Lining and labs/ hemolyzed specimens - page 3

So it was decided by our hospital that it is no longer "acceptable" to draw labs when starting an IV--i.e. they have to be peripherally stuck for blood in addition to the stick for the IV start. The... Read More

  1. Visit  LilgirlRN profile page
    1
    In my opinion it depends on who is working in the lab as far as how many times we get the call that the blood is hemolyzed. So lets say they do call and say it is. We go back in stick the patient again, send it to the lab and guess what? It's hemolyzed again. I've gotten where I just keep extra tubes when I start an IV and send them up if they do call, most of the time, they aren't hemolyzed. Depending on where you work and the labs policies you can use pedi tubes which seem to not be as bad to me.
    One1 likes this.
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  3. Visit  LilgirlRN profile page
    1
    Oh yeah and sometimes I just pop the top off the tube and let the blood just flow into the tube with no suction at all. I do this if I'm in a vein but can't get the catheter to advance but it has great blood return and the vein isn't blowing.
    canoehead likes this.
  4. Visit  WoundedBird profile page
    0
    Quote from LilgirlRN
    Oh yeah and sometimes I just pop the top off the tube and let the blood just flow into the tube with no suction at all. I do this if I'm in a vein but can't get the catheter to advance but it has great blood return and the vein isn't blowing.
    Be careful with this practice as the vacuum on certain colors of tubes is set to allow a certain volume of blood into the tube to mix with the additive in a specific ratio. If that tube is over or under filled your labs will be off and will have to be repeated.
  5. Visit  NurseBatzy profile page
    1
    I'm not an ER nurse, but I think I can give some perspective here. Before becoming an RN, I was a lab tech. You know, the one who actually runs the tests. I think every hospital has a communication barrier between lab and nursing, and it can be difficult to understand exactly why it is the way it is.

    First, as for not having enough blood to run a test, it most certainly has nothing to do with the lab staff. Certain machines need certain amounts of blood. If the machine rejects the specimen, it can not be "made" to run the test. Depending on the test, the lab tech might be able to run it manually, which takes a LOT longer, and if there wasn't enough for the machine, you're not likely to get very accurate results manually either.

    10mls of blood for a culture provides the most accurate results. If the patient is able to give up that much, they should. Just because other cultures have shown positive with less specimen doesn't mean that all cultures will show up with less. If your lab tech is sick to death of fighting with the nursing staff, or the patient is too young to give up all that blood, they can do the test, but again, less accurate.

    It would be a pretty twisted lab tech who would treat specimens drawn by nursing any differently than ones the phlebotomist drew. Also, leaving a CBC sit for a few hours will not cause it to hemolyze. CBCs can be done off of blood up to 48 hours old in either a lavender or green tube, depending on the instrument doing it.

    I've never met a lab tech who really wants to have a patient restuck. Yes, I worked with some nasty people, but no one who ever tried to punish nurses by tormenting patients. We in the lab didn't want to make those phone calls any more than the units wanted to hear from us. Being on the other side, I can see how it is a frustrating system to everyone involved.
    e102587 likes this.
  6. Visit  psu_213 profile page
    4
    Quote from NurseBatzy
    First, as for not having enough blood to run a test, it most certainly has nothing to do with the lab staff.
    I have to say that I have seen cases where this is not true. There has been times where the blood is a half a micron below the line on a light blue (coag) tube and I have gotten called saying they could not run the test. There was another time I was helping another nurse with a difficult stick....she only got the tube half full, removed the tube from the line and said "that'll do." Well, lab ran it. So, something has to be going on...
    VICEDRN, One1, Altra, and 1 other like this.
  7. Visit  CrunchRN profile page
    0
    Why not just have a policy to do a peripheral stick in the case of a hemolyzed specimen from a line draw? I am sure PG doesn't really measure the increased satisfaction that would provide as most patients do not even know it is an option.
  8. Visit  psu_213 profile page
    1
    Quote from CrunchRN
    Why not just have a policy to do a peripheral stick in the case of a hemolyzed specimen from a line draw? I am sure PG doesn't really measure the increased satisfaction that would provide as most patients do not even know it is an option.
    Because waiting a second time for a K level to be run means another 25 minutes in LOS. Welcome to the silliness of being timed on everything!
    Altra likes this.
  9. Visit  CrunchRN profile page
    0
    That truly sucks. You have my sympathies!
  10. Visit  psu_213 profile page
    0
    Quote from CrunchRN
    That truly sucks. You have my sympathies!
    Eh, that's life...but it does get annoying.
  11. Visit  KnitWitch profile page
    0
    Per our department policy, our lab techs/phleebs are supposed to do all lab draws on our patients separate from nurses starting IV sites in order to reduce hemolysis of specimens. I'm kind of ambivalent on this policy as a new nurse probably mostly due to my inexperience. I haven't had a lot of patient complaints and there seems (anecdotally) to be a low rate of re-draws due to poor specimens. The only time this policy is rescinded is in the case of peds and hard sticks. The first time I got an excellent vein in a hard stick pt. the lab tech was right next to me handing me adapters, vacutainers and tubes and telling me what to draw as I'm holding the catheter in trying not to lose the site. I admit I wasn't totally prepared for being asked to draw labs once I finally got a good bleeder. But it all turned out all right in that case with all the tubes/cultures done AND a patent, useable site.
  12. Visit  NurseBatzy profile page
    0
    Quote from psu_213
    I have to say that I have seen cases where this is not true. There has been times where the blood is a half a micron below the line on a light blue (coag) tube and I have gotten called saying they could not run the test. There was another time I was helping another nurse with a difficult stick....she only got the tube half full, removed the tube from the line and said "that'll do." Well, lab ran it. So, something has to be going on...
    I don't want to argue, or inflame, but I am just offering some perspective.

    Coags are a different beast. It only takes about 1/10 of 1 ml of plasma to run a coag test. In this case, it's not a matter of having enough specimen, it is having the right ratio of specimen to anticoagulant. Blue tubes have an exact amount of anticoagulant in them, so that if you fill the tube to the line it is a 1:9 ratio. The machine does not know or check the ratio, it checks to see if there is sufficient specimen. The tech is responsible for checking the ratio. Many will run it short, but then the results are skewed. If it is an emergency, or again when the lab techs just can't handle being cursed out one more time, it can be run, but it is not accurate.
  13. Visit  psu_213 profile page
    2
    Quote from NurseBatzy
    Coags are a different beast. It only takes about 1/10 of 1 ml of plasma to run a coag test. In this case, it's not a matter of having enough specimen, it is having the right ratio of specimen to anticoagulant. Blue tubes have an exact amount of anticoagulant in them, so that if you fill the tube to the line it is a 1:9 ratio. The machine does not know or check the ratio, it checks to see if there is sufficient specimen. The tech is responsible for checking the ratio. Many will run it short, but then the results are skewed. If it is an emergency, or again when the lab techs just can't handle being cursed out one more time, it can be run, but it is not accurate.
    The only point I was making in my post about coags was that some techs will run a tube that is not full, others demand it to be full--in this sense, whether or not a specimen is acceptable depends on the lab tech...just like for hemolyzed specimens.
    Altra and hiddencatRN like this.
  14. Visit  Bobmo88 profile page
    0
    I work as a Tech in the ER and we have had a lot of issues with our lab. I usually don't get very many recollects which is why I am furious every time my specimens get recollected unless I know it wasn't a very good draw. There are many reasons why labs can get hemolyzed but some of the main ones I see from the nurses/phlebotomists end are:
    Leaving the tourniquet on for too long; when using a syringe, using either too big a syringe on a small vein or pulling forcefully on the syringe; shaking the tubes instead of inverting them gently.

    I find that unless it's a really good vein, using the vacutainer with the luer lock for IVs tends to hemolyze the specimens a lot, gently withdrawing with a small syringe tends to work better in my experience. As far as kids are concerned, I never use a vacutainer because the vacuum of the tubes will cause their fragile veins to collapse.

    I don't think all of our issues with recollects are completely our fault though because even the travel nurses that work with us frequently say that they get more recollects at our hospital than other places they've worked. Some of the nurses I work with started their careers working in the lab and they talk all the time about how lab techs and CLSs would hemolyze the specimens themselves after they were spun down. Also, our lab has been known to recollect specimens because the results were abnormal, as if people that show up in our ER aren't sometimes very sick. Not to mention that our lab loses specimens all the time, for example, ammonia levels and lactic acids both need to be sent down on ice and one of our nurses sent both tubes down in the same cup of ice. The lab resulted the lactic but told we us we never sent down the ammonia level. It's so frustrating because we all have so much to do already without having to draw patients 2 or 3 times.


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