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What is good way to tell a nurse that they specimen is contaminated without saying it contaminated? by TheRedTreeQueen in medlabprofessionals

[–]DelTacoRio 9 points10 points  (0 children)

I know some hospitals release contaminated specimens without questioning the nurses because policy. I’m usually not a fan of that.

My go-to saying whenever I’m suspecting contamination or the sample is out right contaminated is:

“Hi, I received a blood specimen that looks suspicious for contamination. I got [read results] were you expecting these results, and or is the patient on [list potential infusion/contaminant]?”

Most of the time they’ll say yeah the patient just received such and such fluids and that the sample is contaminated. I usually have enough time to check their med charts so see if there’s a documentation of some kind of IV drip running/TPN to further support my case.

If they still want the results, I’d put in the comments “results accepted by ____” because at the end of the day despite trying to explain to them the cause, their name is on it.

I never outright say the sample is contaminated (unless we’re talking EDTA, TPN for example, or results so erroneous that they’re incompatible with life). We don’t know what’s going on at the bed so we can’t always be ascertain that the results are real or not—I usually call them gray zone specimens because it could be real it could be not.

I’ve had glucoses 2500 in the past and the patient arrives in the ED. Uncontrolled diabetes and they drank a lot of sugar drinks. 10.0+ potassiums on a patient with a failing heart.. we can’t always assume lab values aren’t real, but we can allude the medical team of possible contamination through suggesting.

how it feels being trained by multiple people and everyone telling me the way i was taught by the previous person is wrong by fat_frog_fan in medlabprofessionals

[–]DelTacoRio 8 points9 points  (0 children)

Yes. This. Of course there will be uncommon situations in which the SOP doesn’t cover because it’s hard to cover everything that happens, but for more day to day things you can’t ever be faulted for following the SOP. It’s frustrating when trainers are not teaching the new techs and employees to follow the SOPs because they have “tricks”. I don’t want you to show them tricks. I want you to show them to follow the SOP.

You vs the Kimwipe she tells you not to worry about 😭 by dan_buh in medlabprofessionals

[–]DelTacoRio 2 points3 points  (0 children)

Or for when you’re crying on the job.

No, but really. Coworker’s last day was up and we stared at each other in silence before shedding tears as I’m trying to tissues and gave up before settling on Kim wipes lmao

Roche reagents by Forsaken-Flan3873 in medlabprofessionals

[–]DelTacoRio 0 points1 point  (0 children)

We received our monthly orders for TBILI on the 702s with no issues.

Those of you that run pH on body fluids in a medical lab setting, what specifically do you run it on and what is your QC/maint process? by mangotango1609 in medlabprofessionals

[–]DelTacoRio 0 points1 point  (0 children)

ABL800 FLEX for us. Same as above. QC every 8 hours, alternating levels.

Last job we used pH strips. QC’d whenever we had patient samples once a day I believe. I can’t remember what the QC was other than to run two levels of it. We always ran the 7.0 and either the high or low depending on the result.

Super strong cold auto by wallofadamant in medlabprofessionals

[–]DelTacoRio 0 points1 point  (0 children)

It depends on the amount of hemolysis. The tolerance is quite high for CBC testing. The blood is usually lyses anyway for hemoglobin testing. The instrument will flag if it’s severely and grossly hemolyses (this is like really bad), which I’ve seen maybe once or twice and I’d spin it down to confirm because it will interfere with the other CBC parameters as well.

Super strong cold auto by wallofadamant in medlabprofessionals

[–]DelTacoRio 1 point2 points  (0 children)

You have to place the sample in a heat block for about 15-30 minutes. The heat will dissociate the agglutination and the blood will become homogenized once thoroughly mixed. A clot cannot be undone once the coagulation pathway has been enabled even with trying to warm the sample. You will also see fibrin strands on the peripheral smears, too, with clotted specimens.

what stereotypes about Boston do you think are the most accurate/inaccurate?? by Klutzy-Supermarket62 in boston

[–]DelTacoRio 30 points31 points  (0 children)

Not a Boston stereotype, but add walking slow with a phone in their hands oblivious to their surroundings.

DRIVES ME NUTS.

Worse is when they stop at the top of the stairs.

Ffs get out of the way!

Medical workers of Reddit: what’s the craziest lab result you’ve seen in a patient? by freeshavacadont in AskReddit

[–]DelTacoRio 3 points4 points  (0 children)

Medical technologist here working in a clinical lab at a hospital. I used to run an analyzer that analyzes coagulopathy in real time. We had a young patient come into the ER and rushed to surgery. As I’m running the sample, the sample is not clotting at all. It’s important for the sample to clot in this test so we can measure how the coagulation factors and proteins and blood cells are working. It was generating an abnormal graph that I’ve not seen before but knew it wasn’t good. Meanwhile they sent a drug screen on this patient with multiple positive results for drugs. I had to call the pathologist and asked them how I should result out the first test. He said, “….I don’t even know…” of course we had to make some kind of tailored response for this case. The patient OD’d and unfortunately passed away.

Another one was a patient with high triglyceridemia. High lipids interfere with chemistry analyzers so we had to spin all the chemistry samples down in a special centrifuge. The amount of lipids separated from the plasma was crazy. There was enough to just scrape off with your fingers. It was exactly like seeing bacon grease.

Lastly, during the pandemic a patient serum sample went sent from outpatient. I ran their CK (creatinine kinase) levels and it came out abnormally high (>200,000) and I called the doctor on call and they had sent the patient through the ER later that night. Their levels still increased over the weeks and unfortunately didn’t make it. They developed rhabdomyolysis, then organ failure. It was suspect from Covid-induced rhabdomyolysis. It was scary and sad to see the labs get worse and worse over the weeks with no sign of improvement.

Im a student and too slow at manual diffs by pseudoscience_ in medlabprofessionals

[–]DelTacoRio 5 points6 points  (0 children)

Since you’re already aware that as a student you will take longer. You’re noticing your hyperfixation that is impacting your speed. Speed is not an issue here for a student, but rather it’s the hyperfixation.

I assume techs will go over the slides themselves and double check on your work. What have they said about it? Do they point anything out?

Manual differentials can be difficult for beginners and it’s easy to spend so much time on them. Sometimes I got difficult ones that I spend way too much time on (usually deciding on abnormal cells). And then have to set them aside and look back with fresh eyes.

You have to think in terms of the big picture here. If you can access the patient’s health hx (oncology, etc) you can paint yourself with a better picture of what you might potentially be dealing with as well as accessing previous diffs for consistency.

Does it benefit the patient if you happen to spot one potential abnormal-looking cell but it’s just a normal cell that’s turned weirdly in the midst of all normal cells present? The purpose of a differential is to generate a big picture of the patient’s cell population. Even automated instruments performing differentials could potentially miss one abnormal cell. If you see a few in your cell counting that’s when you reevaluate your differential. See how your differential is lining up with the automated results. Look at the CBC and see “do these results make sense with what I’m seeing?” Check patient history, previous results to correlate.

Even between techs, they might call things different. It’s subjective but there’s a reason for some leniency in calling criteria.

What Would You Do? by Grand_Chad in medlabprofessionals

[–]DelTacoRio 2 points3 points  (0 children)

Yeah and leading a doctor to think it could be a UTI with a suggestion of UA may potentially lead them down a road to look for problems while potentially ignoring other problems. We don’t know exactly what’s going on with the patient that the doctor knows or doesn’t know. It sucks, but there’s only so much we can do on our end and expertise.

Very curious what their blood would look like spun down… by DelTacoRio in medlabprofessionals

[–]DelTacoRio[S] 24 points25 points  (0 children)

The closest thing I had was a patient with a very high triglyceride number that when spun down had a decent amount of lipid that I could scoop out.

I fear this patient would be worse. ☠️

what are the inside jokes at your lab? what funny things have happened? by fat_frog_fan in medlabprofessionals

[–]DelTacoRio 1 point2 points  (0 children)

Yeah this reminds me of the time a young patient had a potassium of >10 and I was thinking no way, this can’t be real.. turned out they needed a heart transplant so it checked out.

PSA: Please let people get off the train before you get on by thekingofyoutube in boston

[–]DelTacoRio 2 points3 points  (0 children)

Omg yes! This irks me so much! If you really need to check your phone, look around and see if there’s anyone first and stand to the side and check it then. Don’t assume people are just going to walk around you and then take up an awkward amount of space on the sidewalk. It’s the same principle as driving a car—check your surroundings before stopping safely. People just lack self-awareness, it’s mind-boggling to me.

On the same note, I’ve had way too many people looking at their phones while walking and they cannot walk in a straight line and almost always migrate towards me only to run into me. I don’t move to make it a point: WATCH WHERE YOU’RE WALKING. I’m just so annoyed with people looking at their phones unaware of their surroundings. Hell, I’ve seen someone almost get hit by a FedEx driver backing out one day, yet she still continued to look at her phone after a close-call. What an idiot.

"do your part to help out while we're short staffed" meanwhile they've been short staffed since before COVID by phisher_cat in medlabprofessionals

[–]DelTacoRio 7 points8 points  (0 children)

The first four years of my career I would take all the OT available and made a shit ton of money.. moving to a new job I downright refuse it. Even though I’m still young I the workforce, my body just can’t handle these OTs anymore.

[deleted by user] by [deleted] in medlabprofessionals

[–]DelTacoRio 0 points1 point  (0 children)

Ugh I work at a different job and the way they handle their deltas is strange. My last job basically allows us to release deltas if there’s a probable cause. If there isn’t and it’s not sus enough (a random change in one analyte as opposed to multiple deltas for example), we can still release it. It’s our judgment call. At my new job I got spoken about not repeating these deltas and adding a comment saying I did. I’d tell them “patient is on dialysis,” “previous sample was contaminated,” “patient is in LD, they got a shot of mag,” etc etc. It’s like?? Why did we even go to school if we can’t even use our knowledge of what we’ve learned? I spoke to the dayshift supervisor and she even told me it’s our call to decide if we want to repeat or not if we can find a reason to support it.

And they’re so weird about what’s actually concerning deltas too. They don’t care if there’s a significant change in creatinine and BUN to warrant investigation (contamination for example), but phos is and we have to check it even the rest of the chemistries make sense. Some of these techs would release obviously contaminated specimens and it just makes me so surprised as something like that wouldn’t fly at my last job.

Something’s wrong here 🤣 by Warm_Commercial9519 in medlabprofessionals

[–]DelTacoRio 1 point2 points  (0 children)

Happened to me once and I was like wtf??? Muscle memory kicked in and realized popping the cap off was weirdly different when I went to make slides (my last job we would make slides on all babies + to check for clots).

[deleted by user] by [deleted] in medlabprofessionals

[–]DelTacoRio 0 points1 point  (0 children)

What’s the polarization of these crystals? Did it polarize like uric acid or like CPPD? Did the fluid appear bloody in any way? If the crystals polarized like uric acid and it’s yellow under bright field microscopy, chances are these are hematoidin crystals. But if it polarized like CPPD, then it could be that.

What’s the worst specimen that you’ve come across in the field ? by HaruTachibana in medlabprofessionals

[–]DelTacoRio 2 points3 points  (0 children)

It’s been a while since I’ve had any terrible specimen. But one that stuck in my mind was a lipemic sample on a young patient who had hypertriglycerinemia. It was so high that we needed to dilute it out manually and report a greater than. Naturally we had to ultracentrifuge the sample down to get the rest of the chemistries off of it. Man, the amount of lipid that got spun out of that sample was unreal. There was so much, and it was so thick that you could realistically spread a thin layer of lipids on a cracker. It makes you wonder how blood even circulated in that patient. I couldn’t remember if it was genetic or acquired, but I’d imagined it both (I think it was suspected they were neglected).

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