The Laboratory 2

“Here we are, back in the basement of St. E’s. Whenever I come down here I fear that some day I’ll ask about you and the answer will be, ‘Oh, Curmudge is over there in the morgue.’ “

“Don’t worry, Jaded Julie. If I’m there I’ll be in good hands. I have a friend who drives a hearse for a local funeral home. She often comes down here to pick up ‘clients.’ Shall we continue our laboratory tour with Mary Dikeman?“

“Now we leave the Blood Bank and head into the area where urines are examined, fecal occult blood tests and pregnancy tests are done. Good thing they keep it so clean or it could become very odiferous very easily! In the back aisle is the large Coulter instrument that does the CBCs—Complete Blood Counts—and also the microscopes used when a manual differential is required. And there is another smaller instrument that serves as backup to the CBC instrument; so important to have a backup so that CBCs can still be done even if the Coulter is having a time out to have maintenance done. There are an average of 100 CBCs done each day. Across the aisle are the two instruments that are used for Coagulation tests, such as PT, PTT; again there is a backup for the testing.

We continue around the corner and see a large screen that lists pending stat tests and how long they have been waiting. Turn to the right toward the Chemistry Department and see the two blood gas instruments where arterial blood gases are run. Straight ahead are the workhorses in the lab, the chemistry instruments that do the chem panels. The instruments are each the size of a small VW Beetle. Again there is two of each instrument that run different tests, but they can be the backup to each other in case one is not working. On average, about 200 chem panels are run each day. There are also two very large instruments that do hormone testing, cardiac testing, thyroid testing, and other specialty tests. These instruments pass the results to the lab Meditech computer via an electronic interface.”

“You must have noticed, Curmudge, that the lab seems to have two of each of the most critical instruments. They can’t afford to have a request for an essential test ‘stat’ and have to respond that the instrument is ‘down’ for maintenance.”

“ ‘Stat’ is another one of those medical terms that is not obvious to every layperson. It’s like ordering a gelato in Italy, and the waiter says ‘subito’ and brings the ice cream immediately.”

“Around the back corner there is the ECI instrument that does troponins (to diagnose a suspected heart attack), hepatitis and HIV testing. Also in that area are the Variant instrument that does hemoglobin A1C testing (to diagnose and manage diabetes) and the protein electrophoresis instrument that uses electric current to separate proteins in serum or spinal fluid. Testing for lead in patient’s blood takes place on the back counter in this area. Lead poisoning is still a problem in our community. You also notice the Plexiglas-covered instrument that is used for vitamin D, varicella, mumps and rubeola testing. The medical technologists and technicians (also ASCP certified) rotate through the operation of these instruments. You will notice the wall is completely covered by refrigerators and freezers that store reagents for the chemistry tests.

Now let’s walk past the lab office, which is the central area for clerical business and the lab secretary, and into the Microbiology area. On the left is the blood culture instrument that incubates the BC bottles and takes a reading every 10 minutes. It looks for an increase in CO2 production that would indicate the presence of bacteria. On the right are a long counter and a Plexiglas front cabinet. Watch the technologists put their hands under the opening to the cabinet and put the culture specimens onto the culture media. There is airflow that will capture any stray bacteria and pull them away to a filter, so the technologist/technician is protected from infection. Once the culture media is inoculated with the specimen (such as urine, sputum, wounds, throat), the media is placed into the large refrigerator-like box. This incubator is kept at a temperature of 35 degrees Celsius, which is close to the human body temperature that bacteria like to grow in. It also has 5% CO2 gas pumped into it to really make the bacteria happy so they will replicate while in the incubator. In 8-24 hours they will have multiplied hundreds of times and formed colonies of bacteria that are 1-2 mm in size. In this room, the rapid tests for influenza, RSV (respiratory syncytial virus), strep, rotavirus and Clostridium difficile are performed, and there is a microscope for looking at gram stains of the specimens that came in.”

“I must admit, Julie, that many of the tests performed in Mary’s lab are new to me; and they might be fairly new to the lab. For example, their vitamin D testing was started in the fall of 2010. Not only must a hospital lab be responsive and accurate; it must stay up to date. When a test is developed that can answer a critical diagnosis question, the laboratory needs to be able to do it. Of course, if the test is not requested often and the results not needed ‘stat,’ it can be sent out to a so-called reference lab.”

I’m impressed by the measures taken by the lab to protect the technicians from infection. We wrote about C. difficile on February 5, 2009, and I still shudder when I think of it.”

“You can shudder for a whole week, Julie. Mary has other work to do, so let’s continue our lab tour in the next posting.”

Affinity’s Kaizen Curmudgeon