A Blood Bank Manager in the Carolinas reports that when blood specimens intended for pre-transfusion compatibility testing are drawn in her hospital's operating rooms, the specimens are drawn by a Certified Registered Nurse Anesthetist, who hands off the tubes to "someone else" for labeling. The "someone else" signs the test requisition form under "collected by". The inquiring colleague reports that she "discovered" this situation when investigating a disparity between a historical ABO/Rh and a current specimen. She was told that the handing off of the specimen tubes by the CRNA to a second individual for labeling was "standard practice in the operating room". She was then informed by Risk Management that it was a 'sterility issue'. She is concerned about the aforementioned behavior, which is NOT practiced in the rest of her institution. She wonders if others would comment on their operating room practices with regards to phlebotomy and labeling of blood specimens intended for pretransfusion (and other) laboratory testing.

The following comments have been received.

ADDENDA July 12, 2005

1. A 'blood center' physician reports that in her past 'hospital' life she faced the exact same issue. While she is of the opinion that it is best practice to have the collector label the tubes, the following argument can be made for handing tube off in the OR. If a single patient is in one operating room at any time, so long as each blood specimen tube is labeled IN that specific room, it should not pose an increased risk of misidentification. She adds that this kind of labeling is the usual province of the non-scrub nurse- for example, they will label specimens for anatomic pathology. Taking tubes out of the room before they are labeled however would be a disaster.

2. A transfusion medicine colleague in Georgia reports that in her opinion there is no problem with a second person labeling a pre-transfusion blood sample that has been collected from a patient, so long as both the person drawing the blood and the person labeling the tube are both identified as the phlebotomists. For example, if Jane Dough (who could be a doctor, nurse or other approved personnel) draws a sample, and she hands the sample to John Smith for labeling, the 'phlebotomist' of that tube would be identified as Jane Dough/John Smith. The Georgia colleague emphasizes that the second person must actually visually witness the phlebotomy, and that the sample not leave the bedside before labeling. She reports having used the aforementioned approach successfully in three facilities. It is a practice that can be used all over the hospital. Many times a nurse or doctor that is gloved for a special procedure will draw the sample (from a port, etc.) with another employee viewing. The witness/labeler would then label as described - it is a "witnessed" phlebotomy and is acceptable because it is defined in both the facility and blood bank SOP.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator