Whyyyyy? Rant from a Lab Tech

Nurses General Nursing

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Hi! I am not a nurse yet. I start an accelerated BSN program in August. I have been a lab tech for five years. I read urines and run the machines that do coags and blood gases and chemistry panels and all that fun stuff. After college, I lived with two roommates who were nurses, and before I became a lab tech, they would always come home from work and talk trash about the lab. It was helpful to me to be able to talk to them when I got this job, because I feel like there's a lot of miscommunication between the nurses and lab techs, and it's nice to talk to someone on the other side. Anyway, here's my rant of the night.

When we have a critical value on a patient, or a value that seems suspicious, we call the nurse. They have to accept the value before we enter it in the computer. Once they accept the value, give us their last name and we end the call, that value is getting entered in the computer and we are not allowed to take it out. I can not tell you how many times I've called a nurse, gave them the value, asked them if they accepted it, gotten their name, and entered the value in the computer only to get a call back in the next five minutes saying it was wrong and asking if we can take it out. We can't!!!! That's why we're calling in the first place!!!! Whyyyy does this happen?

Tonight I had a critical vanco trough on a patient. A lot of times, when that happens, the patient actually has vanco running when the trough is drawn, so I called the nurse to check. I told her the value and said that it was really high for a trough and asked if the patient had vanco running. She started freaking out about how nobody told her the patient had a trough drawn and asked when it was drawn. I said 2040. She said now she was going to have to call the doctor and she can't believe no one told her he had a trough done. I said, "so you're accepting it?" She said yes and gave me her last name. I hung up, entered the value, and five minutes later I get a call back. "Did you just call me about a vanco trough? What time was that drawn?" "2040" (I already told her that the first time.) "Oh, that patient has had vanco running since 2000. Can you take it out of the computer?" "No, I can't, I'm sorry." "Ok fine bye" (in a cranky voice.)

I know that she probably had fifty million things to do and this value was the least of her worries, but this happens so often that it just gets annoying. I needed to vent. Thanks for listening!

Specializes in Infusion, Med/Surg/Tele, Outpatient.

1. Why is Vanco not running through some sort of central access? 2. If your pt does have a CL/PICC/Port, why is that pt getting stuck instead of drawing through the line by a nurse? If I have a pt who has been on Vanco for more than 1 day and has been through 2 PIVs (original + 1 restart) I will always get a PICC order from the doc. Vanco really should be given into a large vein. And then I have to draw troughs myself, thus eliminating the problem at least with Vanc. With PTT/heparin and hemolyzed K+, all I say to our phlebotomists is that they should also develop critical thinking skills in their own professional development. But on a personal note, I love the "critical values" for our PTTs on heparin gtts - "I see the last 8 PTTs have all been critical too, and are all within the therapeutic range for the heparin protocol, but I have to report ...." Can these types of calls not wait until after 9 am med pass?

Specializes in Med/Surg.
1. Why is Vanco not running through some sort of central access? 2. If your pt does have a CL/PICC/Port, why is that pt getting stuck instead of drawing through the line by a nurse? If I have a pt who has been on Vanco for more than 1 day and has been through 2 PIVs (original + 1 restart) I will always get a PICC order from the doc. Vanco really should be given into a large vein. And then I have to draw troughs myself, thus eliminating the problem at least with Vanc. With PTT/heparin and hemolyzed K+, all I say to our phlebotomists is that they should also develop critical thinking skills in their own professional development. But on a personal note, I love the "critical values" for our PTTs on heparin gtts - "I see the last 8 PTTs have all been critical too, and are all within the therapeutic range for the heparin protocol, but I have to report ...." Can these types of calls not wait until after 9 am med pass?

We often ask for PICCS....it doesn't mean we get them. Wish I was in charge of the ordering.

Wow! I never wrote a post here before and it's neat that so many people read it. Here's a little more info:

-Yes, it was drawn by a phlebotomist. I think that's the problem most of the time. I've seen labs that were ordered for 4am and not drawn till 2pm. Most phlebotomists just get the stickers and draw the blood, they have no idea what the tests are or what they mean.

-I believe that our protocol is that the trough is drawn half an hour before giving the dose.

-You'd be amazed how many people get peak and trough levels confused...as in, they draw a peak with a trough label on it, and vice versa.

-My rant was because I specifically called the nurse because I knew that a trough shouldn't be that high and to ask her if the patient had vanco running and she ignored me and just went off about how nobody told her the patient had a trough done and she accepted the value even though I had told her I thought something was wrong and then called back to try to get it taken out of the computer. I do not call and rattle off values and then hang up. I'm sure some people do, but I don't. Also, we have to talk to the nurse who is taking care of that patient, not just whoever answers the phone.

-I know, it sucks that we have to call every single critical value even if the patient has been running that way for days or weeks or months. Trust me, I would rather not waste the time, but we have to. It's protocol. And we have to do it within a time frame...I believe five minutes...of getting the result.

-Want to hear a story? A doctor called once because she didn't understand why a patient having a high level of anticoagulants in their blood would make their serum clotted. It seems counterintuitive, right? I mean why would an anticoagulant make blood clot? I learned the answer and I want to share it with the world. An anticoagulant causes blood to clot slower than normal, right? When you draw a normal patient, their blood clots in the tube in like 5-10 minutes. We spin it down, separate the serum from the cells, and run tests. When patients are on anticoagulants, their blood takes a much longer time to form a clot. Sometimes, when their blood is drawn into a tube and spun down, it's not done clotting yet, and stringy fibrin strands keep forming in the serum, and we can't put it on the machines because it will clog the probe. That's what we mean when we say patients are clotted, or keep clotting.

Specializes in Med/Surg.
Wow! I never wrote a post here before and it's neat that so many people read it. Here's a little more info:

-Yes, it was drawn by a phlebotomist. I think that's the problem most of the time. I've seen labs that were ordered for 4am and not drawn till 2pm. Most phlebotomists just get the stickers and draw the blood, they have no idea what the tests are or what they mean.

-I believe that our protocol is that the trough is drawn half an hour before giving the dose.

-You'd be amazed how many people get peak and trough levels confused...as in, they draw a peak with a trough label on it, and vice versa.

-My rant was because I specifically called the nurse because I knew that a trough shouldn't be that high and to ask her if the patient had vanco running and she ignored me and just went off about how nobody told her the patient had a trough done and she accepted the value even though I had told her I thought something was wrong and then called back to try to get it taken out of the computer. I do not call and rattle off values and then hang up. I'm sure some people do, but I don't. Also, we have to talk to the nurse who is taking care of that patient, not just whoever answers the phone.

-I know, it sucks that we have to call every single critical value even if the patient has been running that way for days or weeks or months. Trust me, I would rather not waste the time, but we have to. It's protocol. And we have to do it within a time frame...I believe five minutes...of getting the result.

-Want to hear a story? A doctor called once because she didn't understand why a patient having a high level of anticoagulants in their blood would make their serum clotted. It seems counterintuitive, right? I mean why would an anticoagulant make blood clot? I learned the answer and I want to share it with the world. An anticoagulant causes blood to clot slower than normal, right? When you draw a normal patient, their blood clots in the tube in like 5-10 minutes. We spin it down, separate the serum from the cells, and run tests. When patients are on anticoagulants, their blood takes a much longer time to form a clot. Sometimes, when their blood is drawn into a tube and spun down, it's not done clotting yet, and stringy fibrin strands keep forming in the serum, and we can't put it on the machines because it will clog the probe. That's what we mean when we say patients are clotted, or keep clotting.

That is good to know, thank you. :) I don't think I've ever heard that (that a patient is "clotted,") but it's a good piece of info to store in the old brain.

I know what you mean about labs being drawn much later (the 4am/2pm example); in this case, is it truly ordered FOR 0400, or is ordered as a "today" value, and the usual collection time is 4am? If it's specifically ordered for a time, and not drawn until 10 hours later, holy cow, that is inexcusable!! I'd have some PO'd docs on my hands if that kind of thing happened regularly where I work!

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.

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