Third: serum tubes with a clot activator, without a clot activator; or, gel separator (red, gold, speckled, tops); Fourth: heparin tubes (beige or green top); Fifth: EDTA tubes (lavender top); Sixth: glycolytic inhibitor (gray top). CLSI maintains this order of draw is sufficient to prevent additive carry over without the use of a clearing tube, whether one uses glass or plastic tubes. Many labs have internal reasons to elect not to follow this CLSI protocol; so, the phlebotomist must learn the lab protocol and use that method. Syringe method order of draw is the same as above.
  
• Look for a hematoma and check that bleeding has stopped after the completion of the venipuncture.
  
• Hypo-allergenic band aids are recommended.
  
• Drawing above the IV site allowed with great caution, but recommends the facility establish their own policies. ASPT recommends the use of the other arm or draw as distal to the IV site as possible and document additives in the IV.
  
• CLSI maintains that the use of a discard tube prior to the drawing of a coagulation tube is "circumstantial at best"; therefore, they have changed their terminology from "should be used" to "it may be advisable..."ASPT believes that a clearing tube is the safest, surest way to avoid specimen contamination; so, why not use a clearing tube, other than cost? CLSI does say a clearing tube should be used when filling a coagulation tube through a butterfly to avoid under filling and this is consistent with the most recommended practices.
  
• CLSI no longer recommends cleaning the tops of the blood culture bottles and refers to the manufacturer recommendations. This is a good practice for any medical product. ASPT does recommend the above.
  
• Sharps containers for needle disposal should be close to the point of use. Needle re-sheathing was also officially renounced as an acceptable practice.
  
• CLSI added to their standards that tourniquets must be discarded before leaving an isolation room.
  
• CLSI distinguished between punctures and incisions as two separate processes.
  
• CLSI revised some standards to reflect OSHA requirements. The use of retractable devices such as scalpels and lancets were added to their recommended use. Potentially injurious items for use such as glass capillary tubes and wire lancets were removed from their use of suggested items to use.
  
• Pre-warming was recommended for all skin punctures.
  
• The great toe was removed from their list of recommended sites for skin punctures.
  
• In the CLSI coagulation guidelines small gauge needles were not responsible for hemolysis and platelet activation.
  
• CLSI no longer recommends pro-times be stored refrigerated. The limit for cold storage is seven hours according to their information.
  
• Specimens measuring potassium levels "should not be centrifuged more than once..."
  
  

I hope these updates will help you in your profession.

Have a wonderful Holiday Season! Helen Maxwell

2005 - 2006 Membership Renewal Info!

CEU 's are due between 11/15/05 and 11/30/05 for 2006 and renewals are due between 12/15/05 and 12/31/05 for 2006. No renewal cards or seals for 2006 will be sent prior to 12/15/05. Please be patient, the process takes time with so many.

Do not let your certification expire! ASPT does not charge for certification validations and we do not sell certification validations. In effect, the certification validation seal is free, but the member must meet certain qualifications in our computer before the computer will generate a certification card and authorize the shipping of a validation seal. A member earns the certification renewal by obtaining "validated" CEU's and paying a renewal application fee. At no time can a member fail to obtain CEU's or renew as instructed. All records must be contiguous for the computer to track and issue seals.

The #1 requirement is 6 hours of validated continuing education. The member can get automatic CEU credits through ASPT from our home study ceu program, ASPT-SPONSORED CEU programs, or through ASPT approved CEU programs. All ASPT related CEU's must be completed during the year 2005. A member can also get CEU's validated by submitting 6 or more hours of medically related continuing education to the AAHS. These AAHS hours must be able to be documented, meaning that AAHS must be able to verify the member did in fact attend the program. Letters from supervisors or human resource directors will be acceptable if on institution letterhead and if the institution providing the education lists the speaker, speaker qualification, and contact hours attended by the employee. Transcripts from community colleges are acceptable if the program has been attended within the last 12 months. Certificates from recognized agencies are acceptable, but programs from such events are not acceptable. An event program or bulletin does not verify participation and attendance so such brochures will be rejected and the application will be denied. Work experience does not count as continuing education. The CEU requirement applies only to those who joined prior to 2005. This is not based upon when you received your certificate; so, if you do not know when you joined follow Option #1 .

All ASPT members who joined prior to October of 2005 must pay a $20.00 fee for membership application by 12/31/05, which will be consistent with the confirmation letter. Members joining after October of 2005 will be processed as 2006 members but will have a $25.00 membership renewal application fee due by 12/31/06 and must send in an application form regardless as explained in your confirmation letter. If you do not understand any of this or you do not remember what your letter said, follow Option #1 from below. If you do not have any ASPT related CEU's then there are two options for renewal:

Option #1: (Fastest and best way)

Send ASPT $50.00 and your 6 hours of non-ASPT medically related continuing education. If you just send $50.00 ASPT will not renew your certification. Continuing education must accompany the membership renewal fee; or, your application will be rejected and you will be required to obtain valid continuing education and then you will be required to reapply for certification. This is intended to be a one step process. If you must re-apply each and every renewal re-application is expected to be accompanied by a $20.00 re-application fee. Use ASPT form only for option #1.

Option #2:

Send your 6 hours of non-ASPT continuing education to AAHS on the enclosed AAHS form with their $20.00 CEU approval application fee. Wait until 12/15/05 and then send ASPT your $20.00 renewal fee on the ASPT membership renewal application form enclosed. Regardless of circumstances, two weeks must separate CEU's and membership renewals with CEU's coming first, and no other way. If you just send $20.00 to AAHS you will not have CEU's to validate. If ASPT does not have CEU's in the computer by the time you send in membership application renewal fees to ASPT your application will be rejected by the computer and you will be required to re-apply, when you have CEU's with an additional $20.00 application fee. If you do not understand Option #2, or any other renewal issue, use Option #1.