Tales from the Dungeon

Through out my entire college career and following into my career as a Lab Tech, the idea of a quality sample has been pounded into my head. After all if you get a garbage sample you’ll get garbage results that are inaccurate and don’t paint the correct picture of what’s going on with a patient.

The other day I had a nurse bring a urine sample from the ER that was visibly bloody, and my first thought was “Well that’s not good”. The nurse handed it to me and said that the patient was menstruating and got some blood from that in the urine cup. I said “Ah, well that means the sample is contaminated and isn’t going to give accurate results.” The nurse said she was told to bring it over anyway by the doctor. 

Being the diligent patient advocate that I am, I picked up the phone and called the ER to speak to the doctor. I explained to him that there was vaginal contamination in the urine, and that anything that is seen in the UA will be inaccurate as we won’t know if it’s because of her urinary system, or because of the vaginal contamination. His response was “Well I don’t really care what the results are, I’m just doing it for the admit” I said “Well since she is menstruating and not able to give a clean sample, couldn’t we do a cath UA then?” His response was “Nah, I don’t really want to do that, and I don’t really care about the results so just use the one that you got from the nurse.”

I have a lot of respect for nurses. I have a lot of friends that are nurses, heck I’m even married to a nurse. With that said though, every once in awhile I run across a nurse that I just stare at and think, how the hell did you pass you boards.

During one of my busier days while working in chemistry, my analyzer alerted me to a panic K value. As always I waited the what feels like a billion years for the result to print and transmit to the host (we have one of those analyzers that will flag the criticals, but you can’t see it until everything is done). To my shock and surprise I see the K is reading as 15.0 and repeated on the other analyzer with about the same value, I silently chuckle to myself. I find out that the sample was a line draw from the nurse.

I pick up the phone and call the floor to speak to the nurse, and here is how the conversation went.

Me “I need a redraw on patient ____, I believe there was contamination in the tube and the results aren’t correct”

Her “Well I did everything correct so I don’t see what the problem is.”

Me “Well the K value was too high, and it’s not accurate so we need another sample”

Her *huff* “Well what was it”

Me “Well the analyzer said 15.0″

Her “OK, and...”

Me “Umm, well is your patient still alive”

Her “Yeah, why would you even ask that” (at this point she wasn’t trying to hide the irritation in her voice anymore)

Me “Because that high of a value is not compatible with life. So I guess I’ll just have a phlebotomist come up and do a peripheral draw on them”

So we get the redraw and miraculously the patient was still alive...Yay...with a K of 4.2

We never found out originally what happened, but the RN wasn’t happy with me. In fact she was so unhappy that she had her manager write to my manager saying that it wasn’t the labs responsibility to determine if a lab result was valid or not, and that we should just release the results and leave it up to the patients nurse to decide what to do at that point.

So having worked in a hospital lab for the last ten years, I’ve come to the understanding that some doctors just have no rhyme or reason to what tests they order on patients. Our ER doc the other day seems to have a specific order set that he uses for everyone. 

Patient One - Chief complaint Shortness of Breath, Labs ordered CBC COMP Trop, PT/PTT Blood Cultures x2 Lactic Acid, Rapid Flu, BNP and UA

Patient Two - Chief Complaint Dizzy, Labs ordered CBC COMP Trop, PT/PTT Blood Cultures x2 Lactic Acid, Rapid Flu, BNP and UA

Patient Three - Chief Complaint Fall  Labs ordered CBC COMP Trop, PT/PTT Blood Cultures x2 Lactic Acid, Rapid Flu, BNP and UA

Patient Four - Chief Complaint Finger Laceration  Labs ordered CBC COMP Trop, PT/PTT Blood Cultures x2 Lactic Acid, Rapid Flu, BNP and UA

Patient Five - Chief Complaint UTI  Labs ordered CBC COMP Trop, PT/PTT Blood Cultures x2 Lactic Acid, Rapid Flu, BNP and UA.

I think you get the point on this. Now I know it makes it easier for the nurses and him to order things in sets, you always know what to draw. But it seems a bit excessive and unwarranted to order tests that aren’t needed, not to mention driving up the bill for the visit.