Wednesday, May 7, 2008

I fought the lab and ... hey I won this time

One of my favourite tasks as an intern was acting as the after hours (and frequently during hours) blood collection service. Right up there with IVs and manual disempactions.

We all remember being called to draw blood from a patient. The patient was either:

1. A little old lady covered in bruises on all four limbs from IV and blood collections.
2. A heavy smoker with no veins.
3. A child on chemo with a severe needle phobia.

So after multiple stabs and tears you would fill the multiple different coloured tubes that the nurse handed you. An hour later you would be paged back to the same patient to draw more blood because:

1. There wasn't enough blood in the tube
2. There was too much blood in the tube
3. You collected blood in the wrong coloured tube (I used to fill one of each colour just in case)
4. The specimen was not properly labelled
5. The sample was "hemolyzed".

Of course it is over 25 years since I was an intern so I should have gotten over it by now. I still of course collect blood from patients under anaesthesia, and very rarely get called to the floor because no-one else can get blood. I also collect blood from nurses who got a needle stick which brings me to my story.

Now for several years I have resolved to wear gloves when starting IVs but this year I actually started doing so. The other day I went to start on IV on my first patient of the day. He was a little difficult and I had to try a second time but I got the second IV in. I am not the neatest person but I do make a point of being responsible for my own sharps. I picked up the two IV needles with me gloved hand and walked back towards my sharps container. That was when I felt a little prick (not the surgeon) and when I took off my glove I could see a little break in the skin.

Oh shit.

The patient had no obvious risk factors and no visible tattoos. Nevertheless I felt that I should draw blood from him and myself. At our hospital we have a needlestick protocol. You get a ziplocked bag with two tubes, one for the patient and one for you. There are two reqs one for the patient and one for you. You put everything in the same bag and it goes off to staff health.

The patient was still under some I drew some blood from a vein and put it into one of the tubes which I labelled with a sticker. I put his sticker on the req. Finding somebody to draw blood from me was harder. The OR nurses didn't want to do it. Recovery room nurses are good at drawing blood but the req had written across it in handwriting "please do not ask recovery room to draw blood". I finally found another anesthetist between cases. I labelled the tube with my name, filled out the req including my name, my date of birth and my healthcare number. Everything, mine and patient's blood went into the ziplock bag and off to staff health. Now as I was labelling my tube, I thought back to those happy times as an intern acting as the afterhours blood collection and recollection service.

Not much to my surprise, I got a call from the staff health nurse about 30 minutes later stating that the lab would not process my sample because it was not labelled properly. I suggested maybe she should call the lab and straighten things out with them as there were only two samples in a zip-locked bag and one was labelled with the patient's label, the other one had my name it. She asked if I was concerned about the patient's risk factors. I asked if she had never heard of universal precautions?

Now I could have just found somebody to draw another sample, but hey it's my blood, my integrity was violated to get the sample, they should process it. So I phoned the lab director who actually had heard about the fuss already. He said he would bring the sample to the OR and I could label it properly. About five minutes later he phoned back saying that the lab tech had told him, there was no way even if it was relabelled that they would process it.

I asked him, "Are you a physician?" He said "yes". I asked "and you have done a pathology residency?" Yes again. So says I. You have over ten years of post high school training and you are letting someone who graduated from a two year technical school telling you what you can do.

One hour later, he brought the tube to the OR and we relabled it.
Score: Lab 217 BH 1. But at least I'm on the board.

And by the way the patient was negative.

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