blood cultures

yesterday was a busy day. and in some strange way, i needed a busy day. i needed a thousand little and strange tasks to keep my mind churning on work instead of my life.

i had a 30 year old patient yesterday; he is 8 days older than me. his transplant was two weeks ago and still, he has no white blood cells. by now, at least a few hundred little white blood cells should be present, circulating in his blood stream. his immune system should be on it's way back. he needs an immune system. his temperature was 104 ALL day long. and he was miserable. sweating. shaking. nauseated.

one of my jobs was to do blood cultures. typically that means, draw about 30mL of blood from a patient's permanent line - we call them Hickman's (after the doctor that invented that specific central line). i call it a faucet. it's an easy way to access the patient's blood; it's like a permanent IV that threads a catheter all the way to the entrance of the heart. anyway, a set of blood cultures requires lots of supplies - syringes, flushes, blood culture bottles, patient labels, a transfer device, plastic bags, a requisition slip with more identification labels. we draw the blood from the line and then, with aseptic technique, transfer the blood in three different bottles for the lab to watch and grow out bacteria. typically, it's a simple process. a good nurse can draw the blood in less than two minutes and be out of the room in less than five. i'm a good nurse.

but...

yesterday, i was to draw blood cultures from EVERY line the patient had coming out of his body. and the number of lines this patient had is inconceivable. a PICC line in his right arm. a large bore dialysis catheter in his right chest. a portacath in his left chest. and a peritoneal dialysis catheter in his abdomen. some of the catheters have two lumens, a white and a red side. so, in total, i drew six sets of blood cultures, each with three bottles (for those numerically challenged, that's 18 bottles!). i took so much blood that my patient's hematocrit dropped three points and he needed 2 units of blood.

the best part of my day was when the lab called me. it was only about 10 minutes after i had sent down ALL of the bottles, each delicately and meticulously labeled. often the lab calls to clarify a problem. sometimes it's an easy fix - "you forgot to note the time of the draw." but sometimes it's a horrible call. if the lab says, "the patient labels on the samples don't match the labels on the requisition. you need to redraw your sample," you're screwed. you messed up big time. we've all done it. but it's frustrating. and for just a second, i feared that i would have to RE-draw ALL the patient's blood cultures.

instead, the lab technician said, "ma'am, did you send down lots of blood cultures a few minutes ago?" why yes, yes i did. "well," he said, "you're hired. you did everything right. the labels are perfect. the requisitions are filled out 100% correctly. thank you for doing your job so well. you just made my job easier."

a simple compliment made my day. somebody appreciated my hard work. it's nice to be reminded every now and then that you're good at something - even if it's totally random and un-applicable to real life. i'm good at drawing and labeling blood cultures. what are you good at?