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Nurses can't draw blood, its always hemolyzed

Posted

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.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

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

chenoaspirit, ASN, RN

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.

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.

Inservice for the ER folks?

Dalzac, LPN, LVN, RN

Specializes in CCU,ICU,ER retired.

Have they tried a bigger bore needle?

Cindy-san

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?

Altra, BSN, RN

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!

Altra, BSN, RN

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.

Altra, BSN, RN

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?

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

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.

cjcsoon2bnp, MSN, RN, NP

Specializes in Emergency Nursing.

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 :specs:

panamishe

Specializes in med/surg 1 year, ER 5 years. Has 5 years experience.

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.

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?

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

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.

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.