Lab Scientist

Perhaps, but most likely the chloride is the biggest giveaway when looking at the NA/CL results (contamination with NS)

You are 100% correct with your theory. I am a clinical lab scientist and I see this frequently in the lab. It is a hallmark of D5W contamination for an H&H, WBC, and PLT to drop from this, as well as the MCV to rise (from glucose swelling the RBCs). Also in chemistry, the K, CA, and other parameters are affected (diluted) and the glucose significantly increased. If I saw this specimen, I would not have bothered to give you those results. To me it was obvious and the lab "tech" who produced those results gives the rest of us a bad name. He/she better learn to recognize IV fluid contamination, not just with D5W, but with TPN, NS, HNS, etc. I can't stand reading stories like this about idiot techs who do bone-headed things. Also, I'm amazed that the nurse or the doctor would actually entertain the thought that those results were correct; I mean, the patient didn't exhibit signs of having a critically low potassium, etc. Your coworkers are dismissive fools to say that the lab mixed up the tubes. Please. That's just the stock answer for anyone not intelligent enough to actually think through a problem. I know of a lab scientist who transposed a PT and PTT result once (the PT 18.0 and the PTT >240). The nurse was notified that the PTT was >240 (verbal) but the written report said that the PTT was 18.0. The doctor freaked and gave a big bolus of heparin. I mean, what fool looks at a PT/PTT set of results where it is OBVIOUS the PT is wrong (and if it was correct, would be critically high) and then bolus a patient? Of course the scientist had to take ALL the blame, because God knows a Doctor NEVER makes a mistake! BTW, that was not me, in case any of you are thinking that.

That stinks that a manager would discipline someone for simply speaking up about a breach in the rules. That manager should be reported to his/her manager for breaking the rules.

You can have the XRay department do it...we do when our equipment is being repaired.

I am a med lab scientist, and if I come across a value that is incompatible with life I get it recollected to verify and don't report the first result. I let the nurse know what is going on so he/she is in the loop and is prepared for the call if the result verifies as being critical. Also, when a lab scientist calls a critical result even if the patient is improving, it is because they are mandated to do so by the rules or their lab/hospital. The hospital where I work demanded this because a doctor was not notified by the nurse of a critical result and the doctor himself didn't notice the critical until the THIRD time it was reported! I know that a CO2 that is high on a COPD patient is expected and we all roll our eyes at having to call the seventeenth such result, but it's something we grit our teeth and bear along with other insults to our intelligence. I have heard people say we in the lab are not being paid to think, even though we were extensively trained to think (bachelors degree) and are QA specialists. The lab scientist is supposed to check the validity of results and supposed to do look-backs constantly (at least I do) to see what a patient has been running before reporting. The belief that a lab scientist is a brainless button masher is no more true than the belief that a nurse is a butt wiper. It's insulting, arrogant and ignorant to think like that about any profession. Get to know your good lab scientists and be nice to them; they can be your best resource and actually help make a nurse's job easier if they will let us. That's what we're here to do. That's what I want to do.

Just a comment from a Lab Scientist point of view: The value may not have dropped, but could have been the same or actually risen. I know this sounds like a crazy statement, but if you understand how our instruments work and basic statistics, you can reasonably conclude that 120 and 119 are essentially the same number. You can run a specimen 20 or 30 times on an instrument and get 20 or 30 similar or slightly different values. There is an acceptable range (within Gaussian distribution or 1-2 standard deviations from the mean of a set of values) for any assay. For example: if that 120 had been repeated, it may have been 119 or 122 or 121, etc. You can't conclude that the patient's condition is worsening based on two lab values so close together within the assay's range of acceptability. In our lab, a sodium (control value) of 123 can acceptably be reported as 120, 121, 122, 123, 124, 125 or 126 since all these values are within 2 standard deviations of the mean=123. Hope this helps and doesn't just muddy the waters.

There's NO WAY you can know the blood was "just fine" after drawing it until it is spun down and visualized at that point. Hemolysis is the destruction of the red blood cell and it's contents spill into the surrounding serum/plasma. After centrifugation, the RBCs WBCs and PLTs are at the bottom and the serum/plasma portion is at the top. The case you mentioned would be an out-and-out lie on the lab's part; either that, or the person to whom you were speaking was mistaken about the disposition of that specimen. Of course, the problem isn't always the nurse; but it's not always the lab either.

Good Lord, don't these techs investigate before reporting the "panic" value? Anytime I get a result that could be intepreted as a critical, I first check with the nurse to see if that patient is receiving heparin, find out how the specimen was collected to rule out contamination, and get a recollect if there is doubt. Cheers.

I sure hope the lab didn't seriously believe that glucose result. On our chemistry analyzers, we will see a sharp increase in the potassium, glucose, total protein, and usually either see the specimen is grossly lipemic, or if we don't get to see the specimen, we will get a supressed high lipemia index. This is a hallmark of TPN contamination and any lab scientist worth their salt would just call for a recollect. I would NEVER give a result like that to a nurse!

excellent reply. i know of someone who was killed from receiving lidocaine iv rather than im. different drug, i know, but just goes to show that wrong route can be devastating.

MLT is an associates degree. MLS (formerly MT) is a bachelors degree.