# Bright Red Venous Blood?



## Simusid (Jul 26, 2010)

I responded to a call for an unresponsive female age 56 at a cancer care facility.   When we arrived we found her lying on her side in bed and was borderline verbally responsive.   She has a hx of lung cancer and the lead medic believed her issue was related to her meds.   The transport was routine, with a normal 12 lead and IV access started.  

I usually do the glucose check using the sharp I'm handed by the medic after the IV is started.  I'm very used to seeing dark red venous blood but this time it was very bright red.   I don't think I understand what this might indicate.   My first thought was that it's because of the lung cancer, but why would that be?   Bright red means it's carrying oxygen that it got from the lungs, and to me it means that the blood cells did not give up their oxygen to the body.   

Now if I saw dark red arterial blood that would have made sense to me with the cancer hx.  

Google tells me that two most common causes of bright red venous blood are CO and cyanide poisoning.   I can't rule them out of course, but I doubt this was the cause.


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## mycrofft (Jul 26, 2010)

*That's the art of medicine (pun unintended)*

"Venous blood is always dark". Nope. I had an instructor say venous blood was bluish, and I've read that also in laypersons' pamphlets. It is generally darker than arterial blood, but "light" and "dark" can be affected by light (amount and color), perception, and extrinsic factors like dilution.
That said, one way blood can look brighter is if there is a lot of serum in it. Oversqueezing glucose fingersticks too close to the puncture site will force more serum into the specimen, and since it is a colorimetric test, it can throw off your results.


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## TraprMike (Jul 26, 2010)

mycrofft said:


> "That said, one way blood can look brighter is if there is a lot of serum in it. Oversqueezing glucose fingersticks too close to the puncture site will force more serum into the specimen, and since it is a colorimetric test, it can throw off your results.




whoa,,, slow down, this sounds like something I should know.. 

the puncture site of the lancette?? so, force blood for glucose from the bottom of the finger??


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## Jinkx (Jul 26, 2010)

mycrofft said:


> "Venous blood is always dark". Nope. I had an instructor say venous blood was bluish, and I've read that also in laypersons' pamphlets. It is generally darker than arterial blood, but "light" and "dark" can be affected by light (amount and color), perception, and extrinsic factors like dilution.
> That said, one way blood can look brighter is if there is a lot of serum in it. Oversqueezing glucose fingersticks too close to the puncture site will force more serum into the specimen, and since it is a colorimetric test, it can throw off your results.



...And the amount of gas exchange, as well as where in the body. Bright red blood can come from burst capillaries in the throat from a nasty cough, nose from pickin it, blowing to hard, or doing to much blow. CO poisoning also causes this in the lungs.


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## mycrofft (Jul 26, 2010)

*Finsgerstick 101*

Worked six years on the diabetic area of our jail.
Perform puncture, holding the finger you are sticking firmly at the next proximal joint (distal interphalangeal, or DIP). This acts like a venous TK but is not too near the puncture. Don't gronch down  on it. If there is still no blood flow, "milk it" once or twice _*at the joint*_ (not the puncture) but not with caveman force. Failure=>bandaid, go to other finger.
The old maneuver of the pt whipping their hand (like shaking down a thermometer, same priniciple) can be done in advance if the pt is conscious and there is room. Don't have them sling it after it's punctured, it might sling blood droplets all over. 

I've seen nurses SQUEEZE the distal phalanx right around the puncture and get a good specimen, but I have also seen and gotten bad specimens that way.


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## Jinkx (Jul 26, 2010)

Ive seen that as well. Off subject Ive scene medics use a drop off the end of an IV Cath to do a D stick. It gets a result but rarely accurate. I think its a bad and lazy habit.


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## TraprMike (Jul 26, 2010)

Jinkx said:


> Ive seen that as well. Off subject Ive scene medics use a drop off the end of an IV Cath to do a D stick. It gets a result but rarely accurate. I think its a bad and lazy habit.




thanks guys,,, and this quote is what I was taught several months ago also. but I not used this method. and appears, I won't until told to by the higher ups.


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## mycrofft (Jul 26, 2010)

*IV cath is okay if IV has not been started yet.*

If it has started, you are measuring the color of the IV solution too.

PS: a glucometer reading of IV solution would not show the _glucose_ in it, just the dilution of the blood by the clear solution plus the colorimetirc reponse of the RBC's.


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## rhan101277 (Jul 26, 2010)

Jinkx said:


> Ive seen that as well. Off subject Ive scene medics use a drop off the end of an IV Cath to do a D stick. It gets a result but rarely accurate. I think its a bad and lazy habit.



Yeah I agree, cutting corners is not a good habit to get into.


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## reaper (Jul 27, 2010)

Depends on you Glucometer. There are ones that are quite accurate on venous blood. So never say it is cutting corners.


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## Aidey (Jul 27, 2010)

^^^ Yup. If you have a glucometer that is rated for venous blood it is an acceptable method of obtaining a sample. Ours are rated for venous blood, so it isn't so much cutting corners as it is 1 stick vs 2 sticks.


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## livewiremaxx (Jul 27, 2010)

Same here, we use the blood sample from the first flash - and it doesnt have IV fluids mixed because the IV isnt hooked up yet till thats out.  It is less invasice for the pt.


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## mycrofft (Jul 27, 2010)

*I'm curious why the IV drip was not accurate*

MAybe...too much blood, or with IV solution in it? Curoous what indicated it was inaccurate. Just curious, not trollish.


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## lampnyter (Jul 27, 2010)

doesnt the pulmonary vein have bright blood?


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## rook901 (Jul 27, 2010)

I've never heard that BG via glucometer was colorimetric. Interesting.

Just out of curiosity -- we're told that if a patient has had a traumatic head injury and has clear fluid coming from the nose, to check it with a glucometer to check for glucose (indicates that the fluid is CSF). If the glucometer is colorimetric, how does it measure glucose in a clear liquid?


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## MasterIntubator (Jul 27, 2010)

Anemia typically causes brigher coloring.  Also, squeezing fingers to hard can rupture fragile RBCs and release extra glucose.

Old school glucometers used to be colorimetric, now a days, they are enzimatic.  The colorimetric are a step above the old blot the strip, wait 60-90 second... wipe and read by matching the colors on the bottle.  ( those were the days... )

:-/


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## mycrofft (Jul 28, 2010)

*Ach, yes! Sorry. No longer colorimetric!*

Dang, maybe they WILL measure glucose in an IV solution?
Oldest "glucometers" WERE colorimetric. In fact, Bayer makes a colorimetric machine to read urine dipsticks.


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## Shabo (Aug 2, 2010)

We were taught that CSF has 1/2 the GL of blood.

So do your BGL get 100 if the fluid from the ear is has GL of ~50 +CSF


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## Jinkx (Aug 2, 2010)

Interesting point but why would you do a Dstick on CSF?


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## lightsandsirens5 (Aug 2, 2010)

Birght red is not bad. Neither is dark red. Kool-aid like is bad.h34r:


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## Shabo (Aug 2, 2010)

to confirm CSF rather than another clear fluid


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## Jinkx (Aug 2, 2010)

Shabo said:


> to confirm CSF rather than another clear fluid


Never thought of that. Cool. We have traditionally used a halo test.


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## MasterIntubator (Aug 3, 2010)

Shabo said:


> We were taught that CSF has 1/2 the GL of blood.
> 
> So do your BGL get 100 if the fluid from the ear is has GL of ~50 +CSF





It technically around 2/3 the venous glucose level.  Glucose levels should normally be 50-80 mg/dL ( depending on your labs' standards and book ref )..... kinda like normal venous glucose levels are 80-110 or 70-120 or 60-130....  you get my drift....

I would not rely on a CSF glucose level to indicate normal venous glucose status.  Not in EMS.  If you get the chance to sample CSF glucose levels in the field.... the pt probably has bigger issues at hand.


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## MasterIntubator (Aug 3, 2010)

Shabo said:


> to confirm CSF rather than another clear fluid



Urine can show glucose.... serous fluid can and should show glucose ( e.g. External ear canal trauma from a q-tip or even a burn, causing serous fluid to ooze )


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## Shabo (Aug 3, 2010)

Just like any test there can be false positives, It's just another tool to have in our arsenal. For as many fluids that there are that can give a false positive with a glucose check there are many more that can do the same with the halo test. 

Your right, the pt probably does have more pressing issues at hand... especially if they have glucose + urine coming out of their nose and ears


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## MasterIntubator (Aug 4, 2010)

True that


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## Hellsbells (Aug 4, 2010)

> Ive seen that as well. Off subject Ive scene medics use a drop off the end of an IV Cath to do a D stick. It gets a result but rarely accurate. I think its a bad and lazy habit



I routinely get BGL samples off the flash chamber, and its not a bad or lazy habit by any means, provided your BGL strips are rated for venous blood. After a previous debate on the subject I looked at the directions on the side of the test strip box, and they are rated for both cap and venous samples.


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## b2dragun (Aug 11, 2010)

So, if the meter and strips are rated for" whole blood" and "capillary blood" does this indicate it cal be used for venous blood?  It is a Precision Xtra meter.


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