This week, our BC Children's Hospital was treated to a Code BROWN, or major chemical spill of parafromaldehyde. Para-formaldehyde can cause skin and eye irritation, and can be harmful if inhaled. It is also highly flammable.
http://www.cbc.ca/news/canada/british-columbia/bc-children-hospital-chemical-spill-1.3259740
Each hospital drills every year in case of this occurrence, and the procedures in place seem to have been followed to the letter. No one was reported hurt, and the spill was contained in under two hours.
Just in case you aren't familiar with common protocol, each hospital usually has a color coded to indicate that a chemical spill has occurred to the staff without alarming patients or visitors. Once a Code Brown is called, there are processes in place to do some or all of the following:
- Summon security or someone trained to address the spill.
- Evacuate anyone who could come into contact with the spill, or fumes from the spill.
- Call in a HAZMAT team or fire fighters to address more dangerous chemicals.
That's all well and good, but when is a Code Brown called, and what should lab staff do directly after a spill?
First, lab staff need to determine if they should be calling a Code Brown, or cleaning it themselves. Questions to ask include:
Do you know what chemical was spilled?
What volumes are involved?
What are the hazards of the chemical that was spilled (Found in the MSDS kept on site by law)
Is there a Chemical Reaction or hazard present, and can the area be cordoned off?
Do you know where the spill kit is, and how to use it?
Make sure to inform your supervisor and close by staff about the spill before attempting to clean it up.
ALWAYS CHECK AND WEAR APPROPRIATE PPE BEFORE APPROACHING THE SPILL.
Some spills you will need breathing equipment, or special gloves. Do not make assumptions; always check the MSDS.
A Code Brown is called if there is a spill over a certain volume of chemicals or matter deemed low risk, or any amount of spill of high risk chemicals or gases. Each facility will have it's own categories.
Low Risk Spills: (Dealt with by lab staff, not HAZMAT/Code Brown)
This tends to include a chemical spill less than 500 mL of a known chemical that shows no visible chemical reaction (bubbling, hissing, gases emitting when in contact with surface spilled onto).
Example: Spilling 10 mL of 0.1M HCl onto a bench surface.
Intermediate Risk Spills: (Dealt with by security and lab staff, Code Brown called)
This includes chemical spills that are large volume and can't be handled by lab staff alone, that are not reacting with the surface spilled onto, and also are not emitting fumes. You would call a Code Brown in this case, and security would come and help you keep people off the area, and clean it up.
Major Risk Spills: (HAZMAT, Security, Lab Staff work together, Code Brown called, Evacuation)
Either the substance spilled is unknown, the volume of the spill is unmanageable, the chemical fumes/contact is dangerous, or there is known/visible reactions that are happening between the chemical and the spill surface.
This is where parafromaldehyde lies, if dealt with outside of a fumehood. It is both highly flammable and emits fumes that are harmful to humans if inhaled. It makes sense that the evacuated the hospital, and ensured no harmful fumes/risk of fire was transfered to staff and patients.
Wednesday, October 7, 2015
Thursday, April 30, 2015
Link: CBC Article on 2015 Research towards the universal blood type
http://www.cbc.ca/news/canada/british-columbia/ubc-researchers-step-closer-to-creating-universal-blood-type-1.3056650
Thursday, April 2, 2015
Too much Iced Tea causes Kidney Failure - NEJM Article
Case Study: A man with kidney failure caused by oxalate toxicity from drinking a 16 glasses of black
iced tea a day... (Iced Tea has about 500 to 1000 mg of oxalate per litre; overloaded kidneys)
This is a short (but sweet!) case study involving both pathology and chemistry; patient comes in with weakness and body aches, initial blood work up shows high serum creatinine and a high number of calcium oxalate crystals in the urine.
Followup testing showed 24 hour urine oxalate excretion to be elevated; also a kidney biopsy showed oxalate crystals. Patient history revealed none of the usual causes for this (hx of gastric bypass, ethylene glycol poisoning, 'juicing', or vitamin C overdose), but above detailed habit of iced tea.
Interesting!
Sunday, June 1, 2014
[Urinalysis] Sperm
Image by Cooldesign, from FreeDigitalPhotos.net
When we take a look at urine under the microscope, there are things we tend to look for. Most of them seem pretty clear cut on why they are reportable - they are signs of infection or conditions that the doctors can then treat. Bacteria, and WBC are both obvious signs of urinary tract infections; yeast signal a yeast infection. White cells casts can predict pyelonephritis, and red cell casts glomerulonephritis.
But what about sperm?
Shouldn't sperm be something we see in every male midstream sample?
Nope.
Spermatozoa are only normal if the sample isn't midstream, AND the patient has had sexual activity within five hours of collection. As collection protocol for urinalysis is midstream, we should not expect to see sperm in sample.
Sperm is seen in midstream urine when the bladder sphincter fails to produce the usual tightening before ejaculation. The sperm then travel into the bladder instead of out of the body, and are excreted during urination. This condition is called retrograde ejaculation, and can be due to nerve damage, diabetes, medication side effect, post bladder/prostate surgery, or weak muscle condition. This is one of the more common causes of male infertility, and can be treated.
Another reason sperm may be seen in male patients' urine is prostatitis. When the prostate is swollen with fluid, it can block off the paths that sperm would normally travel, causing a redirect. This can be due to prostate cancer, recent surgery, bacterial infection of the prostate or urinary system, or arousal without ejaculation. Sometimes this is also seen when methods to avoid mess are used in sexual expression; the interference (or application of Hughes Method) to prevent ejaculation can cause backflow into the bladder. Unless other symptoms are present, treatment is generally unnecessary.
Reporting sperm in male urine can be a real clue to infertility patients
.What about females and children though? You should never see sperm in a child's urine. If you do, you must report it; that child could be sexually abused. I would advise confirming with a second sample if you can, to ensure there are no mistakes. Know that you cannot be sued for bringing this to your hospitals' attention so they can follow up; this is part of your duty to report as a technologist. In one case, the parents attempted to sue, but failed. Seeing sperm in an adult female's sample is a non-clinical finding.
[Hot Topic] CBS Blood Donation Policy, Update
Last year, the big news was Canadian Blood Service's attitude change towards accepting blood donations from gay men. Previously completely banned, gay men can now donate blood if they have had no same sex sexual activity for the past five years.
This is a huge step for Canadian Blood Services.
Last year, they had still not quite ironed out how this change would echo through the rest of their policies.
For instance, what about women who had had sex, even once, with a man who had had a male sexual experience? Up until last May, they were also still excluded from giving blood. Even last May, when I called and spoke with a CBS associated nurse, they were still excluding those women from giving blood, as they "just didn't know" how things would play out.
I called back this year and clarified. Now the question for women has been changed from
"Are you a woman, who has had, even once, had sex with a man, who has had sex with a man?"
to,
"Are you a woman, who has had sex with a man, who has had sex with a man, in the last five years?"
I.e. if the same sex sexual experience took place greater than five years ago, then you can donate.
This is particularly applicable for bisexual men and women, or partner's of those who "experimented" in college. Previously, if they were aware of their partner's past, they would have been permanently deferred. Now, if it has been more than five years since the MSM encounter, women are eligible to donate again.
As always, if you have questions about your eligibility to donate blood in BC, call the donor line at 1888- 2DONATE, and ask for the nurseline. They will be able to help address concerns about whether you are a good fit for a donor.
CBS continues to collect data to see if it can relax it's deferral policies in the manner any further.
It will likely be at least ten years of data collection though before we see any more change. One step at a time though is all we can do.
Hopefully, the screening process will continue to move more towards an actual sexual-risk based policy based on number/frequency of sexual partners rather than the sexual orientation of the donor.
Friday, May 2, 2014
[Acronym of the Day]: DAP
Acronyms are certainly part any workplace's jargon; the lab is no different in that respect.
One of the more important ones to know about is DAP.
What is DAP, and what does it do? The Diagnostic Accreditation Program, according to the DAP website:
"sets accreditation standards for best practices that are evidence based, outcome focused and aligned to the principles of continuous quality improvement. The accreditation standards are comprehensive and address medical, technical, and management aspects of service delivery."
Since 1971, each facility in British Columbia that performs laboratory testing must be DAP reviewed, public or private.
What this boils down to is every four years, an outside team of your profession/stakeholders comes in and goes over your work with a fine toothed comb to ensure you are meeting standards in patient care, quality, and safety. It sets an external standard of trust in the system, and encourages vigilance in maintaining current methods, up to date safety procedures, and overall evidence based best practice.
DAP also produces a line of external quality control samples, or blind controls, to ensure your results are accurate. They are released quarterly, and laboratories that do not meet standards are held accountable.
The DAP is headed by some of the top minds in each discipline in the province; there are representatives from the management, educational and the vocational views on each board. They in turn supervise DAP teams, each formed depending on the facility and disciplines necessary in review.
If you have a chance to participate in a DAP review of another facility, take it; it's a great way to learn from the ground up.
One of the more important ones to know about is DAP.
What is DAP, and what does it do? The Diagnostic Accreditation Program, according to the DAP website:
"sets accreditation standards for best practices that are evidence based, outcome focused and aligned to the principles of continuous quality improvement. The accreditation standards are comprehensive and address medical, technical, and management aspects of service delivery."
Since 1971, each facility in British Columbia that performs laboratory testing must be DAP reviewed, public or private.
What this boils down to is every four years, an outside team of your profession/stakeholders comes in and goes over your work with a fine toothed comb to ensure you are meeting standards in patient care, quality, and safety. It sets an external standard of trust in the system, and encourages vigilance in maintaining current methods, up to date safety procedures, and overall evidence based best practice.
DAP also produces a line of external quality control samples, or blind controls, to ensure your results are accurate. They are released quarterly, and laboratories that do not meet standards are held accountable.
The DAP is headed by some of the top minds in each discipline in the province; there are representatives from the management, educational and the vocational views on each board. They in turn supervise DAP teams, each formed depending on the facility and disciplines necessary in review.
If you have a chance to participate in a DAP review of another facility, take it; it's a great way to learn from the ground up.
Monday, April 14, 2014
New in Serum Osmolality: Zander's Formula
Serum Osmolality and OGAP... two of the formulae chemistry techs can do in their sleep. We all know the standard textbook Worthley et al equations;
Serum Osmolality (all in mmol/L):
2 Sodium + Urea + Glucose + 1.2 Blood Alcohol
Osmolar Gap
Measured Osmolality - Calculated Osmolality
To make it easier for doctors or nurses without a lab handy, many websites/apps are even set up to do the math, with the reference ranges and criticals on the side. We've used the same formula for more than twenty-five years.
Last year, 2013, Zander's Formula was released as a "better, more useful calculation" for osmolality.
Zander's Osmolality (all in mmol/L):
(Sodium + Urea + Glucose + Potassium + Bicarbonate + Lactate +6.5)x0.985
How is it better? Not only does it show a much better correlation between calculated and measured, it also has the closest 95% limits of agreement, when compared to 36 other possible formulae, (including the Worthley.)
This new formula also only uses analytes commonly found on a blood gas analyzer panel. This will enable, in the future, a calculated osmolar gap to be added on automatically to trauma panels, giving the clinician one more piece of the puzzle in differentiating metabolic acidosis.
This is important because with such improved accuracy of OGAP, we would reduce the necessity for follow up methanol or ethylene glycol testing on many of our trauma patients who present with elevated gaps due to renal failure/shock/lactic acidosis, thus speeding diagnosis. (Remember though, the measured osmolality MUST be done by freezing point method if looking for any types of alcohol, as vapour pressure methods don't detect volatile solutes such as ethanol/methanol)
That said, Zander's is built to be used broadly; it doesn't include ethanol contribution as a matter of course; you would have to add the 1.2(ALC) yourself, to rule out/confirm any gap being due to ethanol rather than methanol, mannitol, or any of the other usual suspects. Depending on your population and preferred use, it could do with some tweaking.
Saturday, June 1, 2013
[Hot Topic] Changes to Blood Donation Policy
Jargon: none
The right to donate blood into our national Canadian reserve has been limited to straight donors for over twenty five years (since 1985). The act of "men having sex with men, even once" has been listed as a clear high risk activity on questionnaires, and up until this year, has been a cause for a lifetime deferral, or ban, from donating. This was during the start of the AIDS/HIV epidemic, and we simply didn't have the testing knowledge to differentiate who had AIDS/HIV and who didn't. What we did know is that AIDS/HIV was being seen mainly in one population (MSM), and we needed to do everything in our power to prevent it's spread. At the time, generally everyone agreed that it was a good idea to ban donation.
Canadian Blood Services website states:
"All men who have had sex with another man, even once, since 1977 are indefinitely deferred. This is based on current scientific knowledge and statistical information that shows that men who have had sex with other men are at greater risk for HIV/AIDS infection than other people."
While the highest incidence of AIDS/HIV diagnosis/transmission is still from men having sex with men, there is also a high rate of heterosexual women being diagnosed each year. Our rules are no longer taking the appropriate risk factors into consideration... It's not the orientation that increases risk, it's the sexual behavior.
Right now, the donation questionnaires default to permanent ban on blood donation for any male on male experimentation at all; a permanent deferral for women who have sex with a man who has ever had any sexual contact with a man(bisexual men); and yet only a six month deferral on heterosexual people who have had sex with someone new. It's deemed to be "too invasive" and possibly "would deter donors" to ask any more specific questions about the sex lives of heterosexual donors. So Suzie, who has had three failed dating relationships this year in which she didn't use a condom, gets a six month deferral; but a gay man who has been monogamous with his partner for tens years would still be automatically banned for life. If Suzie starts a relationship with Jim, who experimented in college before deciding that he was heterosexual, Suzie now is deferred for life as well.
Over the last ten years or so, momentum to lift this ban has increased exponentially. The argument states that it is not the genders of the people have sex that is risky, it is the sexual behavior. Our technology has improved to the point of being able to screen for HIV in under three minutes, if testing for HIV antibodies (Health Canada approved BioLyticalInsti HIV test), or within ten days of infection, with the RNA amplication method. These testing methods have a 99.96% accuracy rate, and current process ensures blood is double checked for HIV/AIDS with a traditional test as well. We no longer have to worry about not detecting the AIDS virus.
On May 22, 2013, Canadian Blood Services release a memo updating it's policy to reflect this advance in technology and a more action based deferral policy. Now, Men who have had sex with men, if they are abstinent for five years, are now eligible again to donate blood. This change in policy, while a step in the right direction, is still problematic. The centre's media contact states that they will be collecting data on the blood donated from this new group of donors, and if encouraging, they will be opening up more opportunities for gay men in monogamous relationships to donate as well.
Wrinkles that are still being ironed out include the donation status of women who have had sex with bisexual men, and the timeline of the introduction of these new policies.
CBS is currently aiming for a summer 2013 change to it's questionnaires, and further changes to come.
The right to donate blood into our national Canadian reserve has been limited to straight donors for over twenty five years (since 1985). The act of "men having sex with men, even once" has been listed as a clear high risk activity on questionnaires, and up until this year, has been a cause for a lifetime deferral, or ban, from donating. This was during the start of the AIDS/HIV epidemic, and we simply didn't have the testing knowledge to differentiate who had AIDS/HIV and who didn't. What we did know is that AIDS/HIV was being seen mainly in one population (MSM), and we needed to do everything in our power to prevent it's spread. At the time, generally everyone agreed that it was a good idea to ban donation.
Canadian Blood Services website states:
"All men who have had sex with another man, even once, since 1977 are indefinitely deferred. This is based on current scientific knowledge and statistical information that shows that men who have had sex with other men are at greater risk for HIV/AIDS infection than other people."
While the highest incidence of AIDS/HIV diagnosis/transmission is still from men having sex with men, there is also a high rate of heterosexual women being diagnosed each year. Our rules are no longer taking the appropriate risk factors into consideration... It's not the orientation that increases risk, it's the sexual behavior.
Right now, the donation questionnaires default to permanent ban on blood donation for any male on male experimentation at all; a permanent deferral for women who have sex with a man who has ever had any sexual contact with a man(bisexual men); and yet only a six month deferral on heterosexual people who have had sex with someone new. It's deemed to be "too invasive" and possibly "would deter donors" to ask any more specific questions about the sex lives of heterosexual donors. So Suzie, who has had three failed dating relationships this year in which she didn't use a condom, gets a six month deferral; but a gay man who has been monogamous with his partner for tens years would still be automatically banned for life. If Suzie starts a relationship with Jim, who experimented in college before deciding that he was heterosexual, Suzie now is deferred for life as well.
Over the last ten years or so, momentum to lift this ban has increased exponentially. The argument states that it is not the genders of the people have sex that is risky, it is the sexual behavior. Our technology has improved to the point of being able to screen for HIV in under three minutes, if testing for HIV antibodies (Health Canada approved BioLyticalInsti HIV test), or within ten days of infection, with the RNA amplication method. These testing methods have a 99.96% accuracy rate, and current process ensures blood is double checked for HIV/AIDS with a traditional test as well. We no longer have to worry about not detecting the AIDS virus.
On May 22, 2013, Canadian Blood Services release a memo updating it's policy to reflect this advance in technology and a more action based deferral policy. Now, Men who have had sex with men, if they are abstinent for five years, are now eligible again to donate blood. This change in policy, while a step in the right direction, is still problematic. The centre's media contact states that they will be collecting data on the blood donated from this new group of donors, and if encouraging, they will be opening up more opportunities for gay men in monogamous relationships to donate as well.
Wrinkles that are still being ironed out include the donation status of women who have had sex with bisexual men, and the timeline of the introduction of these new policies.
CBS is currently aiming for a summer 2013 change to it's questionnaires, and further changes to come.
Wednesday, January 11, 2012
So You Want To be a Medical Technologist - Practicum Tips
So you have entered the medical technologist program, and are about to embark on your first practicum, away from your classmates and familiar environs. You've arranged a new place to live for the quarter (as most practicums at BCIT and NAIT are speckled throughout B.C and Alberta), and are armed with your Blue Book of Learning Requirements. For some of you, this will be your first foray into a workplace.
Welcome.
Some things to remember though about your soon to be teachers.
Teaching technologists are a thing of the past.
All technologists showing you the ropes will be expected to do so on top of holding their regularly scheduled benchwork. The majority of us will not be paid for teaching you during your practicum. Those that will, will be paid at most an extra three dollars a day (oh, wonderful 0.30/hr differential). If they are to do a through and useful job teaching you, you can bet they have put in time at home to prepare lesson plans, review sheets, and to dust off the hows and whys to explain things they know bone deep. They will have shown up five or ten minutes early to plan out the day's work, pull some interesting cases for you, and figure out how to fit giving you the most experience as well as the odd rare test (oh, fecal meat fibres) into the schedule. In return for this, they expect three things.
1) Respect for the fact that they are taking the time to do so.
2) That you listen, learn, and review pertinent theory before time if asked.
3) That you follow instructions.
They are, for the most part, not millenials. The style of discourse you may be used to among your peers (and to your parents) is not found in this particular work environment. Talk-back, whining, or arguement when your instructor or section head asks you to do something is both unappreciated and will frankly prejudice against your hiring (and your school's students being accepted back) for in the future.
After putting in said thought, it highly irks to give instructions for a student to help out for a few minutes with a skill they have already mastered, and be met with talk-back and stated entitlement of Learning All Teh Time. Simple logic states that if you want more of your teacher's time to help walk you through doing new things, the workload must be met too. Loading samples onto machines, or aliquoting tubes under supervision can help make that twenty minutes to talk about fluid pH theory, or to learn how to troubleshoot an osmometer. What is helpful is having two or three topics you want to cover in your head, so if we have a spare ten minutes, you can bring that up and we can plan that into the day.
Your Blue Book:
Yes, we are aware you have one. Every program sends their students with some version of competency requirements. We absolutely do not want you to bring the book to every bench day. As it must be returned to your practicum supervisor at the end of the three years, we want to keep it non-biohazardous. ^^ Ideally, you would bring it on your second to last day on each area, so we can then zero in on anything not covered during the usual process.
Appropriate Dress:
In general, scrubs are safe. Some labs allow street clothing, if gowns are worn overtop, and others prefer business casual. All of these work.
Do not wear shirts with obscenities on them, revealing clothing such as tube tops or shortie-shorts, or flip flops. You may think that an obvious statement, but we've had to memo two separate schools for students thinking "casual" meant variations of club-wear.... And flip flops will not protect you if you drop a glass tube on your foot. Think professional.
Break Times:
Finally? Each department generally has a break schedule of where they go each day. Take at least the first few days and follow along to get to know people, and how the department functions. Show off your social skills, and that you can fit in. After those few days, feel free to eat where you want, but if you don't follow your trainer to where ever the pack eats, people will think you are stuck up, socially maladusted, or simply not remember you from the multitude of other students coming through. All are negatives when it comes hiring time.
[Case Study] Bright Green Urine
Patient A is admitted for cardiac surgery on January 10. All his pre-op chemistry tests are normal, and he is cleared for surgery. His surgery is sucessful, and post-op blood and urine samples are submitted to check his status. His urine sample immediately drew notice upon arrival to the lab. Upon analysis, the urine showed:
Colour: Bright Green
Clarity: Clear
pH : 5.5
Specific Gravity: 1.015
Leukocytes: Negative
Hemoglobin: Trace
Protein: Negative
Ketones: Negative
Urobilinogen: Negative
Nitrite: Negative
Microscopic analysis confirmed the occasional red blood cell and 6-10 epithelial cells. No bacteria were seen.
The pre-operative urine sample was pulled, and the colour was a normal clear yellow with normal results.
But what was causing the urine to be so oddly coloured? Was it clinically significant? Upon investigation, the ward confirmed sample quality and a list of possible causal drugs were produced. Among those drugs was a short-acting, intravenous sedative-hypnotic agent by the name of Proprofol (Diprivan). Used to induce and maintain anesthesia or sedation, one of the more infrequent side effects (in < 1%) from Proprofol is a production of bright green urine. It is not clinically significant, and the colour change is known to cease once the proprofol is discontinued.
Other more common causes of the colour change are:
- Methylene Blue: (Blue + Yellow = Green): used in treatment of malaria (third world countries due to cost), methemoglobinemia, cyanide poisoning, and cancer. Also a component of an older urinary analgesic.
- Pseudomonas infection: This produces a deeper, forest green colour with a grapey smell.
- Dietary changes: Examples are excess quantities of Clorets or Blue Listerine
- Magnesium Silicate (Doan's pills): A NSAID used for back pain. OTC medication.
- Medical imaging: Some dyes such as biliverdin are used to assist in in vivo scanning.
Medscape has done an article on similiar cases here.
Thursday, June 9, 2011
So you want to be a Medical Laboratory Technologist --Schools
Congratulations -- So you're thinking that you may want to be a medlab tech too.
Basic Info: Starting Salary at entry level is about $50 000, with pay increases as you gain experience and responsibilities. You can be employed at hospitals, research centres, vetrenary centres, private labs, or in commercial pharmeceutical development. This job is not suitable for those who are squeamish, who have open sores/bad acne, colour-blindness, or who cannot make appropriate decisions under pressure. It is suitable for those who love science, enjoy helping people, and solving problems under the clock.
First things first. Do you have a solid science background in highschool? Have you taken(and done well in) Biology 12, Chemistry 12, Physics 11, University Math 12, and English 12?
These are all baseline necessary for entry.
Note that the links of below schools have a list of basic requirements, but also all have a fine print line stating that most sucessful applicants have at least first year university science experience as well. I would recommend at least first, and maybe second year university science before applying to the program -- Of the six fresh-from-high-school students in our class of sixty-five, only one graduated with us. That girl's mother was a medlab tech.
'Nuff Said.
Also note that all practicums below are UNPAID. Do not rely on having to have a job to get through that year period, as working practicum full time and being responsible for online classes is not a good formula for keeping a second job.
Most programs fill up at least a year in advance, so apply early. For example, this year's BCIT intake in 2012 is already full. They are starting to take applications for 2013 now.
There are four main schools in Western Canada that are able to prepare you for the CSMLS exam necessary to work in Canada. I'm going to go over the basic differences of each.
1) BCIT: (2.5 year program) Includes interspersed practicum to make those all important
contacts. Students can finish early, and work as QNR(Qualified
Not Registered) to make some extra cash while waiting to take
their CSMLS exam. Usually about 60 to 70 seats available each
year. Requires 30+ hours of health care volunteer experience.
2) NAIT: (2.0 year program) Includes one year of in school studies, one year of practicum.
Special post-secondary requirements of an Accredited Medical
Terminology course and a year of university Anatomy and
Physiology with a minimum grade of 60%. Typical successful
Applicants have a 80-83% average in these. Seats unknown.
3) SAIT: (2.0 year program) Includes one year of in school studies, and a second year of 1/2
practicum/1/2 in class studies. No special requirements over
high school classes. 48 seats available each year.
Already full for Fall 2011.
4) U of Alberta (4.0 year program)
Format is two years university classes, then a year of practicum,
followed by a final year of university classes. Note that the first
year is a "pre-professional year" at any university. That's when
you take the same 30 credits of courses as all the other hopefuls
and then apply to the Medical Laboratory Program at the
beginning of second year. B- average at university or higher was
last year's standard to get in. 29 seats are available each year.
Whoah, information dump. Wrapping this up and will continue in a followup post.
Basic Info: Starting Salary at entry level is about $50 000, with pay increases as you gain experience and responsibilities. You can be employed at hospitals, research centres, vetrenary centres, private labs, or in commercial pharmeceutical development. This job is not suitable for those who are squeamish, who have open sores/bad acne, colour-blindness, or who cannot make appropriate decisions under pressure. It is suitable for those who love science, enjoy helping people, and solving problems under the clock.
First things first. Do you have a solid science background in highschool? Have you taken(and done well in) Biology 12, Chemistry 12, Physics 11, University Math 12, and English 12?
These are all baseline necessary for entry.
Note that the links of below schools have a list of basic requirements, but also all have a fine print line stating that most sucessful applicants have at least first year university science experience as well. I would recommend at least first, and maybe second year university science before applying to the program -- Of the six fresh-from-high-school students in our class of sixty-five, only one graduated with us. That girl's mother was a medlab tech.
'Nuff Said.
Also note that all practicums below are UNPAID. Do not rely on having to have a job to get through that year period, as working practicum full time and being responsible for online classes is not a good formula for keeping a second job.
Most programs fill up at least a year in advance, so apply early. For example, this year's BCIT intake in 2012 is already full. They are starting to take applications for 2013 now.
There are four main schools in Western Canada that are able to prepare you for the CSMLS exam necessary to work in Canada. I'm going to go over the basic differences of each.
1) BCIT: (2.5 year program) Includes interspersed practicum to make those all important
contacts. Students can finish early, and work as QNR(Qualified
Not Registered) to make some extra cash while waiting to take
their CSMLS exam. Usually about 60 to 70 seats available each
year. Requires 30+ hours of health care volunteer experience.
2) NAIT: (2.0 year program) Includes one year of in school studies, one year of practicum.
Special post-secondary requirements of an Accredited Medical
Terminology course and a year of university Anatomy and
Physiology with a minimum grade of 60%. Typical successful
Applicants have a 80-83% average in these. Seats unknown.
3) SAIT: (2.0 year program) Includes one year of in school studies, and a second year of 1/2
practicum/1/2 in class studies. No special requirements over
high school classes. 48 seats available each year.
Already full for Fall 2011.
4) U of Alberta (4.0 year program)
Format is two years university classes, then a year of practicum,
followed by a final year of university classes. Note that the first
year is a "pre-professional year" at any university. That's when
you take the same 30 credits of courses as all the other hopefuls
and then apply to the Medical Laboratory Program at the
beginning of second year. B- average at university or higher was
last year's standard to get in. 29 seats are available each year.
Whoah, information dump. Wrapping this up and will continue in a followup post.
Medical Laboratory Education -- Bachelor's versus Certification
At first glance, the question of which of a bachelor's degree at a nationally recognized university or a three year certificate at a technology institute is more employable looks rhetorical.
Of COURSE a bachelor's degree in Medical Laboratory Science will get you job in a hospital faster...right?
Wrong.
One of the traps students fresh from high school fall in each year is thinking that a Bachelor's in Medical Laboratory Science from UBC/U of Calgary will enable you to work in hospital laboratories. They don't. Such programs are for job steams that focus on either university research(mainly in universities, so you will be competing will all those other Science degree graduates for graduate student salaries), or for those who already have a certificate and are returning to gain ART or management level equivilents.*
In order to work in a hospital laboratory here in British Columbia, one must pass the Canadian Society for Medical Laboratory Science national exam.
In order to be eligible to even take said exam, one must have taken an accreditted CSMLS course. The University of British Columbia is not accreditted by CSMLS, so thus you are not even eligible to take the qualifying exam.
Thus, to become employable, the student rockets off to to BCIT, NAIT, or SAIT to take the full three year course to qualify for hospital work. That's right -- seven year's minimum of school to start working, if you take the university route. Ug. And that's wishing that you knew straight from the starting gate what you wanted to do with your life. Many of my classmates at BCIT had bachelor's or Master's degrees in biology, chemistry, and microbiology before starting at BCIT.
If you're interested in becoming a medical laboratory technologist, there is a post coming about just that.
*The exception here the Bachelor of Medical Laboratory Science of the University of Alberta. The program is four years in length, and focuses on university theory, the nitty gritty needed in the workplace, and the knowledge base to pass the CSMLS exam.
Of COURSE a bachelor's degree in Medical Laboratory Science will get you job in a hospital faster...right?
Wrong.
One of the traps students fresh from high school fall in each year is thinking that a Bachelor's in Medical Laboratory Science from UBC/U of Calgary will enable you to work in hospital laboratories. They don't. Such programs are for job steams that focus on either university research(mainly in universities, so you will be competing will all those other Science degree graduates for graduate student salaries), or for those who already have a certificate and are returning to gain ART or management level equivilents.*
In order to work in a hospital laboratory here in British Columbia, one must pass the Canadian Society for Medical Laboratory Science national exam.
In order to be eligible to even take said exam, one must have taken an accreditted CSMLS course. The University of British Columbia is not accreditted by CSMLS, so thus you are not even eligible to take the qualifying exam.
Thus, to become employable, the student rockets off to to BCIT, NAIT, or SAIT to take the full three year course to qualify for hospital work. That's right -- seven year's minimum of school to start working, if you take the university route. Ug. And that's wishing that you knew straight from the starting gate what you wanted to do with your life. Many of my classmates at BCIT had bachelor's or Master's degrees in biology, chemistry, and microbiology before starting at BCIT.
If you're interested in becoming a medical laboratory technologist, there is a post coming about just that.
*The exception here the Bachelor of Medical Laboratory Science of the University of Alberta. The program is four years in length, and focuses on university theory, the nitty gritty needed in the workplace, and the knowledge base to pass the CSMLS exam.
Links of Interest
Been a while since I've posted, so I thought I'd toss out a couple links on interesting developments in the medlab world.
1)Should herbalists use lab tests in their practise? Jake Fratkin discusses.
2) The development of a painless needle -- Japanese Researchers are working on the development of a serrated needle, based on the shape of the probiscus of a mosquito. See here for more information.
3) The development of a patch to apply vaccinations instead of needles -- See here.
4) An article on needle-free injections, including nasal sprays, patches, and genetically-altered potatoes that protect you from cholera -- here.
5)Here's an older peice detailing the pain patches that hospitals such as BC Children's Hospital have in use for before-venipuncture. In short, the patch uses a small electric current to dispense lidocaine directly to the venipuncture area, numbing it up. It's always good to know your technology before you need it.
1)Should herbalists use lab tests in their practise? Jake Fratkin discusses.
2) The development of a painless needle -- Japanese Researchers are working on the development of a serrated needle, based on the shape of the probiscus of a mosquito. See here for more information.
3) The development of a patch to apply vaccinations instead of needles -- See here.
4) An article on needle-free injections, including nasal sprays, patches, and genetically-altered potatoes that protect you from cholera -- here.
5)Here's an older peice detailing the pain patches that hospitals such as BC Children's Hospital have in use for before-venipuncture. In short, the patch uses a small electric current to dispense lidocaine directly to the venipuncture area, numbing it up. It's always good to know your technology before you need it.
Thursday, September 17, 2009
Hot Topic: H1N1 Snapshot : BC September 14
14 September; school is back in, and infections begin to rise. BC stats for this week include:
- 865 confirmed H1N1 cases
- 48 hospitalized due to H1N1
- 5 deaths.
(facts found at BCCDC FluWatch, ILI Watch, and Authority Bulletins)
As one dives into the spreadsheets and graphs, a picture begins to make sense beyond the obvious. Although children between the ages of 10 and 19 have the highest number of positive cases, when taking into account they were also the most extensively tested this week (possibily due to parental concerns upon sickness following return to school), it makes sense that the most positives were found in this demographic. Remember, testing of mild cases is now discouraged in otherwise healthy adults.
What concerns me from this weeks picture is that those healthy adults(20-39) seem to be the hardest hit, and most hospitalized. Usually the flu preys on "weak" populations, those with other conditions, the old, the very young, or in vulnerable states such as pregnancy. H1N1 has almost been taking a spanish flu like approach instead; the majority of hospitalized patients in this bulletin were adults or young adults.
As well, new this week is the magic percent of known positive cases upon which WHO suggests schools are to close: *drum roll* The magic number is: one percent. That means if a school of 700 has seven ill students, WHO suggests closing. That said, the Public Health Agency of Canada promptly replied that unless the severity of the pandemic gets a lot worse, or massive numbers of children fall ill, it is unlikely they will activate school closures. (http://www.cbc.ca/health/story/2009/09/11/h1n1-school-close-who.html.
Still no vaccine available in Canada, not even for health care workers.
Hot Topic: H1N1 Basics
H1n1 Basics: Recognition
The following symptoms have been found in patients testing positive:
The following symptoms have been found in patients testing positive:
- 92% had fever
- 92% had a cough, mild to heavy
- 66% had a sore throat
- Only 25% had diarhoeae or vomiting/nausea.
(Note that in elderly patients, the fever can be absent, substiting instead with delirium or decreased level of consciousness.)
H1N1 has not been a nosocomial infection, but instead has been transmitted via the community(on your commute, in the workplace, in the schools, etc). You do not need to be around one of these hospitalized sick people, or someone who has been to Mexico, to contact the flu anymore.
H1n1: So I have the above symptoms.... What next?
DO NOT run to the emergency room for mild flu symptoms. This clogs up the system!
DO take a self inventory. Are your symptoms mild? moderate? debilitating?
If your symptoms are mild and you don't have underlying issues, the BCCDC is not even recommending you go and get tested at the moment. If your symptoms are moderate or if you are pregnant, have concerns about a newborn, or immunocompromised, testing and follow up are still recommended.
The BC Centre for Disease control is currently recommending people who have a fever and respiratory symptoms do the following:
- Self Isolate for seven days after your symptoms first start. This will prevent spreading.
- Practise Hand Hygiene (Wash your hands with a non antibacterial soap often)
- Practise Cough Etiquette (Cough into your elbow, or into a handerchief).
- If your newborn has H1n1, encourage breastfeeding; this will help.
- If you DO go out in public, use a surgical mask to prevent spread to other people.
- Do NOT go to work.
Friday, July 10, 2009
Blood Conservation Systems: BBCIM
It's obvious that the need for more blood is there, both from looking at our interhospital ledgers and the ads on television. The drive is already at maximum to inspire more blood donation (see PSA's here, here, and here), so how do we make what we have last longer, especially in this wavering economy? Each hospital is working on reducing the need for blood by being more stringent with requirements for transfusion already; "top-up" transfusions are nigh a thing of the past, and Which leaves end stage management, an area untouched before 2003: we can do our best to ensure the units we have aren't wasted.
Yes, outdating blood is a problem. Some of the precious blood supply does end up expiring before we use it, even with the high turnover of product and sometimes inappropriate indications given for transfusion. In fact, in 2001/2002, over 4500 units of blood expired without being used in British Columbia(over 98 hospitals); 30% of these were type O (the universal donor).
The main reasons given were as follows:
Yes, outdating blood is a problem. Some of the precious blood supply does end up expiring before we use it, even with the high turnover of product and sometimes inappropriate indications given for transfusion. In fact, in 2001/2002, over 4500 units of blood expired without being used in British Columbia(over 98 hospitals); 30% of these were type O (the universal donor).
The main reasons given were as follows:
- wrong blood type for population (only 3% people have type AB blood),
- rural locale (no need for the unit, but it had to be on hand Just-In-Case),
- phenotyped units saved for special patients and then never used, and
- trauma's not needing the massive amounts of blood ordered (Some surgeries/traumas can take anywhere from 4 to over 30 units of red cells to patch back together, so ordering can be overestimated to ensure supply in emergency).
Base line alleviation of this loss is simply shipping the close-to-outdate units to the nearest larger hospital, in hopes they will use it. In the case of phenotyped units, rare blood, or even universal donor units, this method just doesn't fufill potential as is; so enters the British Columbia Blood Inventory Management Pilot.
BCBIM's goals are as follows: (from website)
- Build a web-based provincial blood inventory communication system.
- Monitor provincial RBC inventory status and provide early warnings on RBC shortages.
- Guide Canadian Blood Service’ and hospitals’ ordering policies to correspond with provincial RBC inventory.
- Establish appropriate medical rules and guidelines for hospitals in response to provincial RBC shortages or other contingencies.
Started in 1997, this program has grown to include over 60 hospitals, leaving only 26 of British Columbia's hospitals uninvolved. After one year of more stringent application of the program, the number of unused blood units in BC had been reduced to 3187. That's over 1000 units of blood saved for use, or at least $500,000 in health care budget, (base cost of replacing all those units). Even better, it brings the outdate percentage down by half for our province.
In plainer English, by documenting exactly how many units of blood (including specialized blood) each hospital has, and when they expire, this overseeing program can plot the logistics of getting blood to the place most needed. For instance, CMV neg and irradiated units, which have a shorter shelf life, to pediatric hospitals, or matched phenotyped units to appropriate donors. woot.
I would highly recommend hospitals to get on board with BCBIM, or their Canadian regional equivilent. At grass roots, it is simple: Just take your daily inventory down on a standardized form,(noting which of your units outdate within seven days), and send it off. The staff at BCBIM then work with the central blood provider to coordinate best allocation of blood to ensure use. Ship your units when requested to the central blood provider(or where they ask you to ship it), and its done.
Although I searched the internet high and low, I cannot seem to find an equivilent system in Washington, or California, the two more active online med lab states. Is this type of system only practical with socialized medicine, where the province is responsible for all blood distribution rather that individual hospitals? Closest I could get to the concepts were:
http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Blood+Management.htm
Thursday, June 4, 2009
Endings
I heard today some bitter news; one of my friends and mentors in medlab has recently passed on.
Karen Morrison nee Sigvaldisen was one of my major inspirations to entering medical laboratory science. She was the mother of my best friend in high school, and we would have amazing conversations about current chemistry procedures and how they developed from what was happening when she was starting out; how safety standards back then were such things as "to not try and multitask when mouth pipetting" (see anecdote here for why).
She encouraged me all thoughout the intense medlab program, and explained things to me in high school when the textbooks just didn't cut it. I remember her easy chuckle at those who just hadn't been inspired to love science yet, and how much she loved bike riding and swimming and sailing with her family and friends.
Throughout her life Karen was many things; a teacher, a technologist, a tutor, a mother, a friend, a loving wife, and a charming lady all the way around. My sincere condolences go out to her three daughters and husband.
Karen Morrison nee Sigvaldisen was one of my major inspirations to entering medical laboratory science. She was the mother of my best friend in high school, and we would have amazing conversations about current chemistry procedures and how they developed from what was happening when she was starting out; how safety standards back then were such things as "to not try and multitask when mouth pipetting" (see anecdote here for why).
She encouraged me all thoughout the intense medlab program, and explained things to me in high school when the textbooks just didn't cut it. I remember her easy chuckle at those who just hadn't been inspired to love science yet, and how much she loved bike riding and swimming and sailing with her family and friends.
Throughout her life Karen was many things; a teacher, a technologist, a tutor, a mother, a friend, a loving wife, and a charming lady all the way around. My sincere condolences go out to her three daughters and husband.
Sunday, May 31, 2009
Pediatric Red Cell Tranfusion
Jargon warning: Present.
Let's talk a little about transfusions in children....
So, what are the top three indications for pediatric transfusion?
1. Acute hemmorhage
2. Bone Marrow Failure
3. Symptomatic chronic anemia (sickle cell anemia, diamond-blackfan anemia, or thallessemia)
Transfusion is something most doctors try and avoid, for two reasons:
I've seen hospital procedure vary a lot, around those two golden principles. Some hospitals saline wash to remove preservative solution just before giving the unit, some do not. Some hospitals insist on across-the board irradiation of the units as well, to cover the special cases such as new oncology patients with unconfirmed diagnosis. Others treat older adolescents like adults. One endorsed method was to always have a fresh CMV negative unit available, that would be hand washed to remove the preservative and then given out with a form to denote how much of the unit was actually given. Another method was to divide the single PRBC unit into three or four bags, to be given out to the patient as needed over the twenty four hour period
(thus reducing the number of donors the child is exposed to, as well as enabling smaller transfusions.)
Both have solid reasons....Doctor's who choose to go with a single donor unit, are typically concerned about minimizing the amount of donor exposure. Aliquots are taken off the sterile unit and used for the amount of permitted storage. The rationale of the traditional choice of fresh packed cells involves trying to side step the possible buildup of potassium(during unit storage) being passed on to the patient(usually more of a concern when patient is in the first four months of life). Let's take a look at this concern.
After the full 42 days of storage, extracellular plasma potassium levels in a single unit of packed red blood cells are shown to be 50mEq/L. I agree that giving the whole unit at once on the last day of possible use would decidedly be too much of a system shock to a neonate, and therefore unsuitable. Thing is, most neonate transfusions we give 15mL/kg. For small amount transfusions(<15mL at a time), the age of the blood is not a concern, as maximum potassium levels would be only 0.015mEq/L (tiny amount) of potassium per transfusion. (See Nelson Pediatrics 18th Ed 2007, pg. 2057). Anything over 25mL of older blood is getting a bit more dicey, and shoule be avoided. That said, non-neonatal pediatrics
can handle the 50mEq/L maximum possible amount of potassium, as can adults.
In short, neonate transfusion requirements and pediatric transfusion requirement are different. Not all hospitals denote that, instead preferring to stick to the more stringent newborn guidelines for all. As blood banking protocols improve, we are working on tailoring out unnecessary product preparation while ensuring that the proper precautions are still in place.
Let's talk a little about transfusions in children....
So, what are the top three indications for pediatric transfusion?
1. Acute hemmorhage
2. Bone Marrow Failure
3. Symptomatic chronic anemia (sickle cell anemia, diamond-blackfan anemia, or thallessemia)
Transfusion is something most doctors try and avoid, for two reasons:
- Children are generally most robust than adults.... their systems can easily compensate for blood loss of up to 25% and remain asymptomatic. They tend to not have any of the underlying conditions that complicate adult cases. If the patient isn't symptomatic, why risk transfusion, and the associated risks of iron overload, and possible infection or reaction?
- There tend to be other treatments available for most conditions with symptoms; EPO for renal insufficiency, colloid solution for blood volume problems, or oral iron for IDA. Other than acute hemmorhage, there tend to be other viable options instead of transfusion.
I've seen hospital procedure vary a lot, around those two golden principles. Some hospitals saline wash to remove preservative solution just before giving the unit, some do not. Some hospitals insist on across-the board irradiation of the units as well, to cover the special cases such as new oncology patients with unconfirmed diagnosis. Others treat older adolescents like adults. One endorsed method was to always have a fresh CMV negative unit available, that would be hand washed to remove the preservative and then given out with a form to denote how much of the unit was actually given. Another method was to divide the single PRBC unit into three or four bags, to be given out to the patient as needed over the twenty four hour period
(thus reducing the number of donors the child is exposed to, as well as enabling smaller transfusions.)
Both have solid reasons....Doctor's who choose to go with a single donor unit, are typically concerned about minimizing the amount of donor exposure. Aliquots are taken off the sterile unit and used for the amount of permitted storage. The rationale of the traditional choice of fresh packed cells involves trying to side step the possible buildup of potassium(during unit storage) being passed on to the patient(usually more of a concern when patient is in the first four months of life). Let's take a look at this concern.
After the full 42 days of storage, extracellular plasma potassium levels in a single unit of packed red blood cells are shown to be 50mEq/L. I agree that giving the whole unit at once on the last day of possible use would decidedly be too much of a system shock to a neonate, and therefore unsuitable. Thing is, most neonate transfusions we give 15mL/kg. For small amount transfusions(<15mL at a time), the age of the blood is not a concern, as maximum potassium levels would be only 0.015mEq/L (tiny amount) of potassium per transfusion. (See Nelson Pediatrics 18th Ed 2007, pg. 2057). Anything over 25mL of older blood is getting a bit more dicey, and shoule be avoided. That said, non-neonatal pediatrics
can handle the 50mEq/L maximum possible amount of potassium, as can adults.
In short, neonate transfusion requirements and pediatric transfusion requirement are different. Not all hospitals denote that, instead preferring to stick to the more stringent newborn guidelines for all. As blood banking protocols improve, we are working on tailoring out unnecessary product preparation while ensuring that the proper precautions are still in place.
AIDS Symptoms Causes: Part One of Three
Jargon warning: None
Okay, this is going to be a several parter, as I'm delving quite deeply into what is happening in several organs and the body as a whole to cause symptoms. Forgive the variety in assumed knowledge, b/c I'm not quite certain how much I need to go into the basics. This first post will be quite basic. Clear as mud?And it begins!
General AIDS facts:
Okay, this is going to be a several parter, as I'm delving quite deeply into what is happening in several organs and the body as a whole to cause symptoms. Forgive the variety in assumed knowledge, b/c I'm not quite certain how much I need to go into the basics. This first post will be quite basic. Clear as mud?And it begins!
General AIDS facts:
- Transmitted through blood, sex, and blood products
- Usually targets immune cells called T cells that have a specific protein called CD4 present, although it can infect other types of cells
- Two types of the virus exist, HIV-1 and HIV-2
- The type of virus is the retrovirus, lentivirus sub-family.
- Four stages of AIDS:
Initial Infection: Mono like illness with fever
Asymptomatic Infection
Asymptomatic Infection with Swollen Lymph Nodes
AIDS - fever, weight loss, swollen lymph nodes, neurological symptoms, and a poor immune system
Basic Hematological changes in AIDS:
- Low platelet count - platelets make up the clot when you stop bleeding. So when you don't have many, you bleed longer, and bruise easier. Sometimes you can bleed from the nose or gums.
- Bone marrow changes - Your bone marrow stores the cells that make new cells to maintain your immune system. AIDS can change these momma cells, either to make your immune system ineffective, or to slow down the rate at which they reproduce.
- Low neutrophil count - Neutrophils are some of the cells in the blood that play important roles in the body's immune by fighting off infection. Low numbers of these mean you catch infections easier.
- Anemia - ie a low red blood cell count. If you don't have many red blood cells, you don't get the oxygen you need to your body as easily. This can make you tired, short of breath, dizzy, pale, or insomniacic, among other things.
Next post I'm going to look further into why the above happen. Look for Subject: AIDS, Hematological Changes
Children and Blood Draws
Jargon warning : None Present
Current Mood: relaxed
Lately I've been asked on what you can do to help a child's blood being taken go easier, and be less stressful on your child. Here are a few things that are helpful.
A. Before you come in:
If the child is old enough, explain what will happen when they get poked, or leave enough time that the person taking the blood can explain it to them when you get there. There are several online booklets that can help. See Here.
DO NOT tell your child that it will not hurt, because it will. Tell them its like being pinched or bitten by a mosquito, but the needle will be very small and it will be over quickly. If your child thinks it will not hurt, and then it does, the mismatched expectation often causes thrashing and panic during the procedure.
DO ensure you child has had plenty of water to drink before you come in. Even if a specimen is to be "fasting", you can still drink all the water you want. This will cause the veins to be more plump and visible, which equals an easier poke and no "digging" in the arm. This works for adults too!B. During the Collection
Decide beforehand if you as a parent are able to stay calm being in the same room during the blood draw. Either way is fine; its just if you think you will fuss or cry yourself during the procedure, this will upset your child. If you do stay in the room.....
B. During the phlebotomy:
You can hold your smaller child in your lap to help prevent squirming. A parents lap is a safe space for a young child.
You can help distract! Depending on the age of the child, there usually will be small stickers to give out after the draw, finger puppets, a stuffed animal, and/or comics on the walls, to look at.
Some of the more sucessful child phlebotomists I know have memorized a mountain of knock-knock jokes. Even asking questions that the child has to think about to answer is a good distraction from getting upset.
You can hold their other hand, for older children
Tell them its okay to make as much noise as they want, or cry, as long as they don't move their arm. (or hit the person with the needle ^^) Parent and child can sing a favorite song if they like; whatever distraction that enables the child to hold still, we're happy with.
If your child is not of an age to hold their arm still, often we have the parent and another helper immobilize the arm and torso. If the child is still, the chances of needing a second poke are much slimmer.
C. After the Collection :
Praise your child! Tell them they were brave, and did well. Positive association is important for next time.
Hope this helps!
Current Mood: relaxed
Lately I've been asked on what you can do to help a child's blood being taken go easier, and be less stressful on your child. Here are a few things that are helpful.
A. Before you come in:
If the child is old enough, explain what will happen when they get poked, or leave enough time that the person taking the blood can explain it to them when you get there. There are several online booklets that can help. See Here.
DO NOT tell your child that it will not hurt, because it will. Tell them its like being pinched or bitten by a mosquito, but the needle will be very small and it will be over quickly. If your child thinks it will not hurt, and then it does, the mismatched expectation often causes thrashing and panic during the procedure.
DO ensure you child has had plenty of water to drink before you come in. Even if a specimen is to be "fasting", you can still drink all the water you want. This will cause the veins to be more plump and visible, which equals an easier poke and no "digging" in the arm. This works for adults too!B. During the Collection
Decide beforehand if you as a parent are able to stay calm being in the same room during the blood draw. Either way is fine; its just if you think you will fuss or cry yourself during the procedure, this will upset your child. If you do stay in the room.....
B. During the phlebotomy:
You can hold your smaller child in your lap to help prevent squirming. A parents lap is a safe space for a young child.
You can help distract! Depending on the age of the child, there usually will be small stickers to give out after the draw, finger puppets, a stuffed animal, and/or comics on the walls, to look at.
Some of the more sucessful child phlebotomists I know have memorized a mountain of knock-knock jokes. Even asking questions that the child has to think about to answer is a good distraction from getting upset.
You can hold their other hand, for older children
Tell them its okay to make as much noise as they want, or cry, as long as they don't move their arm. (or hit the person with the needle ^^) Parent and child can sing a favorite song if they like; whatever distraction that enables the child to hold still, we're happy with.
If your child is not of an age to hold their arm still, often we have the parent and another helper immobilize the arm and torso. If the child is still, the chances of needing a second poke are much slimmer.
C. After the Collection :
Praise your child! Tell them they were brave, and did well. Positive association is important for next time.
Hope this helps!
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