collection of extra tubes-allowed? where to hold and who?

[DFields]

Does your institution allow nurses to collect extra tubes (such as ER or L&D) in case the pysician orders tests (or more tests) at a later time? Is collection of extra samples permitted?

Are there time frames for holding and storage?

Where are they stored and held for possible orders?

This is a problem for the Lab as a whole at our instituion and we are trying to find out what other facilities are doing/requiring.

[Mabel Adams]

We have only phlebs drawing which simplifies things. We recently instituted a Draw and Hold test in the computer. This test has to be ordered whenever extra samples are collected. That creates a track in the computer and a label for the specimen. BB has used a similar test called Band Only for many years.

[Lcsmrz]

Drawing extra tubes is routine in our ER, where evaluation and changes in condition may require additional or follow-up testing. Same could be said for codes or OB in a triage situation.

Drawing extra for a routine draw is a waste, unless the physician specifically requests it.

Our HemOnc patients get a "BB Hold" tube drawn with their CBC to save them another port access, should the counts come back low enough to transfuse.

My problem has always been the volume of blood drawn. Why draw a 4 mL EDTA, when the analyzer uses 300 uL? Or why a 7 mL chemistry tube when the sample+deadspace is 75 uL? I don't want 100% pedi tubes, but if I had some say, I would change the type of available vacutainer tubes in stock ...

[rcurrie]

Our ED thinks drawing a rainbow is the best thing since chicken fried steak. The problem is that the specimens rarely are completely labeled. They usually have a patient sticker on them, but no date/time/initials. We routinely toss them within seconds of their dropping down the tube station if improperly labeled.

BC

[lioness@50]

I completely agree with Larry and Bob! And, to make matters worse, I have witnessed phlebotomists use extra tubes for testing without consulting with the tech(s). Of course, you can imagine running a glucose on serum that's been on the cells for 6 hrs; PTT from a tube drawn 12 hrs ago, and so on and so on. I have always thought that any dept or person drawing a rainbow besides ER is not only a waste, but extremely bad medicine.

[Karen Olsen]

Our Emergency department typically draws a rainbow on almost everyone and a "hold clot" for BB when they think there may be BB orders. They draw the Hold Clot following the same procedure as any other BB specimen. The "Hold Clot" is sent to BB as soon as it is drawn. Orders can then be added on at any time for 72 hours.

The "Extra" tubes in the rainbow are labeled properly, sent to the lab and are stored in the appropriate department.

[Cathy]

Our OB patients and some of the ED (depending upon symptoms) patients have blood bank hold samples. Label requirements are the same as a type and screen, anything less gets tossed. These samples are held in blood bank. I find that we often spot a 5gm hgb faster than hematology. Also some names become all too familiar, ex multiple antibodies. I might call the ED to find out what's up with the patient and let them know the time frame they might be looking at should blood become necessary.

When we receive orders for add on testing, the phlebotomy staff brings the order and the sample to the tech running that test to add the new label to the sample and make the final determination if the sample is appropriate or not.

[rcurrie]

I don't get excited about those 5 g/dL Hgb samples any more. We have too many sickle cell patients who do just fine at that level. It's those 3's and 4's I worry about.

BC

[DebWerner]

Has anyone had any issues with the nurses thinking that there is blood available just because the patient is wearing a Blood Bank Band???

[Deny Morlino]

For years phlebotomy has drawn extra blood "just in case". ED also draws a rainbow of tubes (I think we finally beat them into submission on the labeling issue ). Within the last year the LIS team added an orderable JIC test. We hold all specimens for seven days refrigerated. All coagulation tubes are centrifuged and the plasma separated into an aliquot tube labeled with a JIC label. We use the citrate tube to cap the aliquot to help differentiate between plasma and any serum aliquots.

We have had a problem in the distant past with the mindset of "a blood bank ID band means blood is available". We have also had the issue of a type and screen means blood is ready to be transfused. Working with the nursing educators we have over a couple of years tackled educating all of nursing to correct these issues. We also have these issues addressed at new hire education for nurses to be certain everyone is on the same page.

[KKidd]

Has anyone had any issues with the nurses thinking that there is blood available just because the patient is wearing a Blood Bank Band???

I feel your pain! No matter how many times we try to explain how to check in the computer it doesn't work. The secretaries and nurses don't seem to realize that it is simpler to check . THey are wasting their own time as well as ours. I've already had one order today that had to be cancelled.

I think the main problem for us is the initial computer training! Deb, thanks for the opportunity to vent!

:threaten::threaten::shakefist:shakefist

[adiescast]

I feel your pain! No matter how many times we try to explain how to check in the computer it doesn't work. The secretaries and nurses don't seem to realize that it is simpler to check . THey are wasting their own time as well as ours. I've already had one order today that had to be cancelled.

I think the main problem for us is the initial computer training! Deb, thanks for the opportunity to vent!

:threaten::threaten::shakefist:shakefist

I had aan OR nurse stop me in the hall today to tell me about a terrible problem they are having with patients who come through the ER to the OR as transfers from other hospitals, who (gasp!) use a blood bank band just like ours! Then the OR assumed that blood was available on this patient, even though the patient was also wearing a hospital band that clearly was NOT ours. They now are looking for someone to blame for this problem! I told her talk to the ER people about cutting off foreign bands on arrival... No use in beating the dead "look in the computer" horse!

[AMcCord]

Has anyone had any issues with the nurses thinking that there is blood available just because the patient is wearing a Blood Bank Band???

Oh yes.........surgery is the worst about this. We also have to explain the Type and Screen process over and over and over and over, to doctors (one in particular over and over and...) and nurses.

We are 99.8% phlebotomist drawn. They collect extra blood bank tubes in the ER on traumas and on OB admits. They have pretty good radar, especially the more experienced phlebs, when it comes to picking up conversations about someone bleeding, going to surgery, broken hip suspected, etc. and will draw extra if they suspect there is a reasonable chance we might use it. We have a separate rack in Blood Bank for those specimens and we use enough of them, that it's well worth doing.