Blue top coagulation question

[quitomate]

Hello. I had a confrontation with an RN and an MD today about the way a blue top must be filled. A nursing student filled the blue top (citrated plasma) tube to the very top, about 2ml past the mark. I pointed out that the patient needed another draw, but the RN and MD told me to take the extra blood out from the tube with a syringe. It is my understanding (and I might be wrong) that a 9:1 ratio is required. this tube, with the extra blood volume, was about an 11:1 ratio, and it doesn't matter how much blood i take out from the tube, the ratio will remain 11:1 because the blood had already been mixed with the NaCitrate in the tube.

Some extra info: the tube was filled by opening it and allowing blood to drip from the puncture site (we didn't have vacutainers).

I would love feedback from MT's, RN's, Phlebotomists or MD's 🙂

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[Frozen]

Hello. I had a confrontation with an RN and an MD today about the way a blue top must be filled. A nursing student filled the blue top (citrated plasma) tube to the very top, about 2ml past the mark. I pointed out that the patient needed another draw, but the RN and MD told me to take the extra blood out from the tube with a syringe. It is my understanding (and I might be wrong) that a 9:1 ratio is required. this tube, with the extra blood volume, was about an 11:1 ratio, and it doesn't matter how much blood i take out from the tube, the ratio will remain 11:1 because the blood had already been mixed with the NaCitrate in the tube.

Some extra info: the tube was filled by opening it and allowing blood to drip from the puncture site (we didn't have vacutainers).

I would love feedback from MT's, RN's, Phlebotomists or MD's 🙂

WTF? Dripped in from a puncture site?
You cannot take blood out of a citrate tube (blue top) after overfilling it. You are correct, you will end up with an overly dilute anticoagulant solution and no coag study from that tube can be trusted.

 

[primadonna22274]

You're right. Sodium citrate tubes are not forgiving...do they seriously want invalid results?!

 

[jwk]

I can't get past the "dripping it into the tube" concept. That's already unacceptable technique. If you don't have the equipment/supplies you need, WAIT FOR IT!

 

[pamac]

Hello. I had a confrontation with an RN and an MD today about the way a blue top must be filled. A nursing student filled the blue top (citrated plasma) tube to the very top, about 2ml past the mark. I pointed out that the patient needed another draw, but the RN and MD told me to take the extra blood out from the tube with a syringe. It is my understanding (and I might be wrong) that a 9:1 ratio is required. this tube, with the extra blood volume, was about an 11:1 ratio, and it doesn't matter how much blood i take out from the tube, the ratio will remain 11:1 because the blood had already been mixed with the NaCitrate in the tube.

Some extra info: the tube was filled by opening it and allowing blood to drip from the puncture site (we didn't have vacutainers).

I would love feedback from MT's, RN's, Phlebotomists or MD's 🙂

im a lab scientist, and you are right.... you must fill to the line to get the proper ratio and arrive at the proper result. removing plasma after overfilling is definately not allowable. you should have given a quick call to lab to clarify, and they would have set you straight. nobody should have been opening that tube anyway, as that compromizes the sample, and everyones safety (withdrawing blood from a vial with a syringe is also a violation of safety standards). a lot of procedures were violated right there. but its hard to stand up to a doctor and a senior nurse. but yeah, 2ml from the top? that could change your values by over 90 percent depending on the volume of the tube (there are ones that hold 1.5 ml that we use when it looks like you might not get much blood). additionally disturbing is the fact that the MD and RN actively tried to circumvent the lab policy. the way i know this is because: if taking blood out to make it kosher was something reasonable, then they would have just let it get sent on to lab and have them do it. instead, they wanted to make sure the lab didnt reject it, so they did it themselves, and that they put out a faulty result. a nurse at my facility would at least get written up if they did that, and possibly let go. dont let them talk you into doing something like that, just call lab and ask them, and make it uncomfortable for them when the doc and nurse come back and ask you if you did it. they are asking you to risk your job and license. if its that important to them to not redraw the specimen, they can call the lab and tell them that they want it run despite the circumstances, and see what can be done there. since you know the right way to do it, you cant claim ignorance down the road when this comes up again. the RN and the MD wont take the fall for you. and the dripping from the puncture site..... thats..... amazing.... im not necessarily faulting everyone in that scenario for not being a lab scientist and knowing how lab methods and machines work, but im also a nursing student, so i also know what nurses are taught about those kinds of things. all of that is such bad form. theres no way that would hold up to someone who happened a group acting that way.im not even so appalled by all of that because of how far the measurement would be off as much as i am the willingness for everyone to go ghetto at the drop of a hat. that begs the question of how long that knd of thing has gone on.... thats how folks get fired. if it puts a bunch of patient records in question, then the facility just cuts thier losses and fires folks. employees cutting corners can try to blame it on training, but that would mean someone else in the hospital would have to take the fall, and a lot of times the trainers have records showing that they showed you how to do things the right way... right next to your signature and the date. its always the coverup that gets folks... not the crime

 

[Boogie Man]

WTF? Dripped in from a puncture site?

This was my reaction... do you not have syringes on the floor?