Readers respond - Letters to the Editor

Medical Laboratory Observer, April, 2003

Difficult draw

I enjoyed reading Dr. Harty-Golder's response to "When should a phlebotomist ask for help with a difficult draw?" (January 2003). It's an issue every phlebotomist struggles with. She is correct that there is much to consider when deciding when another phlebotomist should be sought for assistance. I particularly appreciate her insistence that facility policy should include a list of acceptable sites, as well as those that must be avoided. As an expert witness in phlebotomy-related injuries, I frequently encounter patients who have sustained permanent disabling injuries as a result of venipunctures attempted in ill-advised and unorthodox sites.

Dr. Harty-Golder states that "no hard-and-fast rules exist about how many times a phlebotomist should attempt to draw a patient's blood before giving up and asking for help." In actuality, the rule of thumb is that phlebotomists should seek assistance after two unsuccessful attempts, if possible. According to the NCCLS standard, "It is advisable not to attempt a venipuncture more than twice. Have another person attempt to draw the specimen or notify the physician."' Most textbooks echo this passage. Not all situations present the collector with the luxury of finding able assistance. But when competent help is available, it should be recruited after two failed attempts.

As a pathologist-attorney, Dr. Harty-Golder's columns offer an interesting insight to many laboratory issues. I look forward to her column every month.

Reference

(1.) National Committee for Clinical Laboratory Standards. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture. Approved Standard, H3-A4, Villanova, PA, 1998

Dennis J. Ernst MT(ASCP)

Center for Phlebotomy Education Inc.

www.phlebotomy.com

E. coli education

As an undecided college sophomore, I found your E. coli article, "V/hat's Cooking with E. coli" by Dr. Sherry Woodhouse in the December 2002 edition very intriguing. I am very interested in science, especially pathology and microbiology. This article ties both of these genres together. I had to read an article from a journal related to my field of study and write a summary for my English class. Without such a requirement, I don't think I would have forced myself to read a medical or educational journal. I found myself being pleasantly surprised with the content, I thought it was going to strictly be information about E. coli; but rather I read about the positive and negative technological advancements of E. coli. All of the information was fascinating and kept me wanting to read more. I also enjoyed the pictures from the microscopes illustrating one of the possible outcomes of E. coli. I could directly relate to the pictures I found from the cultures in my microbiology class.

I have read more articles of your journal because of this first one I picked up for one of my classes. It helped me realize how much I do enjoy pathological diseases and the research done to help the lives of thousands.

Ericka Schmidt

Central Michigan University

Mount Pleasant, Ml