BNA NURSES

15/09/2022

Blood, Blood, Blood

How to haemolyse blood.
Ever had the lab ring you in the ward and say you need to rebleed Mr Jones, his sample was haemolysed?

Well me too!
Haemolytic blood most commonly occurs when these four things occur:

1. You took the blood through a small or bent needle.
Use a 21g (green hub) needle to take blood where possible. I know we get those patients with tiny weedy veins but you are doing no favours using a 23g or smaller needle. Never bend the needle- a rigid tube structure will narrow its intralumenal diameter whenever you bend it. As red blood cells are squeezed through the bend their flow is turbulent, some cells fracture and release the haem into the serum - haemolysis.

2. If you take blood from a cannula, put syringe directly onto the cannula hub. Avoid pulling a sample through the valve of a b**g. Again, just like a bent needle, many b**gs have a valve structure that causes turbulence to flow, fracturing the RBCs.

3. Use the smallest syringe necessary, and ease back the plunger at the rate of flow so as to avoid too much swirling of the blood under high vacuum. A well engorged vessel will almost fill a 5-10ml syringe under its own pressure. 20-30 ml syringes create more vacuum and thus risk damaging the blood.

4. Never never never shake the blood tubes. Blood is a delicate fragile medium that when shook, breaks- literally. Be gentle and rock the blood tube to mix the sample 7-8 time before setting it down to bag.

Bonus tip for those who in rural areas spin their blood. Never spin it fresh. The yellow top tube (SST) must be allowed to form a clot befor you spin. This takes 5-15 mins for most patients. Those on warfarin or DOACs might need a couple of extra mins, but a red lump needs to be visible before you put it in the spinner.

There is probably more tips you can share below but as a Cannulation and venepuncture teacher for 15 years, these 5 tips would be the highest yield.
Quick post .
Hope it helps:
Check out our page and feel free to share the love.
If your crew need a cannulation workshop - I’m keen to oblige. You know how to find me.

15/09/2022

another article from a July 2019 post. Educational

Great article in Emergency Medicine News on the ongoing tPA debate. Dr. Mosley takes a deep dive into the tPA literature and explains why tPA has no role in the treatment of acute stroke. He also dispels the myth that “time is brain”, as all of the evidence shows us otherwise.


https://journals.lww.com/em-news/pages/articleviewer.aspx?year=2019&issue=07000&article=00022&type=Fulltext

31/07/2017

Is it irresponsible to advise type 2 diabetic patients to eat a low-fat, high-carb diet?

Dr Campbell Murdoch says, "Having seen the results, and after many hours of research to understand the physiology better, I believe it would be unacceptable for me to not offer advice on using a 'low-carb' diet to patients with type 2 diabetes."

He goes on to say, "At medical school 20 years ago, I was taught that type 2 diabetes is a progressive disease. This is not true—turn off the 'sugar tap' and the disease begins to reverse."

Dr Campbell says some doctors are concerned they are going against the guidelines by advising a reduction in carbohydrates because carbohydrates are considered "essential."

He says "This is not true. There is no such thing as an essential carbohydrate, and our livers are pretty nifty at gluconeogenesis [generation of glucose from non-carbohydrate sources] if required.

One of Dr Campbell's patients says:

"‘I was initially quite angry when told I could reverse my type 2 diabetes. I was angry because for 12 years the NHS (doctors, consultants and internet) told me the disease was irreversible and progressive. And of course they are right, if you follow the standard low fat high carbohydrate dietary advice.

"I changed to a real food, low carbohydrate, healthy fat diet in August last year and the results are, at least to me, a miracle. I no longer take diabetes pills, or pills for gout, or for high cholesterol, and I take fewer blood pressure pills. I have far more energy and now enjoy life to the full."

31/07/2017

Febrile neutropenia is a common complication in patients undergoing anticancer treatments. A neutrophil is a specific type of white blood cell (immune cell) that plays an important role as the body's first line of defense. The neutrophils usually make up about half to two-thirds of all white blood.....

29/07/2017

Interesting data

This case report describes a case of mistaken diagnosis in persons with external thumbnail characteristics indicative of Hutchinson sign.

28/07/2017

So less shivering seems a good idea!

This randomized clinical trial tested the effect of targeted temperature management to 33°C for 48 hours vs 24 hours on neurologic outcomes at 6 months in survivors of out-of-hospital cardiac arrest.

28/07/2017

22 Must-See Diagnoses-Case 21: 31 yo with after fall. What's the diagnosis? See the answer at: http://bit.ly/1IyGC6e

28/07/2017

This Clinical Evidence Synopsis summarizes a Cochrane review of clinical trials comparing the effects of antiviral therapies plus oral corticosteroids vs oral corticosteroids alone for patients presenting within 72 hours of onset of Bell palsy.

28/07/2017

Educate

27/07/2017

This has been promoted for over a year in Sydney.

Research shows advice to “complete the course” when taking antibiotics is outdated and could actually be making drug-resistant bacteria worse

26/07/2017

Traumatic brain injury (TBI) is a major public health concern, affecting an estimated 10 million people worldwide per year and more than 40% of US residents over the course of a lifetime.1,2 Mild TBI, also referred to as concussion, is defined as blunt, nonpenetrating head trauma associated with...

26/07/2017

AF.. or not AF.. that be the quandary

Edward H. Livingston, MD discusses atrial fibrillation with Eric N. Prystowsky, MD, author of Treatment of Atrial Fibrillation, and talks about new technologies to facilitate screening for atrial fibrillation with Leslie Saxon, MD.

26/07/2017

Good chart

Please click on the 'Download PDF' link above to get the A3 PDF version.

26/07/2017

14/02/2017

Organizing new website for BNA Nurses, but in process of relocating 460km north

15/10/2014

First office was at Bankstown, then also opened one at Parramatta, and at Ingleburn. Our head office at Leumeah became not only our nursing agency but the Fisher's Ghost Coach Terminal.

02/07/2014

In Queenstown, NZ....... have decided to not retire to Tasmania any more.... Queenstown wins on all counts!
Dart River Jet Safaris are excellent