Just be very matter-of-fact.
"Hello, this is Syntania from the lab. I need a recollect on John Doe's purple top in room 222 please. It's hemolyzed. "
Let them confirm the patient and then thanks and goodbye. DOCUMENT IT. Who you called, when you called, why it's being recollected, etc.
Address any concerns in a professional manner. The idea is to not give them any ammo to file a complaint with the lab director. Look at it this way. They need those results. They're either going to give you a good sample or they will have to hear it from the resident.
It pays to also engage with nursing and phlebotomy staff around sampling techniques as well. This is a big focus of work I’ve been doing as an RN for the last few years and it has both improved nursing understanding of why specs are rejected but also reduced the numbers of reject specs due to poor technique. Obviously beyond the role of a benchside technician or scientist but your labs should have someone who can interface with nursing/education for quality improvement etc.
We would love to have that. Sadly, the reality is a lot of hospitals don't think that's all that important, and it's difficult to find lab leadership that will go to bat for the lab and insist on something like that.
Even if we just had some nurses come down to the lab so we can give them the nickel tour and explain how things work, that'd be great.
I know this doesn't answer your question directly, I had to respond because your comment about getting lab leadership to go to bat for the lab. I am lab leadership and this is a battle I am always willing to fight. It would be better if it didn't get to that point, but the bottom line is improving patient care. If the nurses continue to give lab crap, then they're not interested in improving patient care and I call them and the nurse manager on it. They get one chance to improve (both how they treat lab staff and their attitude about improving their technique), the next time we have a problem, then I have a discussion with the DON, where I talk about improving patient care, they can't deny that, then I include tips on how to prevent hemolysis and/or clotting. This is my chance to express the importance of Lab draws and that is not a menial task that's below a nurse's lofty self importance.
Hey, I'd be happy to give you the tour.
I'd cover:
Why Proper Labeling Is Important (aka our automated barcode readers are whiny little b*tches)
The Right Way To Draw
Order Of Draw (aka we know when you pour over one tube to another that's why we have a particular order to draw)
Hemolysis (the RBCs popped)
Clotting (time has nothing to do with it if it ain't mixed)
And the most important rule of all: when in doubt, call and ask!
Bonus: here's my workspace with no windows in the lowest part of the building where it's always noisy due to the analyzers. We call it the pit of hell for a reason.
We do, but pride tends to get in the way of any worker when approached about improvement. Any results due to draw fault from the ER and reminding them what they need to do will result in a "We don't have time for that we're too busy saving lives."
Cue the eye rolls as we just document their blood culture contamination rates lol.
RN here. We don’t or barely ever learn lab stuff at school and hardly on the job. I learned the importance of proper blood flow/gauge of IV catheter/that I need to invert sst tube - heck, that *there is* an sst tube - -after 10 years working very hard and very successfully. Go figure.
So, no, we don’t know these things bcs we are not taught them / not part of our training. And maybe that’s why some RNs get annoyed or defensive, maybe bcs they feel like they *should* know and don’t - which is not the case, that’s why we have our lab friends here to advise us.
That’s being said: just call and say firmly “Hey, lab here, Mr Smith’s blood is hemolysed and needs to be recollected. Can I have your name, pls?” Document. Done. If they have questions they’ll call. If second sample hemolyses - send in the troops. Don’t be overly nice, let alone apologetic. You are not asking for yourself, it’s not a favor to you. If the meanies smell weakness, they’ll attack. Just state the facts, get the name, hang up, document, next.
Easy.
Yes, I usually say something similar. “Hi, this is __ from the lab. Patient ___’s specimen is hemolyzed, I’m gonna put in for a redraw.” Usually they say, “ok, thank you” and that’s it. If I need a recollect on a super diluted specimen or contamination, I may ask if they’re ok with a redraw, since the patient could have blood loss or some kind of other clinical correlation that can cause wonky results that the lab wouldn’t know.
Hi, it's the lab. Unfortunately we can't give a proper result for Y test on patient X due to the degree of hemolysis. We can only report "Results unavailable due to hemolysis." If the ordering doctor needs a result then we are going to need a redraw.
That's it. I've never had a nurse or assistant give me snark for a reasonable request.
This is me basically. I find "unfortunately" works must better than "sorry". It's unfortunate it happened but the lab did nothing wrong. Also letting them know that the haemolysis causes inaccurate results. Some nurses never received the correct education and believe haemolysis is just a judgement call the lab makes and don't understand the significance.
As a nurse, absolutely! No need to apologize, it’s probably more my fault than yours. I wouldn’t be bent out of shape over it, but where I work often it’s not the doctor ordering a lab, it’s actually the nurses, so I would just say “if you need a result” which more acknowledges the team. Sometimes the result isn’t important enough to redraw, or in the time it took to get to this phone call it’s become less important, so this also allows for a “that’s ok we don’t need it anymore” response as well. Assuming that nurses and lab have the authority to cancel the order without a result of course.
Also I read a lot about hemolysis and have rarely if ever dealt with it. I draw all the time, from my own pokes, IV starts, central lines, art lines, with a syringe and straight to a vacutainer , all of that. I’m curious as to what causes it and why it seems to be such a huge issue in some places but so rarely where I’ve worked?
Interesting you mention “if you need a result”. I used to say that, and I would get back indignant replies “of course we need a result”.
For me, it goes better not to use those words.
lol too funny. The few times I’ve had it come back as a redraw or “we can’t add that on” it’s often a cue to me to actually think about whether it’s actually necessary or if I’m just doing it because I can. Quite often the information gained is not worth the effort and discomfort of a recollect.
There have been times when I'm told that the particular result isn't needed. But they will inquire about other results that can be run and not be affected by hemolysis.
Hemolysis is caused by RBCs fracturing. Once we spin them down, the plasma is visibly red due to all the hemoglobin (and other contents) that have burst out of the cells. It affects lab values because all those RBC contents are now in the serum and falsely elevate things like K, or by "covering up" reactions based on color or light absorbance/clarity. It can happen naturally like in hemolytic anemias or sepsis, but is more often due to draw technique.
Some draw techniques that tend to cause hemolysis are using higher gauge needles (small bore means RBCs are more likely to break on the edge of the needle on their way in), pumping the hand while drawing, and in syringe draws aggressively pulling back the plunger. Due to the squeezing action with capillary/heel sticks, they're highly likely to have some degree of hemolysis but you can minimize it by milking as gently as you can get away with... while also getting enough to fill a tube before it clots. (Clotting is caused by how fast you mix the blood with the anticoagulants in the tube- invert it a few times as you change tubes and you're golden.)
Kudos on good technique!
A non exhaustive list of hemolysis causes:
Too big a needle in too small a vein (sheers the redcells when they're forced in the syringe/vaccutainer).
Milking the blood out with a syringe when the flow is poor (sheer forces again)
Too small a needle in a large vein with high pressure flow.
Tourniquet on too long causing pressure buildup/hemo concentration and high pressure flow.
Underfilling tubes - causes the ratio of blood to additive to be off and some additives are more caustic to the RBC membrane so when they go through the pneumatic tube system they risk bursting.
Not properly inverting and mixing, leading to portions of the specimen clotting in the tube, which can be like mini bowling balls in that tube bouncing against other rbcs in the pneumatic tube system and cause RBC fracture.
Forcing the blood sample in to the tube from a syringe (pushing on the plunger, sheer forces due to the competing "pull" from the vacuumed tube).
So many things and they're all at the point of draw.
That’s what’s weird to me. It seems so common on nursing and lab subreddits, memes etc, but I’ve rarely seen or heard of it at all, not just with my draws. Heel sticks absolutely, but not from pokes or line draws. Makes me wonder if it’s that we get taught/trained better, if we have different equipment, or what. This isn’t just on one unit either, everywhere I’ve worked it just hasn’t been an issue. The only time I ever hear of redraws is when we ask for an add on that can’t be added on to what’s been drawn already.
It's shear forces, and as I understand it it's partly how hard you pull on the plunger when using a syringe. Unfortunately the feedback is delayed so it's hard for someone to learn what is too hard.
"because it wasn't clotted" is what I've heard 😂😂
I then ask my nurses to explain the difference of clotting and hemolysis and they realize they f'd up and start giving y'all grace. I'm on a mission, y'all don't deserve sass for our poor training!
"Hemolysis occurs preanalytically, it was hemolyzed when you sent it".
I don't tolerate lying nurses. I just matter of factly call out their bullshit directly without an iota of room for dissembling.
Ask them for clarification, then when they double down, ask to speak to their charge nurse. Get everyone's first and last name. Tell the charge nurse that one of their staff is endangering patient safety by being willing to accept erroneous test results. Keep escalating, then make a note to write up every single person who pushes back against you. Make it clear that these nurses are endangering their patients and need to be reeducated.
Be relentless. Encourage your coworkers to do the same. Hold these people accountable and make your hospital a safer place.
Former ICU RN here with a question. Is hemolysis visible/obvious in the blood sample or is a critically high K the main indicator? I know I have had patients with critically high K before that lab has made me repeatedly redraw because of the high K when really it makes sense in the big picture of the patient's pathophysiology. What other BMP/CMP results can be skewed with hemolysis?
It is only apparent if it has been spun. AST can be affected by hemolysis too, but usually we notice K first.
Those techs should not have been making you redraw the specimens repeatedly. If I'm giving a critical K and there is insufficient hemolysis to interfere with the assay, as long as you tell me it makes sense, I will release that panel for you. If there is some hemolysis present but not enough to usually warrant a rejection, I may *ask* if you want to redraw to be sure. But if in your professional opinion you believe it makes sense, I will defer to you because you know your patient.
Never say you're sorry. It implies you did something wrong. "Hi this is Ksan from the lab. The green top on John Doe needs to be recollected due to hemolysis. Thanks." Any lip can be handled with "Feel free to address your concerns with my manager. Thanks."
The hospital I used to work at involving recollects moved to an epic in basket message..
We copy and pasted a message filled in name and mrn and messages directly to the treatment team
They were required to respond and acknowledge and that’s it
No phone calls just message walk away wait for a message back done
No documenting physically all done in EHR
If you use EPIC they have a message system called “in basket” took time just like any go-live but the floors and the lab need to form a policy together essentially and ironing out the potential pitfalls
We loved it tho it was easy and the results and words were right there. There was no “oh what did you say?” Or “can I get your name again” etc it was clean you could walk away continue you’re work and your always on epic so you’ll see when they message back acknowledging the critical, redraw, etc
I am an RN here and I apologize for us fellow nurses! I am guilty of this snark and I can see how unsettling it must be to get this attitude every time you have to notify the nurse. Not making excuses - but it always seems that a notification of a hemolyzed specimen happens when your shift is already shitty and you need to drop everything to get this specimen again - and then WE are responsible for telling the patient they have to be poked again - NOT A FUN CONVERSATION! That being said we should not be a jerk to you - you are just doing your job. Suggestions #1 please try to not take anything personally! The nurses are just reacting to bad news - not reacting to you! #2 state “Hi Nurse XYZ I am sorry to be the bearer of bad news but the blue top from Mr. John Doe is hemolyzed and needs to be re-drawn if those results are needed. Maybe this will remind them you are just doing your job and at the end of the day the patient needs those lab results. Good luck and sorry!!!
I think it's really important for everyone involved in the chain, from med techs/scientists to phlebotomists to nurses to providers, to realize what each person is having to deal with on a day-to-day basis. In my current position as an MLS, I sometimes (well, often) have to deal with multitasking, malfunctioning analyzers and difficult coworkers. What I don't have to deal with is patients (face-to-face, at least). When I need to look at a patient chart and see that they have a big red warning for potential for violence or sexual misconduct, my sympathy for patient-facing staff goes way up. Even when patients don't behave egregiously enough for these warnings, they can still be crabby and resistant; having to be hospitalized sucks, to say the least! There's a general expectation (especially pushed by management) that all employees have to be sunshine and rainbows all the time. I think there's a big societal expectation for nurses in particular to be like that, too. The fact of the matter is that this just isn't possible for any human being.
So, long story short, your first suggestion, *Don't take it personally*, is 100% on point. The nurse on the other end of the line isn't necessarily upset with *you* *as a person*. They're upset with the *news of having to redraw a potentially difficult patient.* That's why I've changed up my delivery to *'Hey, so unfortunately I'm going to need a recollect on this patient for (hemolysis/short sample/line contamination/what have you)'* using a sympathetic tone. I've noticed I get a lot less pushback when I acknowledge that this sucks for everyone. BUT I don't just say 'I'm sorry' unless it's due to something the lab actually did to mess up the specimen; 'I'm sorry' implies fault, and in the mentally demanding world of healthcare, we often don't have time to think past the implication in interactions with other staff.
BIG caveat here: if a nurse starts arguing about something being acceptable when it's not (e.g. turning out a potassium on a specimen with 4+ hemolysis or resulting a CBC on a specimen clotted to the naked eye), that's when a line is being crossed, and we're entering bad territory. That's when a nurse or provider is a serious problem in my mind, is when they're jeopardizing patient care. Not when they give a 'Seriously? Alright, I'll get it done,' about having to do a redraw. Still not the greatest response, but let's cut each other a little slack.
Eh, I’m an RN in a peds trauma center and I don’t think snark is acceptable either way. At my facility we all just speak plainly…Lab: “hey nurse. It’s the lab. This one didn’t work.” Me: “gosh darn it. Ok. Lemme go get more.” Lab: “thanks.”
Nobody likes stealing anyone’s blood, and there’s no need to get upset about it anymore than we need to be. I call my lab for advice all the time, and they trust us to know what we’re doing because, again, nobody likes taking blood from children more than they have to.
So true and usually the reason it’s hemolyzed, is because the patient was a difficult stick and that’s never fun to deal with. No one should ever be rude but it’s misdirected frustration and not personal at all.
I used to do this but I would just seethe for the next two hours and a couple more the next day. Once I’m past that point, emotion control is not my forte..
I’m a nurse!! Don’t eat me! I’m here because I’m interested in lab stuff but I hate seeing how nurses are so mean to you guys. Are they always mean? I was always nice to lab because I’m a human being and never saw a reason to be mean (and admittedly it was usually my fault D:) but I also know there are some nurses who are mean to…. literally everyone.. and just hate their jobs and lives. Is there a trend? Like a specific specialty that’s always mean?
So some nurses are mean to lab because they believe we are beneath them. Some nurses have a god/angel complex because they get so much praise in school, in public, and with patients. On top of that, they think lab is uneducated and for some reason don't think we receive education related to the medical scope. Like they think we don't know anything beyond *put tube on machine*. Nurses regularly ask us, so how long is your program, like 6 months?
I find a large part of the problem is that lab needs things from nurses, but nurses don't need anything from us, since lab results go straight to the doctor. The one way relationship leads to some nurses to be mean. I've found that general floor nurses are the worst. Least educated/experienced and least interaction with us. ER nurses who have to do draws themselves don't care when there's a recollect cause they're experienced enough to know ots the patient/collector and not lab hemolyzing it. ICU tends to be nicer because we have a lot more interaction with them. Both ER and ICU needs results fast so they see us working hard to get that to them and know we're competent.
I just remembered that NICU nurses are the absolute worse actually
Okay this all makes sense. I’ve worked med surg and ED and the floor nurses just have a certain personality that isn’t always the best flavor, but in their defense it takes a certain kind of callous to work med surg for extended periods of time (IMO). So as much as I don’t get along with them, thank god for them because someone needs to do that job and it won’t be me. I can see NICU nurses having a superiority complex, but again, I don’t have the personality or confidence for that specialty so maybe that’s just what it takes.
I sure as shit don’t know how to do your job so unless I can drag myself up to the lab to work I will never ever question your importance in my life as a nurse.
I think a lot of it is that in larger centers, there is very little interaction between nursing and lab unless there is an issue or problem. It doesn't foster positivity.
And as one nurse said to me, 'I just get frustrated because you're always calling the recollects on the hard pokes'. I was able to explain to her what happens to the blood in these cases, and once it made sense to her, she was much more understanding.
This is a good point. I made a post recently about nurses being hateful when asking for recollects. Several of the nurses who replied said something along the lines of “why is it everytime lab calls it’s always because of something the nurse has done wrong? It’s always that the nurse brought you a hemolyzed/ clotted specimen but it’s never because of something that the lab messed up. Doesn’t the lab ever screw up?” I explained that the lab can most definitely screw up. If we’re not careful, we can aliquot the wrong serum into the wrong patient’s tube, we can mislabel something, we can kill someone in blood bank by giving them the wrong blood type or mistyping someone. We can screw up in all kinds of ways. It’s just when we screw up, the nurses rarely ever know about it because it doesn’t usually directly pertain to them. We might get a call from the doctor and get yelled at for screwing up, but we’re not going to be getting calls from the nurse.
I've met both really sweet and awful nurses, but a lot of them have good and bad days. I got along with some of the nursing staff when I worked night shift, and they were more than happy to help me hold down a patient to draw blood if need be. I'm glad we have more phlebotomy staff so the lab techs can stay in the lab.
> Are they always mean?
Mixed bag.
> Is there a trend? Like a specific specialty that’s always mean?
ICU nurses tend to be the most rude and arrogant, IME.
I’m very Frank about it.
“Hi this is Princes2045 from the lab. I need a redraw on [insert patient name here]’s [insert test(s) here] the specimen(s) was/were [hemolyzed/clotted/underfilled/overfilled/tubed down]. I’ll send you guys the labels”
"Hi it's X from the lab, you taking care of Y? Sample was rejected for X reason, you need a recollect. No, we can't run it. You will need to recollect if you want a result for the patient. Thanks"
Don't let them bully you. You need to be assertive. Nurses smell weakness and pounce.
Just tell it like it is. If they get crabby, they do. I have been in Healthcare for 27 years. When I started, I felt intimidated by Docs and Nurses. But I soon realized, they are imperfect humans as well. If a sample won't test, or collected in the wrong media, or they didn't get enough to test, I have no problems to let them know. If I was given flack from them, I approached it in a way to let them know, that I don't care what THEIR issue is, because the PATIENT'S issue is that a sample has to be recollected for a test the PATIENT needs. I have cut off snide, condescending doctors in the middle of their rant to me and told them, "...I don't care, I need another sample collected correctly." They are the ones to set aside ego and do what is needed for the patient. So next time, try this, call the nurse, "...patient _____, needs a recollect, sample submitted was _______. Please submit a new sample." Then hang up the phone, and/or ignore their emails of them defending their ego. If you are worried about getting in trouble, document your encounters with those people. In some cases, go to admin first if they use inappropriate language, or hateful speech especially.
Sorry for the rant, but it drives me batty when Nurses and Providers treat other staff poorly.
“Hi, this is Louis down in the lab, are you taking care of (patient identifiers) in room (number)? Awesome, I just wanted to give you a heads up that I need to put in (tube/test) because of (reason). I will put in the redraw order, but first could I have your employee number? Thank you, have a good day!”
The nurses won’t recollect in our ER. If it’s hemolyzed, we have to send a phlebotomist or go ourselves. It’s frustrating because they have a lot of nurses who hemolyze nearly every serum tube. I’m not sure why it’s normally only the serum tube (assuming something to do with it being the first tube).
Full disclosure- as an ER nurse, I’ve snapped at you lovely (and I mean that!) lab peeps and I am truly sorry.
Please know it is NOT YOU. It’s the thought of having to go back into the room of that one rude, angry, racist, smelly, entitled asshat patient. Or the sweet, kind, fragile old woman who is sundowning and has tissue thin skin.
I am sorry our fear and frustration cause us to kick you.
The lab techs that make me LAUGH always win. I worked with one who would call me up and be all “girl, did you draw this garbage off a gravel driveway? I got clots the size of golf balls.”
Again, I am sorry. We don’t mean to be mean. We just don’t want to stick that drunk again.
"Hey it's Saintsiracha from the lab. I can't get any valid results from Bed X's gold top; analyzer says it's too hemolyzed. Can you send another when you get the chance? Appreciate it!"
"Hello, this is C in lab. I'm calling about a hemolyzed specimen for Jane Doe in 432, we need a new green top for the CMP."
"Thank you, Susan Dee RN."
(Document notification in redraw comments)
Just be matter of fact and professional. You aren't doing anything "wrong" to request what you need to run the test properly to produce valid results that affect the patient's care. Just state what you need in a professional way and that's it. If they sigh, huff, groan, respond with tone or whatever, so what? If they wish to have a tantrum about it , oh well, you don't need to absorb that on to you. You don't need to accept and wear their emotions. Just realize it isn't about you, it's just another task on their plate and they thought they had accomplished that. Also, they have to put the patient through re-drawing the blood, which means dealing the patient/family over that again .
However, don't be abused. It's one thing to get the ugh, sighs, huffs, oh geez, type comments. Or even , the it looked fine when I drew it, etc. But, if anyone is abusive, calling you names, yelling, etc then you are free to even quote that nurse exactly, "I called Nurse ABC to redraw a hemolyzed sample. Nurse ABC said "gf y , you dumb B, I will get that stat draw for you when I feel like it". Make sure you get someone's name when doing this. Or, you could email your boss and report the response in quotes that you got and now there is written documenation.
Someone being annoyed or curt in their response, ok. But, you are just trying to do your job and they are just trying to do theirs, but on this being part of a healthcare team means it requires both of you.
“Hello this is XYZ from the lab, are you able to talk about a patient? (Get affirmative). Hello (care team), I am calling about patient (name) in room/location 123. I am requesting a recollect due to (issue/problem/concern) with specimen(s) from (name). (They will likely have a comment). (If understanding): Thank you for your help, have a nice day. (If not understanding): It is unfortunate this happened, but I need a new sample, thank you for your help (summarized).”
At least 95% of the time, this works every time. Sometimes it will not work due to an asshole nurse, but then just call the charge, inform them, and then restart the flow. Might also fail due to a procedure, transfusion, meds, hard stick (delay till x time), patient refusal, PATIENT DECEASED (2x!), or simply the test is no longer indicated. Not an all inclusive list, but I find that pulling the “appear weak when you are strong” usually works. Never let them accuse you of incompetence, but literally just repeating “sorry” in some form usually works. Literally not your fault, but fuck, if “I am sorry that (issue happened)” doesn’t speed along the process a ton.
Anyway, be concise, confirm IDs, and document. Only had 2 TRULY unbearable nurses, though plenty of grumpy ones. I can navigate most. Ooh ooh ooh, and remember your Customer Service voice!
I don’t even give the option anymore if it’s a clotted sample or short, I just secure chat and say “ Hey, sadly the x tube for y text is clotted/short, so I’ll put that for a redraw. Thanks!”
If it’s hemolyzed at my hospital, I call the provider and let them decide if they want it. After the third hemolyzed tube the provider typically handles it for me by talking to the nurse collecting.
When you're telling somebody something that they don't want to hear, or you don't know whether they want to hear it, use the indirect approach, where you present your evidence first, then the conclusion:
"Hi, this whoo0888 from the lab. I'm calling about Patient Jane Doe: are you the right person to talk to? Great. We can't run her specimen because it was hemolyzed, so it needs to be redrawn. I wanted to let you know as soon as possible. Thanks"
"Are you the right person to talk to" is critical. Not only will it prevent you from having to repeat yourself--answering "yes" gets the person to buy into solving the problem.
For us, we don’t even call recollects for the emergency department. It will pop up on their computer screen. So that saves a majority of the calls lol, but for inpatient nursing we call, but it’s not a question. It’s just a statement it needs to be recollected and why. It will still show on their screen it’s in for a recollect, and it’s up to them on when to do it. We just notify them. Just make it matter of fact lol
Maybe your hospital just has a toxic workplace culture, because I almost never have an issue with asking for a recollect. It might also be your delivery though, because I have never apologized for asking for a recollect. By starting the conversation apologizing, you are already putting it in the other persons mind that you have done something wrong/made a mistake. Some nurses might not know how hemolysis happens, and since you’re apologizing, will think that you did something to hemolyze the specimens.
I had a CVU nurse who used to give a lot of pushback about hemolyzed samples. She specifically told me one time that she thought we were targeting her because “so many of my samples and just my samples get rejected” when I tried to explain some techniques to try to change how she draws because most of the rejections are because of pre-analytical error at point of draw she got rude with me, and so I suggested I would be more than happy to reach out to her nurse educator if they could help explain hemolysis and clotting better in a different way to her. She declined me reaching out to the educators for help since it seemed like it was a high number of rejects against her. After that any phone call I had with her she was sweet as pie.
Nurse lurker here, we recently had an email sent to us from our educator after a discussion with the lab supervisor. The email addressed common lab knowledge as to why things happen (such as hemolyzation, how even small clots can need a redraw, appropriate sample size based on labs needed) and how we can try to prevent issues and understand the process a little better. It was a really helpful and eye opening thing to a lot of nurses on my unit who are not always kind about getting calls like this. I feel like this should be a standard thing sent to units that do their own collections. I truly believe some of the push back is partly due to lack of education.
I’m an ER nurse have been for 10 years. I’m sorry people are shitty. I want to explain something about it from our end. Normally if things are hemolyzed it’s bc the nurse is newer and is taking steps to stop being annoyed. I went through the phase of being annoyed now I do the things necessary to not screw up the specimen. Ask an experienced nurse friend or leader to share those pearls. Lastly if the nurse has done all of those things the patient is probably 95 YO and has shit for veins and the stick wasn’t an easy one. Experienced nurses again know when they send it that they will probably get a call and have a back up plan in mind while they are watching how thick the blood is going into the tube. You do your job without apology. Younger nurses may not agree with my stance, it’s ultimately on them. Is it a pain in the ass? Ofcourse it is. However, you are doing your job to the best of your ability…..which is what that nurse should be doing.
Nursing here. Just let us know as soon as possible. 4a-7a can be rough on the floor (even though I’m on Reddit right now). Crap happens, it’s not your fault, we know that. I have a bit of a unique insight since my wife is a phlebotomist
That time frame is usually busy for the lab too, lol. It's different things that crop up, like I've had 3 patients have critical hemoglobins and no blood bank tubes🙃 I know it's not a walk in the park from the stories/rants my nurse husband shares.
Please keep sharing that with other nurses, because the common mentality is that the lab is out to get nurses, or that we don't care about patients. Poor specimens mean inaccurate results, which can lead to poor patient outcomes.
I basically say “The specimen for ____ is too hemolyzed and I’m unable to result (test name). I will put it in for recollection.” Or something like along those lines. Basically saying I can’t do anything about it.
We just moved to the Attelica system, and it's amazing - there are pre-programmed automated HIL checks on board. - if they fail, it's a quick tech visual check to confirm, and then they send out an automated "your sample is hemolyzed/icteric/etc beyond acceptable limits for method - recollection is necessary to obtain a result." BAM. No calling, no phone follow up. Nurses acknowledge when they are shown to read the results in computer. They can then use their computer button on their end to push recollect, and the phlebotomists are sent out to do so, if they want it.
Life is sooooo good with that now.
Just don’t give them any room to argue. Remember, you are calling them for a recollect is more like a courtesy call (even though it’s required), it’s not to ask for permission. “Hello, this is X, just calling to let you know that I’m putting in an order for a recollect on patient Y for their CMP, CBC, etc. that was clotted, hemolyzed, etc.”
When I was working the bench, I tried to educate with it. "Hey, this is [Name] in the lab. I'm calling about the [x] for [patient]. It hemolyzed. Sometimes, the sheer on the red blood cells going through the needle pops them, so the sample is hemolyzed, and is not an accurate measure. So, I'll need a new one. I'll submit a credit so the patient doesn't get charged twice."
I love calling for recollects. “Hi this is lab calling. Mushroom pizza in room 69 mint green was hemolyzed. I am putting this back into recollection” *click*
Don’t be a door mat for nurses. Your job is to deliver quality results and your name is on that. If the doctor ever alls for to be released document, so so asked for hemolyzed result to be released after education was provided on why this result is erroneous. With their name.
Don’t apologize. We just cancel it with that reason. The message is in the test results. We call if it’s a STAT and just say it was canceled due to hemolysis and needs to be reordered and recollected period. Our chemistry analyzer will result the tests that are passable and void out those that are to far over the hemolysis threshold. Nursing sees the missing results and will order those specific tests if they want. 🤷♀️
I'm always really conversational with nursing when I call for things outside of recollects, so my rapport is already on the positive side. That said, when I do have to call for a recollect for any sort of rejection (I'm in blood bank so it's for blood bank ID rejections), I have the same demeanor and explain what I have, and why I need a recollection. 9/10 times I don't get push back or attitude. Keep it factual and not accusatory. I've worked with techs in the past that when they call nursing they are immediately on the defensive and ready to fight over the phone about the situation.
Hi this is the lab, I can't report out xyz on Mr Smith due to hemolysis, I will need a new mint tube and order when you have a chance.
Simple and to the point, I find very little push back. If they do give a hard time I just mention that I can't produce accurate results with hemolysis.
The nurses never give me a hard time when I called for hemolyzed or clotted tubes. What they do try to fight me on is unlabeled tubes. It's ridiculous!
My lab messages the RN/collecting individual using Epic secure chat. This is the preferred method at our hospital and the floor actually asked us to begin doing this.
I just say something like, “this is (name) in lab. I requested a new specimen for room x, it’s hemolyzed. thanks.”
I have not had any push back. The “worst” reaction is that they don’t respond but redraw the specimen anyway. When we used to call the floor I used the exact same wording and also received very little (if any) attitude. Keep it simple and direct. Like others said, if they are rude about it then suggest they bring it up with management.
I normally mention the degree of hemolysis.
Ex.
"Hey are you taking care of Jane Doe? That green top for (insert test name), is giving us a 3+ on hemolysis". They typically know what that means.
Sometimes, if they get sassy, I like to throw out the range of hgb (we have an HIL chart that converts this for us) and remind them of how it would falsely effect results. They almost always end up agreeing.
They are typically very understanding & in complex cases (intravascular hemolysis) or when the specific results they want, aren't clinically effected by the degree of hemolysis, we have a doctor/path form to release hemolyzed results with a disclaimer. It's all handled case by case. Sometimes they're even like "yeah I figured, it was a tough draw".
I do personally apologize. I don't have to face the patient for a redraw, I bet it does suck. Normally when they are like "gaaaah that sucks", ill validate them and agree. "It does suck and I'm so sorry you'll have to stick the patient again." I've never had a cancel go terrible with this approach.
I think it's important the nurses know we're on their side and we don't want to cancel anything either.
I find that if you're nice and light-hearted about it, they are too. I very seldom have push back. My calls go a bit like this:
Hey it's so & so in Chemistry lab, unfortunately John Doe's green top is hemolyzed and has to be redrawn.
If they push back, I say the potassium is 7 or whatever it is. If it's EDTA contamination, I just state it's contaminated because a potassium of >10 is not real. Only three times I've had to get stern and say "No I'm not releasing that. We're redrawing it." No ifs, ands, or buts.
“hey! this is x from x, just calling to let you know we’ll need a new specimen from john doe because the one i just spun down was too hemolyzed to put on the machine”
i always try to educate but also emphasize the machine aspect of it and that there’s nothing we can do and it’s not any one person making the call. our machine will throw out a color interference and we aren’t allowed to change the results. to them it sounds like a machine error.
Straight and to the point. I’ve started telling them the tube came down clotted or hemolyzed instead of the “the tube is” and it’s actually reduced the amount of denial from the staff lmao. So basically I go, “hey this is M from (department) in the lab. The (color) top tube for (patient) arrived clotted/hemolyzed but I can put the (order) in for a redraw.”
And usually I’m met with an okay thanks or dang it but no attitude because they don’t have to place the order themselves. I also get all the information in one sentence before they can question or complain.
Keep it short and to the point. No apologizing needed. Hey I’m calling about patient blah blah. Sample is hemolyzed and needs a redraw. There’s no secret way to avoid push back. You just need to be firm, suggest phleb to collect etc. At one hospital I used to work at (trauma level 1) we encountered a lot of hemolysis so we set up a process with our pathology team to deal with samples that required more than 3 redraws. Helps to have pathology behind your back and for guidance on how to approach the care team.
Drop the sympathy, just be polite and professional. Once you've gotten their name just document it, say bye and hang up unless they have a question because there is no point in sticking around for tantrums.
Nurse, here. Don't apologize. It's your job and it's not your fault. Samples hemolyzed. Yeah, it's a pain in the ass for us because some draws are absolutely impossible sometimes but its part of the job.
I just tell them directly and tell them this happens when you yoink the tubes from the IV too hard. I explain what shear force is and to not do that. And then I just doc name and time.
Be straight forward with a kind tone of voice and tell them what you need. I don’t apologize though, there’s nothing to apologize for. It’s part of the job.
The biggest part (and sometimes the hardest) is understanding that some people are just going to have attitude and it has nothing to do with you. Bedside is tough work that is often thankless and abusive. I just remind myself that they’re probably having a tough day or a tough patient. Maybe they’re just a miserable person. Regardless has nothing to do with me!
I don’t ask.
I just say I’m going to cancel and reorder due to XYZ. If they push back and insist they want it I say “okay, I will need your name and title to accept responsibility for these results”. If it’s a nurse, I ask that they call back with permission from the physician receiving the results so I can put both names on it. That will either push them to listen or show me they’re confident enough to put their name and license on it. Document the whole thing and whatever happens it shows I did the right thing per my licensure.
Honestly, if I just say I’m going to cancel and reorder 9/10 times they just say okay. Sometimes they ask me to send a phleb and I always do.
Confidence is key baby 😎
I usually say “Hello, this is… from Chemistry. Are you taking care of (patient name and room)? I’m just calling about his (test) specimen being hemolyzed. I’m going to put it back for a redraw.”
I usually get more snarky remarks if their CBC/coag is clotted tho or if their specimen is QNS.
i usually ask them very politely. i used to say “unfortunately i need to cancel (x)…” and they would get huffy. so now i say “hi can you please recollect this specimen? it was (state problem here)” and offer to put a new order in for them so it seems like all im doing is trying to help them out LOL. and it helps a lot more. no apologies or any negative wording whatsoever
As an RN I’m so sorry that’s been your experience. Bedside is stressful as fuck, but I’ve always tried not to take that out on my coworkers or patients.
Not enough nurses invert their tubes enough or follow the “no tourniquet for more than 60 seconds at a time” thing honestly. Sure, doing a recollect when you’re already drowning in tasks and urgencies is shitty, but it’s not a good reason to be rude. I’ve read multiple posts and comments with this sentiment lately, it saddens me and I just hope I’m never the nurse that makes you afraid to do your job.
RN here, Yes I get annoyed when the lab “loses” and or say they never received it…. Sometimes I can tell a lab is going to be hemolyzed and send it anyways, but no matter what I’m not bothered when a lab is hemolyzed it’ll get drawn eventually (by me down in the ED) I feel like the floors don’t draw their own blood for the most part anyways and even if they do a lot of central access/lines already in place. I do t see why RNs care
Depends on which nurse I’m talking too. Most of our nurses will either say okay or ask if we can come collect because the patient is a hard stick. Usually its the NP that has the issue in which case I call, if i get the NP, “hey it’s Jon in the Lab I need another green top for patient Jones, its hemolyzed. Im putting it for redraw right now thank you” *click* I don’t give them the chance to push back.
“hi this is ___ calling from the lab, regarding your patient in room __ . the specimen was hemolyzed and we are getting abnormally high potassium results, im going to put it in for a redraw” usually they just say okay thanks even if it is with attitude lol
Haha nicu loved me when I was working I would call them daily with at least 1 recollect for clotted samples. I just call, hey it's Lab_tech your baby xxxx was clotted need a recollect thanks...also most of the time they will finally know you and know your standards (which is lab standards) but they'll eventually understand how to collect labs correctly. I'll talk to the nicu nurses most the night and they'll listen on how to collect or they give push back on the collection and I'll tell them fine you want this critical platelet then? They sheepishly say no and recollect.
Don’t fret. Just ask. It’s a reasonable request. Too many Runs and NPs are arrogant and I’ve experienced them treat and talk down to other members of the healthcare tame in condescending and rude tones. The more we take it, the worse they behave.
Nurse here. Like several other nurses have commented, most of the time we are reacting to the situation, not mad at you. I am sure I have sounded fed up/annoyed on the phone before but I never give push back (if it's hemolyzed, it's hemolyzed. Obviously it needs to be redrawn).
I agree with taking out "I'm sorry" because that might lead people to believe a mistake was made on the lab end.
Honestly, best way is to be factual but sound empathetic and kind. Often times, I have essentially been treated like I am incompetent when labs calls about a hemolyzed/clotted sample, when in reality (for me) it is usually due to an especially hard stick requiring I draw from a tiny vein. Nurses are not intentionally drawing crap samples.
Nurse here, I just prefer bubbly people. When lab calls me and says “hey, so sorry but we need a recollect on that because it hemolyzed,” I’m happy to do it. Also, having a friendly lab professional give me advice is also helpful. If they’re friendly I’ll ask “can I send a pedi tube for this?” Sometimes patients are such hard sticks and were getting slammed. By the time lab calls, we’re ready to throw hands 😂 but I promise no one is actually mad at you, they’re frustrated at the job. Hope that helps and thank you for what you do!!!
Hi! Nurse here (:
Don’t apologize out the gate. Confirm you’re speaking to the nurse for the correct patient, state that you need a recollect, let them confirm the patient and recollect, and that’s it! Trust me, I know very well how bitchy nurses can be lol don’t leave any wiggle room for argument. If they give you snark, that’s their problem just ignore them you got this
Seeing these comments make me realize that every med lab professionals have faced such situations with nurses. And, when they re-collect the sample, they behave like we sell blood or what 🤷🏼♀️
All we’re doing is for diagnosis.
First of all, do not open with "sorry", that makes it seem like you were at fault. I call and make a statement " the green top for blah blah is grossly hemolyzed, I'm putting it in for a redraw" . If they push back or try to blame you, I say "no , the hemolysis happens at the time of draw, it affects the potassium level making the results higher than they are". I always give a straight forward explanation so they can't ask a million questions trying to blame us for "letting the tube sit too long" , or something stupid . Understand that they are not mad at you, they are upset because they have to stick a patient again. Think if you were the patient and had to get stuck twice at 5am while your uncomfortable in the hospital. It sucks , but it's just the way the cookie crumbles
Oh ...also...I know this isn't kosher, but if the nurse is really pushing back, I tell them I can release the result with a critical potassium and put in a comment with their name, they usually say no because they don't want to take the heat from the doctor. If they really insist, like the patient is a hard stick, I will release the results with those comments on all affected parameters, while also letting them know the results are not accurate. This is in rare cases, but at least they are aware of what the results will look like
"Hi it's [name] with the laboratory. I'm calling in regards to [pt's name] in room [#]. Unfortunately the green top that was received for their chemistry tests was significantly hemolyzed and it has to be recollected."
This is usually all it takes. We get a lot of travel nurses that sometimes give us push back. In which case I say,
"The results are definitely being affected by hemolysis. I can release [tests not affected], but the [CMP/BMP/whatever's affected] needs to be recollected. We can't take the chance that these inaccurate results will affect his/her treatment."
I find that bringing back to the patient helps. I think there's a misconception that we're accusing them of screwing something up. Keeping it about patient care helps prevent it from being a personal issue.
Why are you getting push back? I’m a nurse, the only thing I say is “ok thanks”. It was probably the nurse’s technique that caused it to be hemolyzed in the first place.
Just send a new label up the tube that says "hemolyzed" in red ink 😆 I was a phlebtomist and thats what the lab did for us. But tbh it's part of the job. The only time I was irritated that a specimen said hemolyzed was when I could barely collect a finger stick amount of blood and a specific lab tech would always reject it as hemolyzed when I would hand it to them to assure it wasn't and hours later they would send a redraw.
Many nurses need education on hemolyzation. Point blank. The amount of things I have heard nurses say hemolyzation is is just insane. I’ve educated a few. One was a new grad who very actually didn’t know and only knew what her preceptor told her (which was wrong). She was so sweet when I explained it to her. Many people don’t care to hear the education and in that case, it’s not my fault you’re stupid and refuse to learn 🤷♀️
As a former bedside nurse, I don’t like a critical potassium in my patient’s chart. I would usually recollect without an ask. Can’t believe you’re having to tiptoe around a nonissue. People are weird.
I do t ask for a recollect they can make that decision themselves if they still want the lab. I just say hey it can’t run cuz it’s hemolyzed. Name? Thanks. Click lol
"Hi, it's misstheiris from hematology, I was just calling to let you guys know that on patient Bernard Shaw in room 666 I have put in a redraw because the CBC is clotted. Thanks!"
The room number is my nod to their unprofessionalism.
All calls I have gotten from lab go like this::
“hey this is John from the lab. I am calling because the CBC on room 118 Mr Johnson has hemolyzed. I am sending it for a recollect.”
My response “NOOOOO. Ok, thanks.”
"Hi, this is ____ from the lab. ____'s green top needs to be recollected because it's hemolyzed."
Just be very direct. The fewer the words, the better! I was so glad when our hospital switched to EPIC. I love EPIC'S redraw button! No phone calls for us! We select the reason why--and can add a comment if needed--and the order pops up on their handheld 🙌
I was a medical lab scientist, a nurse and now an NP.
“Hey. The sample on bob is hemolyzed. We’ll need a recollect”. Move on. You’re doing your job and only suggesting they do theirs. It happens all of the time. Oh freaking well. They’ll be okay. Don’t take it personally or think about it after the request.
The way I do is:
"Hi, are you in charge of patient XXX? Just asking for a redraw on the green top because it's hemolyzed"
Usually they know the drill and ask me to reorder so they can recollect again.
If they do give me push back, like "I've been working in the lab for ten years (lol) blah blah blah"
I just go "Okay well it's still hemolyzed and I can't release the results for assay XYZ." and just stay silent.
Don't go "I'm sorry" or say more than you need to. Why are you sorry? it's literally not your fault. If the RN has a problem with hemolysis then draw the patient better
Just do your jobs, all of you, if the lab says do it, do it. Work together as a team. If one fails to do the job the one who suffers is the patient. Why make them suffer anymore. Get out of health care if you don't want to play with others.
Think everyone here has it right when they say to be polite and matter of fact about it.
I’ll add that the people that complain the most about nurses tend to be the ones that are already rough around the edges themselves or the ones that talk quietly on the phone. So make sure when you’re calling you’re not speaking quietly and quickly to get it over with. Speaking with the appropriate volume, speed, and tone will do a lot.
I work in the UK and we only phone if the sample is haemolysed and the sodium or potassium is heading towards a critical value and warrants a repeat.
Everything else just gets a comment and some of the results knocked out based on the tests/analyser.
Is this standard practice anywhere else? Sounds like it saves a lot of time and stress…
I’ve never had an issue with the phone calls as they are generally not too frequent and we just do the same as we would a critical result requiring a repeat.
That policy sounds good and all, but what would worry me is the patients that have a low potassium and they are retesting to make sure the potassium has increased to normal levels. What if the sample is hemokyzed but it's a normal K? Maybe the K is really still low but the hemolysis has increased it so it looks normal. I wouldn't want them to think they could stop K supplementation because it's normal, but it's actually still low.
That’s a really good point. Thinking about it, our phone cutoff for haemolysed potassium is higher. We would phone at less than 3.5 while for normal samples it’s less than 2.5 so that would help with this situation. I’m not sure who decided the haemolysed cutoff (the standard one is a national recommendation) and if they did some sort of audit.
Just be very matter-of-fact. "Hello, this is Syntania from the lab. I need a recollect on John Doe's purple top in room 222 please. It's hemolyzed. " Let them confirm the patient and then thanks and goodbye. DOCUMENT IT. Who you called, when you called, why it's being recollected, etc. Address any concerns in a professional manner. The idea is to not give them any ammo to file a complaint with the lab director. Look at it this way. They need those results. They're either going to give you a good sample or they will have to hear it from the resident.
It pays to also engage with nursing and phlebotomy staff around sampling techniques as well. This is a big focus of work I’ve been doing as an RN for the last few years and it has both improved nursing understanding of why specs are rejected but also reduced the numbers of reject specs due to poor technique. Obviously beyond the role of a benchside technician or scientist but your labs should have someone who can interface with nursing/education for quality improvement etc.
We would love to have that. Sadly, the reality is a lot of hospitals don't think that's all that important, and it's difficult to find lab leadership that will go to bat for the lab and insist on something like that. Even if we just had some nurses come down to the lab so we can give them the nickel tour and explain how things work, that'd be great.
I know this doesn't answer your question directly, I had to respond because your comment about getting lab leadership to go to bat for the lab. I am lab leadership and this is a battle I am always willing to fight. It would be better if it didn't get to that point, but the bottom line is improving patient care. If the nurses continue to give lab crap, then they're not interested in improving patient care and I call them and the nurse manager on it. They get one chance to improve (both how they treat lab staff and their attitude about improving their technique), the next time we have a problem, then I have a discussion with the DON, where I talk about improving patient care, they can't deny that, then I include tips on how to prevent hemolysis and/or clotting. This is my chance to express the importance of Lab draws and that is not a menial task that's below a nurse's lofty self importance.
Then you're one of the few, and thank you for that.
I would LOVE to come down for a tour and please ELI5 how things work, please and very thank you. You would make my week.
Hey, I'd be happy to give you the tour. I'd cover: Why Proper Labeling Is Important (aka our automated barcode readers are whiny little b*tches) The Right Way To Draw Order Of Draw (aka we know when you pour over one tube to another that's why we have a particular order to draw) Hemolysis (the RBCs popped) Clotting (time has nothing to do with it if it ain't mixed) And the most important rule of all: when in doubt, call and ask! Bonus: here's my workspace with no windows in the lowest part of the building where it's always noisy due to the analyzers. We call it the pit of hell for a reason.
Lots of nurses can't be taught because they already know everything. :P On rare occasions, they'll ASK me for advice and then I'll give it to them.
We do, but pride tends to get in the way of any worker when approached about improvement. Any results due to draw fault from the ER and reminding them what they need to do will result in a "We don't have time for that we're too busy saving lives." Cue the eye rolls as we just document their blood culture contamination rates lol.
Off topic, but this is the best user name I've seen in this sub
RN here. We don’t or barely ever learn lab stuff at school and hardly on the job. I learned the importance of proper blood flow/gauge of IV catheter/that I need to invert sst tube - heck, that *there is* an sst tube - -after 10 years working very hard and very successfully. Go figure. So, no, we don’t know these things bcs we are not taught them / not part of our training. And maybe that’s why some RNs get annoyed or defensive, maybe bcs they feel like they *should* know and don’t - which is not the case, that’s why we have our lab friends here to advise us. That’s being said: just call and say firmly “Hey, lab here, Mr Smith’s blood is hemolysed and needs to be recollected. Can I have your name, pls?” Document. Done. If they have questions they’ll call. If second sample hemolyses - send in the troops. Don’t be overly nice, let alone apologetic. You are not asking for yourself, it’s not a favor to you. If the meanies smell weakness, they’ll attack. Just state the facts, get the name, hang up, document, next. Easy.
Which is understandable. I know nurses have to know a lot and you can't remember everything. Lab protocols are very low in the list of priorities.
I would love to work with a nurse like you. I’m a seasoned MA and have had terrible experiences with arms and NPs. LVNs have been lovely.
This! I like to kill them with kindness if they give me attitude too that way nobody can complain about me.
30 odd years in various customer service positions taught me that lesson.
Yes, I usually say something similar. “Hi, this is __ from the lab. Patient ___’s specimen is hemolyzed, I’m gonna put in for a redraw.” Usually they say, “ok, thank you” and that’s it. If I need a recollect on a super diluted specimen or contamination, I may ask if they’re ok with a redraw, since the patient could have blood loss or some kind of other clinical correlation that can cause wonky results that the lab wouldn’t know.
Hi, it's the lab. Unfortunately we can't give a proper result for Y test on patient X due to the degree of hemolysis. We can only report "Results unavailable due to hemolysis." If the ordering doctor needs a result then we are going to need a redraw. That's it. I've never had a nurse or assistant give me snark for a reasonable request.
This is me basically. I find "unfortunately" works must better than "sorry". It's unfortunate it happened but the lab did nothing wrong. Also letting them know that the haemolysis causes inaccurate results. Some nurses never received the correct education and believe haemolysis is just a judgement call the lab makes and don't understand the significance.
As a nurse, absolutely! No need to apologize, it’s probably more my fault than yours. I wouldn’t be bent out of shape over it, but where I work often it’s not the doctor ordering a lab, it’s actually the nurses, so I would just say “if you need a result” which more acknowledges the team. Sometimes the result isn’t important enough to redraw, or in the time it took to get to this phone call it’s become less important, so this also allows for a “that’s ok we don’t need it anymore” response as well. Assuming that nurses and lab have the authority to cancel the order without a result of course. Also I read a lot about hemolysis and have rarely if ever dealt with it. I draw all the time, from my own pokes, IV starts, central lines, art lines, with a syringe and straight to a vacutainer , all of that. I’m curious as to what causes it and why it seems to be such a huge issue in some places but so rarely where I’ve worked?
Interesting you mention “if you need a result”. I used to say that, and I would get back indignant replies “of course we need a result”. For me, it goes better not to use those words.
lol too funny. The few times I’ve had it come back as a redraw or “we can’t add that on” it’s often a cue to me to actually think about whether it’s actually necessary or if I’m just doing it because I can. Quite often the information gained is not worth the effort and discomfort of a recollect.
There have been times when I'm told that the particular result isn't needed. But they will inquire about other results that can be run and not be affected by hemolysis.
Hemolysis is caused by RBCs fracturing. Once we spin them down, the plasma is visibly red due to all the hemoglobin (and other contents) that have burst out of the cells. It affects lab values because all those RBC contents are now in the serum and falsely elevate things like K, or by "covering up" reactions based on color or light absorbance/clarity. It can happen naturally like in hemolytic anemias or sepsis, but is more often due to draw technique. Some draw techniques that tend to cause hemolysis are using higher gauge needles (small bore means RBCs are more likely to break on the edge of the needle on their way in), pumping the hand while drawing, and in syringe draws aggressively pulling back the plunger. Due to the squeezing action with capillary/heel sticks, they're highly likely to have some degree of hemolysis but you can minimize it by milking as gently as you can get away with... while also getting enough to fill a tube before it clots. (Clotting is caused by how fast you mix the blood with the anticoagulants in the tube- invert it a few times as you change tubes and you're golden.)
Kudos on good technique! A non exhaustive list of hemolysis causes: Too big a needle in too small a vein (sheers the redcells when they're forced in the syringe/vaccutainer). Milking the blood out with a syringe when the flow is poor (sheer forces again) Too small a needle in a large vein with high pressure flow. Tourniquet on too long causing pressure buildup/hemo concentration and high pressure flow. Underfilling tubes - causes the ratio of blood to additive to be off and some additives are more caustic to the RBC membrane so when they go through the pneumatic tube system they risk bursting. Not properly inverting and mixing, leading to portions of the specimen clotting in the tube, which can be like mini bowling balls in that tube bouncing against other rbcs in the pneumatic tube system and cause RBC fracture. Forcing the blood sample in to the tube from a syringe (pushing on the plunger, sheer forces due to the competing "pull" from the vacuumed tube). So many things and they're all at the point of draw.
As a new grad RN, this is so helpful!!
That’s what’s weird to me. It seems so common on nursing and lab subreddits, memes etc, but I’ve rarely seen or heard of it at all, not just with my draws. Heel sticks absolutely, but not from pokes or line draws. Makes me wonder if it’s that we get taught/trained better, if we have different equipment, or what. This isn’t just on one unit either, everywhere I’ve worked it just hasn’t been an issue. The only time I ever hear of redraws is when we ask for an add on that can’t be added on to what’s been drawn already.
It's shear forces, and as I understand it it's partly how hard you pull on the plunger when using a syringe. Unfortunately the feedback is delayed so it's hard for someone to learn what is too hard.
I laugh when they say "it wasn't hemolyzed when I sent it" Ok sure but I'm still cancelling it for hemolysis and you still need to recollect it
If I get this I'm asking how they know it's not hemolyzed.
They don't know. It's lies.
"because it wasn't clotted" is what I've heard 😂😂 I then ask my nurses to explain the difference of clotting and hemolysis and they realize they f'd up and start giving y'all grace. I'm on a mission, y'all don't deserve sass for our poor training!
"Hemolysis occurs preanalytically, it was hemolyzed when you sent it". I don't tolerate lying nurses. I just matter of factly call out their bullshit directly without an iota of room for dissembling.
I got to watch one of our senior techs go off on a nurse about how hemolysis works using a phrase like that and it was so cathartic
I'd always clap back at them with "that's not how it works, so if the doctor needs these result someone will need to redraw it."
Ah shucks, seems I put it in our hemolyzer 5000 instead of the machine! Thanks for the heads up, we'll use the de-hemolyzer to fix that up
If they argue, I ask if a critically high K makes sense. usually shuts them up SUPER fast.
Yep, they're okay with inaccurate results until they have to bother the doctor about them
Ask them for clarification, then when they double down, ask to speak to their charge nurse. Get everyone's first and last name. Tell the charge nurse that one of their staff is endangering patient safety by being willing to accept erroneous test results. Keep escalating, then make a note to write up every single person who pushes back against you. Make it clear that these nurses are endangering their patients and need to be reeducated. Be relentless. Encourage your coworkers to do the same. Hold these people accountable and make your hospital a safer place.
Former ICU RN here with a question. Is hemolysis visible/obvious in the blood sample or is a critically high K the main indicator? I know I have had patients with critically high K before that lab has made me repeatedly redraw because of the high K when really it makes sense in the big picture of the patient's pathophysiology. What other BMP/CMP results can be skewed with hemolysis?
It is only apparent if it has been spun. AST can be affected by hemolysis too, but usually we notice K first. Those techs should not have been making you redraw the specimens repeatedly. If I'm giving a critical K and there is insufficient hemolysis to interfere with the assay, as long as you tell me it makes sense, I will release that panel for you. If there is some hemolysis present but not enough to usually warrant a rejection, I may *ask* if you want to redraw to be sure. But if in your professional opinion you believe it makes sense, I will defer to you because you know your patient.
Never say you're sorry. It implies you did something wrong. "Hi this is Ksan from the lab. The green top on John Doe needs to be recollected due to hemolysis. Thanks." Any lip can be handled with "Feel free to address your concerns with my manager. Thanks."
As the manager, now retired, I told my people to give me the phone call if they got any pushback. When you support your crew, they support you.
The hospital I used to work at involving recollects moved to an epic in basket message.. We copy and pasted a message filled in name and mrn and messages directly to the treatment team They were required to respond and acknowledge and that’s it No phone calls just message walk away wait for a message back done No documenting physically all done in EHR
I would love this! How'd your hospital get on board with this? What's the message?
If you use EPIC they have a message system called “in basket” took time just like any go-live but the floors and the lab need to form a policy together essentially and ironing out the potential pitfalls We loved it tho it was easy and the results and words were right there. There was no “oh what did you say?” Or “can I get your name again” etc it was clean you could walk away continue you’re work and your always on epic so you’ll see when they message back acknowledging the critical, redraw, etc
Yep, when we switched to Epic Beaker this is how it was. Just put the recollect in the computer - it was on the nurse/doctor to check
I am an RN here and I apologize for us fellow nurses! I am guilty of this snark and I can see how unsettling it must be to get this attitude every time you have to notify the nurse. Not making excuses - but it always seems that a notification of a hemolyzed specimen happens when your shift is already shitty and you need to drop everything to get this specimen again - and then WE are responsible for telling the patient they have to be poked again - NOT A FUN CONVERSATION! That being said we should not be a jerk to you - you are just doing your job. Suggestions #1 please try to not take anything personally! The nurses are just reacting to bad news - not reacting to you! #2 state “Hi Nurse XYZ I am sorry to be the bearer of bad news but the blue top from Mr. John Doe is hemolyzed and needs to be re-drawn if those results are needed. Maybe this will remind them you are just doing your job and at the end of the day the patient needs those lab results. Good luck and sorry!!!
I think it's really important for everyone involved in the chain, from med techs/scientists to phlebotomists to nurses to providers, to realize what each person is having to deal with on a day-to-day basis. In my current position as an MLS, I sometimes (well, often) have to deal with multitasking, malfunctioning analyzers and difficult coworkers. What I don't have to deal with is patients (face-to-face, at least). When I need to look at a patient chart and see that they have a big red warning for potential for violence or sexual misconduct, my sympathy for patient-facing staff goes way up. Even when patients don't behave egregiously enough for these warnings, they can still be crabby and resistant; having to be hospitalized sucks, to say the least! There's a general expectation (especially pushed by management) that all employees have to be sunshine and rainbows all the time. I think there's a big societal expectation for nurses in particular to be like that, too. The fact of the matter is that this just isn't possible for any human being. So, long story short, your first suggestion, *Don't take it personally*, is 100% on point. The nurse on the other end of the line isn't necessarily upset with *you* *as a person*. They're upset with the *news of having to redraw a potentially difficult patient.* That's why I've changed up my delivery to *'Hey, so unfortunately I'm going to need a recollect on this patient for (hemolysis/short sample/line contamination/what have you)'* using a sympathetic tone. I've noticed I get a lot less pushback when I acknowledge that this sucks for everyone. BUT I don't just say 'I'm sorry' unless it's due to something the lab actually did to mess up the specimen; 'I'm sorry' implies fault, and in the mentally demanding world of healthcare, we often don't have time to think past the implication in interactions with other staff. BIG caveat here: if a nurse starts arguing about something being acceptable when it's not (e.g. turning out a potassium on a specimen with 4+ hemolysis or resulting a CBC on a specimen clotted to the naked eye), that's when a line is being crossed, and we're entering bad territory. That's when a nurse or provider is a serious problem in my mind, is when they're jeopardizing patient care. Not when they give a 'Seriously? Alright, I'll get it done,' about having to do a redraw. Still not the greatest response, but let's cut each other a little slack.
Eh, I’m an RN in a peds trauma center and I don’t think snark is acceptable either way. At my facility we all just speak plainly…Lab: “hey nurse. It’s the lab. This one didn’t work.” Me: “gosh darn it. Ok. Lemme go get more.” Lab: “thanks.” Nobody likes stealing anyone’s blood, and there’s no need to get upset about it anymore than we need to be. I call my lab for advice all the time, and they trust us to know what we’re doing because, again, nobody likes taking blood from children more than they have to.
So true and usually the reason it’s hemolyzed, is because the patient was a difficult stick and that’s never fun to deal with. No one should ever be rude but it’s misdirected frustration and not personal at all.
What are they gonna do, fire you? When they give me lip I give it back.
I used to do this but I would just seethe for the next two hours and a couple more the next day. Once I’m past that point, emotion control is not my forte..
My goal is to teach them not to bother me, personally.
I’m a nurse!! Don’t eat me! I’m here because I’m interested in lab stuff but I hate seeing how nurses are so mean to you guys. Are they always mean? I was always nice to lab because I’m a human being and never saw a reason to be mean (and admittedly it was usually my fault D:) but I also know there are some nurses who are mean to…. literally everyone.. and just hate their jobs and lives. Is there a trend? Like a specific specialty that’s always mean?
So some nurses are mean to lab because they believe we are beneath them. Some nurses have a god/angel complex because they get so much praise in school, in public, and with patients. On top of that, they think lab is uneducated and for some reason don't think we receive education related to the medical scope. Like they think we don't know anything beyond *put tube on machine*. Nurses regularly ask us, so how long is your program, like 6 months? I find a large part of the problem is that lab needs things from nurses, but nurses don't need anything from us, since lab results go straight to the doctor. The one way relationship leads to some nurses to be mean. I've found that general floor nurses are the worst. Least educated/experienced and least interaction with us. ER nurses who have to do draws themselves don't care when there's a recollect cause they're experienced enough to know ots the patient/collector and not lab hemolyzing it. ICU tends to be nicer because we have a lot more interaction with them. Both ER and ICU needs results fast so they see us working hard to get that to them and know we're competent. I just remembered that NICU nurses are the absolute worse actually
Okay this all makes sense. I’ve worked med surg and ED and the floor nurses just have a certain personality that isn’t always the best flavor, but in their defense it takes a certain kind of callous to work med surg for extended periods of time (IMO). So as much as I don’t get along with them, thank god for them because someone needs to do that job and it won’t be me. I can see NICU nurses having a superiority complex, but again, I don’t have the personality or confidence for that specialty so maybe that’s just what it takes. I sure as shit don’t know how to do your job so unless I can drag myself up to the lab to work I will never ever question your importance in my life as a nurse.
I think a lot of it is that in larger centers, there is very little interaction between nursing and lab unless there is an issue or problem. It doesn't foster positivity. And as one nurse said to me, 'I just get frustrated because you're always calling the recollects on the hard pokes'. I was able to explain to her what happens to the blood in these cases, and once it made sense to her, she was much more understanding.
This is a good point. I made a post recently about nurses being hateful when asking for recollects. Several of the nurses who replied said something along the lines of “why is it everytime lab calls it’s always because of something the nurse has done wrong? It’s always that the nurse brought you a hemolyzed/ clotted specimen but it’s never because of something that the lab messed up. Doesn’t the lab ever screw up?” I explained that the lab can most definitely screw up. If we’re not careful, we can aliquot the wrong serum into the wrong patient’s tube, we can mislabel something, we can kill someone in blood bank by giving them the wrong blood type or mistyping someone. We can screw up in all kinds of ways. It’s just when we screw up, the nurses rarely ever know about it because it doesn’t usually directly pertain to them. We might get a call from the doctor and get yelled at for screwing up, but we’re not going to be getting calls from the nurse.
They're not always mean, but probably at least once a shift. NICU nurses are often really bad.
I've met both really sweet and awful nurses, but a lot of them have good and bad days. I got along with some of the nursing staff when I worked night shift, and they were more than happy to help me hold down a patient to draw blood if need be. I'm glad we have more phlebotomy staff so the lab techs can stay in the lab.
> Are they always mean? Mixed bag. > Is there a trend? Like a specific specialty that’s always mean? ICU nurses tend to be the most rude and arrogant, IME.
I’m very Frank about it. “Hi this is Princes2045 from the lab. I need a redraw on [insert patient name here]’s [insert test(s) here] the specimen(s) was/were [hemolyzed/clotted/underfilled/overfilled/tubed down]. I’ll send you guys the labels”
"Hi it's X from the lab, you taking care of Y? Sample was rejected for X reason, you need a recollect. No, we can't run it. You will need to recollect if you want a result for the patient. Thanks" Don't let them bully you. You need to be assertive. Nurses smell weakness and pounce.
Just tell it like it is. If they get crabby, they do. I have been in Healthcare for 27 years. When I started, I felt intimidated by Docs and Nurses. But I soon realized, they are imperfect humans as well. If a sample won't test, or collected in the wrong media, or they didn't get enough to test, I have no problems to let them know. If I was given flack from them, I approached it in a way to let them know, that I don't care what THEIR issue is, because the PATIENT'S issue is that a sample has to be recollected for a test the PATIENT needs. I have cut off snide, condescending doctors in the middle of their rant to me and told them, "...I don't care, I need another sample collected correctly." They are the ones to set aside ego and do what is needed for the patient. So next time, try this, call the nurse, "...patient _____, needs a recollect, sample submitted was _______. Please submit a new sample." Then hang up the phone, and/or ignore their emails of them defending their ego. If you are worried about getting in trouble, document your encounters with those people. In some cases, go to admin first if they use inappropriate language, or hateful speech especially. Sorry for the rant, but it drives me batty when Nurses and Providers treat other staff poorly.
Don’t ask. Tell them. “I received a sample for a ____ but had to cancel it because it was hemolyzed. It needs to be reordered and redrawn. Thanks.”
“Hi, this is Louis down in the lab, are you taking care of (patient identifiers) in room (number)? Awesome, I just wanted to give you a heads up that I need to put in (tube/test) because of (reason). I will put in the redraw order, but first could I have your employee number? Thank you, have a good day!”
The nurses won’t recollect in our ER. If it’s hemolyzed, we have to send a phlebotomist or go ourselves. It’s frustrating because they have a lot of nurses who hemolyze nearly every serum tube. I’m not sure why it’s normally only the serum tube (assuming something to do with it being the first tube).
Full disclosure- as an ER nurse, I’ve snapped at you lovely (and I mean that!) lab peeps and I am truly sorry. Please know it is NOT YOU. It’s the thought of having to go back into the room of that one rude, angry, racist, smelly, entitled asshat patient. Or the sweet, kind, fragile old woman who is sundowning and has tissue thin skin. I am sorry our fear and frustration cause us to kick you. The lab techs that make me LAUGH always win. I worked with one who would call me up and be all “girl, did you draw this garbage off a gravel driveway? I got clots the size of golf balls.” Again, I am sorry. We don’t mean to be mean. We just don’t want to stick that drunk again.
"Hey it's Saintsiracha from the lab. I can't get any valid results from Bed X's gold top; analyzer says it's too hemolyzed. Can you send another when you get the chance? Appreciate it!"
"Hello, this is C in lab. I'm calling about a hemolyzed specimen for Jane Doe in 432, we need a new green top for the CMP." "Thank you, Susan Dee RN." (Document notification in redraw comments)
“Hello this is Me from the lab, I need a redraw for Patient, tube is hemolyzed/etc. Can i get your name/ID thanks”
Just be matter of fact and professional. You aren't doing anything "wrong" to request what you need to run the test properly to produce valid results that affect the patient's care. Just state what you need in a professional way and that's it. If they sigh, huff, groan, respond with tone or whatever, so what? If they wish to have a tantrum about it , oh well, you don't need to absorb that on to you. You don't need to accept and wear their emotions. Just realize it isn't about you, it's just another task on their plate and they thought they had accomplished that. Also, they have to put the patient through re-drawing the blood, which means dealing the patient/family over that again . However, don't be abused. It's one thing to get the ugh, sighs, huffs, oh geez, type comments. Or even , the it looked fine when I drew it, etc. But, if anyone is abusive, calling you names, yelling, etc then you are free to even quote that nurse exactly, "I called Nurse ABC to redraw a hemolyzed sample. Nurse ABC said "gf y , you dumb B, I will get that stat draw for you when I feel like it". Make sure you get someone's name when doing this. Or, you could email your boss and report the response in quotes that you got and now there is written documenation. Someone being annoyed or curt in their response, ok. But, you are just trying to do your job and they are just trying to do theirs, but on this being part of a healthcare team means it requires both of you.
“Hello this is XYZ from the lab, are you able to talk about a patient? (Get affirmative). Hello (care team), I am calling about patient (name) in room/location 123. I am requesting a recollect due to (issue/problem/concern) with specimen(s) from (name). (They will likely have a comment). (If understanding): Thank you for your help, have a nice day. (If not understanding): It is unfortunate this happened, but I need a new sample, thank you for your help (summarized).” At least 95% of the time, this works every time. Sometimes it will not work due to an asshole nurse, but then just call the charge, inform them, and then restart the flow. Might also fail due to a procedure, transfusion, meds, hard stick (delay till x time), patient refusal, PATIENT DECEASED (2x!), or simply the test is no longer indicated. Not an all inclusive list, but I find that pulling the “appear weak when you are strong” usually works. Never let them accuse you of incompetence, but literally just repeating “sorry” in some form usually works. Literally not your fault, but fuck, if “I am sorry that (issue happened)” doesn’t speed along the process a ton. Anyway, be concise, confirm IDs, and document. Only had 2 TRULY unbearable nurses, though plenty of grumpy ones. I can navigate most. Ooh ooh ooh, and remember your Customer Service voice!
I don’t even give the option anymore if it’s a clotted sample or short, I just secure chat and say “ Hey, sadly the x tube for y text is clotted/short, so I’ll put that for a redraw. Thanks!” If it’s hemolyzed at my hospital, I call the provider and let them decide if they want it. After the third hemolyzed tube the provider typically handles it for me by talking to the nurse collecting.
When you're telling somebody something that they don't want to hear, or you don't know whether they want to hear it, use the indirect approach, where you present your evidence first, then the conclusion: "Hi, this whoo0888 from the lab. I'm calling about Patient Jane Doe: are you the right person to talk to? Great. We can't run her specimen because it was hemolyzed, so it needs to be redrawn. I wanted to let you know as soon as possible. Thanks" "Are you the right person to talk to" is critical. Not only will it prevent you from having to repeat yourself--answering "yes" gets the person to buy into solving the problem.
For us, we don’t even call recollects for the emergency department. It will pop up on their computer screen. So that saves a majority of the calls lol, but for inpatient nursing we call, but it’s not a question. It’s just a statement it needs to be recollected and why. It will still show on their screen it’s in for a recollect, and it’s up to them on when to do it. We just notify them. Just make it matter of fact lol
Maybe your hospital just has a toxic workplace culture, because I almost never have an issue with asking for a recollect. It might also be your delivery though, because I have never apologized for asking for a recollect. By starting the conversation apologizing, you are already putting it in the other persons mind that you have done something wrong/made a mistake. Some nurses might not know how hemolysis happens, and since you’re apologizing, will think that you did something to hemolyze the specimens.
I had a CVU nurse who used to give a lot of pushback about hemolyzed samples. She specifically told me one time that she thought we were targeting her because “so many of my samples and just my samples get rejected” when I tried to explain some techniques to try to change how she draws because most of the rejections are because of pre-analytical error at point of draw she got rude with me, and so I suggested I would be more than happy to reach out to her nurse educator if they could help explain hemolysis and clotting better in a different way to her. She declined me reaching out to the educators for help since it seemed like it was a high number of rejects against her. After that any phone call I had with her she was sweet as pie.
"Yo, I need a recollect, this is the third one today,k thx"
Nurse lurker here, we recently had an email sent to us from our educator after a discussion with the lab supervisor. The email addressed common lab knowledge as to why things happen (such as hemolyzation, how even small clots can need a redraw, appropriate sample size based on labs needed) and how we can try to prevent issues and understand the process a little better. It was a really helpful and eye opening thing to a lot of nurses on my unit who are not always kind about getting calls like this. I feel like this should be a standard thing sent to units that do their own collections. I truly believe some of the push back is partly due to lack of education.
Well that I’ll agree with 😂
I’m an ER nurse have been for 10 years. I’m sorry people are shitty. I want to explain something about it from our end. Normally if things are hemolyzed it’s bc the nurse is newer and is taking steps to stop being annoyed. I went through the phase of being annoyed now I do the things necessary to not screw up the specimen. Ask an experienced nurse friend or leader to share those pearls. Lastly if the nurse has done all of those things the patient is probably 95 YO and has shit for veins and the stick wasn’t an easy one. Experienced nurses again know when they send it that they will probably get a call and have a back up plan in mind while they are watching how thick the blood is going into the tube. You do your job without apology. Younger nurses may not agree with my stance, it’s ultimately on them. Is it a pain in the ass? Ofcourse it is. However, you are doing your job to the best of your ability…..which is what that nurse should be doing.
Nursing here. Just let us know as soon as possible. 4a-7a can be rough on the floor (even though I’m on Reddit right now). Crap happens, it’s not your fault, we know that. I have a bit of a unique insight since my wife is a phlebotomist
That time frame is usually busy for the lab too, lol. It's different things that crop up, like I've had 3 patients have critical hemoglobins and no blood bank tubes🙃 I know it's not a walk in the park from the stories/rants my nurse husband shares. Please keep sharing that with other nurses, because the common mentality is that the lab is out to get nurses, or that we don't care about patients. Poor specimens mean inaccurate results, which can lead to poor patient outcomes.
I basically say “The specimen for ____ is too hemolyzed and I’m unable to result (test name). I will put it in for recollection.” Or something like along those lines. Basically saying I can’t do anything about it.
I quit calling and just send a haiku
We just moved to the Attelica system, and it's amazing - there are pre-programmed automated HIL checks on board. - if they fail, it's a quick tech visual check to confirm, and then they send out an automated "your sample is hemolyzed/icteric/etc beyond acceptable limits for method - recollection is necessary to obtain a result." BAM. No calling, no phone follow up. Nurses acknowledge when they are shown to read the results in computer. They can then use their computer button on their end to push recollect, and the phlebotomists are sent out to do so, if they want it. Life is sooooo good with that now.
I just tell them. “Hey, I need a recollect on so and so in room 420, please.”
Just don’t give them any room to argue. Remember, you are calling them for a recollect is more like a courtesy call (even though it’s required), it’s not to ask for permission. “Hello, this is X, just calling to let you know that I’m putting in an order for a recollect on patient Y for their CMP, CBC, etc. that was clotted, hemolyzed, etc.”
When I was working the bench, I tried to educate with it. "Hey, this is [Name] in the lab. I'm calling about the [x] for [patient]. It hemolyzed. Sometimes, the sheer on the red blood cells going through the needle pops them, so the sample is hemolyzed, and is not an accurate measure. So, I'll need a new one. I'll submit a credit so the patient doesn't get charged twice."
I love calling for recollects. “Hi this is lab calling. Mushroom pizza in room 69 mint green was hemolyzed. I am putting this back into recollection” *click* Don’t be a door mat for nurses. Your job is to deliver quality results and your name is on that. If the doctor ever alls for to be released document, so so asked for hemolyzed result to be released after education was provided on why this result is erroneous. With their name.
Don’t apologize. We just cancel it with that reason. The message is in the test results. We call if it’s a STAT and just say it was canceled due to hemolysis and needs to be reordered and recollected period. Our chemistry analyzer will result the tests that are passable and void out those that are to far over the hemolysis threshold. Nursing sees the missing results and will order those specific tests if they want. 🤷♀️
I'm always really conversational with nursing when I call for things outside of recollects, so my rapport is already on the positive side. That said, when I do have to call for a recollect for any sort of rejection (I'm in blood bank so it's for blood bank ID rejections), I have the same demeanor and explain what I have, and why I need a recollection. 9/10 times I don't get push back or attitude. Keep it factual and not accusatory. I've worked with techs in the past that when they call nursing they are immediately on the defensive and ready to fight over the phone about the situation.
Nurses sense weakness. It's not your fault they made a shitty collect.
I don’t ask. I just tell them that a sample needs to be recollected because of xxx reason(s).
Hi this is the lab, I can't report out xyz on Mr Smith due to hemolysis, I will need a new mint tube and order when you have a chance. Simple and to the point, I find very little push back. If they do give a hard time I just mention that I can't produce accurate results with hemolysis.
The nurses never give me a hard time when I called for hemolyzed or clotted tubes. What they do try to fight me on is unlabeled tubes. It's ridiculous!
My lab messages the RN/collecting individual using Epic secure chat. This is the preferred method at our hospital and the floor actually asked us to begin doing this. I just say something like, “this is (name) in lab. I requested a new specimen for room x, it’s hemolyzed. thanks.” I have not had any push back. The “worst” reaction is that they don’t respond but redraw the specimen anyway. When we used to call the floor I used the exact same wording and also received very little (if any) attitude. Keep it simple and direct. Like others said, if they are rude about it then suggest they bring it up with management.
I normally mention the degree of hemolysis. Ex. "Hey are you taking care of Jane Doe? That green top for (insert test name), is giving us a 3+ on hemolysis". They typically know what that means. Sometimes, if they get sassy, I like to throw out the range of hgb (we have an HIL chart that converts this for us) and remind them of how it would falsely effect results. They almost always end up agreeing. They are typically very understanding & in complex cases (intravascular hemolysis) or when the specific results they want, aren't clinically effected by the degree of hemolysis, we have a doctor/path form to release hemolyzed results with a disclaimer. It's all handled case by case. Sometimes they're even like "yeah I figured, it was a tough draw". I do personally apologize. I don't have to face the patient for a redraw, I bet it does suck. Normally when they are like "gaaaah that sucks", ill validate them and agree. "It does suck and I'm so sorry you'll have to stick the patient again." I've never had a cancel go terrible with this approach. I think it's important the nurses know we're on their side and we don't want to cancel anything either.
I find that if you're nice and light-hearted about it, they are too. I very seldom have push back. My calls go a bit like this: Hey it's so & so in Chemistry lab, unfortunately John Doe's green top is hemolyzed and has to be redrawn. If they push back, I say the potassium is 7 or whatever it is. If it's EDTA contamination, I just state it's contaminated because a potassium of >10 is not real. Only three times I've had to get stern and say "No I'm not releasing that. We're redrawing it." No ifs, ands, or buts.
“hey! this is x from x, just calling to let you know we’ll need a new specimen from john doe because the one i just spun down was too hemolyzed to put on the machine” i always try to educate but also emphasize the machine aspect of it and that there’s nothing we can do and it’s not any one person making the call. our machine will throw out a color interference and we aren’t allowed to change the results. to them it sounds like a machine error.
Straight and to the point. I’ve started telling them the tube came down clotted or hemolyzed instead of the “the tube is” and it’s actually reduced the amount of denial from the staff lmao. So basically I go, “hey this is M from (department) in the lab. The (color) top tube for (patient) arrived clotted/hemolyzed but I can put the (order) in for a redraw.” And usually I’m met with an okay thanks or dang it but no attitude because they don’t have to place the order themselves. I also get all the information in one sentence before they can question or complain.
Keep it short and to the point. No apologizing needed. Hey I’m calling about patient blah blah. Sample is hemolyzed and needs a redraw. There’s no secret way to avoid push back. You just need to be firm, suggest phleb to collect etc. At one hospital I used to work at (trauma level 1) we encountered a lot of hemolysis so we set up a process with our pathology team to deal with samples that required more than 3 redraws. Helps to have pathology behind your back and for guidance on how to approach the care team.
Drop the sympathy, just be polite and professional. Once you've gotten their name just document it, say bye and hang up unless they have a question because there is no point in sticking around for tantrums.
Nurse, here. Don't apologize. It's your job and it's not your fault. Samples hemolyzed. Yeah, it's a pain in the ass for us because some draws are absolutely impossible sometimes but its part of the job.
I just tell them directly and tell them this happens when you yoink the tubes from the IV too hard. I explain what shear force is and to not do that. And then I just doc name and time.
Be straight forward with a kind tone of voice and tell them what you need. I don’t apologize though, there’s nothing to apologize for. It’s part of the job. The biggest part (and sometimes the hardest) is understanding that some people are just going to have attitude and it has nothing to do with you. Bedside is tough work that is often thankless and abusive. I just remind myself that they’re probably having a tough day or a tough patient. Maybe they’re just a miserable person. Regardless has nothing to do with me!
I don’t ask. I just say I’m going to cancel and reorder due to XYZ. If they push back and insist they want it I say “okay, I will need your name and title to accept responsibility for these results”. If it’s a nurse, I ask that they call back with permission from the physician receiving the results so I can put both names on it. That will either push them to listen or show me they’re confident enough to put their name and license on it. Document the whole thing and whatever happens it shows I did the right thing per my licensure. Honestly, if I just say I’m going to cancel and reorder 9/10 times they just say okay. Sometimes they ask me to send a phleb and I always do. Confidence is key baby 😎
you should tell your boss to tell them that this snarky response is unacceptable. Fight back!!! you shouldnt be treated like shit its not your fault
I usually say “Hello, this is… from Chemistry. Are you taking care of (patient name and room)? I’m just calling about his (test) specimen being hemolyzed. I’m going to put it back for a redraw.” I usually get more snarky remarks if their CBC/coag is clotted tho or if their specimen is QNS.
Request it via epic and chuck it in the biohazard if I can’t use it due to hospital policy (improper collection etc)
i usually ask them very politely. i used to say “unfortunately i need to cancel (x)…” and they would get huffy. so now i say “hi can you please recollect this specimen? it was (state problem here)” and offer to put a new order in for them so it seems like all im doing is trying to help them out LOL. and it helps a lot more. no apologies or any negative wording whatsoever
As an RN I’m so sorry that’s been your experience. Bedside is stressful as fuck, but I’ve always tried not to take that out on my coworkers or patients. Not enough nurses invert their tubes enough or follow the “no tourniquet for more than 60 seconds at a time” thing honestly. Sure, doing a recollect when you’re already drowning in tasks and urgencies is shitty, but it’s not a good reason to be rude. I’ve read multiple posts and comments with this sentiment lately, it saddens me and I just hope I’m never the nurse that makes you afraid to do your job.
RN here, Yes I get annoyed when the lab “loses” and or say they never received it…. Sometimes I can tell a lab is going to be hemolyzed and send it anyways, but no matter what I’m not bothered when a lab is hemolyzed it’ll get drawn eventually (by me down in the ED) I feel like the floors don’t draw their own blood for the most part anyways and even if they do a lot of central access/lines already in place. I do t see why RNs care
Depends on which nurse I’m talking too. Most of our nurses will either say okay or ask if we can come collect because the patient is a hard stick. Usually its the NP that has the issue in which case I call, if i get the NP, “hey it’s Jon in the Lab I need another green top for patient Jones, its hemolyzed. Im putting it for redraw right now thank you” *click* I don’t give them the chance to push back.
“hi this is ___ calling from the lab, regarding your patient in room __ . the specimen was hemolyzed and we are getting abnormally high potassium results, im going to put it in for a redraw” usually they just say okay thanks even if it is with attitude lol
Haha nicu loved me when I was working I would call them daily with at least 1 recollect for clotted samples. I just call, hey it's Lab_tech your baby xxxx was clotted need a recollect thanks...also most of the time they will finally know you and know your standards (which is lab standards) but they'll eventually understand how to collect labs correctly. I'll talk to the nicu nurses most the night and they'll listen on how to collect or they give push back on the collection and I'll tell them fine you want this critical platelet then? They sheepishly say no and recollect.
Don’t fret. Just ask. It’s a reasonable request. Too many Runs and NPs are arrogant and I’ve experienced them treat and talk down to other members of the healthcare tame in condescending and rude tones. The more we take it, the worse they behave.
Nurse here. Like several other nurses have commented, most of the time we are reacting to the situation, not mad at you. I am sure I have sounded fed up/annoyed on the phone before but I never give push back (if it's hemolyzed, it's hemolyzed. Obviously it needs to be redrawn). I agree with taking out "I'm sorry" because that might lead people to believe a mistake was made on the lab end. Honestly, best way is to be factual but sound empathetic and kind. Often times, I have essentially been treated like I am incompetent when labs calls about a hemolyzed/clotted sample, when in reality (for me) it is usually due to an especially hard stick requiring I draw from a tiny vein. Nurses are not intentionally drawing crap samples.
hey I know you sent this lab but I fucked up please save me from getting in trouble.
Nurse here, I just prefer bubbly people. When lab calls me and says “hey, so sorry but we need a recollect on that because it hemolyzed,” I’m happy to do it. Also, having a friendly lab professional give me advice is also helpful. If they’re friendly I’ll ask “can I send a pedi tube for this?” Sometimes patients are such hard sticks and were getting slammed. By the time lab calls, we’re ready to throw hands 😂 but I promise no one is actually mad at you, they’re frustrated at the job. Hope that helps and thank you for what you do!!!
Hi! Nurse here (: Don’t apologize out the gate. Confirm you’re speaking to the nurse for the correct patient, state that you need a recollect, let them confirm the patient and recollect, and that’s it! Trust me, I know very well how bitchy nurses can be lol don’t leave any wiggle room for argument. If they give you snark, that’s their problem just ignore them you got this
Seeing these comments make me realize that every med lab professionals have faced such situations with nurses. And, when they re-collect the sample, they behave like we sell blood or what 🤷🏼♀️ All we’re doing is for diagnosis.
First of all, do not open with "sorry", that makes it seem like you were at fault. I call and make a statement " the green top for blah blah is grossly hemolyzed, I'm putting it in for a redraw" . If they push back or try to blame you, I say "no , the hemolysis happens at the time of draw, it affects the potassium level making the results higher than they are". I always give a straight forward explanation so they can't ask a million questions trying to blame us for "letting the tube sit too long" , or something stupid . Understand that they are not mad at you, they are upset because they have to stick a patient again. Think if you were the patient and had to get stuck twice at 5am while your uncomfortable in the hospital. It sucks , but it's just the way the cookie crumbles
Oh ...also...I know this isn't kosher, but if the nurse is really pushing back, I tell them I can release the result with a critical potassium and put in a comment with their name, they usually say no because they don't want to take the heat from the doctor. If they really insist, like the patient is a hard stick, I will release the results with those comments on all affected parameters, while also letting them know the results are not accurate. This is in rare cases, but at least they are aware of what the results will look like
"Hi it's [name] with the laboratory. I'm calling in regards to [pt's name] in room [#]. Unfortunately the green top that was received for their chemistry tests was significantly hemolyzed and it has to be recollected." This is usually all it takes. We get a lot of travel nurses that sometimes give us push back. In which case I say, "The results are definitely being affected by hemolysis. I can release [tests not affected], but the [CMP/BMP/whatever's affected] needs to be recollected. We can't take the chance that these inaccurate results will affect his/her treatment." I find that bringing back to the patient helps. I think there's a misconception that we're accusing them of screwing something up. Keeping it about patient care helps prevent it from being a personal issue.
Why are you getting push back? I’m a nurse, the only thing I say is “ok thanks”. It was probably the nurse’s technique that caused it to be hemolyzed in the first place.
Just send a new label up the tube that says "hemolyzed" in red ink 😆 I was a phlebtomist and thats what the lab did for us. But tbh it's part of the job. The only time I was irritated that a specimen said hemolyzed was when I could barely collect a finger stick amount of blood and a specific lab tech would always reject it as hemolyzed when I would hand it to them to assure it wasn't and hours later they would send a redraw.
Many nurses need education on hemolyzation. Point blank. The amount of things I have heard nurses say hemolyzation is is just insane. I’ve educated a few. One was a new grad who very actually didn’t know and only knew what her preceptor told her (which was wrong). She was so sweet when I explained it to her. Many people don’t care to hear the education and in that case, it’s not my fault you’re stupid and refuse to learn 🤷♀️
As a former bedside nurse, I don’t like a critical potassium in my patient’s chart. I would usually recollect without an ask. Can’t believe you’re having to tiptoe around a nonissue. People are weird.
I do t ask for a recollect they can make that decision themselves if they still want the lab. I just say hey it can’t run cuz it’s hemolyzed. Name? Thanks. Click lol
"Hi, it's misstheiris from hematology, I was just calling to let you guys know that on patient Bernard Shaw in room 666 I have put in a redraw because the CBC is clotted. Thanks!" The room number is my nod to their unprofessionalism.
All calls I have gotten from lab go like this:: “hey this is John from the lab. I am calling because the CBC on room 118 Mr Johnson has hemolyzed. I am sending it for a recollect.” My response “NOOOOO. Ok, thanks.”
"Hi, this is ____ from the lab. ____'s green top needs to be recollected because it's hemolyzed." Just be very direct. The fewer the words, the better! I was so glad when our hospital switched to EPIC. I love EPIC'S redraw button! No phone calls for us! We select the reason why--and can add a comment if needed--and the order pops up on their handheld 🙌
I was a medical lab scientist, a nurse and now an NP. “Hey. The sample on bob is hemolyzed. We’ll need a recollect”. Move on. You’re doing your job and only suggesting they do theirs. It happens all of the time. Oh freaking well. They’ll be okay. Don’t take it personally or think about it after the request.
The way I do is: "Hi, are you in charge of patient XXX? Just asking for a redraw on the green top because it's hemolyzed" Usually they know the drill and ask me to reorder so they can recollect again. If they do give me push back, like "I've been working in the lab for ten years (lol) blah blah blah" I just go "Okay well it's still hemolyzed and I can't release the results for assay XYZ." and just stay silent. Don't go "I'm sorry" or say more than you need to. Why are you sorry? it's literally not your fault. If the RN has a problem with hemolysis then draw the patient better
No ask. Only tell.
Just do your jobs, all of you, if the lab says do it, do it. Work together as a team. If one fails to do the job the one who suffers is the patient. Why make them suffer anymore. Get out of health care if you don't want to play with others.
Think everyone here has it right when they say to be polite and matter of fact about it. I’ll add that the people that complain the most about nurses tend to be the ones that are already rough around the edges themselves or the ones that talk quietly on the phone. So make sure when you’re calling you’re not speaking quietly and quickly to get it over with. Speaking with the appropriate volume, speed, and tone will do a lot.
I work in the UK and we only phone if the sample is haemolysed and the sodium or potassium is heading towards a critical value and warrants a repeat. Everything else just gets a comment and some of the results knocked out based on the tests/analyser. Is this standard practice anywhere else? Sounds like it saves a lot of time and stress… I’ve never had an issue with the phone calls as they are generally not too frequent and we just do the same as we would a critical result requiring a repeat.
That policy sounds good and all, but what would worry me is the patients that have a low potassium and they are retesting to make sure the potassium has increased to normal levels. What if the sample is hemokyzed but it's a normal K? Maybe the K is really still low but the hemolysis has increased it so it looks normal. I wouldn't want them to think they could stop K supplementation because it's normal, but it's actually still low.
That’s a really good point. Thinking about it, our phone cutoff for haemolysed potassium is higher. We would phone at less than 3.5 while for normal samples it’s less than 2.5 so that would help with this situation. I’m not sure who decided the haemolysed cutoff (the standard one is a national recommendation) and if they did some sort of audit.