Lining and labs/ hemolyzed specimens - page 5

by psu_213 7,659 Views | 64 Comments

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 supposed reasoning behind... Read More


  1. 0
    I haven't read all the replies but....

    We went through a period where it seemed like we had a VERY high incidence of hemolyzed specimens. After a lot of back and forth between the lab and ER, it was decided that our t-sets attached to the catheter hub was partly to blame. It was also decided that there was one lab tech that was, basically, too lazy to attempt to run a minutely hemolyzed specimen. It was always the same chick that called to say the specimen was hemolyzed. Always!
    Anyway, we got new t-sets and changed our order of draw and we don't have near the amount of recollects.

    As far as not getting blood with an IV site, I'd be pretty upset if I were the pt and had to be stuck separately. Now, I realize that sometimes that IV won't draw but will flush or you are already running some med or fluid but to just stick like you are describing is just creating more time-consuming work for me. I really hate when I am forced to work harder and not smarter.

    m
  2. 0
    Quote from KeeperMom
    but to just stick like you are describing is just creating more time-consuming work for me.
    Not to mention that every time a needle breaks the skin, there's a non-zero chance of infection, accidental needle stick, blown vein, hematoma, etc, etc.

    I'll stick 'em as often as necessary but it's not optimal patient care to routinely require additional sticks when the vast majority of samples drawn by a skilled nurse through a patent IV site are perfectly fine.
  3. 1
    Your residency doc who says they line/lab draw (all in one stick) everywhere would do well to be informed that the problem of hemolysis using this method exists EVERYWHERE. From San Fransisco to New, New York; Weslaco, Texas to Detroit, Michigan and everywhere in between.
    keylimesqueez likes this.
  4. 2
    It takes much more work to reject a sample due to hemolysis, than to run one and release the questionable results.
    keylimesqueez and psu_213 like this.
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    [QUOTE=Bobmo88;7131222]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.



    just curious, how would a lab tech hemolyze the specimen.

    I have been called about hemolyzed specimens when I knew what I sent to lab was a perfectly good specimen.
    Last edit by icuRNmaggie on Sep 4
    psu_213 likes this.
  6. 4
    There are many reasons why labs can get hemolyzed but some of the main ones I see are: Leaving the tourniquet on for too long
    I dispute this. There is no mechanism by which the tourniquet duration would result in hemolysis nor have I seen this in my 5 years of drawing blood... and on occasion I've left tourniquets in place longer than is optimal due to multiple sticks in a time-critical patient or placing a particularly difficult ultrasound line.

    Quote from icuRNmaggie
    I have been called about hemolyzed specimens when I knew what I sent to lab was a perfectly good specimen.
    I've had the same experience. I know when a sample is possibly hemolyzed.

    We had a CLS who was observed by our ED manager shaking the tubes. When she was on-call, I preferred to spin them down myself before she got there so that there could be no argument.
    zmansc, emtb2rn, psu_213, and 1 other like this.
  7. 3
    Quote from ♪♫ in my ♥
    I dispute this. There is no mechanism by which the tourniquet duration would result in hemolysis nor have I seen this in my 5 years of drawing blood... and on occasion I've left tourniquets in place longer than is optimal due to multiple sticks in a time-critical patient or placing a particularly difficult ultrasound line.
    +1
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    Maybe it's certain lab techs.
    I dont work in the lab and won't even attempt to know how things go but im willing to bet that most spin the samples and then call me to complain..

    Where there's 1 tech that seems to call the instant the tubes arrive and tell me every single 1 is no good.
    I would rather redraw 1 tube and know that's the bad tube then redraw a rainbow on a difficult stick..

    Any why oh why, when a pt goes outpatient to the lab for testing, do we never hear about hemolyzed labs?
    I worked ambulatory 3 years on the telephone and never once had to notify a pt that their labs needed redrawn... Hmmmmm
    emtb2rn, psu_213, and icuRNmaggie like this.
  9. 0
    Quote from Sassy5d
    Any why oh why, when a pt goes outpatient to the lab for testing, do we never hear about hemolyzed labs?
    ^^^^^^ This!!



    Sent from my iPad using allnurses
  10. 0
    Outpatients do occasionally need to be recollected due to hemolysis. You never hear about it, because the lab takes care of calling their own redraws back. It might be a HIPPA violation for this data to be published. Tubes for most chemistry tests are definitely spun down first; this is how the serum or plasma is obtained to perform testing. Plus, this is really the only way to tell if tubes are hemolyzed. Veteran lab scientists can tell by the way the blood coats the tube when, they rock it, whether it's hemolyzed. Also, some parameters of the CBC are grossly elevated when the tube is hemolyzed, MCHC for instance. The big reason the tubes drawn with an IV start are hemolyzed better than fifty percent of the time is that the lumens are designed to introduce liquid fluid into the body NOT to TAKE IT OUT. Red blood cells are solid and very small, and when they strike the surface of the IV device they rupture and spill their CK, potassium, LDH. Sometimes the pressure when pulling tubes with a syringe does this too. It is not a conspiracy. This is a world-wide problem; hemolyzed IV draws in an emergency room, or any other setting. It takes more time and involvement to have a hemolyzed sample redrawn than to submit marginally credible results obtained from a hemolyzed specimen. Many RN's have figured out a good technique that works for them and they use it. As healthcare providers, we need to consolidate correct drawing procedure and stick with it. We owe this to our patients!


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