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Posts posted by jcdayaz
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We will not infrequently say, "I am working on a problem patient. I need to concentrate." None of us are ever offended--as we have all been there. We also know those of us who talk problems out to ourselves outloud as we are working through them. It is not an uncommon occurrance to hear a coworker say "Let me know when/if you are talking to me and when/if I should respond." We all just know that sometimes it helps to hear our thoughts/logic/plan/whatever out loud.
I would suggest NOT using the "QUIET IN THE BLOOD BANK" sign idea. It seems really offensive. I have always been an advocate of open and honest communication--it works the best. I would suggest putting the "blame" on yourself the first time or two and admitting that you are not able to concentrate with all the chatter when you have a problem patient to work on. I think people will get the message.
We just hold a hand up and say "Not right now" if someone tries to chit-chat while we are deep in thought. No one is ever offended. We know the deal. Obviously, you couldn't just start doing these things out of the blue without offending most people. I think, however, after a meeting or something of the sort explaining it all to everyone you should be just fine.
I REALLY need to learn to read all the responses before making a post myself!
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As a new Blood Bank supervisor I'd like to get input from you on a sticky subject.
How do you let your co-workers know that when you are performing blood bank work at the bench the interruptions need to be kept at a minimum? I'm often interrupted by casual greetings or chit-chat and find this very frustrating.
I realize I could post a big sign that says "QUIET IN THE BLOOD BANK," but I'm hoping for a less offensive way of getting the message accross.
Ideas?
We will not infrequently say, "I am working on a problem patient. I need to concentrate." None of us are ever offended--as we have all been there. We also know those of us who talk problems out to ourselves outloud as we are working through them. It is not an uncommon occurrance to hear a coworker say "Let me know when/if you are talking to me and when/if I should respond." We all just know that sometimes it helps to hear our thoughts/logic/plan/whatever out loud.
I would suggest NOT using the "QUIET IN THE BLOOD BANK" sign idea. It seems really offensive. I have always been an advocate of open and honest communication--it works the best. I would suggest putting the "blame" on yourself the first time or two and admitting that you are not able to concentrate with all the chatter when you have a problem patient to work on. I think people will get the message.
We just hold a hand up and say "Not right now" if someone tries to chit-chat while we are deep in thought. No one is ever offended. We know the deal. Obviously, you couldn't just start doing these things out of the blue without offending most people. I think, however, after a meeting or something of the sort explaining it all to everyone you should be just fine.
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I have a recipe somewhere for making stroma from a donor unit. Unfortunately, it is not in electronic format, so I can't share it at the moment. Lately we have been saving up reagent screening cells and doing PEG adsorptions with them instead. Preparing stroma from 3 units of red cells was a day and a half chore that I really don't have time for right now.
We are currently looking into doing PEG adsorptions. Do you have a procedure for that you can share?
Thanks in advance.
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George Garratty, to name but a few).
I had the distinct pleasure of attending a teleconference last Wednesday given by Dr Garratty. He is doing a series every Wednesday for the next several months. Unfortunately I cannot attend tomorrows teleconference--but I plan the make the others. He is amazingly knowledgeable and the infortmation he presented on auto antibodies was nothing short of brilliant.
I recommend to all of you who might have the opportunity to join in the teleconference series to do so. They are from 8:30am-10:30am each Wednesday. I am not sure how to access the conferences, but I know he is working at the ARC in Paloma, California. Perhaps one could get information through a link or something. Like I said, I'm not sure.
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No problem. I notice that I still can't spell (rally, instead of really)!
You crack me up Malcolm.
Did you get my private message about the HrB or hrB antibody patient we thought we recently had? Thank goodness it turned out not to be, but I would still love to have the information.
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I believe David was referring to performing a PeG autoabsorption. That is different than a regular antibody screen/crossmatch. We are currently investigating this procedure to replace our current W.A.R.M absorption procedure.
You are correct in your statement that PeG generally enhances reactions more than LISS in a regular screen/antibody panel situation--but not more so than gel. Gel is the most sensitive technique I've seen.
OOPPSS! I guess I should have scrolled down a bit more in this post before making my reply.
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I don't understand this. Immucor states that PeG enhances reactions. How does it "absorb out any auto" ? Pardon my ignorance.
Thank you,
Liz
I believe David was referring to performing a PeG autoabsorption. That is different than a regular antibody screen/crossmatch. We are currently investigating this procedure to replace our current W.A.R.M absorption procedure.
You are correct in your statement that PeG generally enhances reactions more than LISS in a regular screen/antibody panel situation--but not more so than gel. Gel is the most sensitive technique I've seen.
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You should understand that it is ALWAYS our fault if something goes wrong. Doesn't matter if they wait until 30 minutes before surgery and then the patient has an atypical antibody. Don't you know that WE gave it to them, we are delaying the surgery and WE are responsible for the patient being kept under so long.
How true your comment is. We had a surgeon actually write a letter to the CEO of our hospital complaining when one day he had to delay surgery because he waited until 30-45 mins pre-op to have a type/crossmatch done. Guess what? The patient had an antibody! In the letter, the surgeon said something about the Blood Bank not opening until 8:30am.!? Thank goodness we had appropriate documentation of all the notification phone calls we had made and the times the calls were placed. The kicker of this story is the CEO tried to come down on us hard about it. Our BB Pathologist backed us 100% and the CEO backed off.
We now make jokes among ourselves that the Blood Bank is closed for breakfast from 6-8:30am and closes again for lunch from 10am until 2pm. Ha! How ridiculous!
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Anyone else ever notice how the ER patient is dying and we are uncaring right up to the point the Doc has to sign for uncrossmatched blood. Then things are not quite so bad after all but please hurry as fast as you can with that cross match!
:disbelief:disbelief
Happens all the time here also John. Once we tell a DR we can provide him with O Negs, he will just have to sign an emergency release form, the "emergency" typically becomes not quite so life-threatening.
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This one is a bit sad as it reflects on society today, but amusing at the same time.
A little girl of about 4 came into the emergency department with several bumps and scrapes. Both of her parents were with her. The ER physician asked the girl several times throughout the visit how she had become injured. Each time she told him that she had fallen down while playing. When he asked her the same question for the fourth time she gave him a strange look and said,"I told you stupid, I fell down!" At that point with both parents completely mortified at the response from the girl the ER doctor said in reply while chuckling, "I guess I had that one coming!" We have reasons for the protocols that are in place, but sometimes we must seem very dumb to the children we care for in the medical profession.
"Out of the mouths of babes"... I love that saying. They say it like it is!
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Walking into a darkroom to read some platelet antibody tests and sitting down on a chair flooded with warm saline, or worse having plastic vials containing dry ice pop their caps under your chair in the dark. Or maybe it's the day my "friends" got every timer in the lab to go off within a minute or so and every single one of them was hidden somewhere, one of them even inside a light box - those were the days
Denise
I am going to use the timer idea one day! Fellow coworkers--BEWARE!!!! That is a great one!!!!!
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This was during the hay day of the physician office labs - I remember when a chemistry tech had decided to “jump ship†for a physician’s office lab – great hours and no weekends and holidays. He was back in just a few weeks. When he arrived he found all the reagents in drawers, not the refrigerated storage as required. He asked about getting a refrigerator and replacing the reagents that had been stored incorrectly. They said No, it was too expensive, and the same went for control reagents as well! Who needs them, right? I bet the doctor still thinks that CLIA was unfair. Needless to see the few folks in the lab that were going to that office switched in short order.
I won't deny having been tempted to "jump ship" to a physician's office lab before. I have two young boys and the hours and no weekends/holidays sound appealing. However, I am not willing to work in a lab that is unsafe/not following and/or exceeding protocol, etc etc. It's just not worth it. I'll take my weekends/holidays over a physician's office any day!!!!
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Malcolm, speaking of things that were not entirely unexpectedly absent, years ago I took my daughter to our pediatrician. She was having stomach cramps. The doctor asked for a urine sample, then proceded to put a drop of the raw urine on a slide, cover it with a cover slip, and look at it through a monocular microscope that might have dated from the late 1800s. "There's nothing there", he announced. I told him "I'm not surprised, in my lab we centrifuge the urine and remove the supernatant which concentrates it 10,000 times and gives you a fighting chance of seeing something in there." He gave me the stink-eye. I found a new pediatrician.
Good thing. I wouldn't have taken my dog back to that pediatrician.
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We have performed multiple control testing over the years with known anitbodies present (weak ones of course), just to see about diluting out antibodies, and we have shown that, in fact, this does not happen.:D:D:D:D
When I worked at my reference lab, we made our own red cell stroma to do adsorptions (absorptions--I always get the grammar wrong). We would do two different ad/absorptions and based on what the stroma was positive/negative for we could rule out/in whatever (pretty much) we needed to. It worked really well.
I wish I still had the "recipe" for making the stroma. Is there perhaps anyone out there who has such a "recipe"? How do other people do ab/adsorptions? We have tried the WARM (Ortho, Immucor, don't remember just now) Auto Absorption method and I find it lacking...in several areas.
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a reference lab i worked at did semen analyses for an IVF clinic. most would arrive early Saturday A.M. and the responsibility for completing them was assigned on a rotating schedule. one particular saturday none was submitted and we thought that a terrible shame because the gal scheduled to do them always finagled other folks into helping her complete them. we had happened to get a new handsoap that looked like ejaculate. so, we filled a couple dozen specimen cups and generated false requisitions (easy since the clinic wasn't interfaced and everything was submitted on down-time reqs.) the look on her face when the courier dropped off several full cartons of specimens was priceless. she actually "counted 3" of them before she noticed the strong lemon-lavender smell of soap and began to notice that the clients had names like "I.P. Frehley" or worse.
This is another great story! We once played a practical joke on a fellow co-worker who, if I were honest, none of us liked. We got Security involved...planned it all out, etc. We placed in his personal drawer a small zip-loc bag with powdered sugar in it. None of us knew what actual cocaine might look like and that's the best we could come up with. Anyway, we called our security friend after we put the powdered sugar in his drawer and the officer came and did a "random inspection". Well, guess what? He pretended that he had found cocaine in the drawer. The Tech went Ballistic!!! Although a very mean prank..a lesson he apparently took to heart! He was much more tolerable after that.
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I never said no one ever sampled. I said no one ever over indulged. That means no one ever fell down and had to be carried to the donor bed!!!:giggle::giggle:
hahahaha! I just arrived home last night from a 10 day vacation (Malcolm might call it a "Holiday"). I had to be carried a couple times to a bed! Oh well, work hard, PLAY HARD!!!! That motto has gotten me through life.
:D:DBack to work tomorrow. ICK!!!:mad:
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There was a time in the distant past when the laboratory ETOH was NOT denatured. My fisrt lab had a Christmas tradition, mostly do to an MT who was going to med school at the time. He would mix a batch of "punch" and keep it in the chemistry reagent fridge. Usually a mixture of orange juice and laboratory grade ETOH. No one ever over indulged but, that, was generally a happy couple of weeks with a very high Christmas spirit.
And not one of you ever sampled said "Very high Christmas Spirit"!! Do you think any of us are buying your story John??
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Hi John,
This isn't my area, but I've just asked one of the experts in the area here, and the answer is yes, liver problem s can cause this, but they are more likely to actually be sequestered in the spleen than the liver.
:):)Yes, in most cases the spleen is the organ sequestering the platelets. In my experience in this area, which is admittedly minimal, that is why they sometimes remove the spleen in platelet disorder situations.
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Loved the bubbling dry ice - I think we did it one time too many times creating a crack in the sink:redface:
And we also used to have "saline fights"- my best was once crawling under the bench and squirting warm saline onto a collegues sock to see how long it took for him to reqister. I used to keep a small umbrella close by for protection.
Ahhh the good old days when you could work hard AND play hardWe still work hard and PLAY hard. It is not an infrequent experience for one of us to shoot a rubberband at another and/or throw a rubber stopper out of some sort of control vial at another person. No biologically hazardous projectiles are used obiviously, and it really makes for a less stressful environment. Is it correct practice? Of course not...but sometimes you improvise for sanity's sake..
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A number of years ago while working second shift I was in the emergency department drawing blood from a "young" lady 103 years of age. We had been talking and she had very sharp hearing, vision, and wits. While I was collecting the specimen from her, the ER physician walked in and immediately raised his voice to address her speaking very slowly and in short simple sentences as if addressing someone with hearing difficulties and having memory problems as well. I ducked by head hiding a smile as this lady was a pistol. She looked over at me, raising an eyebrow before looking at the physician and stating in a quiet voice, "Doctor, I am neither deaf, nor a 5 year old child." "If we are going to get along I would appreciate it if you would speak to me in normal tones in regular sentences." The physician to his credit stopped short, smiled, and said "let's start over and try again." With that he left the room closing the door, knocked and stepped in introducing himself at a normal conversational level. He asked her if she was feeling OK today and how could he help her. With a twinkle in her eye she said she would not be in the ER if she were feeling well, and he could get on with the exam as she had other things to do at home. I couldn't help but to laugh at the reply as did the physician. Never assume.
This is a GREAT STORY!! Thanks for sharing it.
This scenerio should be a lesson to us ALL in the healthcare field. Unfortunately, we all too often stereotype patients based on what we perceive their strengths/weaknesses will be.
BIG APPLAUSE is deserved to that DR who left the room and started over.
What a GREAT life-lesson this is for us all also. Recognize when you mess-up---the DR in this case, and make it right--- like it sounds like he/she did.
Another big applause for that DR!!!!
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My first job in a hospital was graveyard ER Admissions clerk while going to college. We were close to the less savory parts of town and we saw a number a patients from there. Anyway, one night we had a gentleman in who happened to be deaf in his right ear and blind in his left eye and well in to his drink. To talk to him I had to stand on the left side and lean over to his right so he could hear and see me at the same time.
Oh my, John. Sounds like a fun scenerio to me. Almost like the time I was performing phlebotomy on a very "practiced" drug abuser who essentially had no veins left. I tried twice, missed both times of course, and then she grabbed the syringe with needle and drew her own blood from behind one of her knees!!
It took me several minutes to realize what had just happened..that's how stunned I was by it. I guess the "good" drug abusers know where they still have a usable vein.
:eek::eek:How scary is that?????
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I had a new one the other day. Irriatable blood--it was pronounced EERIA TABLE blood. Sometimes not laughing right in the ear of the nurse calling is quite challenging!! I'm glad I wasn't having dinner at that EEERIA TABLE!!!
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[b
See what thinking haematologically does to me?My spelling has never been great, but BLOOS??????????!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
:eek::eek:I was going to ask you what a BLOOS film is.!!!!!
:D:D:D;) I've posted a couple of misspellings myself Malcolm. It is always horrifying to me to go back to one my posts and find a misspelling. I guess it proves that we are all human.
Although, I will admit it is refreshing to see that even you are!!:D:D:D:D:D:D -
And as far as the MD wanting FFP for volume replacement; that is also an MD call.
I am not meaning to be critical but I would just caution you about questioning a physicians orders "too" much. Yes, there are absolutely times that they order inappropriately and it should be questioned (like the new MD at my hospital who ordered 10 platelet apheresis 1 night; but he had come from a place that had used the whole blood donor individual platelets; but the RN said that is what the doctor ordered so that is what she wanted; so my staff called me at home and I had to intervene), but you can get yourself in hot water if you end up inappropriately questioning their Orders.
Anyway, just something to think about...
Brenda
:confused:
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:eek:
Holiday!
in All other topics
Posted
Malcolm,
That's why the rest of us Blood Bank nerds carry laptops with us when we travel! Even in the midst of vacation, there are normally some moments to SNEAK onto BBT! Wait for the wife to doze off and you're home free!
:) But you're right, divorce can get expensive and ugly...VERY ugly.
Have a great trip!