Getting the Labs there on time?

hoolahan, ASN, RN · Mar 18, 2005

Anyone out there with a great understanding and knowledge about Labs? I work in the country where it could be 45 minutes between houses, and longer to the "local" hospital, a term I use lightly. :rotfl: I don't like the lab in the box. For the more popular tests I do regularly, how long can they sit in the car, and do they need icepack. Every time I call the lab tech, they give me different answers, so that is why I am asking all the smartest people I know!
For example: CBC, bmp/cmp hgb a1c, pt/inr, lipid panel, cpk, Dilantin, digoxin, Phenobarb tsh/ft4,alt ,ast, mag, uric acid are the ones I do the most.
Another thing I would like to find out is how much volume is needed for each test, so I know how few tubes I can draw.
Thanks in advance!

I never had to worry about this much, since I work the suburbs and city and am never too far from a hospital. So I will try to shed a little bit of light, but I am by no means an expert.

1. We had to use 3 labs, depending on if it was Medicare, or HMO. Each lab uses their own tubes, this can be extremely important when it comes to the PT/INR. So, as far as how much to put into each tube, you need to check with their policies, the lab whose tubes you use. I know there is a line on the label of most of the tubes I use, and a teeny tiny writing that says how many cc's are needed. If they give you baloney when you ask, ask if they have a package insert from the box the tubes come in, or ask for a policy on that test. Other than that I don't know what to say.

2. For bmp/cmp they have to be spun within 2 hours. If not, I believe it can become hemolyzed which will falsely elevate the potassium, and perhaps other components. So, I would imagine if you drive 45 min, someone better address that sample in the next hour, spin it at least.

3. I have always been taught to keep labs on ice, or in a cooler with a cool pack, but I am not sure if it is a must. On cold days, I use the cooler no ice, but hot scorching summer days, I am sure to use the ice pack.

4. I used to plan my labs to be first thing in the am or last in the day. So, if I had fasting labs, I went to that pt home first, got the labs, dropped off, then went into the office. We are lucky, we had a daily pick-up from the 2 HMO labs by 10am, and the Medicare by 11am. So, If I did it that way, I wouldn't need to go to the lab, just repport back into the office. Since my manager knew I preferred this, she usually gave me a call the day before, so I could get it together. She also lived down the street and dropped off charts and lab supplies for special labs she needed covered, like when another nurse was off, so I was just all-around lucky that way!

Other days, best laid plans go to heck! Those days you just figure your day will be disorganized no matter what and you just do the best you can.

Are there any satellite offices for the labs? We have a satellite in every township for the HMO labs.

Traveler · Mar 18, 2005

As far as the volume needed for each test I don't know. I would imagine that this might vary from lab to lab. I know what you mean about being far away from the hospital- that is one of the biggest hassles. I was told that PT/INR can be two hours out and the rest can be up to a day. However, I have also been told that this is not correct and all labs need to be there within an hour- sometimes that just can't be done. The last co that I worked for loved Lab in a Box. Supposedly they have something in the tubes that keeps them fine for shipment, etc. I think there is a big waste with what you don't use and just chuck. Also, we don't have Fed Ex places too close either so it's just as easy for me to go ahead and get it to the hospital. I would also like to hear what others have to say about the timeframes.

Home Health Columnist / Guide · Mar 18, 2005

I used to carry a portable centrifuge that plugged into cigarette litter for spinning down blood. See if lab will be willing to give your agency one if you do ton of lab work.

LowPaidNurse0000 · Mar 18, 2005

I get mixed messages from the labs too. Our agency just got us new Pt\Inr ratio machines and they are soooo nice just call the doc from the pts house, but this doesn't help on the other draws...also does anyone know about PTT's? Do they have to be frozen? The lab has been calling the office latley and saying telling us this. I think they are waiting to long on the PTT's even though I make it a point to tell the lab when I drop it off that there is a PTT to run.

Sorry I know this doesn't answer any of your questions....

cherricka · Mar 18, 2005

Thanks for all the replies:

Are there any satellite offices for the labs? We have a satellite in every township for the HMO labs -I have called the nearest MD offices, and their Nurse managers check with their lawyers, and doctors, and they all say no, even though it is the same lab picking up their samples, as I use to drop off my samples. I even asked if I can put it in a separate box provided by the lab, they all still said no. The office that I work out of is in a different county, farther than the hospital.

I used to carry a portable centrifuge that plugged into cigarette litter for spinning down blood. See if lab will be willing to give your agency one if you do ton of lab work - We always laugh at this at every meeting. You are very lucky!

Our agency just got us new Pt\Inr ratio machines and they are soooo nice just call the doc from the pts house, but this doesn't help on the other draws... We are in the process of getting newer updated PT/INR machine's, because the old one was so hard to use, it was easier to just do a blood draw.

It sounds like we are all in the same boat, labs giving different answers, driving far distances, etc. And yet I love homecare! Maybe if I bring some goodies the next time I drop off labs, they will give me a cheat sheet or something, if they have one. I will pass it on if I find one!

Maerzie · Apr 21, 2005

I cover 100-250 mile radius daily, and, like Hoolihan, I plan my labs as my first patients of the day, take them in to the nearest lab, (regardless of the extra mileage), and the go on to my other patients. Except in winter, I always have an icepack in my cooler, and on those days I have forgotten, I have found patients to be more than happy to give me a few ice cubes in a plastic bag or tied up in gloves. Each test requires a certain colored tube, and the volumes required are always printed on the labels of the tubes I use. When in doubt, I always call a lab tech, which is better than screwing it up, causing a repeat draw and irritating everybody concerned.