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Everything posted by jcdayaz
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:) Tee hee! I would pay money to see a patient who needs CPR perform it on him/herself. TOO FUNNY!!!!
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Wow. Wow. I think I have several points to make on this post. Reader BEWARE! :) First and foremost I would NEVER issue type specific blood even in an emergency situation on a 1 second expired sample. NEVER! Anything issued until a new crossmatch specimen could be obtained would be O Neg on everyone with an Emergency Release form signed by the physician--depending on inventory. If O Neg's are in short supply (cancelling surgeries and notifying ER level) we would try to switch a male recipient to O Pos with Pathologist approval. Jaimie--I take it in New Zealand you have an endless supply of O Negs? I am jealous! We would start a male with O Negs but if the situation seemed like it would be one of massive transfusion--we would switch to O Pos. The point behind giving a woman of childbearing age O Negs is that if she becomes pregnant in the future it saves the fetus potential harm from an Anti-D.
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We call any unit of blood that reacts at AHG by the same testing methodology at a lower strength than the patient's DAT "Least Incompatible" in the Autoantibody cases. A different physician's order is required for us to issue/transfuse "Least Incompatible" blood. These patients have typically(hopefully) been referred to one of our Heme-Oncs who know a bit about transfusion medicine. Our two most prominent Heme-Oncs(Hematology-Oncology specialists) know when we call them there is a valid reason. They are well versed in our procedures. They also know it is best NOT to transfuse a patient with an autoantibody. We almost always recommend steroid treatment first--patient condition certainly plays a factor--but the chance of enhancing that auto is in most circumstances not worth the risk. Obviously, trauma-ish circumstances don't apply here.
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Lcsmrz, You make very valid points here. However, there are many Techs who interview well and then don't perform well (or at all). We all have "Bad Days"(once again myself not excluded--unfortunately), but there are some errors that just can't be okay. I agree that any Tech who claims to have never made an error needs to be feared. They typically are the most dangerous ones! We have to recognize that we are all human. Each and every one of us has made an error in our careers. To me it is the severity of the error made that is of vital importance! There is a HUGE difference between entering an armband number incorrectly and issuing the wrong-incompatible-type blood to a patient and potentially causing their demise. Just my thoughts.
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Cool. We were neighbors! I was at ACH in the BB. I applied at UAMS when we first moved to Little Rock from Shreveport, LA. There were no BB jobs available at that time. I applied for an open Hematology position(Yes, I needed a job THAT bad at the time). I was in the door, so to speak, until I observed the Bone Marrow clinic, etc. I still can't believe Medical Technologists perform the bone marrows there. We have all assisted in bone marrows before, if only in our Medical Technologist clinical rotation--made slides, preserved the core, etc etc. But I could not even fathom being the person actually doing the tap without a Physician even present. Obviously, I didn't take the job.
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Ann, Which hospital do you work at in Little Rock? That's where I lived for a while before moving to Tucson 3 1/2(ish) years ago!
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If I were in your position, I would not chance training this person in the Blood Bank. Marilyn makes some very valid points--I still would Not take the chance. Yes, everyone makes errors from time to time--myself not excluded (unfortunately), but there are some errors that are unforgivable.
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Hmmm, I'm not too sure how to interpret all these posts. We are an AABB, CAP, FDA accredited Blood Bank. We have sailed through every inspection that I am aware of. Well, except for a "space issue" deficiency a couple years ago. We do all the typical pretransfusion testing on the original armbanded specimen, but we do allow the redraw of a patient if more sample is needed for antibody workup, etc. without rebanding. We have the nurse/phlebotomist hand write the armband number on the new specimen(s). This practice ensures the original armband was verified at time of redraw. I might get blasted for this post----but it works for us and all of our regulatory agencies. Obviously common sense is required by the BB tech to determine if such a scenerio is appropriate for a specific patient. Hopefully no one would have a tech working in the BB that couldn't do that!
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ha ha ha! I will never forget my Micro instuctor's lesson on how to explain specimen requirements to a patient. She told us Medical Technology novices (we hadn't started clinicals yet in a hospital) that as a new Microbiology Tech she tried to tell a patient she needed a stool sample and then provided him with the container. It came back the first the first time with urine and the second time with the other aforementioned fluid. She finally (after two rounds) said to the patient "Hey man, just take a dump in the cup!" A good lesson for us. Communicating effectively with our patients is of vital importance!
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I was a patient at St. Jude back in 1980(ish). Not cancer related--just severely broken arm that the local Children's Hospital couldn't handle. Had surgery complete with pins/plates/etc and a 7 day hospital stay! Ha! A seven day hospital stay now is laughable for a broken arm!!
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WELCOME cmello! Memphis/ Beale Street is the coolest place ever! Well, maybe New Orleans beats it--but NOT during Mardi Gras! You will learn significant amounts of information from this site. Glad you joined us!
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mjshepherd-- You just reminded me of my "Christening" into the world of health care-------had a patient run through the ER doors exclaiming LOUDLY that she had a condom "stuck" and needed help. It was my first job as a Med Tech--probably in my first month! Kudos to the ER nurses who somehow managed not to laugh. I had to turn my face away from her to hide my amusement.!!
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ha ha ha ha!!!! Laughing out loud--waking up my family!! This post just might be the prize winner for the best one!!--at least in my book!!
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To be honest, that's a good question. Any patient who has received Rhogam is obviously Rh neg and we would be transfusing Neg units anyway. I do not know of any patients who meet these criteria who have required transfusion. If the pattern of the antibody found on initial testing does not fit the pattern of an Anti-D then a full workup is performed. We look for time since last Rhogam, strength of reactions, etc, etc. If ANYTHING looks suspicious at all, a full work up is performed.
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LOVE THIS ONE!!!!! We not infrequently refer to the surgery as a CABG(pronounced as cabbage) X a number(however many vessels are being bypassed) but to see it on an official medical record would be priceless!!!! We get some crazy admitting diagnosis where I work now also. How about--"Fell down". Gee, that's real specific! I have been told, although I have not confirmed, that the admitting staff have to list whatever the patient tells them when they are being admitted. I can not even imagine the things they hear! Although, I do wish at least some of them knew how to spell!!!!
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We report Labor and Delivery specimens (or any other we can verify recent rhogam administration on) showing Anti-D specificity as "Passive Anti-D presumably due to Rhogam administration on (insert date). We don't waste our time with doing a panel to ID. It works well for us. And for our patients who probably don't want an added antibody ID charge for something that is expected to be present anyway after RhiG injecton.
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WHAT THE HECK???? "way ti"...what is that? I have apparently adopted Malcolm's spelling "issues".
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We use gel for almost all our testing. We do not even IS crossmatch anything anymore (pretty much, although I may be forgetting something right now). We computer crossmatch (validated computer system) every patient that has no history of antibodies or other issues.way ti We have flown through multiple CAP and AABB inspections with no issues noted. Although it is uncomfortable to us who are "old school", computer crossmatching is the way to go when you have a patient with no other issues and a computer system that will SCREAM at you if an error is made.
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I have no references or concrete info you can access. I do know, however, that NOTHING other than normal saline can/should be transfused with rbc's. We get the call at least once a week from nursing staff saying something like "My patient is on XXXXX medicine via IV, can I transfuse the rbc's I just picked up with that?" The answer is ALWAYS absolutely not!!!
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Unfortunately, not an infrequent occurance!!!! Some think they can "fish out" the clots from a specimen and still get accurate results!!!
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Hmmm...I wonder where that Bee stung her!;) And how it got there!!!:D:D
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Gosh, I wonder what the cardiac status would be of a patient with a 42 potassium!!:cries: How scary some of the things we encounter are...
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I see your location is CA. Perhaps you can contact the ARC reference lab directly for information? Or if you send me your e-mail address I will gladly forward you the information I have.
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Even scarier than students doing things like this is an MLT(Board certified, supposedly) that would VORTEX his urine sediment before he looked at it under the scope. All of us were horrified! We all tried to tell him that he is breaking up casts, etc but he wouldn't listen. His reply was "well, they are more frequently negative after vortexing". NO KIDDING!!! Management turned a deaf ear and a blind eye to the situation. To all you managers out there-------LISTEN TO YOUR EMPLOYEES!!!!!
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Perhaps try the exam AFTER indulging in some of that wine! :)