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

Lamentations of a Medtech

Bilang isang medtek, di niyo alam kung paano namin naranasan ang:

...pagkahiya sa tuwing pinaggagalitan dahil hindi nakakuha ng dugo
...antok, sa tuwing nasa night shift kami nagwawarding
...pag-aalala dahil hindi pumasok ang controls sa machine
...baho sa bawat tae na pino-process namin
...panghe ng mga ihi na nasa tube
...nanlalabong paningin sa kakagamit sa microscope for diff count and platelet count
...panic sa tuwing may blood typing, crossmatching at transfusion
...pagkahawa sa tuwing may culture, gram stain at AFB na pinoprocess
...ma.IR (incident report) dahil hindi kaagad na release ang STAT request
...lungkot sa tuwing may hemolyzed o clotted na sample


Araw-araw kinakaharap namin ang mga panganib na ito na pwedeng ikamatay namin.
Pero hindi alam ng lahat, na kami ang gumagawa ng lahat ng to para matulungan ang mga doktor na mapagaling kayo. Lahat na lang kinakaharap pero ang liit pa rin ng sweldo. Only in the Philippines kung saan hindi pinagtutuunan ng pansin ang mga tao sa loob ng laboratoryo. We are the 'unsung heroes' ng hospital pero bakit walang nakakakilala sa min? hindi kami nakikita?

May dagdag pasanin pang CPD points. Pag-aabroad na lang ang tanging paraan maiahon lang ang pamilya pero may ASCP at IELTS pang dapat ipasa. Malaking pera pang kailangan. Hahay..Laban at kapit lang mga medtechs! May makakarinig rin sa tin. Makakaahon rin tayo. 

Appreciate the work you have

First of all, it would be a hypocrite for me to say 'I'm contented' when I want something more but lately I'm sick and tired of listening complaints from people about their work. True, private hospitals pay you less compared to government hospitals which I think a double of our salary, but what about that? Some wondered what if they work in a government hospital or 'why the facilities in the other hospital are far beyond compared to ours? Too many comparisons and what-ifs. If I could just tell them to keep it to themselves or ask 'why you're still here when you don't like it' then these would sort things out.

People keep complaining about work but do nothing about it. Tsk2. I understand everybody wants something for the better but you could be at least thankful of what you have for a while. To have landed a good job and earn a good salary, you may settle for it for some time while you work for your next big step. In short LESS TALK, MORE WORK.  

That's the problem to some of us. We tend to ignore what is laid in us until we realize its worth when it's gone. Think about the people still looking for a job, I'm sure they'll take your place no matter how little the salary (for a start),

Wherever the place you're working now serve it as a stepping stone and a training ground. Learn from your experiences. God has a reason why you're there and had some plans for you in the future. Work for it and He will help you. Put passion in your work and never tag everything with a price. 

A CRY OF EVERY PHLEBOTOMISTS

If you think that being a phlebotomist or a warding medtech is easy, think twice.

"Here comes the NURSE...", as people sometimes call us when getting a blood sample, but at the back of our minds, how we would love to tell them that we are medtechs. But that's how they see us and to make things easy, we remain silent.

At just a simple look, a patient might ask: "Are you an intern?" but then we just ignore the insult and laughed at the thought to stay confident and prove to them they're wrong.  As the Coldplay song goes, 'Nobody said it was easy'. Sometimes, they have no idea how nervous for us just palpating the small veins of a cancer patient, obese patients and even babies when pressured to do it JUST ONCE (either thru syringe, vacutainer or butterfly method).

Well, the issue in here is...they just don't have the idea how it feels like to be degraded by someone emotionally, professionally and even physically just because you failed to extract. Here's also the thing, the SOs or the significant others cursing us for being so incompetent and pointing their fingers like we owe them a big deal. Even calling the attention of other people just to humiliate or compare us to other phlebotomists as well. REALLY! These situations do happen just to compensate that one mistake we did! They were not in the position when some of us phlebotomists want to disappear in an instant just because of shame, and the dignity that was taken out from us.

Yes, we encounter these scenarios everyday not mentioning the health hazards we face! They don't have an idea how frustrated we are trying to get blood as we swim the needle through and through. Even a simple 'Tsk, Tsk' is an alarm that we need to pull it out because it's hopeless and the patient complained already. Worse, we get discouraged that at the end of the struggle, the blood is still hemolyzed, clotted and needs re-extraction.

Yes, our job is to inflict pain to patients by using needles. Yes, we do accept our mistakes (even the hematoma on your skin, we're really sorry) because humans as we are, we fail. We're just asking you to give some understanding and a little of your respect to be considerate enough. We're also health professionals who took our time and dedication of studying and even passing the licensure exam. If we fail, I think there's a formal or a right way that you could vent your frustration, not to shout or curse us in public. Take note, this job is just a portion of being a medical technologist. Don't judge us as a whole.

But in the lighter note, we commend those people who regard us phlebotomists as vital in the laboratory. We really do appreciate those people who reply in our sincere 'Thank you' after every extraction.

This is a shoutout for those people who don't know us yet.  You just don't know...AS PHLEBOTOMISTS, WE CARE. To all the phlebotomists and warding medtechs out there, don't just say 'I'm just a phlebotomist.', Be proud of it because the patient's laboratory results depend on you. Blood collection is where it all started. We are the key players of the patient's diagnosis.

LONG LIVE TO THE SO-CALLED BLOOD SUCKERS IN THE LABORATORY!

Working in a hospital-based laboratory

Our first week in CDUH.

After seven months of working in THCDC, I took my biggest decision of whether or not to transfer to another workplace for the better. Honestly, there's nothing I could say about THCDC (because my workmates there were OK) but I do think a hospital experience would be a great advantage as a medical technologist.

I do admit I was already in my comfort zone when a friend of mine urged me to apply in the hospital she's working. At first I had second thoughts but with the help of my family, I took the courage to pass a resignation letter to the clinic and start to submit my application to the hospital. I didn't settle for less.

Working in a hospital-based laboratory is a whole lot different from the freestanding laboratory. In my first few weeks I made some mistakes but eventually it taught me to be careful and at the same time precise in what I'm doing.

Here are some of my RANDOM list of comparisons:
1. FREESTANDING: Some lab tests (even electrolytes and prothrombin time) are considered send-outs.
HOSPITAL:  Because of the wide variety of equipments/machines used, one can simply run the test required. The 'send-outs' are only those considered special tests

2. FREESTANDING: Seldom do we receive STAT requests.
HOSPITAL: Should take note STAT requests time to time or else you'll get Incident Reports from doctors.

3. FREESTANDING: Arterial puncture is prohibited.
HOSPITAL: I perform arterial punctures in situations where patients have difficult veins (esp edematous). Arterial puncture is considered as the last resort when 2 to 3 attempts of venipuncture failed.

4. FREESTANDING: Sunday is day-off.
HOSPITAL: Shifting of schedules w/ a tedious night shift. There's 16 hrs duty depending on the staffs available.

5. FREESTANDING: Less exposure to microbiology and blood banking department.
HOSPITAL: In Micro department, you'll be hands-on in different clinical work-ups to be done in each specimen. A lot of gram stain, AFB, KOH, water bacteriology and culture/sensi to do.
In Blood banking, you''ll get exposed to cross matching, preparation of blood units and platelet apheresis. In case of Rh negative patients, we do Weak D testing for confirmation.

6. FREESTANDING: Most of the walk-in patients (for annual physical exam, employment, etc) are giving normal lab results
HOSPITAL: You'll encounter critical patients giving you abnormal results. So correlation of other tests and even documenting patient's history and their previous results are very important before releasing.

7. FREESTANDING: There are only Pap smears.

HOSPITAL: Biopsies, FNAB, cell block and cytology are being performed by pathologists.

8. FREESTANDING: Only routine lab tests are performed.
HOSPITAL: As warding medtechs, we are the ones to perform special procedure tests like Osmotic fragility test, urine myoglobin, fibrin split product, etc with the approval of the Pathologist.

9. FREESTANDING: Not so much trainings for medtechs.
HOSPITAL: Trainings/seminars by medical lab companies are conducted to ensure continuing education to the lab personnel.

During an annual mobile physical exam in THCDC
courtesy from miss ingrid's photoS.

To sum it up, there are more advantages in working to a hospital-based laboratory. No doubt it is a requirement for us if we want to work abroad. TBH, It is in this hospital I developed my skill in phlebotomy especially in getting blood from newborn babies and geriatric patients. Though stressful at times but I think that's a part of being a hospital lab personnel anyway. I met several people and I got to work with them every other shift. Just mind your own business by the way :-)

Well, it is true that the pay of hospital-based laboratories isn't that much compared to the free-standing laboratories but the experiences of working in a hospital esp to the departments in the laboratory are worth it.

Nevertheless, I'm so thankful for THCDC for giving me the experience to work in such a short time. It helped me to prepare in working for a hospital setting. Who would have thought I landed at Cebu Doctors' University Hospital?