Updated: Mar 19
Mistakes Made In Healthcare
This list is composed of the most common mistakes Phlebotomy Technicians make during practice and out in the field. These mistakes can cost the facility you are working in money, possible harm to your patient, or loss of employment. None the less these mistakes will reflect poorly on you as a phlebotomist and should be avoided. The best way to avoid them is to know what not to do. But remember mistakes will happen in the workplace, give yourself the time to understand why you made the mistake, so you can learn from it to prevent it from happening again.
10: Not Balancing a Centrifuge Machine Properly
When a Phlebotomist does not balance the centrifuge machine properly it can cause a number of issues. The most common being hemolysis or the destruction of red blood cells. This happens due to the tube vibrating within its holding area. Another result from the machine not being balanced properly is the cracking or breaking of the tubes themselves inside the centrifuge machine. In order to balance the machine properly place tubes directly across from each other so the rotor has an equal amount of weight on each side. This will prevent hemolysis in the blood and damage to the tube.
9: Not following Infection Control or Verifying Patient information
As a phlebotomist, you will be working with a team of healthcare professionals to provide care to patients. One thing you must note is that we are all human and mistakes happen! There may be situations where the wrong patient is sent for blood work or a patient's ID wrist band does not have the correct information on it. You will come across this if you are in a hospital setting. Verifying your patient is extremely important before you start your procedure. You do this by asking the patient their full name and date of birth. If the information matches the rec form you are good to go! Infection control is cleaning the area of incision this is done with an alcohol pad. Failing to clean the site can result in infection in the blood of your patient and not allowing the site to dry properly will interfere with testing.
8: Not Having all supplies ready before starting your procedure
Preparing your tray with all the supplies you need is very important for phlebotomy! Also, it is important to have extra of everything (tubes, cotton balls, ECT) as some equipment may be defective and not work properly. You must check the expiration date of all equipment to ensure a proper procedure. Once you perform your venipuncture you cannot let go of the needle to grab a tube you forget so having all the things you need and extra will ensure a fast and hassle-free procedure.
7: Not selecting a proper Vein
For a starting phlebotomist, a common mistake is to go where they see the biggest vein. However, this is not always the case. Patients will have veins you can see and veins you can feel, sometimes both, sometimes one or the other. You should also select the vein that has the most bouncy (squishy like feeling). Veins will feel like this when there is good pressure within the vein. Selecting a vein, you can see but you cannot feel as it has no bouncy is bad because once you stick the patient and place in your tube you could collapse the vein. Simply asking your patient where the normally get blood drawn is an effective way of finding an effect vein for a blood draw.
6: Improper Angle of Incision
Venipunctures should be performed at about 15 degrees for superficial veins and 30 degrees for deep veins. Entering at the wrong angle can result in several complications. The most common being not receiving any blood. This can happen by performing the procedure at a low angle that is too superficial will result in you staying above the vein. Going in too deep will result in you going through the vein and you also run the risk of hitting a nerve which can be extremely painful for your patient. A way to avoid this is with practice! You will feel it once you have entered a vein. It can best be described as a slight feeling of nonresistance, like a giveaway. The resistance of the layers of skin ends and it feels like a smooth slide in.
5: Not following the correct order of draw
The order of draw is Yellow tubes, Light Blue, Red, Green, lavender, Gray. When you go out of the order of draw you run the risk of contaminating tubes with the additive from others. This will lead it tubes not being able to be tested and inaccurate test results which can cause the patient to be diagnosed incorrectly. Follow the order of draw and if for any reason you fall out of order to use a red tube with no additive to “clean” the need that punctures the tubes in the tube holder and continues the order.
4: Poor tourniquet Application
Not placing the tourniquet properly on your patient can result in several complications. Some of which being, low pressure in the veins from the tourniquet being placed too loose. Where on the other hand if the tourniquet is placed too tight it can cause too much pressure in the veins. Also, improper tourniquet application can cause the needle to move inside your patient when you attempt to remove it. Also, the tourniquet should be placed on the patient for no more than 60 seconds as this can cause petechiae which is the skin changing color that may result in premiant damage and hemolysis in the blood sample. Always place your tourniquet on with the right amount tightest and with a “bunny ear” for easy and quick removal.
3: Not knowing the lab uses for the Tubes
Before you start working as a phlebotomist you must know the lab uses for the tubes like the back of your hand. This is because when blood work is ordered, the tests that are to be done on the blood are printed on the requisition form. The lab uses on the requisition will inform the phlebotomist of the appropriate tube to use. Not knowing the lab uses for your tubes will hurt your chances of obtaining a passing score for your nationals and leave you as dear in headlights when you are out in the field.
2. Not performing inversions correctly
As a phlebotomist, you may grow to dislike the lab. You will find that tubes are often “sent back” for hemolysis or other conditions rendering the blood not eligible for testing. There are many things that could cause hemolysis, however, it can commonly happen during poor inversion techniques and transportation for the blood sample. In addition to hemolysis, not properly performing inversions could result in the additive in the tube not mixing appropriately with the blood which will also render the blood sample not eligible for testing.
1. Breaking HIPAA
The Health Insurance Portability and Accountability Act is a law enacted to keep patient information confidential. HIPAA establishes guidelines for healthcare professionals to follow to avoid releasing patient information to anyone outside the immediate group of care-providers for any patient. Speaking to anyone about a patient that is not within the range of necessary providers can result in immediate termination, loss of certification or license, and possible legal action. Keeping patient information confidential is one of the most important things a healthcare provider such as a phlebotomist can do.