Nurses can't draw blood, its always hemolyzed

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Okay, now that I've gotten your attention, I didn't really mean it...or did I =)

First and foremost I am not a nurse, I'm a technologist in the stat lab with a whopping 1 month of experience. Now, there's been some bad blood brewing recently between the lab and the ER. The issue, hemolyzed blood specimens. For the past 4 days, it seems as if EVERY single specimen sent from the ER is hemolyzed. We call because we need a restick, the ER gets ******, we get the tubes, its still hemolyzed, we get ******, we call again, they get more ******, we get the tubes, we get more ****** etc. etc. Its gotten to the point where the clerks won't even document a hemolyzed specimen and we have to speak to the Doctor directly. I'm just curious as to why all these specimens drawn from the lines are hemolyzed. Enlighten me.

P.S. Feel free to rant off about the lab and I'll try my best to shed some light upon your qualms.

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Specializes in ER.

I guess if you want to do something right you gotta do it yourself.

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Specializes in Med/Surg, Home Health.

Could the tubes be bad or expired? It may be their technique. If they are using a butterfly needle, they may be aspirating the blood too quickly and causing it to hemolyse.

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Could the tubes be bad or expired? It may be their technique. If they are using a butterfly needle, they may be aspirating the blood too quickly and causing it to hemolyse.

Honestly, I couldn't tell you. I don't see what happens in the ER and I don't know how they draw the blood there. All I really know is that once we finish spinning it down in the centrifuge, its hemolyzed. Its pretty much a blame game, the ER thinks that we're the ones hemolyzing the specimen, but the only time it can happen is during the draw. The specimens that we recieve from our phlebotomists' rounds are fine, so it has to be the way the blood is being drawn, and from my understanding they almost always take it from the lines.

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Inservice for the ER folks?

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Specializes in CCU,ICU,ER retired.

Have they tried a bigger bore needle?

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Specializes in CCU & CTICU.
Honestly, I couldn't tell you. I don't see what happens in the ER and I don't know how they draw the blood there. All I really know is that once we finish spinning it down in the centrifuge, its hemolyzed. Its pretty much a blame game, the ER thinks that we're the ones hemolyzing the specimen, but the only time it can happen is during the draw. The specimens that we recieve from our phlebotomists' rounds are fine, so it has to be the way the blood is being drawn, and from my understanding they almost always take it from the lines.

I wouldn't think they would be putting in so many central lines in the ER.

It might be the tubes are bad. Or maybe the phlebotomist is using a different needle-set to draw blood?

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Specializes in Emergency & Trauma/Adult ICU.

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!

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Specializes in Emergency & Trauma/Adult ICU.
I wouldn't think they would be putting in so many central lines in the ER.

It might be the tubes are bad. Or maybe the phlebotomist is using a different needle-set to draw blood?

I believe the poster meant, from new IV lines being inserted.

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Specializes in Emergency & Trauma/Adult ICU.
the only time it can happen is during the draw.

Can you elaborate on this? Are you saying that hemolysis can't occur during handling?

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Specializes in ER.

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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Specializes in ED, OR, SAF, Corrections.

It can be ANY number of reasons. Here's a quick list of causes and corrective actions

http://www.bd.com/vacutainer/pdfs/techtalk/TechTalk_Jan2004_VS7167.pdf

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