Ever looked at a set of blood results and thought ‘I wish I knew what these mean for my patient’?

Well today I’m here to tell you why interpreting results is not only the vet’s job.

Sure, as veterinary nurses we can’t diagnose - that’s a task limited to veterinary surgeons. But this doesn’t mean we don’t need to know how to interpret diagnostic tests - particularly in our medicine patients.

We know that our medical patients need a lot of different diagnostic tests. From basic biochemistry and haematology tests, to blood gases and complicated biochemical tests.

But what do those results mean for our patients? And how will they affect their treatment and nursing considerations?

In this post, I’m sharing 3 reasons why it’s vital for veterinary nurses to interpret results - so you can begin looking at your results differently in practice!

Want to know more about interpreting blood results? Make sure you join me for the first medical workshop of 2023: Biochemistry 101: How to Interpret Blood Results!

This 90-minute evening workshop will:

Walk through a full set of blood results
Explain what every parameter means
Explore the common causes for low and high results, and the impact this might have on your patient.

We’ll also go through some sets of results, so you can practise interpreting them against real cases!

The workshop will take place on February 8th at 7.30 pm (GMT). And if you want access, I’ve got something very exciting you’ll want to know about…

Introducing the Medical Nursing Academy!

The medical nursing academy is a brand new medical nursing CPD community for veterinary nurses/technicians!

Doors open on February 1st, and as an academy member you get:

Access to every VIMN workshop ever
Live Q&A and case discussion calls
A live medical nursing book club
Access to an exclusive community forum, so we can learn together, support each other and bounce ideas off of each other.

All this is the same cost as one workshop (£30 a month). Discounted subscriptions are available for enrolled student nurses, too!

If you want to be the first to know when doors are open, join the waiting list below, and I’ll let you know when you can get inside!

Let’s talk biochemistry

A biochemistry panel is one of the most fundamental tests performed in the sick patient.

It gives us an overview of the function of various organs by analysing levels of different substrates, enzymes and hormones within the plasma/serum.

In most cases, a basic panel of tests is requested, including the following:

Albumin
Total protein
Urea (blood urea nitrogen or BUN)
Creatinine
Glucose
Alanine aminotransferase (ALT)
Alkaline phosphatase (ALP or ALKP)
Gamma glutamyltransferase (GGT)
Total bilirubin
Total calcium
Inorganic phosphate
Sodium (Na+)
Potassium (K+)
Chloride (Cl-)

Extra parameters are often included in medical patients, including:

Cholesterol
Triglycerides
Lipase
Amylase
Bile acids
Creatine kinase (CK)
C-reactive protein (CRP)
Symmetric dimethylarginine (SDMA)
Thyroxine (T4)

By learning what each of these parameters mean and how they affect our patients, we can make sure we are providing appropriate nursing care. Here are my top 3 reasons why it’s vital for veterinary nurses to do this…

#1: It helps you provide better care

Now we know we can’t diagnose based on results, but we can use those results to adjust our nursing approach to our patients.

By understanding what our biochemistry results mean and how they affect our patients, we can ensure we’re monitoring at-risk parameters.

Let’s look at some examples:

Hypoalbuminaemia impacts wound healing, so if you’ve taken surgical gastrointestinal biopsies in a patient with protein-losing enteropathy and low albumin levels, we need to monitor that patient closely for wound breakdown (and septic peritonitis).

Anorexia is a common cause of hypokalaemia, so patients with an insufficient food intake may require potassium supplementation (intravenously or enterally)

Ongoing monitoring of creatinine (+/- urea, phosphate and electrolyte levels) is important in patients hospitalised with renal dysfunction, and their fluid therapy rates will be (in most cases) adjusted based on these results.

Young puppies or kittens admitted with gastrointestinal signs or infectious diseases (e.g. giardia, coccidiosis, canine parvovirus or feline panleukopenia virus) are at high risk of hypoglycaemia, so serial glucose monitoring may be required in these patients - and they should be regularly assessed for signs of hypoglycaemia.

#2: It helps you prepare for emergencies

By knowing what the different parameters mean for our patients, we can more easily spot changes that are likely to significantly affect our patients.

This means we can prepare for potential deterioration, get emergency treatment on board at an earlier stage, and improve patient outcomes.

For example:

Let’s say you’re nursing an acute kidney injury patient in your ward. You run the patient’s bloods and see a potassium level of 8.9mmol/L on the results (the reference range is approx 3.6 - 5.1mmol/L).

We know that dangerously high levels of potassium need emergency intervention. They can cause bradycardia and cardiac arrhythmias that can progress to cardiac arrest.

So if we see a potassium level that high, we need to act quickly by:

Informing the veterinary surgeon
Pre calculating doses of calcium gluconate, neutral insulin and glucose solutions
Preparing the equipment needed for these. For example, vials of medication, water for injection/saline diluent, syringes and needles
Checking the patient’s IV access is patent
Placing them on an ECG to identify arrhythmias

It’s not just when results are high that we see problems, though - for example, spotting hypoglycaemia, hypocalcaemia and hypokalaemia are important, too.

Hypoglycaemia causes mostly neurological signs, since the brain is the largest user of glucose in the body
Hypocalcaemia causes signs such as facial itching/rubbing, muscle twitching and tremors
Hypokalaemia causes muscular weakness - typically neck ventroflexion, but other muscles (including the respiratory muscles) can be affected in severe cases.

By knowing what these results mean for our patients, we can adjust our monitoring to spot these signs quickly, and intervene rapidly with glucose boluses, or potassium-supplemented fluid therapy.

#3: It helps you collect diagnostic quality samples

When we begin to understand what each of our biochemistry parameters means, we also learn how they can be affected by common artefacts, and how to know if our results are trustworthy.

For example - let’s look at these results

Sodium 137 mmol/L (reference range 136 - 148 mmol/L)
Potassium HIGH 8.5 mmol/L (reference range 3.6 - 5.1 mmol/L)
Chloride 100 mmol/L (reference range 99 - 110 mmol/L)
Total calcium LOW 1.40 mmol/L (reference range 2.2 - 2.6 mmol/L)
Magnesium LOW <0.27 mmol/L (reference range 0.6 - 1.2 mmol/L)

If these results were accurate, we’d be very worried about those potassium, calcium and magnesium levels, right? And some treatment would be likely.

But what if these results are from a patient not showing signs consistent with these results?

These changes are actually the result of EDTA contamination.

K2-ethylenediaminetetraacetic acid (Potassium-EDTA) binds calcium and magnesium, and contains large volumes of potassium, so these results are typical artefacts seen from improper sampling technique.

To avoid these, we can either fill the biochemistry tube first (preferred), or, if filling the EDTA tube first, be very careful to not touch the tube with your syringe, to avoid contamination.

So by understanding how our results are affected by our sampling technique, we collect better quality samples!

There you have it - my top 3 reasons why understanding blood results is not just the vet’s job! By knowing what each parameter means and how it affects our patient, we can:

Adjust our patient care and monitoring appropriately
Make sure we’re prepared for sudden changes in patient status, and
Ensure we’re collecting samples that will give us the most accurate results possible.

This is vital in our medical patients, who have so many different tests performed, and who have so many changes to their results - on top of already complex nursing care requirements!

Do you get to interpret results in your hospital? Drop me a DM on Instagram and let me know!

Don’t forget, if you want to learn more about interpreting results, make sure you’re in the Medical Nurse Academy, ready for our live Biochemistry 101 Workshop on February 8th! You can get on the waitlist below.

References

Papjeski, B. 2021. How to Collect and Prepare Samples for the Laboratory. [Online] Today’s Veterinary Nurse. Available from: https://todaysveterinarynurse.com/clinical-pathology/how-to-collect-and-prepare-samples-for-the-laboratory/
Sharratt, C.L., Gilbert, C. J., Cornes, M. C. et al. 2009. EDTA sample contamination is common and often undetected, putting patients at unnecessary risk of harm [Online] International Journal of Clinical Practice, 63 (8), pp. 1259-1262. Available from: https://pubmed.ncbi.nlm.nih.gov/19624792/
Sirois, M. 2020. Laboratory Procedures for Veterinary Technicians. 7th Ed. Missouri: Elsevier.
Whitbread, T. J. 2022. Clinical Biochemistry. [Online] MSD Veterinary Manual. Available from: https://www.msdvetmanual.com/clinical-pathology-and-procedures/diagnostic-procedures-for-the-private-practice-laboratory/clinical-biochemistry

3 reasons why vet nurses should know how to interpret blood results