Our lab's new toy: the vein finder!

In the phlebo area, extracting blood from palpable veins is a piece of cake but when you come across with people having easily collapsed and hard to find veins, then that's a problem. But worry no more, introducing the lab's new toy, the vein finder!

If you check the specifications, this handheld vein finder comes with a stand, charger and cradle port. This vein finder is made for pedia patients and patients with vascular positioning difficulties, such as obesity, swollen tissue, hairy skin, dark skin, hypovolemia, etc.

Principle

Vein Illuminator projects near-infrared (no radiation) light which is absorbed by blood and reflected by surrounding tissue, and this information is captured and processed, finally projected in real time directly on the surface of the skin. It provides a real time accurate image of the patient's superficial pattern on the skin of patient.

How to use this?

Simply place the handheld vein finder above the skin of your patient, and the machine will do the rest. This health gadget is perfect for all types of doctors, surgeons, and other types of healthcare professionals. It works on any type of tissue and skin tone.

Visualization Mode Features

Color	there are five colors that you can choose from (green, blue, blue green, red and pink)   for different patient skin tone and personal preference
Inverse	I personally prefer this to view the veins clearly. This allows clinicians to switch entire highlight the veins and highlight the surround tissue, to reduce the interference of skin tone, density of hair follicles and room brightness.
Brightness	3 degree brightness adjustable, allow clinicians customizing the image brightness base on the environment light.
Resize	3 kinds of image sizes, for pediatric patients or when need to focus on only one vessel.
Enhanced Mode	Helpful to find the small or deep veins.

My personal review:

Although this helps you to find the suitable vein of choice for venipuncture, you still need to trust your instinct. Palpate the vein of choice as many times to confirm. I can't agree much using this to obese patients for the reason that it probably can't penetrate the fats:-) However, at least this plays a significant role to help improve the success rate of vein puncture and reduce patient pain.

References:
http://www.meihuatrade.com/ProductInfo_4680.aspx#.WfrjlFuCzIU
http://best-of-technology.com/product/handheld-vein-finder-radiation-free-near-ir-light-0-25mm-accuracy-compact-design-4400mah-works-with-all-skin-types/

Cindy's friends: the microscope

Meet one my friends, the microscope. One thing that I like hanging out with the microscope is that (unlike other people who are so mean and who pretend like they care when they pray the worst behind you) the microscopes are REAL. The microscope never lies. It will magnify things for you and will let you see its true form beyond the naked eye. How I wish I could use the microscope to identify people who are bitch and who's not coz microscopes stay where it is and it adjust for you. It's really hard for me to trust people these days.. whew! #medtechhugot

The pathologist is your friend

When in doubt or when you think you are torn between releasing an unsure result, stop and think before doing it. You're not alone! That's why pathologists come to help.

What could be more alarming when you released it right away and someone will question?You've got to defend and protect your license. Your pathologist will defend you.

If you're confused between what's a blast cell or not, always refer to the pathologist. They are assigned in the laboratory as the experts of these fields. There's nothing to be afraid of them. A thorough diff count with immature cells noted from a cancer patient can help the hematologist monitor the patient's condition. By this, the pathologist can teach you more on how to distinguish the WBC precursors as well as the RBCs.

It's a nice thing to know that in the hospital that I'm working, pathologists are so approachable and very open to junior lab technologists like me. It's also our hospital's protocol to always refer questionable CBC results with various flaggings to pathologist before releasing (with our initial manual diff counts of course). 

I'm talking not just in hematology but other departments as well such as in blood banking where ABO discrepancies are encountered and other special procedures too. They serve as the judge if you really know the procedures and its principles so you have to be knowledgeable.

But then, make sure you're prepared and at least studied. A prepared MT marks an impression to the pathologist that at least you made an effort and you never stop learning. Show your worth. That's why this profession never fails to amaze me. There are still lots of things I need to learn being a medical laboratory scientist!

How important are the microtainer™ tubes?

Each hospital labs and free-standing laboratories must have EDTA and plain microtainers™in their phlebo area.

Why is this so? Because with the baby's smaller veins, would you be able to fill 2cc of baby's blood to a 2cc EDTA tube with another 3cc for its chem test? Hmm..maybe! But it really depends on the baby's vein (if it could withstand the syringe method of draw). I know some of us depend on dripping method where you squeeze the baby's hand as the blood drips from the needle. I know the feeling that you have to get the right amount of blood before it starts to clot. It might even add trouble as you deliver it to the lab and it happened it was hemolyzed or platelets clumped. Tsk2. That's why microtainers™ are a big help for us to an easier blood collection.

REMEMBER: Don't compromise QUALITY over QUANTITY.

Microtainers™ are small blood collection containers designed for collecting a minimum volume enough for running lab tests. Be it thru venipuncture or capillary puncture. Additives such as the EDTA are added in proportion to the blood where you just need to fill a minimum of 0.5cc up to 1 cc. Even plain microtainer tubes can yield up to 300ul of serum enough to run electrolytes or bilirubin.

Microtainers™ can even compensate short draws from your venipuncture. A microtainer™ for CBC can save up more blood to be used for chemistry or other tests requiring serum.

But then, just a friendly reminder... conserve your microtainers™:-) Use it when necessary. It's more expensive than the usual ones. This may give a burden to the ones assigned in hematology because these tubes should be fed manually. So, if you think the blood is adequate, use the regular tubes.

The more microtainers™ you submit (even those who are from adult patients) would reflect your phlebotomy skill.

SYRINGE VS. EVACUATED TUBE SYSTEM: Pros and Cons

Just before I get blood from my patients, I always ask myself on what method should I use to ensure a successful venipuncture. It's after vein assessment that I decide what to use and based from my experience, I've come to realize that both the syringe method and ETS (evacuated tube system) have their own advantages and drawbacks. Check this out!

I've always loved using syringes. I feel safe when using them. This is when I hear compliments such as "It's not painful' or 'I didn't feel anything..Thank you'..

SYRINGE

Registered trademark of Terumo Corporation

1. PROS

• with backflow
• less painful
• you can change the needle gauge for smaller/thinner veins
• can be maneuvered

    2. CONS

• limited amount of blood 
• time consuming in transfering blood from one tube to another
• 10cc plungers are hard to pull and agent for short draws
• needle pricks
• cause for platelet clumps if blood is not transferred immediately

On the other hand, when times are busy, I use ETS! I realize you have to be sure when doing ETS method or else YOU'LL BE SORRY it didn't turn out so well.

EVACUATED TUBE SYSTEM

Registered trademark of Becton-Dickinson Company

1. PROS

• faster way of collecting blood
• with safety feature included
• recommended for multi-sample draws
• suitable for tests requiring closed system method of venipuncture (eg Ammonia, Carbon dioxide)
• reduces the risk of hemolysis

    2. CONS

• proper order of draw should be strictly observed
• not recommended for newborn or pedia patients
• not suitable for easily collapsed veins
• might not get the appropriate amount if vacuum tubes are expired or opened already
• would mostly leave hematoma on the skin

It's all in your hands what to use during your shift but one must consider convenience both for you and to the patient, It's always been like that from the start. So think and use these weapons wisely :-)

Night life of a junior medtech

Night shifts (for me) are the most anticipated shift of the week. While others are sleeping, this is when you have to work as fast as you could to finish all the things on time. So let the COFFEE PARTY get started!

Night shifts had never been easy for me. Setting spooky stories aside coz Micro lab is kinda scary. Before going up for warding, we have to prepare things for the next day by running controls to machines. Reconstituting controls can be stressful at times when the controls don't go well as expected. This is where our pipeting techniques developed.

When I'm assigned in warding department, I really need to be quick in getting in and out of the patient's room for blood extraction. Waking them up can be time consuming so you gotta have a loud voice with a gentle tone to let them know. Each of us has a game plan on how to get all the patient's blood before the time runs out just like what floor comes first or should you prioritize the nursery rooms but in situations when some patients are difficult to extract esp babies or those in ICUs, we take our time..

Well, at the end of the shift you will realize you've survived. But one thing that I don't like from the night shift is that I keep on worrying if everything is OK after I left from work. That wears me out. After that, the day off is spent for the whole day of rest. That's how a night life of a medtech looks like.

Momshies gone to watersports adventure!

Finally, our long-awaited summer vacay has arrived! To tell you guys, we work in the laboratory almost everyday and we're stressed out after shifts. I think we really deserve a day off to a beach under the heat of the summer sun!

Honestly, a day is not enough to grasp our sweet escape from work but we made the most out of it. It's better to have one than to have nothing at all! Right? We were so thankful that the odds were on our favor as the nine of us were able to get in this exciting outing. This is what we've been craving for after one year in CDUH :-)

We took the opportunity to avail Serena Watersport's summer promo. Though a little bit pricey but it's already discounted so I thought it's worth a try the parasailing activity.

Here are the activities I didn't miss ....

JETSKI
At first, everyone was reluctant to drive it but when we had the chance to hold the grips of the jetski, it was enthralling and I hope it never stops. I pushed the button to the max as waves were created out from the motor. As I drove to the vast ocean, it was endless! I felt free! You can turn which way to go and no one's gonna bump your way. I realize you don't need to be a motor driver to ride a jetski.



PARASAILING...
This is my unforgettable and the highlight of today's activity. The thrill by the time you were up there makes you think you don't want to go down anymore. The 15-minute parasailing was never enough for a thrill seeker like me. You can get the bird's eye view of the whole LapuLapu, Cebu. It was awesome yet breathtaking. I found myself at peace as I saw the entire ocean. We shouted at the top of our lungs (no ones gonna hear us anyway) as I fed my eyes with the scenery above water. It was peaceful up there. We climbed all the way up to 800m above the sea.

BANANA BOAT RIDE...
I didn't expect riding a banana boat would be so much fun. It had a twist. We were towed by a rushing speedboat and we enjoyed ourselves for a ride. I just got nervous when they told Kuya driver to take the banana boat upside down which made me think will I ever survive after we plunge down the very deep water. As it happened, each of one struggled to get beneath the water and breathe.




Overall, I enjoyed the whole package. My money didn't go into waste and it was worth it. It's a one-of-a-kind experience that no money can ever buy. I had a wonderful time with my workmates and it truly build a stronger bond among us.

We thank Serena Watersports team for the wonderful accommodation especially to the Kuyas who guided us throughout the day and kept us safe from any untoward accidents. I also thank God for making this possible by providing us the good weather for the outing. Looking forward to more adventures with these people. I'm glad I've ticked off some things on my bucket list !

Phlebotomy 101: How to get blood from babies? Part 1

 Neonatal Phlebotomy is one of the challenging things a phlebotomist could encounter in nursery rooms and neonatal ICUs. Though dangerous, I prefer getting blood samples from babies than pediatric patients.

What's difficult in blood extraction of the babies is that their veins are still thin. You can not always use 3cc syringe to get the baby's blood from the arm. If possible, one should pull the plunger slowly so as to prevent the vein from collapsing. There should be an assistant to hold the baby's arm to secure the vein. Take note, the baby's veins are still movable and their skin tends to stretch.

THE SOLUTION...
To get blood samples for tests like CBC, Total and Direct Bilirubin for babies and the like, a passive blood collection technique called DRIPPING may be applied.

HOW TO DO DRIPPING

1. First and foremost, nursery rooms especially neonatal ICUs limit hand contacts to their babies. And for this reason, we should observe proper hand hygiene by washing our hands with soap and dry it thoroughly with a tissue/paper towel. Also, prepare the things you need. In our hospital, it is a policy to leave the warding trays outside the nursery rooms and bring only the things you only need.
2. It is an option whether you put gloves or not. As for me, I don't wear gloves until I have found the right vein for dripping.

3. VEIN ASSESSMENT: To choose the right vein for dripping, gently press the baby's dorsal hand with your index finger just like when Nurses are going to insert an IV needle. Take your time in finding the vein of your choice.
4. One of the ways to obtain a successful extraction is the way you hold the baby's hand. In order for you to easily squeeze the hand as the blood drops, make a circle around the baby's hand.
5. Clean the site: inner to outer motion. In this manner you can see your chosen vein clearly. Let it dry.
4. Taut the baby's skin. Hold it firmly. A 23-gauge needle can be used. As you insert the sterile needle (bevel up), don't let air get into it. Shallow angle of insertion at first then insert deeper until blood coming from the vein of choice comes to the needle's hub.
5. SQUEEZING TECHNIQUES...
As soon as the blood drops, squeeze the baby's hand gently by letting your index finger massage the baby's hand downward. This is to facilitate the blood to drop in the microtainer tube that you're holding in your other hand. It is advised to observe a 3-second interval after squeezing to avoid needle dislodge and to allow more blood to drop in the tube.
6. In case you observe any clots in the hub, gently remove it by using an alcohol swab. This should be removed immediately or else the blood flow will stop. Also, when you notice the blood stops dropping, adjust the needle inward or outward. Do it gently.
7. After collecting the right amount of blood. Cap all the microtainers and remove the needle with a cotton ball immediately covering the puncture site. Apply pressure for 1 minute then put a plaster.
8. Dispose the sharps in the sharps container and make sure the baby's bed is clean before leaving.

Dripping might be time-consuming but I personally prefer doing it than the syringe method. I hope this helps...
Stay tuned for my Part 2 of neonatal phlebotomy tips!

Iron staining of bone marrow aspirate smears

Iron staining for bone marrow aspirate smear is one of the special procedure a warding medtech is assigned to perform. 

This is one of the most sensitive histochemical tests and will demonstrate even single granules of iron in blood cells.The iron staining procedure utilizes the Prussian Blue stain for ferric iron to assess bone marrow iron stores. This procedure is particularly helpful when evaluating patients with anemia, iron overload, myelodysplasia, etc. In the adult setting, it is commonly performed on the bone marrow biopsy, but can be requested on the aspirates as well.

Principle: Small amounts of ferric iron are found normally in bone marrow. The reaction occurs with the treatment with acid ferrocyanide solution. Any ferric ion (Fe3+) in the tissue combines with ferrocyanide and results in the formaion of a bright blue pigment called “prussian blue” or ferric ferrocyanide.

It is important that you have this staining set to perform the procedure. Then, we ask the hematology dept. for a positive control and proceed to fixing. A bone marrow aspirate smear is fixed in a glutaraldehyde or methanol and after such time it is air dried we immersed to these reagents on the picture.

After the staining procedure is done, we refer it to the pathologist to examine.

Results :
1. Iron (ferric form) - bright blue
2. Nuclei - red
3. Cytoplasm - pink


References:
https://www.labce.com/spg448399_iron_staining.aspx
http://laboratoryinfo.com/perls-prussian-blue-staining/
http://www.inflathrace.gr/sites/default/files/Staining%20Protocol%20for%20Iron.pdf

What is MEDICAL TECHNOLOGY and why I chose it?

As I graduated from high school, I was really firm with my plan of choosing Information Technology course in a well-known university. It was a neat plan to start building my future career until suddenly.... fate have shifted its direction...it changed my life...and the next thing I knew, I found myself in a medical school taking this course I'm not so familiar with... the Bachelor of Science in Medical Technology. 

Let me introduce to you my chosen profession... 

What is Medical Technology? 

BS Medical Technology is a four year degree program that equips students with knowledge and skills in laboratory tests used in the detection, diagnosis, prevention, and treatment of diseases (finduniversity.ph).  Medical technologists also known as medical laboratory scientists work in hospitals or free standing laboratories to collect and analyze/process patient's blood samples and other body fluids. They are trained to operate the machines used in each sections. They are the key players in patient diagnosis by providing accurate results to the physician. 

They are well-trained in the areas of:

• clinical chemistry- where tests like lipid panel (cholesterol, triglycerides), fasting blood sugar, creatinine are performed
• hematology - CBC
• microbiology - identifying isolated bacteria, fungi, viruses in cultures
• immunology -  performing Hepatitis panel, HIV Test, Thyroid panel
• immunohematology (blood bank) - crossmatching, preparation of blood units, operating the platelet apheresis machine
•  urinalysis and body fluids - stool exam, semen analysis

Why did I choose this course?

My father wanted me to become a doctor and he told me that this is the best pre-med course to take. Also, I've always loved science and it made me realize that the course is not so common as compared to information technology. Because of that, I defied the odds and choose this interesting course.

About my college life...

Choosing medical technology was very challenging yet interesting. To add, I had a scholarship to maintain. There were times when I don't know what subject to prioritize. All of them are difficult but then I had friends who made medtech life fun for me. I learned that it's not just always memorization on terms but also you should be able to understand its concepts. This was the time I was not that good in phlebotomy but I got better as internship came. It was a balanced learning actually, as we were fed with lots of theories during lower years and immersed with its application during the internship

Am I using what I learned in college?

Yes. During school and internship, I was able to apply everything I learned.  In school, I learned the manual method in the microscopic examination of urine as well as manual differential counts already. The identification of each cells made easier because of the morphology our instructors taught us. It made me appreciate more  the concepts that I learned in books in the actual practice. 

How long did it take to find a job after graduation?

Since most of the laboratories prefer licensed medtechs, I spent 4 months of preparing for the licensure exam. After I passed the boards, it took me only one week to find my first job. I worked as a all-around medical technologist in a secondary primary laboratory with a good chief medtech that served as one of my mentors.

My current job?

I'm now working as a registered medical technologist in one of the private hospitals here in Cebu.

Do I recommend studying Bachelor of Science in Medical Technology?

Of course. The Philippines needs more medical technologists. Aside from being considered as the best course if you're going to pursue medicine, being medical technologist has a lot to offer.  This profession provides you a continuing education. The pursuit of learning new techniques regarding new clinical advancements are endless and so are the employment opportunities. 

Advice to people who are thinking of studying this course?

Be in mind that this course is a survival to the fittest. If you're already in it, you have to finish what you've started. Medical Technology entails sacrifice, dedication and confidence in your part, may it be while you're still studying or in a working scenario already. You have to possess a positive attitude that you will pass. Focus in your studies and learn to know the subject matter by heart. Theory and application should come together. The microscope is your friend so expect for practical tests on identification on various organisms. A licensed/registered medical technologist gets higher salary compared to those who are not so it is better if you pass the board exam.

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I hope this blog will enlighten your mind on choosing the right course. Good luck!

Newbies in Hema department..what to do?

As a newbie rotating in Hematology department, familiarizing the procedures in your respective institution is a must. A proper orientation by your senior MT can help you understand the workflow as well as to troubleshoot some problem that needs to be addressed immediately. Since you are a newbie in Hema (like me..lol), it is best to ask from your senior MT for clarifications and be open for any corrections. :-) Keep in mind that you are encouraged to ask/confirm if you are confused of something. Don't ever be afraid to approach. It is the senior MT's pleasure to help and guide you to become a self-equipped and independent MT in Hematology Department in the future...

But then, an extra effort is expected for us newbies. We have to do our part too and that is to go back to study again. The procedure manual in your department might be of help and at least will give you the overview of the different procedures to be done in hematology department,

Here are the things that I learned in Hema lately...these are just random pointers.

1. Learn how to use the hematology machine analyzer (Beckman Coulter): reviewing and troubleshooting problems, running the controls, and replacing empty reagents.
2. Familiarizing the RBC and WBC precursors.
3. Taking note to panic values and flaggings!
4. Getting to know the different cells (their characteristics) as well as if there are malignant cells in the differential count.
5. Adjusting the normal value with that of the patient's age: newborn, child, adult
6. Correlating patient's previous results (if there's any).
7. Total cell counts and differential counts on other body fluids (CSF, Peritoneal, Pleural, Synovial fluid)...the dilution and the manner of counting
8. Preparing blood smear to each patient
9. Indirect platelet counts below 100
10. PLATELET CLUMPS...patient's smear needs to be checked. If there are platelet clumps noted, a patient's citrated blood is used.

Now, tips number 2 and 3 are to be given much attention because there may be flaggings (such as MO blast, Left shift, Imm Grans) to show up and we may have mistaken these blasts as lymphocyte or monocyte. So, a referral to your pathologist of your manual diff count is advised before releasing the results. 

And lastly before you leave your working area, make sure you leave it clean and order as it is. You don't want your co-worker talking about how irresponsible you are. Also, observe a proper endorsement (even before and after) to the MT next to you. Double check the requests you've released. Through this, you'll gonna be out from any trouble in the future. Keep on counting cells folks!

CLINICAL MICROSCOPY DISCOVERIES!

Poor fella with so many uric acid crystals

Phlebotomy 101: How to extract difficult veins? Must-see tips!

I think none of us phlebotomists would want to stick a needle twice. If only the patient knows how we tried our best to get his blood once. BUT...We can't avoid having patients with difficult veins and because of this, we might fail to extract some of them. As a result, patients will get angry and all we have to do is to sigh and act like we never heard them.

But then, we're just humans. We're not perfect thus we make mistakes. Letting go might be hard but just like in getting blood where you think it's hopeless and it's hurting, maybe it's best to just pull it out. Well, if you want to know how I deal my patients in situations like these, then this might be of help for you. I tell you a secret: All extractions starts with setting the patient in a good mood before we stick the needle in them.

TRICKS TO ASSURE THE PATIENT...

I think one of the things to keep a patient comfortable is to show to them that you really know what you're doing, Make an impression that you can be trusted. Sometimes, a patient might ask: Are you a sharpshooter? Are you the senior phleb? To gain trust, you must be confident and set a positive attitude that you can do it. Always act like you're an expert. VEIN ASSESSMENT IS VERY IMPORTANT. Do not haste and take your time in finding the right vein. Just with that manner, the patient will understand that you are really taking time and didn't take him for granted. If must, communicate to them but not to the extent of being talkative (I usually ask them if their lab tests are on a monthly or weekly basis and later they do the talking).

WHAT IF IT REALLY FAILED...

Based on my experience, patients tend to understand why the extraction went wrong when you explain to them what happened and also the mood that you set for them can be helpful. So, the next thing you gonna do is to convince him/her to extract again.

If the patient is already angry, it is best to keep calm. Don't contest the patient's high temper. Deal them in a professional way. Don't argue. Why not try these options for yourself?

Option 1: See if there's a basilic or cephalic vein in that arm.

- Although median cubital vein is ideal but sometimes you need to consider other veins as well such as the cephalic vein in which obese ones have more palpable cephalic vein.

Option 2: Find vein in the other arm.
- Go try palpate the patient's other arm. You may find a vein there. As what I've said, take your time. Mostly, palpable veins are located in the dominant arm so it is helpful to ask if the patient is right-handed or left-handed.

Option 3: Look for a vein in the dorsal hand of the patient

- If there's no hope to find a vein in both arms, we can get blood in patient's dorsal hand if they allow it. Sometimes, I'm surprised how some people have palpable veins on their hands while they're having deep and thin veins in the arm.

Option 4: Use small-gauge needle or a butterfly

- An assessment of what to use when extracting blood can help you achieve a one-stick only goal. Take note that thin veins can't stand bigger gauge needles as the vein will collapse upon insertion. Butterfly method is advisable if the veins are thin and superficial or if you're going to extract in the dorsal hand.

Option 5: Ask help from a senior phlebotomist
- Only and only if the patient insisted..but if not, why not try your best? It's not always your senior will come and rescue you. Show to your senior that you made an effort and at least you've tried. If it still failed for the second time, allow the senior to do the job.

PLEASE STAY TUNED FOR AN UPDATE OF MY PHLEBO TIPS

THE SHIELD OF EVERY PHLEBOTOMISTS

No soldier goes to a battle unarmed that's why a Phlebotomist is armed with lots of weapons in his warding tray for his blood extractions. So the first thing he has in mind is to prepare his warding tray. This is where his weapons are found like syringes, tubes, tourniquet, swabs and anything necessary. No phlebotomist comes to go to a blood war without any extras too. So he has to see to it he gets the right things as he enters the patient's room. Let me introduce to you our warding trays in the lab.

the GRAY WARDING TRAY

This is the light-weight warding tray. This is the tray that I used during my first few weeks being a phleb in the hospital. I take this one if the shift is not busy. Although it's easy to carry but it has lots of disadvantages (for me). You can only take 5-10 samples of patients's blood (what if CBC with a chem test for instance). This will also take your busy time refilling when you're out of tubes or syringes. You have to take a look on your requests as it may fall out from the make-shift compartment. What's the good thing of this tray is that it makes your warding extractions faster. You can easily walk through the hallways swinging this tray in your hand. :-)

the WHITE WARDING TRAY

This is the heavy weight warding tray. At first,I find it so heavy with my little hand and short arm to carry, but I'm now used to it. So organized and clean to look at. It has compartments to make your requests secure from missing. Recommended for morning extractions. It can carry up to 45 samples. You can load enough supplies in it. This will make you look more legit phlebotomist too.

The good thing of getting big warding trays is that you can also take the big waste container (that yellow one where you put the used syringe, alcohol swabs, gloves). It doesn't require too much refilling from time to time. Just after your shift is done.

the BLACK tray

This tray is used for home service requests, This contains enough supplies for extraction. There is a butterfly syringe set in this tray in case of patients who have fragile veins. This is lightweight too and keeps the samples secure for transport.

At the end of the shift, the phlebotomist refills his ammunitions for the next day. This is to make sure that as another blood war comes, he is ready to take his shield whenever the call arises.

The introvert in me..

enjoying my time in the field after work

Truly, if you would ask me one thing about myself, I would say I'm an absolutely an introvert person. Yes, that pretty describes me. Right now, I'm comfortable keeping my circle small. I just realized I don't need a lot of friends to hang out. I may just count my friends on my fingers but they're precious to me. Introverts are not really anti-social. Introverts have friends... it's just that they keep that QUALITY OVER QUANTITY philosophy. They might have misunderstood me. Some might think I'm angry just because I stay silent and some might think I'm a snob. It's just about keeping my comfort zone intact but the truth is I'm being expressive to the closest people I know. I love conversations more than small talks. When I'm with other people, I rather stay quiet instead of trying to open up small talks coz it makes me feel weird. As they say, when you don't have anything nice to say, don't say anything.

The most common thing introverts do love is that moment of silence, enjoying his own company and being quiet with the loudest mind. That's why I prefer writing my thoughts through my diary or in this blog to have my say. An interesting book to read and a quiet ambiance are my heaven. When I was a kid, I was in the middle of depression. I used to blame myself for being such a boring person and the shy type but as I grow up, I appreciated the fact that I come to love who I truly am. I'm also trying to come out in my shell sometimes.

No need to act like somebody just to be loved. If others don't like you, so what? As long as you didn't hurt anybody, there's nothing wrong for being an introvert. Few friends? Fine! Just focus and surround yourself with the people who know your worth and keep you to the positive side of life. It's nice to know that although I may have the introvert personality in me, still there are some people who come to understand my weirdoness. I do believe all of us have that introvert side but on a different level though. I love being an introvert and I'm proud to say it.

  

The rainbow colors in our phleb area

Ever wondered why phlebotomists/medtechs fill different tubes in one extraction?

Here is why:

- Each tube has different kinds of what we called as ANTIcoagulants. An anti-coagulant is a substance (be it liquid or spray-dried) inside the tube that prevents the blood from clotting. Take note, some tests require PLASMA as it retains some substances essential for testing. Also, there are also tubes that needs the blood to be clotted so as to obtain what we called as SERUM.

Now, you maybe asking what anticoagulants are inside each tube and which one hasn't? Let me explain to you starting from the left tube up to the last tube.

First, the phlebotomist makes sure to practice the correct ORDER OF DRAW to avoid anticoagulants mixing up (coz it could affect some results if not).

• Light Blue-Top Tube

This tube contains sodium citrate as an anticoagulant. We use this for coagulation studies such as Prothrombin time (PT), APTT, D-dimer, and Fibrinogen split product in the lab.

I've come across different kinds of citrated tubes having different fill lines but what matters most is that the tube must be completely filled on the line. The ratio of blood to anticoagulant (mostly 9:1) is critical for valid prothrombin time results.

• Light orange tube

This is the Serum Gel Tube. This tube contains a clot activator and serum gel (thixotropic gel) separator. This is commonly used for chemistry tests. Not recommended for clotting time studies and in crossmatching though.

• Red-Top Tube

This tube is a plain tube. That means no anticoagulant. This is widely used for the collection of serum for chemistry tests (Fasting blood sugar, lipid profile, serum electrolytes) as well as clotted blood for immunoserological tests (Hepatitis panel, Thyroid Panel, Allergy panel).

• Green-Top Tube 

This tube contains sodium heparin -- used for collection of heparinized plasma or whole blood for special tests such as Venous Blood Gas, Ionized Calcium in our case. This is a good tube for parallel testing in coincide with the red top tubes in chemistry.

• Lavender-Top Tube (EDTA)

This tube contains EDTA as an anticoagulant -- used for most hematological procedures (Complete blood count, retic ct, peripheral smear morph), Troponin I, and HBA1C.


Invertion is a must after getting the samples filled inside the tube. This is to ensure that the blood is getting mixed with the anticoagulant. There maybe times the phlebotomist has to recollect blood because of the clots being detected in the machine (like in CBC where Platelet clumps could lead to inaccurate results if not to be examined manually through the patient's blood smears).

These are just commonly used blood collection tubes in our laboratory. Yes, there are other tubes that you may come across with. So check out my other posts later.

REFERENCES:

www.mayomedicallaboratories.com/customer-service/faq/specimen/collection-tubes