So I get a call from the lab..... - page 3

Your pt has a critical high potassium of 4.8.....seriously? Then in the same sentence....your other pt is set for dialysis....tell the dialysis nurse to stop.....their creatinine is 4.1 and... Read More

  1. Visit  blondy2061h profile page
    1
    I work oncology so when we get new leukemias we see 100,000+, which is a definite problem. Even giving people growth factor shots to prepare them to collect for stem cell transplant we can see 40-60k. While 25 is definitely a problem, the point of calling critical results is notify you of an immediately life threatening situation.
    psu_213 likes this.
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  3. Visit  blondy2061h profile page
    0
    Quote from DSkelton711
    Nobody called it critical, they were making a point about some orders. Your labs critical is 100? That seems excessive to me. If I'm hitting 40 someone better be letting someone know about it ASAP.
    The post was about a doctor being called with critical white counts. See my previous post about why our values may be different that for otherwise healthy patients.
  4. Visit  TiffyRN profile page
    2
    One of the things I really love about our unit is that virtually all the infants as under the care of one neonatology group and they have their own list of critical values. Lab may call for all kinds of "panic" values, but we just given our names and if the value is in our call guidelines then we will notify the MD/NNP. Of course any time the RN is concerned about the infant, they are welcome to share their concerns with the MD/NNP.

    To give an idea of how generous our call guidelines are, our K+ call guidelines are <2.5 or >6.5. Please understand that the vast majority of our blood work is from heelsticks and tends to be hemolysed. I do love it when I send down a heelstick chemistry that I know was difficult to obtain, wasn't sure if the lab would even be able to analyze it then get a call from the lab about the K+. "Your K+ is 8.2 and it's definitely not hemolysed!!" Yeah right, I drew it, I knew it had a good chance of being hemolyzed and the infant is completely asymptomatic (everyone is on a cardiac monitor), I seriously l doubt they would be asymptomatic with a K of >8.

    I don't blame the lab for covering themselves, I know they have standards they have to meet. I could say some pretty hideous things about lab, but I'm sure they could probably say the same things about NICU nurses. We are constantly at odds trying to make them understand how small an 800 gram infant is and what it's total blood volume is and the fact that we can't draw 3mls for a confirmatory whatever on this kid unless they want to send along a bag of PRBCs with the extra lab tubes.
    Luckyyou and merlee like this.
  5. Visit  Indy profile page
    0
    My first job in a hospital period, was phlebotomy. I do love the lab, but I love for people to have common sense too. Some things we get, some things we need explained, some things we can compromise on. Most things I can handle with a sense of humor. Our policies state that we do one of two things with a critical lab: call it and chart that, or chart why it wasn't necessary to call. So there are a lot of times I don't have to call because things trend down or because there are orders on the chart to handle the result, like electrolyte imbalance or the heparin drip. But since people do the job, there are some who are cool with a quick phone call and some who want to get excited about it. Usually it's 5-6 am and I am kind of busy, less time for chitchat there. I just want to chart this mess and get my stuff done, or I really need to get off the phone and call a doc.
  6. Visit  PedRN86 profile page
    1
    My lab always calls us for critical values. I like it, helps it from going unnoticed for another hour or two when I get the chance to check the computer.
    nurse671 likes this.
  7. Visit  T-Bird78 profile page
    1
    Quote from imintrouble
    I'm not sure why all the eye rolling over lab calling results. They have protocols just like us. I'll bet they hate to call the floor over a result that is trending down, just like we hate to call the MD for the same reason.
    I've never had one to interpret results for me, but I don't think I'd ridicule them for it even if they did.

    I wonder if the lab feels small when we make fun of them? I know I do, when I have to call a critical BUN and creatinine on a dialysis pt to a nephrologist. Then have him yell at me because "Don't you know they're on dialysis?"
    We all just do what we have to do.
    Yes, they have their protocol, but I think the rolling eyes are due to the lab tech telling the nurse what to do and critical values that are really in normal range. Call to inform the critical values, but don't tell the nurse or doctor what to do about it. It's like the radiology tech looking at the X-ray and saying it looks good--they take the x-rays, they're not trained to interpret them.
    nrsang97 likes this.
  8. Visit  psu_213 profile page
    1
    Quote from DSkelton711
    Nobody called it critical, they were making a point about some orders. Your labs critical is 100? That seems excessive to me. If I'm hitting 40 someone better be letting someone know about it ASAP.
    I don't think I have ever gotten a call on a white count. I have seen pt's over 100 and not gotten a call--if it's that high, they have leukemia. Calling the doctor within a few minutes is not going to make much of a difference in the long term. Will they treat it? Yes. Do they need to know "ASAP?" Not at the expense of other more critical pts.
    mappers likes this.
  9. Visit  blondy2061h profile page
    0
    Quote from psu_213
    I don't think I have ever gotten a call on a white count. I have seen pt's over 100 and not gotten a call--if it's that high, they have leukemia. Calling the doctor within a few minutes is not going to make much of a difference in the long term. Will they treat it? Yes. Do they need to know "ASAP?" Not at the expense of other more critical pts.
    Over 100,000 puts patients at risk for complications from being in a hyperosmolar state. For 100,000+ we usually leukopherese ASAP or minimally begin Hydrea.
  10. Visit  psu_213 profile page
    0
    Quote from blondy2061h
    Over 100,000 puts patients at risk for complications from being in a hyperosmolar state. For 100,000+ we usually leukopherese ASAP or minimally begin Hydrea.
    Well, there is generally something we do not do in the ER. A leukemia pt had a white count in the 120s...the attending said this was the highest count he's ever seen. Pt got admitted to a non monitored bed.
  11. Visit  Good Morning, Gil profile page
    1
    it does depend on hospital policy, but most labs are required to call with critical lab values. I guess your critical potassium starts at 4.8? That's low, but every hospital uses slightly different lab values. Our lab calls with critical values, but will sometimes even call with any big changes. If Hgb dropped by 3 in a day, they'll call, and ask if they want us to result the value, and I'll say, "yes, they received fluid boluses, etc." or something to that effect.

    I'm always looking for my lab values to pop up anyway, and even though it may seem like it's wasting our time, it's still nice that they call. An extra safety measure.
    nurse671 likes this.
  12. Visit  wyogypsy profile page
    0
    I appreciate the calls as it is an extra check. I am secure enough that I don't get upset if they mention what they think I should do, after all - they may be speaking to someone new or someone without a lick of common sense and thankfully they did say something! I would rather have the calls than not have the calls.
  13. Visit  psu_213 profile page
    0
    I don't think there is anyone upset about getting a call on a critical lab. I think the issue that OP had is with the lab telling the nurse how to treat the pt.
  14. Visit  nrsang97 profile page
    0
    Quote from psu_213
    I don't think there is anyone upset about getting a call on a critical lab. I think the issue that OP had is with the lab telling the nurse how to treat the pt.

    Exactly.


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