Stupid little procedures

[agranulocytosis]

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As my FM rotation nears its end, the attending sent us on a phlebotomy training session in order to learn how to draw blood properly. Fine, that's all well and good learning how to venipuncture correctly using proper technique. But the phlebotomist is a real stickler for technique. I'm talking having to walk through the entire encounter step-by-step.

First you introduce yourself, double check the ID, set your stuff up, prepare the arm, perform the puncture, label the tubes, gently shake the tubes 8 times so the anticoagulant mixes correctly, and obviously dispose of the waste properly.

Well folks, I failed to receive my certificate of competency. It turns out that I forgot to gently shake the tubes at all, thus giving the phlebotomist the pleasure of failing me.

Tomorrow is the day the attending writes our evaluations, and as far as I know, my school does not require any paperwork showing proof of venipuncture competency. I just hope that the attending doesn't require a certificate, otherwise I'd have to go through the training session again tomorrow for another 4 hours. Pain.

Anyone else have to go through silly little hoops like this throughout your clinicals?

 

[Ashers]

As my FM rotation nears its end, the attending sent us on a phlebotomy training session in order to learn how to draw blood properly. Fine, that's all well and good learning how to venipuncture correctly using proper technique. But the phlebotomist is a real stickler for technique. I'm talking having to walk through the entire encounter step-by-step.

First you introduce yourself, double check the ID, set your stuff up, prepare the arm, perform the puncture, label the tubes, gently shake the tubes 8 times so the anticoagulant mixes correctly, and obviously dispose of the waste properly.

Well folks, I failed to receive my certificate of competency. It turns out that I forgot to gently shake the tubes at all, thus giving the phlebotomist the pleasure of failing me.

Tomorrow is the day the attending writes our evaluations, and as far as I know, my school does not require any paperwork showing proof of venipuncture competency. I just hope that the attending doesn't require a certificate, otherwise I'd have to go through the training session again tomorrow for another 4 hours. Pain.

Anyone else have to go through silly little hoops like this throughout your clinicals?

I had to receive scrub training at my away rotation as an M4 (3 weeks into my ortho away) -- stupid waste of time. No scrubbing certification though, just someone telling me what to do at every step as if I had never learned to scrub.

Anyway, as a former phlebotomist, I take issue with her order, if that's the order given. Shaking some tubes should come before labeling. It's important to mix the additives any. HOWEVER, I've only had to draw blood three times as an M3 or M4.

 

[Mayhem]

They have this session on giving IM injections on every rotation in 3rd year...and I do mean every rotation. It's gets a bit absurd when you're on your final rotation (paeds) and the nurses go nuclear because you gave a 12 year old an injection before the injection session. Never mind that you've spent the last year doing the same thing on Surgery, Medicine, Psych etc.

 

[BigRedBeta]

We have a whole list of things we're supposed to have completed, or observed during the course of the clinical years...draw blood 10 times, start an IV 10 times, observe an LP, do 3 urine dipsticks, etc. We have an online server where we have to put in when we did them and who observed us doing them.

It's a little annoying, but makes sense, though it's pretty easy to falsify too. The one I didn't get is the need for documentation of doing 2 full H&P's...not sure how anyone could get through a single clerkship without doing at least 2, let alone make it through 2 years without completing that requirement.

 

[mrantarctica]

We have a whole list of things we're supposed to have completed, or observed during the course of the clinical years...draw blood 10 times, start an IV 10 times, observe an LP, do 3 urine dipsticks, etc. We have an online server where we have to put in when we did them and who observed us doing them.

It's a little annoying, but makes sense, though it's pretty easy to falsify too. The one I didn't get is the need for documentation of doing 2 full H&P's...not sure how anyone could get through a single clerkship without doing at least 2, let alone make it through 2 years without completing that requirement.

It's interesting to read this. I haven't been trained in a US centre, but have travelled pretty widely, and have noticed a general trend to 'objectify' medical student training. On a lot of our clinical rotations, we're often given log books to record the activities we did. However, most of the time these arent used to evaluate our performance. I guess one good thing about it is that it gives you a tidy list of practical skills that you should be competent with before you graduate. It does give a lot of confidence when you look back and think - wow, I have actually done a hell of a lot of practical stuff.

 

[agranulocytosis]

I had to receive scrub training at my away rotation as an M4 (3 weeks into my ortho away) -- stupid waste of time. No scrubbing certification though, just someone telling me what to do at every step as if I had never learned to scrub.

Anyway, as a former phlebotomist, I take issue with her order, if that's the order given. Shaking some tubes should come before labeling. It's important to mix the additives any. HOWEVER, I've only had to draw blood three times as an M3 or M4.

You're actually correct, I didn't write that in order. It's shake before labelling. Ha, this is probably why I didn't get the certificate. But my sterile procedure was spot on!

In any case, the certificate did not matter, and the other students' certificates stated that they successfully completed initial training, but this does not certify them to perform solo...

 

[agranulocytosis]

We have a whole list of things we're supposed to have completed, or observed during the course of the clinical years...draw blood 10 times, start an IV 10 times, observe an LP, do 3 urine dipsticks, etc. We have an online server where we have to put in when we did them and who observed us doing them.

It's a little annoying, but makes sense, though it's pretty easy to falsify too. The one I didn't get is the need for documentation of doing 2 full H&P's...not sure how anyone could get through a single clerkship without doing at least 2, let alone make it through 2 years without completing that requirement.

We have a daily log system where we're supposed to log down all activities from lectures attended to presentations given to patients seen.

You're right, it is annoying, but I guess it's a form of quality control in making sure clinical sites are up to par with what we're supposed to be learning.

 

[drdr2010]

did you at least get to perform the procedure on real people?

we have the same sort of procedure competency thing, but its done entirely on these fake arms. very weird to introduce yourself to an arm.

but we have to get checked off on venipuncture, starting an IV, and ABGs on the arm, plus LPs on a fake torso. i think its ok for learning the step by step procedure, but not entirely useful for knowing what a vein/artery feels like. you can tell where to put the needle in because 100 other med students before you have stuck the arm and there are holes all over it!

we are allowed to practice venipuncture/IVs/ABGs on each other too, but can only complete our competency on the models.

 

[BigRedBeta]

did you at least get to perform the procedure on real people?

we have the same sort of procedure competency thing, but its done entirely on these fake arms. very weird to introduce yourself to an arm.

but we have to get checked off on venipuncture, starting an IV, and ABGs on the arm, plus LPs on a fake torso. i think its ok for learning the step by step procedure, but not entirely useful for knowing what a vein/artery feels like. you can tell where to put the needle in because 100 other med students before you have stuck the arm and there are holes all over it!

we are allowed to practice venipuncture/IVs/ABGs on each other too, but can only complete our competency on the models.

We can't count our practice time with the models as completed attempts.
The worse practice we did on each other was the NG tubes...even 45 seconds with one of those in place makes you a lot more sympathetic for the patients that have them in for days.

 

[Dr McSteamy]

typical for students to think these teaching sessions are stupid.

i'm guilty too

but you're supposed to learn. and what's the hurry? where are you trying to get to in the next 5 minutes?

 

[beastmaster]

but you're supposed to learn. and what's the hurry? where are you trying to get to in the next 5 minutes?

the cafeteria

 

[agranulocytosis]

did you at least get to perform the procedure on real people?

we have the same sort of procedure competency thing, but its done entirely on these fake arms. very weird to introduce yourself to an arm.

but we have to get checked off on venipuncture, starting an IV, and ABGs on the arm, plus LPs on a fake torso. i think its ok for learning the step by step procedure, but not entirely useful for knowing what a vein/artery feels like. you can tell where to put the needle in because 100 other med students before you have stuck the arm and there are holes all over it!

we are allowed to practice venipuncture/IVs/ABGs on each other too, but can only complete our competency on the models.

Yeah, we performed on each other after we passed a qualifying test.

 

[agranulocytosis]

We can't count our practice time with the models as completed attempts.
The worse practice we did on each other was the NG tubes...even 45 seconds with one of those in place makes you a lot more sympathetic for the patients that have them in for days.

Ouch, I can't even imagine what that would feel like. I was a bit hesitant on letting my classmates stick me, as I'm sure they were pretty wary about being stuck as well, but an NG tube! Wow...

 

[agranulocytosis]

typical for students to think these teaching sessions are stupid.

i'm guilty too

but you're supposed to learn. and what's the hurry? where are you trying to get to in the next 5 minutes?

It's not so much the learning aspect as it is the obtaining the certificate. I mean the actual puncture should be good enough, but I guess you do have to make sure the blood sample is good enough for the lab techs to work with.

And the cafeteria does sound like a place I'd need to be in the next 5 mintues.

 

[nzscholar]

I think that's kinda stupid.haha

 

[surrender903]

we had to do this during my urban medicine rotation (august/sept of this year). i did not think it was stupid, but i was not the most adept at drawing the blood.

at the end of my training the phlebotomist said to me "if i were grading you, you would be getting a D. im just being honest."

i actually like learning how to do procedures, but her entire attitude was that i was taking up too much of her time.

 

[Ashers]

we had to do this during my urban medicine rotation (august/sept of this year). i did not think it was stupid, but i was not the most adept at drawing the blood.

at the end of my training the phlebotomist said to me "if i were grading you, you would be getting a D. im just being honest."


i actually like learning how to do procedures, but her entire attitude was that i was taking up too much of her time.

That's their one source of power. Ugh.

I offered to help 2 phlebs once who were struggling finding a vein on a patient (I had lots of MDs and RNs help me when I was a phleb, so I thought maybe I could help just returning a favor, etc., since I can find veins pretty well), and they were like, "If we can't get it, neither can you!"

 

[SoCuteMD]

As helpful as drawing blood is, it's kinda pointless. If the nurses (who have YEARS of experience) can't get it, then I (the med student, resident, attending) am never giong to get blood. The patient is getting an arterial stick.

 

[EM2BE]

What's this with shaking tubes? I was a phleb and we were told to never shake, just invert to mix the anticoagulant. And who cares if the tube for BMP/CMP clots? You spin it down and clot it up anyway (and of course it separates itself out). Plus, SHAKING a tube will cause things like your potassium levels to be off and sometimes lead to the patient getting stuck again. Just thought I'd share because I had a doctor tell me to shake the tubes after he drew and I did because he was in charge and of course the potassium came back extremely high. At least the lab is nice enough to note the blood was hemolyzed.

And no, I haven't had to draw blood on a patient as a med student yet.

 

[45408]

That's their one source of power. Ugh.

I offered to help 2 phlebs once who were struggling finding a vein on a patient (I had lots of MDs and RNs help me when I was a phleb, so I thought maybe I could help just returning a favor, etc., since I can find veins pretty well), and they were like, "If we can't get it, neither can you!"

I've noticed a lot of "King of a Small Kingdom" syndrome in the hospital. God forbid I stand 11 inches from the sterile field instead of the requisite 12 inches. Some people like to take the concept of sterility to the max, despite the fact that the air isn't the least bit sterile.

 

[fakin' the funk]

I've noticed a lot of "King of a Small Kingdom" syndrome in the hospital. God forbid I stand 11 inches from the sterile field instead of the requisite 12 inches. Some people like to take the concept of sterility to the max, despite the fact that the air isn't the least bit sterile.

...and AORN guidelines for sterile technique/procedure are for the most part made-up and without evidence. 👍

 

[agranulocytosis]

What's this with shaking tubes? I was a phleb and we were told to never shake, just invert to mix the anticoagulant. And who cares if the tube for BMP/CMP clots? You spin it down and clot it up anyway (and of course it separates itself out). Plus, SHAKING a tube will cause things like your potassium levels to be off and sometimes lead to the patient getting stuck again. Just thought I'd share because I had a doctor tell me to shake the tubes after he drew and I did because he was in charge and of course the potassium came back extremely high. At least the lab is nice enough to note the blood was hemolyzed.

And no, I haven't had to draw blood on a patient as a med student yet.

Really? So it is quite pointless to begin with...

 

[Ashers]

Really? So it is quite pointless to begin with...

I took "shaking" to mean inverting (you don't want to shake it; it could "potentially" cause hemolysis). It's not pointless. I've seen the purple topped tubes with EDTA clot because they weren't inverted. The lab also thought I didn't invert it on a patient several times, and I had to redraw this dude, again and again, until they figured out he had cold agglutinin or something (it was before I was in med school, so I don't totally remember).

The ones that clot it's not as important, but some have additives for something (not sure what's in the gold top tubes).

The blue top and purple top need to be inverted.

/end phleb rant.