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Nurses can't draw blood, its always hemolyzed



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No. 10
from canoehead
Old Nov 06, 2009, 09:16 AM

Default Re: Nurses can't draw blood, its always hemolyzed
At my ER we draw off a fresh line, but if that doesn't work the lab comes up and does their own draw. Then they know how it was done and if they are likely to get a better specimen. If you get hemolyzed draws over and over again it may be easier to just send your own people up the first time.
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No. 11
from Anisettes
Old Nov 06, 2009, 09:17 AM

Default Re: Nurses can't draw blood, its always hemolyzed
It can be ANY number of reasons. Here's a quick list of causes and corrective actions

http://www.bd.com/vacutainer/pdfs/te...004_VS7167.pdf
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No. 12
from Altra
Old Nov 06, 2009, 09:27 AM

Default Re: Nurses can't draw blood, its always hemolyzed
Originally Posted by Anisettes View Post
It can be ANY number of reasons. Here's a quick list of causes and corrective actions

http://www.bd.com/vacutainer/pdfs/te...004_VS7167.pdf
Excellent resource - thanks!
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No. 13
Old Nov 06, 2009, 10:00 AM

Default Re: Nurses can't draw blood, its always hemolyzed
Having been a phlebotomist and worked in the ER for a while now I am willing to bet $50 your getting hemolysed samples because many nurses who draw blood samples are using the IVs to get the samples instead of drawing the samples with a separate set up and as noted in the article that has a major chance of hemolysing the samples. In our ER we just have kids so in order to perserve atramatic care we don't stick them a second time for blood draws so we get all the blood we need before we even flush the newly inserted IV line. Sometimes the samples need to be redone but most of the time its ok. I think that if I was working with a relatively healthy adult I would just stick them again to get the sample rather than risk ruining the IV line to get a blood sample. But then again that's just me...

!Chris
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No. 14
from panamishe
Old Nov 06, 2009, 10:09 AM

Default Re: Nurses can't draw blood, its always hemolyzed
I've drawn blood after putting in an 18g needle and it's been reported back hemolyzed. I realize that sometimes it is the ERs fault that some specimens get hemolyzed but i have NEVER heard a lab tech admit that they made a mistake and I am POSITIVE that it happens sometimes. I think that a good portion of the blood that is reported "hemolyzed" was actually screwed up and it would be better for both the ER and the lab to admit fault when it's there so that there is less bad blood (pun intended) between us.
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No. 15
Old Nov 06, 2009, 04:10 PM

Default Re: Nurses can't draw blood, its always hemolyzed
cjcsoon2brn
That's exactly why the specimens are hemolyzing! They get the initial sample of blood during the IV insertion, then later when more test are ordered they go back into the IV site instead of poking the patient. The sample is most likely hemolyzied, they redraw the specimen and again it's hemolyzed, by the third time they're calling for the lab to come draw the blood stating the reason as the patient is a difficult draw and several people have tried.....well when I (lab) get there and I'm looking for a vein I notice the patient never has puncture marks?? and you've tried to get the blood several times?
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No. 16
Old Nov 06, 2009, 04:23 PM

Smile Re: Nurses can't draw blood, its always hemolyzed
Are the nurses drawing the blood when they start an I.V.? When I was in school I did some extra training at a different L&D than I work at now, they had recently stopped having the nurses draw blood when they started an I.V. stating it caused the blood to be hemolyzed...we do it at the L&D I work at now and the lab has never complained so I am not sure which hospital is correct.
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No. 17
from Syncand RN
Old Nov 06, 2009, 04:38 PM

Default Re: Nurses can't draw blood, its always hemolyzed
Remember that when extracting blood, do not "tap" the vein since it causes hemolysis even before drawing the blood. The specimen must be delivered immediately to the lab since it hemolyzes with time.
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No. 18
from Nccity2002
Old Nov 06, 2009, 05:49 PM

Nurse Re: Nurses can't draw blood, its always hemolyzed
Hi Guys,
I am of the same agreement with my fellow nurses: Those ER nurses are drawing from an IV site, which is fine, but if a small bore needle is used, hemolyzation is more likely to occur. My advice would be, if the hospital has a policy that permit ER nurses to draw samples from a peripheral IV site...maybe educational inservices should be implemented in the ER. We have to remember: Patient's safety is always first.
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No. 19
Old Nov 06, 2009, 05:49 PM

Default Re: Nurses can't draw blood, its always hemolyzed
Originally Posted by Altra View Post
Well, let's think about this. Are there new staff in the ER? Different supplies? Or just all of a sudden, *for no reason* there has been a spike in hemolyzed specimens?

But I will ask you something. Why, when the lab calls and claims that certain specimens are hemolyzed, and I say "OK, it took 3-4 of us to get the blood that we sent you, and the pt. is X (known frequent flyer/brittle diabetic/renal failure/crap for veins)"

...

after a few seconds of silence, does the lab say "we'll see what we can do." And 20 minutes later, like manna from heaven, I have results from those specimens!

There are two seperate occasions when we can catch hemolysis. Once the specimen is taken out of the centrifuge we see that its hemolyzed, thus it won't be run, and we'll make the call for a restick. Or we miss it and it gets ran anyway, but the results come out funky where potassium is 6.9 after the patient had been running a 4.0, creatinine levels are all out of whack etc etc. When we see something like this, we go back to the instrument, recheck the racks and see whats wrong with the specimen. More often than not its hemolyzed or diluted (another problem caused by drawing from the line). So then thats when we make the call. Sometimes, results from a hemolyzed specimen will still correlate with what the patient has been running. In that case, we file it, why restick the patient? When the lab calls about hemolyzed specimens and they call fairly quick, that means they caught the hemolysis after spinning it down. If it took some time for them to call, they probably have results but just aren't willing to file it because they caught the hemolysis after the fact. Thats why when we call and you sweet talk us a little bit, bribe us with a late night rendezvous in the morgue, your results magically appear like manna from heaven.
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