Top 10 Things Every Nurse Should Know About The Lab

Nurses are awesome! They survived nursing school (no small feat) and really just want to go to work everyday and take care of their patients in an efficient manner. I totally understand. I’m here to facilitate that with my top 10, served up with a little satire and sarcasm for fun. I want us, the collective healthcare team, to start extrapolating our daily cause a little further and think to ourselves, I just want to go to work and take care of my patient, SAFELY and efficiently.

Here goes everything:

1. We Don’t Clot Your Purple Tops

lab gremlin

lab gremlin

As hard as it is to believe, there honestly is not a clotting gremlin traipsing around the lab, itching to wave his double double, toil & trouble wand over your purple top. Purple tops start to clot at the time of collection, if the specimen is not properly collected and mixed.

2. Stick Your Patient WHENEVER Possible

Venipuncture

Venipuncture

The preferred method of specimen collection is to perform a venipuncture. As crude, insensitive, lacking compassion and counterintuitive as it may seem, the best quality blood specimens come from a routine venipuncture. I get it. There are circumstances where patients have “bad veins,” have a line, don’t want to be stuck, or they are on bleeding precautions and can’t be stuck. However, it has been my observation on numerous occasions where a venipuncture should be the first choice, the nurse just chooses to pull it off the I.V.

3. Hemolyzed Specimens Are Problematic. Typically a hemolyzed specimen is the result of poor/slow blood flow into the tube during collection. It also can happen when blood is first collected in a syringe and then transferred to the tubes. It must be transferred to the tube immediately. If allowed to sit on the counter or in your pocket while you go get tubes, the blood starts to clot. Then when you go to transfer it, it’s more difficult to push and it hemolyzes the specimen.

4. The I.V. Start 

The Perfected Side-eye

The Perfected Side-eye

This is my favorite. Somewhere along the way, I think it has been engrained in nurses everywhere that the best time to collect blood is when you start an I.V. If I could only accomplish 5 things in life, I want 1 to be to change this culture. Peripheral I.V. insertion and phlebotomy are 2 separate procedures. I know, “it’s more efficient” to draw the blood when starting the I.V. However, you may jeopardize the line by trying to manipulate it to get blood. AND, it often requires the use of a syringe, see #3 for why this isn’t good.

5. The 23G Butterfly Needles With A Syringe

Butterfly Syringe

Butterfly Syringe

Should be used for special circumstances and pediatric patients, not for EVERY patient. Why? They are expensive. And a properly skilled phlebotomist should know how to routinely use a straight 21G or 22G needle with a vacutainer hub adapter.

6. Labels

facepalm gif photo: Facepalm gif Facepalm-Moving.gif

This may quite possibly be the bane of any laboratorians existence. It is critical that specimens be labeled correctly with 2 patient identifiers, preferably full name & medical record number. This should be done: 1) at the bedside, 2) at the point of collection and 3) after you have properly identified the patient by reading/barcode scanning their wristband and/or asking their full name and date of birth. This means it is BAD to stick the tubes in your pocket & go to the nurses station to label them. It’s a huge opportunity for a mix up to happen.

7. Results Don’t Match?
Nurses loathe when the lab calls to say they need a new specimen because the previous results don’t match or appear to be discrepant. How does this happen? The lab has a handy dandy function in the computer system called a delta check. After the analyzing instrument sends the result to the computer, the computer looks back at the patient’s previous results for that particular test. If the results differ too much from the predefined limit, most likely a new specimen will be requested to confirm the change. In most cases the provider is consulted to be sure it isn’t an expected change based on the clinical picture.

8. Read And Read Back Of Critical Action Values/Panic Results
It’s annoying, time consuming and you don’t like it. I already know, BUT, it’s important for patient safety. That’s why we do it.

9. The Blood Bank
I have fond memories of working in the blood bank. It was one of my favorite departments to work. I digress. This is the most anal retentive area of the lab and justifiably so. Blood bankers want every patient to get the right blood product every time, without fail, EVER. So there are extra precautions in place to mitigate that. We need to know who drew it, when it was collected. It must be properly labeled with the patient’s full name, medical record number, date of birth and transfusion history, if it is known. When blood is being issued, we take our time to go over the patient’s name, medical record number, date of birth, blood type, unit type, unit number. This verification step is necessary at issue and before administration, to catch any mistakes. PLEASE be just as diligent as we are when you administer the blood to the patient. Verify the information with another team member.

10. Specimen Cups
Urine, stool, body fluids, etc. go down to the lab in specimen cups. The mention of those things probably made your lips curl just a bit. PLEASE make sure you screw the lid on tight. And label it. That’s all!

That's All

That’s All

I love healthcare! It’s in my blood and it’s what I know. For over 20 years, I have lived healthcare, either navigating it with my Mom or being a patient myself, and as a healthcare professional. One thing I know for sure is that our system is broken. Besides the rare individual that slips through the cracks, no healthcare worker wakes up with the intention to do harm to a patient at work. Consider these 10 things as you move about your day. Now you know the why behind some of the things that make your blood boil when you think about the lab. Is the lab perfect, heck no! But let’s all work together to take care of the patient, SAFELY.

Now tell the truth, which one are you guilty of?

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