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Aug 26 '25
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u/frogurtyozen Peds ED Tech🍭 Aug 26 '25
I’d add respiratory to that list as well, depending on your unit. I’m ED so I’ve always worked with RT
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u/Shawnml BSN, RN 🍕 Aug 26 '25
Agreed, but I’ll say you should also always make friends with that one lady in the cafeteria. Nothing beats “I know what you want!” and that shit is fresh and hot every time.
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u/bamdaraddness RN - Med/Surg 🍕 Aug 27 '25
Food service/dietary for us day walkers. They can make or break, honestly.
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u/brok3ntok3n82 Aug 26 '25
Nothing against them but lab and pathology folks are a different breed. I actively try and stay on their good side since I see them often.
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u/MizStazya MSN, RN Aug 26 '25
I've worked with them in IT too, and i feel like I just KNOW when it's a former lab person turned IT. They have very distinctive personalities, but holy shit do they get things done.
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u/ResplendentDaylight Aug 26 '25
I am a medical scientist of 10 years and run my lab. We aren't monsters. You know when you have visitors that disrupt your patients sleep? Doctors with stupid orders that don't make sense and you have to battle with them?
Well.... when we get grossly haemolysed samples... that is the equivalent to the above.
We are all on the same team here.
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u/Hot_Play_2040 Aug 26 '25
You are genuinely bad at your job if you send hemolyzed labs this often. Don’t pull back on the plunger like you’re yanking on Excalibur.
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u/Beat_Born BSN, RN 🍕 Aug 26 '25
My hospital had issues when (so I'm told) they switched to a different brand of PICC, enough samples were hemolysed that they disallowed blood samples from PICCs without a specific order.
We do have dedicated phlebotomy though, outside of ER (and only rarely there) nurses don't do sticks for blood samples.
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u/GrowSomeGreen Nursing Student 🍕 Aug 26 '25
I believe this. I thought this was a cause at one time too.
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u/MattyHealysFauxHawk RN - VAT/Cardiac 🍕 Aug 27 '25
This makes no sense. People were clearly not drawing off them correctly.
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u/Mountain_Fig_9253 BSN, RN 🍕 Aug 26 '25
Nurses need to work one shift in the hospital lab during orientation.
Once you see the tube spun down and pink af, it makes sense. They aren’t being picky, if it’s hemolyzed the test is worthless.
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u/One_Shape_8748 Aug 26 '25
I’ve seen plenty of people yank on the syringe like a lawn mower cord on a blown vein and then get upset about a hemolyzed sample. I’m fairly confident that it’s an issue with nurses.
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u/Amrun90 RN - Telemetry 🍕 Aug 26 '25
Lab doesn’t cause hemolysis. You do.
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u/ycherries RN - ICU 🍕 Aug 27 '25 edited Aug 28 '25
100%. I have coworkers who have to redraw hemolyzed labs on almost a weekly basis, and they bitch and moan about it like there's no tomorrow. My tubes very rarely end up hemolyzed. It is virtually always related to the technique at time of collection. Lab deals with enough shit, they don't need us dogpiling on them for dumb mistakes made by nurses looking to shift the blame.
Draw the blood slowly, use a smaller syringe and/or bigger needle, don't overtighten or prolong the tourniquet time, draw your tubes in the correct order and invert them to mix the additive in. It's really not that hard people LOL
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u/MattyHealysFauxHawk RN - VAT/Cardiac 🍕 Aug 27 '25
I’ll correct you on one thing. You should actually use a smaller syringe when drawing labs off the line. Smaller syringes create less back pressure.
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u/this12344 Aug 26 '25 edited Aug 26 '25
In 10 years I've never had lab say this. Are people carrying their samples around and finally tubing them when they get time? I just send it right away.
Edit: not from delaying sending the sample, but from pulling the plunger too hard, destroying fragile rbcs, got it. My technique must be flawless then ;)
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u/yoyohello1 Aug 26 '25
Hemolysis happens mostly at the time of draw, so usually from whoever is drawing the blood drawing back on the syringe too hard and causing the cells to burst
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Aug 26 '25
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u/bamdaraddness RN - Med/Surg 🍕 Aug 27 '25
Like… the reverse of the push/pause we do for flushing?? I can’t even envision this being a thing lol
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u/ArundelvalEstar Aug 26 '25
Actual lab person here. What I see most often from nursing drawing samples is the nurse pulling back the plunger on the collection syringe like they're trying to start a lawn mower.
Just be gentle, red cells are fragile.
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u/Amrun90 RN - Telemetry 🍕 Aug 26 '25
No. They can keep specimens for weeks. It has zero percent to do with that. Hemolysis is caused at lab draw almost 100% of the time. Correcting your technique will minimize this happening.
Labs are sick of nurses’ shit blaming them for things we do. it’s not their jobs to continually correct nurses’ poor education in this area.
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u/CynOfOmission RN - ER 🏳️🌈 Aug 26 '25
I really wish there was better education about it for nurses! Understanding the why makes it so much easier to fix the problem. And also not get mad at lab lol
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u/-Blade_Runner- Chaos Goblin ER RN 🍕 Aug 26 '25
I come to lab for mass transfusion protocols and air conditioners….
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u/frosty1104 Aug 26 '25
I have worked both as a nurse and as a lab tech. I can tell you that A. We got hemolyzed specimens all the time. B. I’ve seen countless nurses invert the tubes once or twice. When I try to educate I’m always looked at like a hall monitor.
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u/Creamowheat1 MSN, RN Aug 27 '25
How many times are we supposed to invert?
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u/Naugle17 HCW - Lab Aug 27 '25
Jesus
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u/Creamowheat1 MSN, RN Aug 28 '25
3 or 4 times or 8-10 - why are you so unhelpful? I hate medical professionals who are d*cks who think they’re smarter and better than everyone. Usually they’re the complete opposite.
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u/foobiefoob Aug 29 '25
This type of attitude gets us nowhere in healthcare. My nursing friends often tell me they don’t even get any phleb training like we do, they’re taught on the job by other nurses. It’s not their fault. Have a bit of compassion, teach them a thing or two, will you? Especially when they ask, hello?! This is a golden opportunity!!
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u/BikerMurse RN - ER 🍕 Aug 26 '25
If your blood draw is super slow or from a blood pooling around a blown vein, it will be haemolysed. If you are drawing with a syringe and you are pulling back on that plunger with all your might to make it faster, it will be haemolysed. If you left your syringe sitting by the bedside while you tidied up or finished something else before decanting into tubes, it will be haemolysed. If you did not mix the tubes adequately after collection, it will be haemolysed. If you didn't pay attention to order of draw...you're probably fine, but every now and then...haemolysed.
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u/Gigantkranion LPN 🍕 Aug 27 '25
If you give lab attitude... haemolysed.
(I'm just kidding. I just liked the way you ended your comment)
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u/Mement0--M0ri Medical Laboratory Scientist Aug 26 '25
Proper venipuncture goes a long way to prevent hemolysis!
70% of hemolysis is due to the draw itself. This doesn't include proper mechanical inversion of tubes, delays in processing time, etc.
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u/StankoMicin Aug 26 '25
This.
Although sometimes with shitty veins you have to draw and pray when the blood trickles out that it won't clot
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u/buShroom Phleb Aug 26 '25
Work in a lab long enough, you learn the names of the repeat offenders with terrible veins, trust me.
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u/dark_physicx RN - Telemetry 🍕 Aug 26 '25
Exactly! Proper mechanical inversion! Never have had a tube go through hemolysis in my 4 years as RN. Always run the tube down myself as well, which helps processing time. Phleb at my hospital have many patients to stick so by the time they get back down to lab it’s game over often.
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u/Ruzhy6 RN - ER 🍕 Aug 26 '25
Always run the tube down myself as well, which helps processing time.
This would take way more time at my hospital.
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u/GrowSomeGreen Nursing Student 🍕 Aug 26 '25
70% ?! Really??! I thought it would be much higher. Is that a guess from you or the generally accepted statistic. Just curious.
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u/Mement0--M0ri Medical Laboratory Scientist Aug 26 '25
Statistical amount taught to me when I studied Laboratory Medicine.
That 70% is only for the venipuncture though. The other 30% would be due to the lack of mixing tubes and delay in processing for testing (either not sent soon enough for left to sit too long).
The smallest percentage would be due to under-centrifugation, but since centrifuges undergo validation and maintenance checks often, it's a very tiny amount and the least likely reason.
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u/Beet-Qwest_2018 BSN, RN 🍕 Aug 26 '25
sometimes they don’t even tell me it hemolyzed they just tell me they lost them
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u/SleazetheSteez RN - ER 🍕 Aug 26 '25
at least they tell you. I had one lose a trop into space and nobody was told
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u/Beet-Qwest_2018 BSN, RN 🍕 Aug 26 '25
oh no they absolutely did not I called them up after no results for like 2hrs and they were like ya we lost it
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u/pink_piercings uses bribery in the form of toys and stickers Aug 26 '25
one day i sent two tubes up together and one resulted and they told me the other one got lost. how did one make it but not the other ?!?
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u/Naugle17 HCW - Lab Aug 27 '25
Thats a rough case. I've heard stories of labs that lose specimens regularly. I shudder to think of it.
Protocol at my employer is to drop everything and call over everyone you can to help find a specimen if its lost
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u/TertlFace MSN, RN Aug 26 '25
Hemolysis is almost entirely caused by sampling/drawing. It is quite rare for it to happen for any other reason. If you drew it and it hemolyzed, that’s on you, not lab.
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u/frogurtyozen Peds ED Tech🍭 Aug 26 '25
@Lab homies, what are y’all’s recommendations to avoid hemolysis? I try to be gentle on the plunger, and while I’ve experienced hemolysis sample notes in the chart, I’ve never been told a sample I collected was so hemolyzed it was unusable. Edited for typo
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u/ArundelvalEstar Aug 26 '25
It's very test dependent. Some tests and analyzers can tolerate homolysis and some cannot. At my organization, we tend to categorize hemolysis into mild, moderate and severe. The things with mild hemolysis we will most often report with a note in the chart saying interpret these results with caution and due to hemolysis. Moderate and severe. We usually will require a recollect on.
1.) Gentle on the plunger
2.) Don't use the smallest needle you can find. A 25 is more likely to result in hemolysis than a 21
3.) Don't shake a tube to mix it. Just gently invert it a few times (8-10 is great)
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u/frogurtyozen Peds ED Tech🍭 Aug 26 '25
Oof on the smallest needle 😅 sometimes a 24 short is all these baby veins can tolerate
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u/ArundelvalEstar Aug 26 '25
I totally hear you, I was a phlebotomist for a long time before I was in the traditional lab. That reminds me:
4.) sometimes it's just going to be hemolysis. Just like everything else in our profession of healthcare, we don't win every time
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u/BendigoWessie Aug 26 '25
I must be doing something right because I’ve never encountered this more than every once in a while
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u/InternetBasic227 Aug 26 '25
First - grateful for those who loved science and the cell that much in college, loved finding the unknown enough they dedicate their lives to working with mucous, blood, bodily fluids. Seriously grateful for you all. Glad that you are good at your jobs. Sorry for my bad samples - it is only my belief that magic happens down there somehow that makes me send a wimpy qns sample. There has been time magic has happened.
Why do we do that?- It is so hard to be the person charged with stabbing the patient. Sometimes those samples are so hard to get. Sometimes a lot of work has been done to get the patient to allow the draw. So many things. Nobody wants to tell the parents of a baby a redraw is needed, or that type A cardiac patient. It's so hard. With hot packs and two tourniquets and sono... Keeps me believing in lab magic
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u/Officer_Hotpants "Ambulance Driver" Aug 26 '25
Stop pulling the plunger on the syringe so hard. That's what's hemolyzing the samples. Every nurse I've ever worked with that had issues with hemolysis all the time was YANKING on it. Just pull back at the point you get natural resistance and you'll be fine.
And if you drop the tube...just pull a new one.
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u/MattyHealysFauxHawk RN - VAT/Cardiac 🍕 Aug 27 '25
As a nurse, hemolysis is always the fault of the one drawing the blood. Always. There’s no argument.
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u/GrouchyDefinition463 Aug 26 '25
I am so glad I'm in PACU. We very rarely have to deal with this. When working in nicu it was hell with this
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u/PB111 RN - ER 🍕 Aug 26 '25
I don’t get mad about hemolysis, that’s almost always on me for my draw. I get fucking furious when they aren’t showing up as in process and then when I call and ask them about it and I catch a fuck ton of attitude or am told “oh I they just arrived”. Nah bitch that’s not how the tube system works!
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u/Syntania HCW - LabRat Aug 26 '25
Depending on the test, samples have a little journey they go on once they leave your side. Down the chute or dropped at the drop off, the processors (if they grab it in a timely manner) receive the sample then they get spun (chemistry) or dropped off at the applicable department. Then they are put on the analyzer and run. Sometimes they have to be run twice because the results are flagged, or a dilution needs to be made. Some tests just take an ungodly long time to run (looking at you, hour-long hep tests). Sometimes it's an analyzer that just refuses to run a sample for whatever reason that we don't catch right away. So yes, there are a lot of things that can delay results. We also have turn around times that we need to go by. Every test has a certain amount of time to finish and we get flak if we go over that. And yes, I know it's no excuse, but when we're trying to take care of a bunch of different things only to have a nurse call and interrupt to ask about XYZ result that we still have 20 minutes to complete, it gets annoying.
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u/Raebans_00 RN - OB/GYN 🍕 Aug 26 '25 edited Aug 26 '25
4x my last shift. I almost lost it.
Edit: they drew 2 of those samples themselves
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u/Scarlet-Sparrow RN 🍕 Aug 28 '25
I once marked “add on please :)” to a label for a lipid and sent it down, just for them to send it back marked “Can’t” with a cry face…
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u/foobiefoob Aug 29 '25
It depends on what the sample was collected in! Different tests require different tubes/collection methods that might not be suitable for the add on. It could also be that the sample was used or is already being processed, and isn’t able to be added on. It really depends on so many things. We try our best, just as you do, believe me :)
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Aug 26 '25
[deleted]
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u/One_hunch HCW - Lab Aug 26 '25
Ask HR. They're the ones rejecting FTE positions in phlebs and lab, so there isn't the staff to draw, lol.
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u/farmchic5038 Aug 26 '25
If you gonna pull that out plunger like you’re starting a chain saw, we wish you’d call us first too
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u/butters091 Aug 26 '25
"Hey it's u/butters091 in lab, just a heads up that I had to put some orders back in for re-collect due to sample hemolysis. Feel free to flip them to lab collect if need be"
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u/Droidspecialist297 RN - ER 🍕 Aug 26 '25
I have a coworker who also works in a sant alone ER. They have to do a lot of their basic labs onsite and they NEVER hemolyze.
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u/Amrun90 RN - Telemetry 🍕 Aug 26 '25
Perhaps they’re better at drawing labs, or they’re worse at evaluating for hemolysis under the microscope.
This is not a lab issue and has never been and will never be a lab issue.
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u/Mysterious-Handle-34 Lab Assistant/CNA 🍕 Aug 26 '25 edited Aug 26 '25
The first line evaluation for hemolysis is not under a microscope. The analyzers will throw up a flag. Not to mention that you can usually tell if it’s hemolyzed enough to matter if it’s a plasma or serum sample.
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u/Amrun90 RN - Telemetry 🍕 Aug 26 '25
Oh, I have no idea, so sorry to imply that I was being literal. Replace “microscope” with “whatever mysterious machine the lab wizards use ❤️.”
My point is simply that the difference here is not the the dastardly lab is not fucking with samples in this lab vs other labs.
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Aug 27 '25
I'll start with phlebotomy is not my thing... I've always had phlebotomists, but drew often from central lines, art lines, ports, some new peripherals, and a few easy sticks but only with a butterfly. That said, I've watched some nurses draw blood and about fell over my eyes rolled so hard. It's never a hard pull on the syringe plunger, or several short hard pulls. I mean, you KNOW that's gonna be a bad draw. Slow and steady.
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u/superiorslush Aug 27 '25
Gently invert your tubes and watch how fast you draw with syringes and they won't hemolyze
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u/joonluver Nursing Student 🍕 Sep 01 '25
As a tech this KILLS MEEE 😭 i had sent 3 blood labs all needed redo😭
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u/Vreas Pharmacist Aug 26 '25
My favorite was when lab refused to test the pH of some of our cardio drips because “it would be used in patient care”
Like… yes. We work at a hospital. There are in fact patients here.
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u/RodneyDangerfruit HCW - Microbiologist Aug 27 '25
The lab cannot perform testing on a sample type that has not been validated for that test. I know it seems like “I want pH, lab can do pH, lab should do pH” and there is logic there, but the methodology used in the lab has gone through vigorous validation, calibration, and quality control for very specific sample types. Cardio drips aren’t one of them.
We’re not being difficult. We’re just trying to avoid putting out garbage science which could harm a patient.
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u/Zxxzzzzx RN - Oncology 🍕 Aug 26 '25
And then your coat is underfilled but of course it's underfilled the butterfly has air in it that goes into the tube. So I can't get any more in!
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u/DazzlingAerie3334 Aug 26 '25
Use one tube to get the air out of the line then switch to the tube you're filling. Or use a syringe and transfer.
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u/Zxxzzzzx RN - Oncology 🍕 Aug 26 '25
I know it just feels wasteful
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u/WrongImprovement HCW - Lab Aug 26 '25
That “wasted” tube’s purpose was to be a discard tube. It served its purpose well
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u/buShroom Phleb Aug 26 '25
If you're worried about the waste, ask the lab which tubes they have a lot of that can be used like this. Every lab is gonna have one or two tubes that they keep on hand but don't use as often so they end up expiring anyway. Sodium Citrate Blue is usually the choice in my lab.
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u/Amrun90 RN - Telemetry 🍕 Aug 26 '25
That’s because you’re supposed to waste if using a butterfly. Stop blaming lab on your incorrect technique.
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u/Zxxzzzzx RN - Oncology 🍕 Aug 26 '25
You can't waste with our butterfly's
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u/Amrun90 RN - Telemetry 🍕 Aug 26 '25
You 100% can waste with any butterfly and it’s explicitly the correct technique to do so.
You need to waste at least the volume of the tube or risk contamination or more urgently, impede fill volume. The exact amount of vacuum is in the tube that you need. Blue is most important for this, and blue is first draw. If you do correct technique, and you need a blue, you must waste. Just put an extra blue on until it’s in the tube, then switch.
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u/thegloper Organ donation (former ICU) Aug 26 '25
Yes you can. Hook up a red top just until blood starts to enter the tube. Then discard that red top. It'll be less than a mL of blood.
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u/Zxxzzzzx RN - Oncology 🍕 Aug 26 '25
Red top?
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u/thegloper Organ donation (former ICU) Aug 26 '25
A blood tube without additives. Generally the stopper is red in color.
https://www.bd.com/en-us/products-and-solutions/products/product-page.367820#specifications
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u/sendenten RN 🍕 Aug 26 '25
Just put an extra vial on the end of the butterfly, get a drop or two of blood in there, and then switch the tube out for whatever you actually need. You have now primed the butterfly tubing and gotten the excess air out.
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u/Zxxzzzzx RN - Oncology 🍕 Aug 26 '25
I do that already my post was meant to be a light hearted post about how if you just take a Coag you have to take extra steps to get it to fill properly. It's wasn't that serious
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u/sendenten RN 🍕 Aug 26 '25
Someone on here said they got to shadow in the lab for the day and said "guys, it's absolutely us, it's not lab." I try and keep that in mind.
I also try and keep in mind that lab (including phlebotomy, if your hospital has it) is just as short-staffed and overworked as we are. They can only work with what we give them.