Question

Case Study 3 Bob has been an MA, working on a Med Surg unit for approximately one year. He has a request to collect STAT electrolytes on a patient. A CBC is also ordered; this is not STAT. After properly identifying the patient, Bob checks for an appropriate site. The patient had an IV just above the wrist in the left arm. The right antecubital area was badly bruised, and the patient did not have any suitable veins in either hand Consequently, Bob decided to collect the specimens by capillary puncture, choosing the right middle fins a the collection site. After making the puncture, Bob decided to collect the electrolytes first because they are STAT and he was having difficulty getting a good blood flow. He was able to fill the serum microtainer and proceeded to collect the CBC. He had to use a lot of pressure on the finger to keep the blood flowing, but he eventually filled a lavender microtainer for the CBC. After the samples had been submitted to the lab he was told to recollect the CBC because the results were questionable. QUESTIONS 1. What was most likely wrong with the CBC sample? 2. Why was only the CBC affected? 3. What procedural error did Bob commit? 4. How should the specimen be mixed during collection?

Answer 1

1. What was more likely wrong with the CBC sample?

Bob used a lot of pressure on the finger to keep the blood flowing. Applying pressure or squeezing the finger makes the blood dilute with the tissue fluid that is plasma, which raises the likelihood of hemolysis.

2. Why was only the CBC affected?

The pressure was applied on the finger only when CBC was collected.