I recently received a message from a local colleague who has received complaints from the nursing department when rejecting clotted coagulation specimens. The problem occurs with both citrated blue-closure and EDTA lavender-closure tubes. A few of the nurses are convinced the laboratory is storing the specimens too long before testing them, thus allowing them to become clotted. My colleague has provided in-services explaining the need for gentle specimen mixing immediately after collection, but has been only partially successful in convincing them that they control specimen integrity at the time of collection. I’d like to get responses from participants who face inter-departmental communication issues like this. How do you convince nurses and phlebotomists of the need to prevent hemolysis, short draws, and clotted specimens? Further, do you have any additional advice about managing pediatric specimens?
Nov 21 2014
Comments (2)Specimen Management
From Ben Troyer: In our facility’s 3 ICUs,
From Ben Troyer: In our facility’s 3 ICUs, nurses draw the blood for their patients’ lab work. When we switched from phlebotomist draws to RN draws, there was a mixed response from the nursing staff, to be sure. One thing that made a world of difference was to have our phlebotomy supervisor give hands on training to each nurse who would be drawing blood. It was a good refresher for many seasoned nurses who hadn’t performed venipunctures for lab work since nursing school. Additionally, we had strong support from nursing administration and management. They were able to be a go-between and reassure nurses that rejections of specimens were for valid reasons.
From Vadim Kostousov, PhD. A recent report
From Vadim Kostousov, PhD. A recent report from France warns do not use partial draw (pediatric) citrate tubes for monitoring unfractionated heparin therapy by APTT or anti-Xa:
“Underestimation of unfractionated heparin therapy assessment due to platelet activation when using partial-draw (pediatric) citrate collection tubes” http://www.ncbi.nlm.nih.gov/pubmed/25248688
confirming their previous findings; monitoring treatments with unfractionated heparin: CTAD must be used instead of citrate as the anticoagulant solution when using partial-draw collection tubes. http://www.ncbi.nlm.nih.gov/pubmed/20950840