Well said. I just had a similar situation with a chemistry (CMP) sample
last night. Luckily I am able to call the lab, tell them to release the
result and I will interpret it with the hemolysis in mind. And potassium
was the only value significantly affected, but not the values with which I
was concerned. By the time I was able to draw the specimen with the aid of
ultrasound, the patient had had 6 attempted veni-punctures, and I am pretty
sure that she did not want another. I got the information that I needed
without another needle stick.
On Wed, Feb 27, 2013 at 2:40 PM, Doc Holiday <[log in to unmask]> wrote:
> Have not kept up with this thread from the start, but it just caught my
> If I understand it, to summarise, the question was whether certain
> parameters which are not affected by the fault in the blood sample should
> or should not be reported (obviously, there would still be an evident
> indication that the sample was faulty and hence the other results are NOT
> reported). Can we rely on ANY test done on a faulty sample if we know that
> this particular test is not affected.
> Well, you cannot rely on a potassium reading from a haemolysed sample, but
> you can still cross-match it for transfusion...
> You cannot culture a non "clean catch" urine specimen, but if you dip it
> for blood and get a negative, would you need to ignore that?
> From: [log in to unmask]> You wouldn't ask a Radiologist to
> try to rule in or rule out pneumonia on a chest Xray of poor quality.
> --> Agree 100%. This would be the equivalent of getting a potassium
> reading from a clotted sample.
> BUT what if your radiologist gave you the following report:"Inadequate
> film - over-exposed and missing right costophrenic/lateral region.
> Endotracheal tube visible and properly positioned. A moderate left
> pneumothorax is present, with an air-fluid level and surgical emphysema
> throughout the soft tissues..."
> Do you ignore this and continue positive pressure ventilation on your
> trauma patient until you can get a better film? Do you wish your
> radiologist had instead simply refused to comment when he noted that the
> film was inadequate?
> In all of the above examples we would all see the need to repeat the test
> in order to get a result we required but which could not be obtained, but I
> think there is merit in avoiding the waste of what IS reliable in the
> search for the eventual perfection we do expect and know we will get in
> these cases eventually.
> Having said all that, I guess there would be the added curiosity, in a
> paid-per-item-profit-driven system... Can they "bill" the patient for an
> investigation which is inadequate? If they don't bill, then why should the
> patient get the result with no profit to the lab for a sample which was
> faulty through no error of theirs? What if the policy is NOT to bill for
> the X-ray in a case like the one I used above, with the "guarantee" that
> there will be a re-X-ray that COULD be billed, but then the doc decides to
> wait and NOT repeat the film until AFTER the chest drain has been inserted,
> thus a case which should have had two films billed only has one? Does that
> come out of the radiographer's monthly bonus? ;-)
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