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Posts posted by jcdayaz
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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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What do you call such a blood unit?
Thanks
Liz
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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"Eoin" makes a great point in not jumping to conclusions on hearsay evidence. The lab could have been an accident waiting to happen, and this tech was the unfortunate one to make it. I know of one tech who was rotated out of blood bank work for "errors" that he was never shown, and I suspect a personality conflict with the supervisor played an important part of that decision.
I find that I make the most errors at the end of a double-shift, trying to keep a woefully-understaffed lab operational by working unwelcomed overtime. Since I know this, I am also the most careful at this time -- a younger, less-experienced tech may not be so introspective of personal limitations.
Occasionally, labs will fire a good employee for being involved with a serious error, listing the corrective action as "employee terminated" when reporting to the FDA. While this makes it sound like it was negligence, it could have been a systems problem that no one bothered to address -- and it may happen again to someone else!
My answer for this one? -- the interview makes it or breaks it for most potential employees!
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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I worked in Transfusion Service at UAMS.
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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Hello Memphis! This site is great to learn (and every once in a while laugh so hard fellow employees come check on you.
Your neighbor from Little Rock,
Ann
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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Originally Posted by mjshepherd
Some of the best ones I've heard;
Patient: Is it okay if there's spit in my husband's sperm count?
I agree, pretty funny. My daughter has always thought the job title "specimen receiver" was hilarious.
One couple came back with an empty Petri dish and reported, smiling, that the specimen wasn't in there. Another came back with a poop in the dish..
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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Hi everyone! I am new to the forum and am really excited about having someone to talk "shop" with outside of my employer. I work at St. Jude Children's Research Hospital as the Evening Shift Supervisor. I look forward to talking with you.
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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Some of the best ones I've heard;
Patient: Is it okay if there's spit in my husband's sperm count?
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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Hi jcdayaz,
Do you ever issue blood on these L&D specimens that you report as "Passive Anti-D presumably due to Rhogam administration on (insert date)" with out doing a panel to ID or do you do a panel if they require transfusion?
JB
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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Favorite diagnosis: Cabbage
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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Donna,
we don't do antibody ID's on our Echo yet, though because of this scenario, we're looking into it sooner than we had planned. What we get is a positive initial antibody screen that comes up AT LEAST 2+ on SI and SII (lot #R099 Capture-R strips) and most often 3 or 4+. We use ImmuAdd as our enhancement. If the doc orders an antibody ID, most often it comes back negative because our reference lab uses PEG and it won't pick up Rhogam-induced Anti-D most of the time. By reporting when the patient got Rhogam and the results of BOTH methods, we're hoping to cut down on how many ID's are ordered on these patients. Our comment that we send with the reports does also state that the automated screen shows "presumptive Anti-D patterning".
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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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.
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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:bonk:We called a nurse to tell him that the EDTA tube was clotted and he replied " it can't be, I fished out all the clots"!!
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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Diagnosis...Bee Sting....complete vaginal workup performed...
Hmmm...I wonder where that Bee stung her!
;) And how it got there!!!:D:D -
We had a new tech working in chemistry. They reported out a value of 42 for Potassium, not 4.2 but 42. When they first saw the result they checked their QC. It was fine, they then repeated the test and duplicated the result as required by the procedure manual. It never occurred to them that a grey top tube containing Sodium Fluoride and Potassium Oxalate should not be used for this testing. After re-educating this tech I had a long chat with the Chemistry Professor at the local Clinical Laboratory Sciences program. First he was mortified and second, he promised to drill the need to recognize impossible results.
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... -
I had the pleasure of seeing Dr. Garratty speak a couple years back...
however, I am googling ( no, not drooling) like mad and not finding anything about this teleconference series...
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!
:)
:)
Originally Posted by mjshepherd 
:bonk:We called a nurse to tell him that the EDTA tube was clotted and he replied " it can't be, I fished out all the clots"!!
;)
:D:D
:cries:
Just For Fun
in All other topics
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