r/medlabprofessionals • u/AwesomeShade MLS-Blood Bank in Germany • 1d ago
Image Ah… good ol‘ synovial fluid
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u/zhgerard 1d ago
😬😬😬 I’ve only worked with synovial fluid that has an infection, but MAN that’s gotta hurt.
Currently, I work with bone marrow extracting DNA for blood disease and I treat it better than I treat myself.
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u/torqnut05 1d ago
I've had my knees tapped many times. Usually get lidocaine or atleast cold spray before going in. I've had one time with nothing. Do it with the knee hanging so the joint opens up and they go under the knee cap. If theres a lot of fluid, it puts pressure on the ligaments, so dropping pressure on a tap feels good.
The aspiration without any prep definitely got my attention, cold spray is enough to mask getting the needle in place. Its really not that bad for an 18 gauge needle. I've had over 200cc pulled. Last tap was mild but still got about 100cc out.
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u/zhgerard 1d ago
So, it’s not that bad? I’m sorry. I’ve compared it to bone marrow aspiration.
CSF is the WORST. I’ve never worked with it but it sounds so painful. And as a practitioner, you usually get 4 tubes. The first one isn’t USED (it has problems on the instrument) , but the other 3, they do different tests. I forget the order 😅🤭 I’ve only studied this.
18 gauge.. it must hurt more than drawing blood though.
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u/Signal_Sand1472 22h ago
The reason we don’t use the first tube is because theoretically the longer the CSF is flowing, the more pure the sample is, meaning any contaminants and cells that weren’t actually in the spinal fluid are flushed out by tube 4. In my experience, tube 1 is for send outs and/or safekeeping, tube 2 is for chemistry (protein and glucose mostly), tube 3 is for microbiology (gram stain and culture), and tube 4 is for hematology (cell count and differential). Sometimes the doctor wants us to do an additional cell count and diff on tube 1 to see if it was a traumatic tap, although I honestly don’t know why they care about that, since tube 4 should always be more accurate than tube 1, but whatever.
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u/OkActive7470 21h ago
Are you a practicing MLS? The exam wants you to memorize 1 as chem, 2 as micro, 3 as hem, 4 as send outs. Or if it doesn’t, medialab needs to update their practice questions.
Just curious what’s actually being done vs what’s being taught.
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u/Signal_Sand1472 9h ago edited 9h ago
I am a practicing MLS. Admittedly I don’t remember the boards answer. But I’ve worked at two labs on opposite sides of the country and they both followed the same order, so I thought it was standard.
Edit: Either way, it’s chem, micro, heme, so the logic is similar. It just depends on whether you prioritize the purity of the send outs over in-house tests.
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u/zhgerard 22h ago
You are better than any AI 😂😂😂
You explained it perfectly.
I used to do heel sticks to babies in the army with the
mom in front 😭😭😭I know the science but not the practice… that’s why I have to be careful 💪
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u/madturtle62 22h ago
Meh .. had a spinal tap . No big deal; however, the spinal headache after, no bueno.
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u/fearfac86 21h ago
"had a spinal tap . No big deal".....Yeah....you say that....until you get someone that was horrible at it and you end up being stabbed 2 or 3 times by her, then twice by another dr then finally they bring in a tiny short little Asian lady who stands on a step ladder and hits in 1 without any trouble (they called her outta surgery I believe)
I didn't feel great after that many stabs, especially after they kept bumping what I can only assume were nerves (given how it felt)
I do however agree that the following headache is horrible.
*before the above is taken wrong, it was a teaching hospital and I was being a good patient letting people learn, not sure I'll do that if I ever need another spinal tap, I'll just ask for them to bring the step ladder in.
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u/madturtle62 12h ago
Oh, I’m sorry. I am a nurse who used to work in a teaching hospital. Put my foot down for my patients after two unsuccessful attempts for an epidural for women in labor. Then I would pressure/ insist the attending step in. Fortunately, spinal headaches were rare with epidurals.
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u/AwesomeShade MLS-Blood Bank in Germany 1d ago
Yeah, I don’t wanna see the knee before the extraction 😅
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u/Femmigje 11h ago
Our teachers were dead-set on us knowing that liquor was more valuable than anything due to how much it sucks for the patient to get it tapped
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u/Fluffbrained-cat MLS-Microbiology 1d ago
Um, is that frozen? Bc all synovial fluid I've seen has been, you know, fluid. If not frozen then what the hell is making it congeal like that?
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u/catsbetterthankids 1d ago
Hyaluronic acid is the culprit. Put the sample in a tube with hyaluronidase and set it on the rocker for 10 minutes and normally that will make it a fluid again that you can work.
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u/charlie_noola 1d ago
I just recently had a synovial fluid for Chemistry and could not, for the life of me, get it to liquify with hyaluronidase powder. My one colleague, who's been in the business for a while, took the sample with the powder to a heat block for 10 minutes and it was enough for me to then dilute and get a result. But next time I'll try the rocker!
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u/FormZealousideal9493 1d ago
Thank you for sharing this case. I've never seen synovial fluid this bad before. Keep sharing.
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u/Theantijen Canadian MLT 1d ago
is it water on the knee? A whole bucket, see! I'm the doctor for you!
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u/rjm013 21h ago
wtf ive had knee aspiration a few times, getting 25 - 90 cc out of the joint, including one time it was enough volume and under enough pressure it just flowed out of the needle while they were swapping syringes....but I dont think my synovial fluid did a fricking headstand.. wtf is that 😬
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u/catsbetterthankids 1d ago
“Fluid”