Blood draw from IVs?

I have just completed a study on this topic that is currently submitted for publication, and I can tell you there are a ton of published studies out there in academic literature.
It would probably suit your needs to do your own search of the literature to find exactly what you are looking for that suits the situation. You can include and exclude any variable you want to make your search more narrowed down to your interest. Doing your own research and compiling a review of literature would give you credibility. Try CINLAHL, MEDLINE, or OVID and you will find plenty of research.

I don't hide it...I label as a nurse draw...if they had a problem with my technique they can let me know. To me it is about the patient first, why make them get a second stick just because some nurses don't know how to draw blood effectively.

We draw from the IV with the initial IV start and after it's been in.

Our facility allows us to draw labs when we initiate IV access. I usually just draw with a 12 or 20cc syringe screwed into the angiocath. When I am done I attach a hub and secure the site. If there is a re-draw or an add on hrs later that the lab cannot use the blood I have previously drawn, the lab tech comes and does a straight stick. In other words, if the IVL has been flushed we are not allowed to draw from it!
This is ok of course on the patient's that have been given the TNKase after an MI where not IV sticks are allowed. Seems like if it works then fine, why not spare everyone else the extra pokes!
Renee

My ER recently did their own study after reviewing the hemolysis rates of specimens we draw and feeling that it was too high. We, like many other ERs, draw blood back from the angiocaths immediately after starting them and before they are flushed.
For one week during the trial, a phlebotomist from the lab was assigned to the ER and she drew blood straight stick (no butterfly needles) from every patient that came in. If they needed an IV then they got stuck twice. (Codes and traumas were a different story obviously)

We all thought that the hemolysis rate would be so much better and we got excited at the prospect of possibly having a dedicated phlebotomist in the ED.

Unfortunately the results of the trial were surprising as the phlebotomist draws had a hemolysis rate that was so slightly better than ours that it was not even statistically significant. Interesting. So what we determined was that it has a lot more to do with technique...for example, tourniquet time left on the patient has something to do with it I believe as well as obviously the size of the vein you are drawing from...an inner wrist vein drawn through a #22 ga may end up hemolyzed. Most times, I know immediately by how the blood looks going into the tube if it's going to be hemolyzed. Honestly, if I have any doubt at the time...I save the IV line and redraw from a straight stick..if it is a veinless person..I do an arterial stick with a butterfly.

In my experience working in a lab as a phlebotomist it was very rare for us to have to go stick the patient again due to hemolyzed specimens. When they were hemolyzed I found it was usually a smaller bore IV, 20g or less,, and the nurse or EMT who started the IV said they could barely get it to flow and so they spent a lot of time "fiddling" with it to get the blood to flow. The great majority of samples were accepted by the lab to be run.

In our Level II Pediaric/Adult Trauma Center (RNs) can draw from the angio site but medics,techs or LPNs are not allowed to do so. There has been a few occassions where hemolyzed blood has been an issue but I find it's when you have a small angio, or a bad vein anyway. Angio size (such as when we do pediatric blood draws with an IV start have been successful for the most part)...but they too have issues periodically.

If I were in your shoes, I'd ask said manager for a copy of that "documentation".

Not to be confrontational - but to 'educate self'. After all, your manager wants you to follow appropriate policy, yeah?

Ditto here.

About the only thing I like to do is replace the extension tubing the medics put in with our own kit - our medics here use a flimsy tubing set and blood drawn off of that set almost always ends up hemolyzed.

Other wise, I draw labs with my IV stick and always draw a "waste" if I'm drawing labs again subsequently. Unless I'm doing blood cultures, I see no reason to stick the patient again if I have a patent vascular access device which gives me good blood return.

cheers,

I will draw labs from the initial IV start, as long as it's a 20 or larger and in a good vein. If it doesn't draw well but flushes, I'll do or let the lab do a butterfly stick elsewhere, rather than risk the line. This is especially true for the elderly and dehydrated pts.

I'll also do BC x1 off of a new IV start. If it's more than 15 min old or an EMS start, I won't, because it's culturing the blood AND the line. (And must say here, that a few nurses I worked with at my last ED were so concerned about just getting the blood and checking off their running timers, that they were draw BC x2 from the same existing line at the same time - really chaps my behind, because it does no good for the pt).

I do find it interesting all the different policies. The different hospitals I've worked at always state one policy, but will also say things are "different" for the ED.

We've had this same story at my hospital. Lab did some testing, and found it was particular nurses that had the problem, not "technique" (ie drawing through a PRN adaptor, through pigtail, into a syringe-then to the vacutainer...etc...)
I've recently started using a 12cc syringe with a PRN adaptor on it, screwed straight to the end of the cath, draw back 12cc (depending on what is ordered) through the adaptor into the syringe. Then let the vacutainers pull the blood out of the syringe, not push it in.
Unscrew the syringe and the PRN adaptor is already on, no mess!
(I was kinda known for my bloody messes when starting IV's....)