Follow along as we live blog the Mayo Medical Laboratories Phlebotomy 2013 Conference. We will be posting presentation summaries, photos and other multimedia throughout the conference. If you are on Twitter, follow the conference hashtag which is #2013Phleb.
Posted on Oct.4 at 2:51 p.m.
“Top Gun Phlebotomy” by Brad Karon, M.D., Ph.D.
The final presentation of this year’s conference outlines technical issues involved in the collection of blood specimens during intravenous starts. Dr. Karon discussed what we know about this practice and spoke to the quality of intravenous start blood collection.
Instead of summarizing Dr. Karon’s presentation, we would encourage you to watch an online version, which is posted on our website. Click here to watch Dr. Karon’s MML Hot Topic, which is approximately 11 minutes long.
Posted on Oct. 4 at 2:23 p.m.
“Trends in Lead Screening in Children” by Valeria Cristiani, M.D.
The first afternoon session was from Valeria Cristiani, M.D., who presented “Trends in Lead Screening in Children.”
- Lead is a heavy metal that has been used by humans for more than 5,000 years.
- Blood lead levels increased 100 times from 1900 to 1975.
- Several federal laws reversed this trend starting in the 1970’s.
- Common lead sources include paint, soil, water, food and occupational exposures.
Lead and its impact on children
- There are half a million children in the United States with elevated blood lead levels, representing 2.6% of the children in the country.
- About four million houses expose children younger than six years old to lead.
- There is no “safe” levels of lead and exposure can affect almost any body system and result in neurocognitive effects.
Who is at risk?
- Children younger than six years old due to the fact that the blood-brain barrier is more immature, an increase in intestinal absorption, and higher prevalence of hand-to-mouth behaviors.
- Pregnant women, especially new immigrants.
- Workers that may be exposed to lead in an occupational setting.
- Children living in older housing typically built before 1960, that is located in lower income, inner city neighborhoods.
- Non-Hispanic Black children.
Mayo Clinic lead study
At the conclusion of the presentation, Dr. Cristiani shared results of a recent Mayo Clinic study that assessed whether Medicaid (MA) alone may not be an independent risk factor for lead testing in low prevalence areas. The study examined low lead screening rates of MA children in Olmsted County. The study found that all children with positive lead tests (N=5) had recognized risk factors other than MA and concluded the Medicaid should not be used as an independent risk factor.
Posted on Oct. 4 at 1:25 p.m.
“Difficult Sticks” by Randy Gruhlke, Shannon Newberg and Danny Grabau
This breakout session allowed the conference attendees to discuss a wide range of clinical situations that may prompt difficult phlebotomy draws.
Difficult collections are caused by two main factors:
- Physiological Factors including vascular conditions resulting from sclerosis, cancer treatments or drug use, critical care environments such as the ICU and emergency department, and edematous, obese, elderly, and pediatric patients.
- Psychological Factors such as needle-phobia and combative patients (pediatric/elderly, confused and the medicated).
Techniques that can be applied to difficult phlebotomy draws include:
- Reexamine – Reassess the site and locations to identify options.
- Alternate sites – There are other places to find veins. Individuals may assess anticubital area and finding nothing, go immediately to the hand.
- Wet massage – Often times, wetting the area, followed by deep massaging/palpating, will reveal (or “confirm”) vein location.
- Gravity – Use gravity to assist you in locating veins.
- Massage – Stimulate the arm or vein with a light massage.
- Heat – Application of heat will cause vasodilation, making them easier to palpate, or perhaps see.
- “The Combo” – Often times, combining techniques can mean the difference between finding a vein – or not.
- Transilluminators – Utilize these devices, which direct high-intensity light through the skin.
- Capillary option – A final resort is the capillary collection, or “micro-amount” – utilizing micro-tubes.
- Sphygmomanometer – Utilizing a blood-pressure cuff can make veins easier to find.
Posted on Oct. 4 at 11:27 a.m.
Panel discussion with Mayo phlebotomy staff
One of the breakout sessions was a panel discussion with phlebotomy staff and management at Mayo Clinic. The goal of the session was to allow attendees to ask questions phlebotomy about how phlebotomy services are performed at Mayo Clinic and, more importantly, has a discussion with other attendees about challenges they collectively face in the field of phlebotomy.
Posted on Oct. 4 at 10:35 a.m.
“Changing Team Behaviors Using Positive Reinforcement” by Linda Backus
Positive reinforcement has been shown to be an effective tool for changing and reinforcing desirable behaviors within a team and yourself. During this session, Linda introduced performance management as a means to incorporate positive reinforcement into the work unit.
- Is based on human behavior – a science based on using applied behavior analysis
- Is data driven, measures and provides feedback
- Is based on fact (without emotion)
- Is a set of specific actions for increasing desired performance and decreasing undesired performance
- Is successful in creating a workplace that brings out the best in people
- Pinpoint by identifying behaviors you want
- Measure using data and facts
- Share the measurement with team and tell them where they are at
- Deliver consistent positive reinforcement
Posted on Oct. 4 at 9:35 a.m.
“Stress Management” by Edward Rosenow, M.D.
The first speaker today is Edward Rosenow, M.D., who presented “Stress Management.” Below are some of the key points from his lively presentation:
- Problems with being stressed include the fact no one talks of stress and its management as normal things, it is 24/7 with no relief, it’s bigger than hypertension, diabetes, obesity, dementia, depression/suicide, we try to suppress it, and we are not always sure to help those around us that are stressed.
- The science around stress management is just beginning to emerge.
- To help us address stress, we should really change the word “stress” to “challenge.”
|Energy (-)||Energy (+)|
|Exhausting/freeze up||Fired up|
|Accomplishes little||Achieves goals|
|Lowers self-esteem||Increases self-esteem|
|Lowers confidence||Increases confidence|
|Attitude (±)||Attitude +++|
- One of the best things you can do to help with stress management is learn to simply say “NO!”
- Ways of dealing with stress:
- Don’t Sweat the Small Things, and They are All Small Things
- DEEP BREATHING and other relaxation techniques such as yoga, meditation, bio-feedback tapes, or tai chi
- Life coaches
- Visit with a psychologist
- Simplify your life
- More SLEEP and EXERCISE
- Seek BALANCE in your life
- Schedule worry time
- WRITE THERAPY—20 minutes a day for 3 days
- Another way to attack stress is to make lists: 1) List of stresses 2) List of things you need to do 3) List of people whose name you want to remember 4) List of all the things you are grateful for 5) List of all your good qualities. Write these lists on the back of photos of your family, pet, favorite places, nature scene, and look at them regularly.
Posted on Oct. 3 at 4:35 p.m.
“Bridging the Generation Gap at Work” by Frederick Wills, Jr.
There are currently four generations in today’s workforce:
- Silent/Traditionalists, born 1928-1945
- Baby Boomers, born 1946-64
- Generation X, born 1964-1980
- Millennials, born after 1980
Link Between Generational Identities and Workplace Behavior Generational identities translate into distinct workplace behaviors as they relate to:
- Relationship with organization
- Relationship with authority
- Relationship with colleagues
- Work styles
- Management styles
- Learning styles
Posted on Oct. 3 at 3:05 p.m.
“Central vs. Regionalized Inpatient Phlebotomy Teams” by Kelly Bute and Mohammed Mustapha
Ms. Bute and Mr. Mustapha discussed the decisions and processes that were made and implemented during Mayo’s shift to a centralized location in 2008. They also discussed the pros and cons of regionalized and centralized teams.
Centrally Located Team
Posted on Oct. 3 at 11:40 a.m.
“Quality Blood Collections from Venous Lines (Catheters)” by Twyla Rickard
Ms. Rickard’s presentation compared and contrasted single lumen and multiple lumen venous lines for blood collection, discussed how to choose the appropriate equipment, as well as strategies to minimize potential contamination.
The following considerations/risks of blood collection were also covered:
- Swift pulling on a syringe
- Milking the plunger of the syringe
- Difficulty in obtaining blood (uneven, slow or sporadic flow)
- No flush, under flushing or over flushing
- Collecting blood from the same port used for infusing medications or fluids
- Fluids are not paused
Posted on Oct. 3 at 10:35 a.m.
Summary of keynote address
The keynote address for this year’s conference was, “How to Create a Respectful & Safe Work Environment.” The presenter was Katherine Flippin, R.N., who is a nursing education specialist at Mayo Clinic.
The goal of the presentation was to help attendees:
- Define mutual respect
- Identify behaviors that may be perceived as disrespectful
- Describe steps to take to create a respectful work environment
Other key points from the presentation were:
- Always follow the platinum rule: “Treat me the way I want to be treated.”
- Learning to develop respectful relationships at work is perhaps the most important work-related skill we can develop.
- Respect is a function of individual values /perceptions, individual behavior and institutional values/behavior .
- A hostile environment typically involves offensive conduct that permeates the workplace, making it difficult or unpleasant for an employee to do his/her job.
- Workplace bullying is a major issue, which impacts work performance, limits motivation, decreases productivity, and may result in employee health issues.
- The important role of a supervisor is to: Get all the FACTS, involve RESOURCES, EDUCATE and DISCIPLINE as appropriate and FOLLOW-UP to ensure compliance.
- Healthy behaviors every supervisor should practice are: Communicating and sharing information, being supportive, being respectful, handling some details yourself, and listening to your manager.
- Creating a respectful and safe work environment starts with YOU!
Posted on Oct. 3 at 9:09 a.m.
Welcome to Phlebotomy 2013
The MML Phlebotomy 2013 Conference is now in session! More than 170 attendees from all around the world are in Rochester, Minn. for this two-day conference.