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Preparation is Key for Pediatric Blood Draws

8/16/2017

Pediatric patientEach day, phlebotomists are tasked with putting patients at ease during a blood draw. This can be especially challenging when it comes to pediatric patients.  

Sue McAnany, MT, phlebotomy education coordinator at URMC, says her trainees are instructed to give special care to younger patients and involve the parents and caregivers to make the draw go as smoothly as possible.

McAnany oversees the 12-week training for all newly hired phlebotomists at URMC. During this time, the employees must perform a minimum of 50 venipunctures (and members of the inpatient vascular access team must perform twice that many). Within the first few weeks of training, phlebotomists perform draws on pediatric patients of different ages. 

Sue McAnany“It’s very important that they feel comfortable with the procedure on adults before we move on to pediatrics,” she said.

The University of Rochester Medical Center and Golisano Children’s Hospital have adapted concepts from the Poke and Procedure Program  which was originally developed at the University of Michigan Health System. This plan outlines specific ways parents and caregivers can be helpful during pediatric blood draws – asking them to fill out a form describing their child’s experiences with needle-stick procedures and what type of distraction techniques or comfort positions they prefer.  

Communication is vitally important in each step of the process, explains McAnany. When the patient arrives for treatment, it’s important for the phlebotomist performing the draw to clearly delegate responsibility to the adults present. This helps minimize potential anxiety for the child.

“If you have more than one person trying to hold the patient, it’s very overwhelming for the child to have everybody talking at the same time,” she said. “One person in the room should be the speaker.”
Sometimes, if there is just one phlebotomist on site and a caregiver is not present in the room, he or she must hold the patient while making the draw.

Most lab locations that frequently have pediatric patients are stocked with photos, bubbles, and other distraction tools that can help divert the child’s attention before or during the needle stick. These tools often include a “Buzzy,” which is a small cold pack shaped like a bumblebee that can vibrate and help numb the area. No matter what tools a phlebotomist chooses, communication is an important part of any draw. 

“For a patient who’s never had blood drawn, you need to explain what’s going to happen (saying, It’s going to be a little bit of a pinch),” said McAnany. “If you distract them just by asking the patient about themselves, they won’t concentrate on the blood draw.”

Each patient is different when it comes to pain or discomfort, and having your blood drawn differs from getting a shot or vaccine because it is drawing the specimen out of the body rather than injecting something into the body. Still, some of the bravest patients often shed tears during or after the “pinch,” but phlebotomists are trained to give words of encouragement and praise.
 
“I always tell them that it’s OK to cry, but really try to hold still,” said McAnany. “You really have to get a good rapport with them and be soft-spoken.”

At the end of the day, she says the quality of these interactions will shape a patient’s overall experience. While needle-sticks can be challenging for patients at any age, following the right protocol and tuning in to the patient’s needs is absolutely essential.

Establishing a good relationship with a patient often results in them asking for a certain phlebotomist for future visits, even when it means waiting longer.

“Even some adults follow the tech from site to site just because they’ve had a good experience,” said McAnany.

Read more on this topic: CAP Today: Helping phlebotomists ease pediatric patient anxiety

Event Celebrates Launch of New NAT Laboratory

8/3/2017

NAT Lab Grand OpeningLaboratory personnel were recently recognized at Strong Memorial Hospital at an event celebrating the launch of the new nucleic acid testing (NAT) laboratory.

The new FDA-approved lab, which officially opened in February, performs serologic testing to screen for HIV, Hepatitis B and Hepatitis C. These results must be obtained before a consenting donor’s organ can legally be transplanted into a recipient.

Prior to the launch, the closest FDA lab that did this testing was located in Philadelphia. Establishing the new lab has significantly reduced the amount of turnaround time for these lifesaving procedures.

Representatives from URMC, the Finger Lakes Donor Recovery Network (FLDRN) and regional organ procurement organizations came together on July 26 to recognize and thank the laboratory personnel who are on call 24/7 to perform this testing when needed.

“Bringing NAT testing here to Rochester really shortens the time, which helps donor organs to be more viable and more appropriate for the recipients, so we really are quite thankful that this team was able to make this testing possible,” said Kathy Parrinello, Chief Operating Officer of URMC.

Since it first opened, the lab has processed tests for 44 donors. It services Rochester, Buffalo, and Albany with hopes to expand this service area in the future.   

“We do this because we in the laboratory are uniquely qualified to do this little piece of transplant testing,” said Dr. Dwight Hardy, Director of Clinical Microbiology at URMC. “We do it to be responsible members of the medical center community and Finger Lakes community, to see that organs that are to be potentially transplanted in patients are safe.”

Surgeons like Dr. Roberto Hernandez Alejandro, Chief of Transplantation Surgery at URMC, see many benefits to having NAT testing under the same roof.

“There was a huge push for doing this in a short period of time because families were requesting it,” said Hernandez Alejandro. “For those (surgeons) that are saving organs for transplantations, this is a great benefit.”

He explained that although this testing happens behind the scenes, no transplant can occur without it.  

“It’s a huge part of transplantation,” he said. “Helping just one donor and saving one life is huge.” 

Read more about the NAT Lab

Forensic Pathology in the News

7/12/2017

Schumer

The national shortage of forensic pathologists in municipal medical examiners' offices was addressed in the local news last week.

On July 6, Sen. Chuck Schumer was joined by local representatives at the Monroe County Office of the Medical Examiner to announce the formation of a new forensic pathology fellowship planned for 2019, made possible by a partnership between the county and University of Rochester Medical Center. 

As quoted in the Democrat and Chronicle, Bruce Smoller, M.D., chair of Pathology & Laboratory Medicine at URMC, said, "This will strengthen the reputation of our own pathology program at the medical center, further helping us bring to Rochester the best and brightest medical residents interested in the field." 

Read more...

Are We on the Heels of a Gene Signature for High-Grade Breast Cancer?

7/11/2017

A pathology researcher at the University of Rochester Medical Center believes she’s discovered an important phenomenon in normal-looking breast tissue that could foreshadow an aggressive tumor known as triple-negative breast cancer.

Xi Wang, M.D., recently reported her findings in Human Pathology; she also presented the data at the U.S. and Canadian Academy of Pathology’s annual international meeting in 2016, the largest international meeting in the pathology field. Wang analyzes hundreds of breast tissue samples each month and based on her observations came up with the hypothesis that an alteration in the p53 gene might be the beginning of a cell’s cascade toward becoming fully cancerous.

P53 gene changes as seen under microscopeP53 is a well-known tumor-suppressor gene. When it’s acting as it should, p53 keeps cancer at bay. But when it is mutated, it no longer suppresses cancer cells. It’s frequently mutated in lung cancer and also commonly mutated in a type of high-grade ovarian cancer. In breast cancer, the p53 mutation is detected in less than 25 percent of cases, Wang said, but the frequency is much higher in triple-negative breast cancer, which is much harder to treat.

Her latest research looked at normal/benign tissue samples from women who also carried the BRCA1 or BRCA2 genetic mutations, which increase the chances of getting breast cancer by more than 50 percent, and significant boosts the likelihood that breast cancer will be the triple-negative subtype. Results showed that p53 is more frequently altered in the seemingly “normal” breast tissue in BRCA carriers, compared with the general population. This may help to explain why BRCA carriers are at much higher risk for aggressive cancer.

These p53 mutated breast cells are not proliferating as crazy as tumor cells and have not yet developed into cancer, Wang said. “But they are funny looking and now I will look at them differently because they might be part of a signature for cancer.”

With so many diverse types of breast cancer, it’s important to be able to identify high-grade disease at the earliest point in time to inform treatment decisions.

Although the science is still in its early stages, Wang said, being able to recognize a p53 signature in normal breast cells could someday give high-risk women more information as they are deciding whether to remove their breasts. Currently, however, there is no standard way to screen for p53 mutations in breast tissue.  

Alumni Q&A: Former UR Pathology Resident, Keith Krabill, MD

6/19/2017

Keith KrabillHometown: Uniontown, OH. Now lives in Buffalo, NY.

Family: Wife, Bonnie McMichael, and three daughters, Lorna (20), Rebecca (18) and Kathryn (15)

Pathology Residency at URMC: 1991-1995

Education: Completed a six-year BS/MD program at Kent State University and Northeast Ohio Medical University. He then spent two years doing antiviral research.

Current Role: Laboratory Director at the Women and Children's Hospital of Buffalo, Laboratory Director at the Center for Laboratory Medicine in Williamsville, and Director of the Transfusion Service at Kaleida Health. He is also a Clinical Assistant Professor in the Department of Pathology and Anatomical Sciences at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences.

What first inspired you to get into pathology?

My medical school had three pathologists that were role models and teachers (Ray Clarke, Howard Igel and Robert Novak). They were able to show how the pathology department made a difference to all clinicians and patients, and I could see that they practiced pathology in a way that crossed between different medical specialties. 

How would you describe your job to someone who’s never heard of it before?

If a clinician has a question that can be answered with a test, my job is to make that diagnosis or arrange for it to get done. I am often presented with troubleshooting missions – things that went wrong in testing or workflow.  I  think I do this well, but those projects are challenging because I need to understand what was supposed to happen, what appears to have gone wrong, and how to quickly investigate to confirm and correct the problem.  

What does your daily work consist of?

I get to practice both anatomic and clinical pathology across four hospitals in the Buffalo area. Over time, I have had responsibilities and leadership roles at all of them. I got my job originally because I was willing to cover the transfusion service as well as general anatomic pathology. Over time, I’ve been given opportunities to practice Clinical Chemistry, Microbiology and Medical Informatics. The training I had in residency prepared me to help my partners cover areas that they weren’t as comfortable with, so I see something interesting every day.

What advice would you give to pathology residents?

Spend time getting to know your fellow residents. The time you spend helping each other makes the residency more pleasant and the studying easier. In the longer term, your fellow residents will become a network of friends and references. A senior resident linked me to the job I have today, and his guidance on what to expect as a junior attending helped me avoid early problems.

How do you like to spend your free time? Do you have any hobbies or interests?

My children are convinced that I spend my free time deleting spam. When it’s quiet, I spend my free time reading (mystery and science fiction) and running (distance running, but slow).

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