r/medlabprofessionals • u/Warm-Alternative6153 • 13d ago
Discusson Just had my first hemolyzed sample rejected and felt like an idiot
Watched the nurse draw it. Knew something looked off – the flow was slower than usual and I could see a little redness creeping in. But she's been doing this for years and I've been doing this for months, so I kept my mouth shut and sent it anyway. Lab rejected it within an hour.
Spent the rest of my shift overthinking every single tube I sent down. Second guessing whether that bruise was my fault. Wondering if the lab people have a nickname for me yet. Anyway, I learned my lesson. I'll speak up next time even if it's awkward. For the lab folks here, what's something you see new people do that tells you "they don't know what they don't know yet"?
106
u/clineluck MLS-Generalist 13d ago
Hemolyzed samples from nurses are super normal. Don't worry about it. If you feel too bad about it, educate the nurses you work with about what causes hemolysis so they blame the lab less.
4
u/Warm-Alternative6153 11d ago
Fair point. I'm not sure I'm at the level of educating anyone yet but maybe one day.
3
u/Numerous_Relation524 9d ago
It might be worth it to bring it up to a more senior coworker to try and do education if you’re not comfortable doing it. I know when I worked in the ED, we had lab come down and tell is about samples that are likely hemolyze. There were nurses that had been there for years and didn’t realize that their method of drawing blood may increase the risk. The knowledge of medicine is ever growing in the community and individuals. Sometimes we need “fresh blood” or views to disrupt what we think is true to find better methods. I think you’d be doing a really great thing for patients and practitioners alike if you pushed for a bit of hemolysis risk mitigation education!
Also don’t be scared of a little pushback from the nurses/techs. The thing providers hate the most but always want is change 😂
63
u/Syntania MLT - Core Lab Chem/Heme 13d ago
Don't worry about it, honestly. We still have seasoned nurses to this day that don't know anything about how the lab works. Just remember these handy tips:
Hemolysis and clotting are 90% of the time due to the draw. Leaving the tourniquet on too long, slamming the plunger down in a syringe draw, or violently shaking the tube can cause hemolysis. Hard sticks, super slow blood flow, and not inverting the tube a few times after withdrawing can cause clots. Things that can't cause clots: letting a tube sit around if it's well- mixed. Once the anticoagulant is mixed in the blood, it can sit around for months and not clot.
Every sample container needs 2 forms of legible patient ID. We're not running the test on the bag so putting the label in the bag isn't acceptable. The smeared, smudged, half- cut off label that we can't read won't work.
If you ever have a question, please call and ask. I'd rather tell you what sort of container to put a sample in rather than have to have it recollected.
3
u/Warm-Alternative6153 11d ago
This is genuinely helpful, thank you. The tip about not slamming the plunger down on a syringe draw is something I hadn't thought about. And noted on calling – I think I'm more afraid of being annoying than anything else but sounds like you'd rather get the call.
5
u/Syntania MLT - Core Lab Chem/Heme 11d ago
One phone call can save a lot of headaches later on for everyone. Trust me, we have better things to do than to try to call up to the floor and get a hold of someone to deliver the bad news that the hard stick or the baby needs a redraw. We'd rather just run the sample and post the results and get on with our day.
20
u/Hamburger_Helpmee MLS-Generalist 13d ago
I feel that the fact that you worried and have concerns shows that you are paying attention and want to do things well. Arrogance does not question itself, and arrogance is dangerous. The confidence part is just gonna come with time. We will all inevitably make mistakes. Being humble and learning from them is important. I really appreciate the staff that are genuinely curious enough to keep learning.
3
u/Warm-Alternative6153 11d ago
I really appreciate this. "Arrogance does not question itself" – that's a good line. I'll try to remember that the self-doubt is probably a good sign as long as I don't let it paralyze me.
14
u/happyfamily714 12d ago
Why would they think you drew it when the nurse did? Accuracy matters, it should be documented in the tube and within the LIS that it was drawn by the nurse.
7
u/Emily_Ann384 12d ago
We don’t come up with nicknames or even look at the name of who collected it unless EVERY SINGLE SAMPLE is hemolyzed. It’s okay. Things happen! I feel embarrassed calling, especially if it’s the second hemolyzed sample on the same patient.
2
u/Warm-Alternative6153 11d ago
That isreassuring. I was definitely in my head imagining someone circling my name on a whiteboard somewhere.
2
u/Emily_Ann384 11d ago
I’ve been working in the lab for 8 years and can guarentee the the only time I look at the collector is if we keep getting short blue tops (like 5+ in an hour or two), or every single purple or green we get is QNS. Sometimes we’ll get tubes recollected for gross hemolysis a few times, but usually after the second collection, the nurses switch it to a phlebotomy collection, so we don’t even look at the names. Things happen! Some patients have internal hemolysis too.
5
u/ACleverDoggo 12d ago
I promise you, unless everything you're sending is getting rejected AND you're an asshole about it, no one in the lab has given you a nickname.
We do give out nicknames if you do something really memorably funny, though.
3
u/Warm-Alternative6153 11d ago
Ok, this made me laugh. Now I kind of want a funny nickname but maybe not for the wrong reasons.
5
u/Migraine3 12d ago
A pet peeve of mine is the way some of these nurses slap the label on the container. Sometimes it’s all crooked so the barcode reader can’t pick it up. Sometimes of them don’t leave a window so I can’t see if it’s clotted or not.
Like, take an extra second to put these things on properly. Also, please don’t make me be the guy to teach you how to put a label on.
1
u/Warm-Alternative6153 11d ago
Noted. I try to be careful with labels but I'll be extra mindful. The window thing makes total sense – I can see how that would be frustrating.
4
u/Kaitlyn_Tea_Head 12d ago
Hey at least you don’t draw into a pink top and then syringe it into a green top! (They do this because “pinks don’t clot”) The calcium and K are always super f’d up lol
2
4
u/zhangy-is-tangy CLS-Generalist 12d ago
The only time I remember someone is when they are difficult to deal with. I had an ED phleb that refused to recollect a sample because “my tubes never hemolyze”.
You’re doing just fine! Hemolysis happens.
4
u/Warm-Alternative6153 11d ago
"My tubes never hemolyze" is a wild thing to say out loud. I'll make sure I'm never that person.
5
u/Pasteur_science MLS-Management 12d ago
Definitely not your fault, not least of which being that you didn’t collect it.
2
4
u/aloofprophet MLS-Generalist 12d ago
This ain’t the first and it won’t be the last hemolyzed specimen the lab will get. Seriously don’t beat yourself up.
Frankly there’s a small amount of people who know how the lab works. Keep doing your best, we will work with you no worries on our end.
1
4
u/91wylie 12d ago edited 11d ago
Some tests can be run if it's only slightly hemolyzed. I tell my collectors if they think it's hemolyzed to let me check how bad it is because I might be able to run it still.
1
u/Warm-Alternative6153 11d ago
Good to know. I assumed hemolyzed meant automatically rejected across the board. Sounds like there are degrees to it.
6
u/WhatsBeeping 13d ago edited 13d ago
If you scanned it as collected, I wouldn’t do that for anyone else if I didn’t collect it lol. If you didn’t the lab can see who collected and will know it wasn’t you!
If you’re a phlebotomist, and they just hand you a tube, you can do it if you watched the collection like this time and know for sure it’s the right patient but you can remove your name from “collector” on the rover.
If you don’t watch a collection and someone just hands you a tube unlabeled not in a patient room, I wouldn’t touch it with a 10ft pole because if it ends up being wrong patient and they investigate you don’t want your name anywhere near that.
(And if it’s labeled but you didn’t watch the collection, you can send it without scanning it as collected. Then they’ll get dinged for no collection information and it won’t be on you if it’s been sitting in a pt room for 2 hours before they handed it to you)
10
3
u/Warm-Alternative6153 11d ago
Super helpful breakdown. I wasn't the collector here so her name went on it. But the point about not touching unlabeled tubes is well taken. I think early on you just want to be helpful but that's how mistakes happen.
3
u/WhatsBeeping 11d ago
Well the good news is the lab is judging her not you then!
I wasn’t sure how it was ‘your’ rejection but I promise we’re judging collectors even if procedure has us inform someone else (we have to call the primary rn signed into the patient where I work, whether they collected it or not) and honestly it happens so often im not even remembering names unless it’s happening a ton from the same person.
3
u/happyfamily714 12d ago
This is the right answer! You can scan it as collected in EPIC or rover and change the collectors name and time, that’s the correct process for accurate documentation
3
u/mcjason04 12d ago
The biggest “don’t know what they are doing” is decanting one tube into another.
1
3
u/Hate2bHurting 12d ago
We are all professionals and all of us do make mistakes, the lab cares about the quality of the results so the patient can get the best treatment possible.
You are part of the team and we are not sitting around looking at initials and trying to figure out who messed up the most. We don't have time to do that. That was just overthinking.
Maybe you can request a tour of the lab to see how things work. That way you can reduce your fears and get a new perspective of what lab ppl are doing with the samples.
1
u/Warm-Alternative6153 11d ago
A lab tour is a great idea. I think seeing the other side would help with the anxiety. I'll ask about it. And yeah, definitely overthinking on my end.
2
u/PossibleIntention465 12d ago
In my opinion we'll know that sample is hemolyzed after the centrifugation.
2
2
u/aFailedGuy 12d ago
Its nice of you to think about us, i really appreciate the effort You should know that sometimes the sample can be hemolyzed and its not gonna be bad for the test. I work in a specialized lab and we dont care if you hemolyze the sample bc we are gonna destroy the rbc's anyway.
Best practice for the patient and your time is to consider hemolysis and try to avoid it but you can still send the sample even if you think its hemolyzed
1
u/Warm-Alternative6153 11d ago
Interesting. I didn't know some tests aren't affected by hemolysis at all. Good to know sending it still gives the lab a chance to make that call.
1
u/aFailedGuy 11d ago
Yes, we, for example need to destroy the rbc's anyway so if it is hemolyzed its not a problem
1
u/Historical-Original2 12d ago
Hey, I worked in Emergency Medicine and currently a Laboratorian. You made the right choice, sending it down and having it spun down to determine hemolyzation is correct. Only then can they determine the next pathway for patient care.
1
u/Warm-Alternative6153 11d ago
Thanks for this. Hearing from someone who's worked both sides is reassuring. I'll trust the process next time and just send it.
1
u/Sarah-logy MLS-Generalist 12d ago
The lab people probably aren't thinking about it at all. Sometimes samples are hemolyzed or clotted or what have you and it's just something that happens sometimes — even the phlebs I know and trust get us an unusable specimen sometimes. Don't let it get you down 🙂
2
u/Warm-Alternative6153 11d ago
Thank you. I think I'm more in my head about it than anyone in the lab actually is.
1
u/DoctorDredd Traveler 12d ago
Honestly I’d rather someone send me something they aren’t sure will work and let me reject it than them redrawing it unnecessarily. There have been plenty of times I’ve had to stick patients myself who were difficult and I had a hard time getting a sample, but there is really no reason to restick without confirming it needs to be done first. I always tell people to send it and let me see what I can do before putting the patient through another painful and unnecessary stick.
I realize lab draws are normal and very routine, but it’s a very uncomfortable experience, and I really wish more people were considerate of this when ordering unnecessary testing and/or redraws.
1
u/Warm-Alternative6153 11d ago
That's a good point I hadn't considered. From the patient's perspective, another stick is worse than waiting for a redraw if needed. Thanks for that perspective.
1
u/OnlyHere4Football 12d ago
I worked with a new nurse so stressed out about her specimens hemolyzing or clotting. Bless her heart, she called me down to the ED because she thinks her Gold top was clotted. That one and the red tops are supposed to clot.
Knowing the order of draw is also very helpful which I’ve found a lot of people don’t know. First your blood cultures, then blue, gold/red, green, purple, grey. Best way to remember is with a mnemonic.
Also, I’ve never given a nurse a nickname in the 8 years of being in the lab, so don’t worry about that either.
1
u/Warm-Alternative6153 11d ago
The gold top clotting thing made me laugh. I can see how someone new might panic over that. Thanks for the order of draw reminder too. I know it but need to have it more automatic. And good to know about the nicknames.
1
u/Ecstatic-Copy2153 11d ago edited 11d ago
I went through Health Tech Academy for my phlebotomy technician training and felt the same way you do. The coursework was solid but nothing prepares you for that first draw where something looks wrong and you're standing there second guessing everything. You did make the right call though. Trust your gut. You've got enough passion to already be this careful, so you'll be fine. Just speak up in a respectful way. You're not there to make friends – you're there to ensure quality, care, etc., is maintained.
1
u/Warm-Alternative6153 11d ago
Thanks for this perfective from someone in phlebotomy! Yeah, will for sure speak up going forward. Don't want to annoy or offend anyone, but the patient comes first.
1
1
u/FlyDiligent4334 10d ago
“Wondering if the lab people have a nickname for me yet” 😂😂😂🤣🤣🤣🤣🤣
Oh myyyyyyy
-22
295
u/ash579 13d ago
There’s no way to be certain that the sample is hemolyzed until it gets spun down. No reason to stick someone again if it may not be necessary, so sending it is the correct thing to do!